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1poorguy wrote:

You would have to have a system where if you opt-out then you are on your own. If you can't pay, you don't get treated. If such a system existed I'm sure your dad would have signed-up (I suspect almost everyone would). Had he not, he would not have been treated and not had to worry about any bills. That sounds harsh, but that would be the only way to make the system fair and still preserve people's right to choose. We all have to live with our choices.

1poorguy, you are presuming that people have that choice, and that they make rational choices. These presumptions are highly suspect in this case -- many people don't have the money up front to pay, making that 'choice' vacuous.

Secondly, another large -- and highly important -- class does not have that choice: children. They comprise the largest group of the uninsured, and those that benefit most from each healthcare $.

Thirdly, the main point of voluntary vs. involuntary is that (if you'd read the Krugman article) the economics mean that if the program is voluntary, the costs are tripled for those who participate. Like many things, when you try to do something on the cheap, it's substantially more expensive all around.

I think this should be the lesson that the 'no tax' crowd should most learn (but certainly won't): you can only push down on taxes so much before those costs pop up other places. When those costs do pop up, they'll be substantially greater.

As a conspicuous example, it's a lot cheaper to fix a bridge than to replace it after it has collapsed. Even when you don't count the costs of routing around the old bridge while the replacement is built.

This is at least as true of health care. And is substantially more true (the ratios are even more egregiously lopsided) when it comes to public health.

rj
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