Papers, Please

[rowyn]

I am not especially adamant on the subject of health care, one way or another. On balance, I still prefer private institutions to government-run ones. But that doesn't mean I think that government run ones are necessarily disastrous, corrupt, and evil incarnate. Or that private ones are necessarily holy and good and perfect. Most first world health-care systems, including ours and including government-run ones, serve most of their population pretty well. The reason everybody argues so much about the topic is because the answer to the question "How do we provide the most people with the best health care?" is not only complicated, but close.

But there's this one little thing that bothers me about one of the proposed ideas -- the "government mandate". This is the idea where the government mandates that all insurance companies accept all applicants and cover pre-existing conditions. In turn, all individuals must buy health care insurance or face steep fines (with people who cannot afford insurance being subsidized). Now, if the government is going to do the first part it has to do the second, because without an individual mandate, healthy people could wait until they got sick to get insurance, which defeats the whole "insurance" idea.

And it's not really a bad idea, except that it makes it a crime not to be able to prove that you have insurance.

And the funny thing about America is that, right now, in this country, you are not legally required to have documentation about your identity. Living without photo id is terribly inconvenient, but not actually illegal. If you're walking along the street, a police officer can't ask you to produce id, and can't arrest you if you fail to show it. It's one of the reasons America has such a problem with illegal aliens, because the burden of proof (as I understand it) is on the INS to show that you are an illegal alien, not on you to prove that you aren't.

I love that, actually. I do not love the way the way this liberty has been chipped away by the TSA, but the fact remains that I can go anywhere in this country, and as long as I'm not flying on a plane or driving a car, I cannot be required to prove who I am to any government entity. I don't have to show my papers.

An insurance mandate, quite by accident, changes that. It would becomes a crime not to have insurance -- and moreover, not to be able to prove that you had insurance. Because the burden of proof would be on you to show that you were insured, not on the government to prove that you weren't. You'd need to be documented. "I am this person, and I have insurance."

That idea makes me unhappy.

Does it bother anyone else? Especially people who otherwise favor overhauling the health care system?

Comments

[pyat.livejournal.com]

In Canada, you are not required to carry ID. Not even a driver's license. If you're driving a car and have a (non-criminal) accident, you only have to provide proof you are a licensed driver within 48 hours or something.

Dunno if that's a useful point.

[rowyn]

I think whether driving without id is illegal or not varies within the state. I didn't think Canada had an insurance mandate, though; since you've got a single-payer system you can just fund it through taxpayer dollars. Requiring documentation of citizens is by no means a necessary component of government involvement in health care; it's just a component of the mandate idea being set forth in America.

[pyat.livejournal.com]

*nods* In Canada they ask you for a health card when you go to the doctor's office, etc. But you don't HAVE to have one. It just makes them grumble if you don't.

[ladyperegrine.livejournal.com]

It bothers me too, though I hadn't really thought it through like that before.

[rowyn]

Sebkha pointed out that in Australia, they just make you produce proof when you file taxes. So that wouldn't be too bad. Assuming that's what they end up doing. I sure hope they know what they're doing, 'cause I keep losing track. O_O

[ladyperegrine.livejournal.com]

I don't think they do. That's the part that bothers me. I'm pretty leftist, and I'm not opposed to government health care, but even I'm worried about what our government seems to be doing to with the concept.

[rowyn]

Some members of Congress were trying to get a 72-hour waiting period placed on legislation -- that any bill had to wait 72 hours after it was finalized before it could be voted on, to ensure that everyone had a chance to read it before they had to vote on it. Which seemed like a good dea to me; I hope it gets done.

I do feel like our national government is micromanaging too much, maybe? New laws are these thousand-page sprawling things written in dense legalese. It's hard to imagine anyone really knows what they all actually say. This is not a complaint about the current administration, it's been an issue for a long time.

[sebkha.livejournal.com]

Wouldn't you only need to prove that you have private health insurance when you file your income tax? It sounds effectively equivalent to the system here in Australia: a "medicare surcharge" on income tax that you don't have to pay if you hold an accredited private health insurance policy.

Although I imagine in the US, selling the notion of a fine might be easier than the notion of a tax surcharge.

[rowyn]

Maybe. I'm not sure how they plan to enforce it. Just checking at tax time doesn't guarantee that they don't cancel during the year and then sign up again before the next tax period, though you can fine them for the uninsured period which is maybe close enough. Not everyone files taxes, either, or has to.

And yeah, apparently selling a fine is easier than selling a tax surcharge. 9.9 Some conservatives are making fun of President Obama because he's been insisting that mandating insurance purchases a new tax.

[sebkha.livejournal.com]

Yeah, the way it's done here is that you claim exemption from the surcharge for the number of days out of 365 that you were privately covered. The insurance companies mail you a document at tax-time confirming your days of coverage for the financial year.

[terrycloth.livejournal.com]

I don't get it. Why would this automatically need you to prove that you were insured at any random time walking around and put the burden of proof on you? If you don't have an identity, then you're not going to be able to have coverage when you go in to get treated, and if you do have an identity, then it's the identity that needs to be covered and that at key points (like, when you go in for treatment) you'd have to prove belongs to you.

No different from drivers' licenses or, like, any other form of government (or non-government) service.

[rowyn]

The point of an individual mandate is that you need to be insured while you're healthy and don't need treatment. Otherwise you could just buy insurance before you went to get treatment and cancel it afterwards, and defeating the whole "insurance" aspect. Which is why insurance companies don't cover pre-existing conditions right now.

