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elleng

(130,156 posts)
Sun Jul 1, 2012, 02:51 PM Jul 2012

In her written opinion, Justice Ginsburg

tells us why we are already being taxed for the uninsured through increased premiums from insurance companies. (Mods, this is Public Domain.)

"Unlike markets for most products, the inability to pay for care does not mean that an uninsured individual will receive no care. Federal and state law, as well as professional obligations and embedded social norms, require hospitals a...nd physicians to provide care when it is most needed, regardless of the patient's ability to pay. As a consequence, medical-care providers deliver significant amounts of care to the uninsured for which the providers receive no payment.

Health-care providers do not absorb these bad debts. Instead, they raise their prices, passing along the cost of uncompensated care to those who do pay. In response, private insurers increase their premiums, shifting the cost onto those who carry insurance. The net result: Those with health insurance subsidize the medical care of those without it.

The size of this subsidy is considerable. Congress found that the cost-shifting just described "increases family [insurance] premiums by on average over $1,000 a year." Higher premiums, in turn, render health insurance less affordable, forcing more people to go without insurance and leading to further cost-shifting. Congress therefore passed the individual mandate provision of the ACA to address an economic and social problem that has plagued the nation for decades."

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In her written opinion, Justice Ginsburg (Original Post) elleng Jul 2012 OP
Thank you, Ellen. This is a fundamental FACT about the Health Care environment in our society. NYC_SKP Jul 2012 #1
Which makes our premiums taxes. dkf Jul 2012 #2
A tax is elleng Jul 2012 #3
So you think the government's demanding the increased prices? Igel Jul 2012 #6
Bad analogy markpkessinger Jul 2012 #7
Indirectly, yes, as elleng Jul 2012 #10
++ This is the path cbrer Jul 2012 #11
A very wise woman. nt Live and Learn Jul 2012 #4
I think you mean - Hosts. ;^) Tuesday Afternoon Jul 2012 #5
Romney and the Republicans have a simple answer to Ginsburg. JDPriestly Jul 2012 #8
K&R! pacalo Jul 2012 #9
Well, duh. Scuba Jul 2012 #12
Thank goodness we have her on the Supreme Court lovemydog Jul 2012 #13
Good point. And there is nothing to prove those people are always poor treestar Jul 2012 #14
 

NYC_SKP

(68,644 posts)
1. Thank you, Ellen. This is a fundamental FACT about the Health Care environment in our society.
Sun Jul 1, 2012, 02:54 PM
Jul 2012

Much as the ACA is a far cry from the Universal Care we'd all love to have, it's clearly movement in the right direction and paves the way for incremental reform.

K/R

elleng

(130,156 posts)
3. A tax is
Sun Jul 1, 2012, 03:05 PM
Jul 2012

a sum of money demanded by a government for its support or for specific facilities or services, levied upon incomes, property, sales, etc.

We are already being taxed for the uninsured through increased premiums from insurance companies, have been for ages.

Igel

(35,197 posts)
6. So you think the government's demanding the increased prices?
Sun Jul 1, 2012, 04:52 PM
Jul 2012

Hardly.

Not a tax. Providing services to the indigent is a cost of doing business. Businesses--non-profit or otherwise--pass their costs on to their paying customers. The owners also reduce their income or, if it's a corporation, they pay less in dividends to their private shareholders or the pensions who hold their stock. (We hear about private wealth and act like there's only private health; many of the largest investors in the US are pension funds.)

The government isn't taxing me when I pay higher prices for my grocer's property tax, for the gasoline tax used in hauling the goods, for employee time the grocer pays for in having his accounting and inventorying done, for complying with ADA regulations, paying extra for holidays and increased minimum wages and for a lot of other things any more than it's taxing me for the wear-and-tear charged on the transportation or on the cost of electricity. Officially the government says it's taxing the grocer, but at that point it's like electricity and flood insurance--just another cost of doing business.

And like all the other costs, taxes are born by the customers and by the shareholders or owners. If the price gets pushed too high then customers go away. If the income goes too low because of no customers or they can't raise the prices enough without driving away customers, the employees don't get paid enough and move on or the owners pack up shop.

There is a sense in which the consumers wind up paying (almost) all taxes because most of them are passed through. It's still handy to at least be sure which meaning you're using, because it has implications for policy and for understanding.

Notice that we'll continue to be taxed (or not taxed) because of the ACA fee/penalty structure. If you're able to pay for insurance it's already likely that even if you don't have insurance you're paying for your care. In some cases it may lead to bankruptcy, but this group is still chucking money into the system.

