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Forced health insurance?

Few drivers quarrel with California’s longstanding law requiring every automobile owner in the state to carry liability insurance. That’s because almost everyone has either been hit by an uninsured motorist or knows someone who has.

Now Gov. Arnold Schwarzenegger is actively promoting the idea of making health insurance similarly mandatory, with one potential plan even including fines for people who refuse to insure themselves.

Persons who refused to obtain insurance could be tracked down either by the state or a private “bounty hunter,” enrolled in a plan against their will and fined until they pay their premiums.

Just as it’s hard to argue with the idea that all drivers should have car insurance, it’s easy to agree with the central tenet of Schwarzenegger’s health insurance plan, namely that basic insurance ought to be available at reasonable cost to everyone. But forcing all citizens to buy? That’s another question.

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For some Californians, principally the working poor, the cost/benefit calculation of mandatory health insurance may not be so great. The bare-bones policy Schwarzenegger suggested last winter would carry a $10,000 deductible and amount to little more than worst-case disaster insurance.

Deductibles at that level would leave the vast majority of policyholders still responsible for all their own bills in all but an extreme health crisis, while also paying a health insurance premium.

“For a lot of people, it’s really no different from no insurance at all,” observed Democratic state Sen. Sheila Kuehl of Santa Monica when she first heard the proposal. She proposed a single-payer state plan with low deductibles last year and Schwarzenegger vetoed it after it passed both houses of the Legislature. It is back in the legislative hopper again this year.

Now Schwarzenegger’s administration is considering adding insult to injury: People who reject an essentially useless policy could be fined until they submit and buy something that might never help them a bit. The policy premium itself would be a major burden for many of the working poor. A fine adds to their problems.

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And then there’s the entire class that’s uninsured by choice. A small, but nevertheless significant, portion of the uninsured 25 percent of Californians just doesn’t want conventional medicine. They seek out alternatives, naturopathic treatments and remedies that virtually no health insurance policy now covers.

In a supposedly free country, should they be tracked down like criminals and forced to buy an insurance policy that they vow never to use? The same question, of course, would apply to Kuehl’s plan. Should anyone be forced into coverage against their will?

These are fundamental issues Schwarzenegger and Kuehl must resolve before any kind of universal health care plan passes.

The justification for making these things mandatory, of course, is that eventually many non-buyers could end up in emergency rooms with taxpayers footing their bills, what Schwarzenegger accurately calls a “hidden tax.” Backers of forced insurance equate this with the way insured drivers and their insurance companies have to pick up the tab for accidents involving uninsured motorists.

But is an uninsured-by-choice really as likely to end up seeking standard treatments as uninsured motorists are to have accidents?

Then there’s the issue of whether insurance companies should be allowed to cancel existing policies once such a plan is adopted, essentially throwing persons they don’t want to deal with onto a basic state plan rather than the more inclusive plans most of the insured now enjoy.

That issue arises in the wake of this spring’s attempted cancellation of a group policy held by the California Association of Realtors with Blue Shield of California.

A Superior Court judge ruled in April that Blue Shield can cancel the policy if not as many Realtors signed up as called for in the group contract.

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It’s an example of an insurance firm dumping a policy it finds inconvenient even though that policy covers more than 8,000 persons and the numbers deficit was spurred by a downturn in real estate sales not caused by the Realtors association, which has forced some Realtors into other jobs.

The loophole Blue Shield exploited might be a forerunner of the kind health insurance firms could look for under the Schwarzenegger plan, if insurance companies were to determine they can make more money as providers under a state plan than they can with free-standing non-government policies.

All of which means that while universal health insurance sounds wonderful on the surface and definitely would be better than today’s willy-nilly system that leaves millions who want insurance uncovered, the devil will be in the details.

And woe to legislators and consumers if they don’t pay close attention

to every detail before any such plan is adopted.


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