But Sebkha pointed out that Australia just makes people prove it when they file their taxes, which isn't a lot worse than the current system.

It's somewhat worse, though. I didn't get my first government-issued ID until I was 25. I was erratic about filing taxes until I was 30+, too. There is currently no legal requirement to file a tax return unless you actually owe taxes. Making people buy insurance ramps up the likelihood of having to prove you don't owe taxes to 100%, since even people with no income have to file to show proof of (presumably subsidized) insurance.

Still, definitely not the kind of thing I was concerned about.

[terrycloth.livejournal.com]

Sooner or later you're going to need to be insured, and then they can check in with your past records and see oh! You don't have any! You haven't had any for 10 years! 10 years of fines it is, then.

Lumnping it in with taxes does sound more like something they'd do, I guess.

[rowyn]

Hee! Or they take it out of your estate when you die instantly in a car crash. >:)

I bet they'd go the tax route, though.

[skyflame.livejournal.com]

Shortly after 9/11 there were some federal feelers about a national ID card, but that died fairly quickly.

I dunno... I believe most European countries have some form of national ID papers. Perhaps it would be better to fold the insurance issue into a drivers license. Or maybe the federal government comes up with one all-inclusive ID that is a DL, an insurance ID and a passport. (Don't laugh -- there are a few border states who issue regional passport cards that look pretty much like DLs. It could happen.)

[rowyn]

I know this is hard to believe, but driver's licenses are not, actually, mandatory. =) That's the funniest thing about the "documentation" topic for me -- probably 90% of people in America say "Who cares? It's no different from a driver's license." But you only need a DL if you want to drive. I didn't get one until I was 30. I didn't get a non-driver's id until I was 25.

[skyflame.livejournal.com]

Also, when I was in NYC last weekend (Sept 24-27), I got interviewed "on the street" by a guy who was doing said 5-min interviews for a grad school media class. Four questions, and babbling answers. My main answer was that I don't particularly care if there's a public option or not, as long as there are affordable options. The most convenient option would be to keep the current subsidized COBRA pricing and make that the benchmark for any national plan.

[jurann.livejournal.com]

I don't understand the problem. I've been all over the world, and I've always needed papers, even in America. Automobile insurance is mandated in almost every State (certainly every State I've lived in) and you are required to keep papers in your vehicle to prove you have it. We all know there's no Perfect Solution to any of this stuff, but really I don't think making everyone carry around a health care card and/or picture ID are really that big of a deal. I think MOST Americans already do that, and by most I mean a very large majority, like over 90%. Frankly, I'm also all for putting the burden of proof on illegal aliens and carting their asses back to wherever they came from, for a wide variety of reasons too lengthy to get into here.

[rowyn]

I know this is hard to believe, but driver's licenses are not, actually, mandatory. =) Neither is insurance! If you don't have a car (just like I don't have a car) you don't need either one.

That's the funniest thing about the "documentation" topic for me -- probably 90% of people in America say "Who cares? It's no different from a driver's license." But you only need a DL if you want to drive. I didn't get a license until I was 30. I didn't get a state-issued id until I was 24 or 25. It's inconvenient not to have one in some ways, but not illegal. And the further we move to making them mandatory, the less happy I am about it. I don't think the insurance thing will make much difference on the national ID front, though, happily (see above comments.

health care

[seraphimsigrist.livejournal.com]

well I am also opposed to that about
mandatory on principle.
I believe that even if the measure will be
eventually passed, as I suppose the odds
favor, this may be ameliorated.

since I have not been able to rise to the
liberal class very successfully it is hard
for me to fully embrace obamacare to begin
with. sigh :(

Re: health care

[rowyn]

I'm not really sure it's going to get passed, any more. It's apparently a lot less popular than it seemed around election-time last year. I do expect it'll be ameliorated in various ways ... I'm just hoping that the compromise doesn't turn out to be worse than going one way or the other without compromise would be. :/

[beetiger.livejournal.com]

You don't have to carry ID in the US for most purposes -- but you do need to be registered for a Social Security number, if you are over 1 year old and you want to make any money or anyone wants to claim you as a dependent on their taxes. So the vast majority of people are already registered with the US government, and I don't see how the insurance mandate changes that significantly.

[rowyn]

Yes, Sebkha's comment was the most reassuring on this count -- if it's enforced at tax time it's not a large additional burden.

It does make for an interesting argument in favor of replacing the income tax with a flat sales tax, though. I don't really like the invasion of privacy that income tax forms impose, either. :) But I think I'm unusual in that respect, most people don't care if the government keeps reams of detailed data on them.

[haikujaguar.livejournal.com]

Yes, it bothers me.

[fortyozspartan.livejournal.com]

I can't say I'm terribly bothered since to do, well, anything in the United States requires documentation. I'm far less afraid of the government having information about me than most corporations.

It seems pretty academic to say, "Well, you only need a driver's license if you want to drive." Well, of course I want to drive! This avenue of argument reminds me somewhat of the civil rights movement when the government pretty much said to local government, "We're not going to give you federal aid unless you de-segregate." Sure, the local government could have said no, but then their school systems would not have been able to perform the duties they were supposed to because of funding. Frankly, it's not really a choice.

But yeah, I hadn't thought about the whole mandatory thing much.

[rowyn]

Driving just doesn't seem as much like this indispensible thing that Americans cannot possibly exist without doing. Seeing as I didn't get a license until I was 30, and have never owned a car, and even today drive maybe one day in twenty.

But yeah, I'm not typical of an American outside of NYC.