Oddly, that cash-paying group also winds up subsidizing those who *do* have insurance--esp. Medicaid patients. From time to time I've paid a lot more for my care without insurance than anybody insured. In one place the office manager said that if they didn't have people like me they'd eventually go belly up: They barely break even on most insurance, they lose money on Medicaid, and the only way they have enough money for new equipment or emergencies is cash-paying customers.

Those who currently don't dump much money into the system are those who would receive subsidies greater than what they'd pay under ACA. This supposedly saves money. The idea is that when there's preventive care and insurance available suddenly people change their habits. Years into this precise experiment in Mass., it turns out that people don't change their habits: They get subsidies, but still preferentially use emergency rooms. Health costs haven't gone down nearly as much as predicted, after adjusting for inflation--not nearly as much as Congress stipulated the CBO had to assume.

The best that happens is that a whole new class of people have to pay a fine or pay for insurance, thus increasing the number of people funding the uninsured--younger, healthier folk. The assumption is that this group won't increase their doctor usage, but I heard this argument at a university that instituted mandatory health insurance coverage. They predicted a small increase in those using student health so they might have to hire another nurse and nurse practitioner. The following year they had to move to much larger facility, buy a lot more equipment, pay more rent and outfit the space. They nearly doubled the size of their staff. They had to increase the insurance premiums and ask for an additional mandatory student fee to cover the cost of the move. The administration mandated that the student health program run itself: It wasn't about to put in one dime, apart from reduced-rates in rent for space and extending its tax-deductible status over it. (The administration was behind the mandatory insurance requirement. If mandatory, then financial aid would cover the insurance premium. Suddenly the TAs and RAs could have health insurance covered by the professors' grants and the school had an additional selling point. It helped that the Chancellor could also say that "he" made sure everybody was covered and so their increased health was his claim to fame: Not those who paid for it, not those who provided it, but the person who merely dictated who'd pay whom and who did the work.)

markpkessinger

(8,381 posts)
7. Bad analogy
Sun Jul 1, 2012, 05:14 PM
Jul 2012

You write:

The government isn't taxing me when I pay higher prices for my grocer's property tax, for the gasoline tax used in hauling the goods, for employee time the grocer pays for in having his accounting and inventorying done, for complying with ADA regulations, paying extra for holidays and increased minimum wages and for a lot of other things any more than it's taxing me for the wear-and-tear charged on the transportation or on the cost of electricity. Officially the government says it's taxing the grocer, but at that point it's like electricity and flood insurance--just another cost of doing business.


In order to apply the grocer analogy to the health care issue, you need the correct analog. Grocers are not required to provide their goods to people who are unable to pay for them. If they were so required, and if they then passed the cost of providing those goods to people who were unable to pay by increasing prices on those who do pay, that would be the analog to the situation in which hospitals are required to provided care regardless of ability to pay.

elleng

(130,156 posts)
10. Indirectly, yes, as
Sun Jul 1, 2012, 08:20 PM
Jul 2012

'Federal and state law, as well as professional obligations and embedded social norms, require hospitals a...nd physicians' to provide services, and as a consequence, the rest of us pay.

Along with Justice Ginsburg and others, I don't accept an analogy between health care and groceries or other goods. There is a unique and peculiar market for health care, and we're all sunk if we don't recognize it and go to Medicare for all. Let us pay providers directly, forget insurance companies (and advertisers) as middle-men.

JDPriestly

(57,936 posts)
8. Romney and the Republicans have a simple answer to Ginsburg.
Sun Jul 1, 2012, 05:23 PM
Jul 2012

Romney would say: "In America, the land of opportunity, everyone gets the health care they can afford."

Of course, I vehemently disagree with that philosophy.

But I realize that Ayn Randian view is a virus spreading across our country.

Let's try to prevent the virus from spreading.

I edited my post because it said the opposite of what Romney would say. It said what I would say.

lovemydog

(11,833 posts)
13. Thank goodness we have her on the Supreme Court
Mon Jul 2, 2012, 09:30 PM
Jul 2012

I've been fortunate to hear her speak and she's down to earth and genuine.

We must reelect the President to keep smart thoughtful liberals on the Court.

treestar

(82,383 posts)
14. Good point. And there is nothing to prove those people are always poor
Wed Jul 4, 2012, 10:37 AM
Jul 2012

So the mandate, with subsidies, organizes things more fairly.

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