The man refused to take his son to the hospital, and decided instead to perform a home-surgery to sew the wound closed himself. The wound predictably became infected – very infected. The boy was hospitalized for almost a month, according to reports. The man was then charged with aggravated battery (a charge that carries up to 5 years jail time) and accepted a plea deal for 2 year’s probation and 250 hours of public service.

This is, to me, much more than the charged battery; it is child abuse and endangerment. It is a betrayal of the bond of trust and protection that any child should be able to expect from a parent. This man put what I can only assume to be financial concerns before his duty to properly care for his son. The boy was hospitalized for a month! That pretty well screams a dangerous and life-threatening infection to me. I can only imagine the pain and mortification the poor boy suffered, or the trauma and complications he may still be suffering because of his father’s actions. That the man was allowed to take a plea that “is not a direct admission of guilt” is disgusting: it is like saying what he did to his son was justified, and the implications of that could not be more upsetting.

The whole story is a sickening reflection on the great need for health insurance. In this nation, health insurance is the way for average people to manage healthcare costs, and to be without health insurance is to live in fear of crippling medical bills and unmanageable life-destroying debt. What else could drive a person to such extremes as to sew such a wound, at home, untrained, and unsterilized? It is only more horrifying that the victim was a child without the power to refuse or resist.

For a person with a chronic illness, a condition that can never be fully cured and will always need medical supervision and care, health insurance is even more crucial than ever. The cost of healthcare is simply too great for the average person to bear alone, and yet the consequences of avoiding healthcare costs, as shown in this shocking tale, are far greater still. It cannot ever be ok; not for people like this man to subject a child to such risks; not for people like this boy to be kept from necessary medical attention; not for anyone to be so driven by financial fear to suffer so horribly for lack of healthcare. As for this family, I can only hope they may somehow heal from this, that the boy will receive proper medical care and recover from the scars of this terrible incident.

The monthly expense of health insurance is significant, but this story truly brings home the importance of accepting that expense: so that when someone needs to go to the hospital they can, knowing that they will get the help they need.

Find out How to Get Your Insurance License here.

About The Author: Rose Newport is Vice President of Insurance License Express, a division of Express Schools, LLC. Since 1996, Express Schools has offered online insurance licensing courses and online real estate courses, as well as online real estate exam prep and insurance license exam prep.

Primary Care Professionals
As of 2010, scholarships, loan repayment programs, and tax incentives came into effect to fill the drastically undersupplied ranks of primary care physicians and nurses. This plan helps to offset the cost of medical education that has encouraged specialization for cost-recovery, leaving general practice and primary care dangerously understaffed.

Preventative Care
All insurance plans created after March 23, 2010 must provide fee preventative care packages, including cancer screenings, flu shots, testing for cholesterol and diabetes, health counseling (treating issues such as weight, smoking, alcohol, and depression), and routine childhood exams and vaccinations until age 21.

Insurance extension
Young adults are now eligible to stay covered under their parent’s insurance plans until the age of 26 (previously 23), helping young people transition into the workplace without dangerous gaps in medical insurance. This came into effect September 2010.

Pre-existing Conditions
In 2014, if the law stands, insurers will be prevented from denying coverage based on pre-existing medical conditions. Already children under 19 with pre-existing conditions are receiving full coverage. Pre-Existing insurance Plan (PCIP) programs for adults have been enacted in 28 states, with the federal PCIP program available in the remaining 22 to act as a bridge to the private insurance deadline. This program package started July 2010.

Cost allotments and Rebates
Insurers are required to spend at least 80% or premium payments directly on medical care and improvements, leaving only 20% left to administration, overhead, marketing, and profit. Companies failing to meet their required percentage must refund policyholders that portion of their premium, encouraging both premium reductions and quality investment in providing healthcare over profit making strategies. The first rebates for calendar year 2011 will be received in 2012 after the June 1 filing deadline.

Shrinking Doughnut Hole
The gap where Medicare Part D prescription coverage drops off before ‘catastrophic’ coverage kicks in is shrinking. As of January 2012, seniors falling into that gap can get their brand-name prescription drugs at a 50% and generics at 86% of the total retail price. Each year the individual cost percentage will decrease until all prescription drugs will cost seniors 25% of the total in 2010.

Small-Business Credit
Small businesses providing employee health insurance are now receiving tax credits to offset insurance costs, 35% for regular businesses, 25% for non-profits. In 2014, this is set to increase to 50% and 35% respectively.

Find out How to Get Your Insurance License here.

About The Author: Rose Newport is Vice President of Insurance License Express, a division of Express Schools, LLC. Since 1996, Express Schools has offered online insurance licensing courses and online real estate courses, as well as online real estate exam prep and insurance license exam prep.

Combined, these reports lead experts to bitter conclusions, among them, that the unemployment rate is falling not due to job creation but to unemployment fatigue: people dropping out of the workforce entirely. In some cases unemployment benefits have become exhausted, in others, workers have become exhausted looking for jobs and have given up. These two are often tied together, as many workers who might have stopped searching earlier were encouraged to keep at it a few months more due to the extension of unemployment benefits (a program requirement is that workers be actively seeking a job). In an election year, news of this nature has sent political interests on the attack, with republicans decrying the Obama administration’s policies on job creation, and democrats rushing to defend them. The media circus of campaigning makes it harder to process what is actually happening.

Is it really that bad? Though job creation slowed in April, a gain was still posted, and the strong numbers leading up to it could indicate a natural pause in hiring cycles. Also, previous job reports have all been revised upwards as more information surfaces, prompting some hope that April’s numbers could show improvement in the next few weeks. Other possible reasons behind the hiring dip include Baby Boomers, women, college cycles, the government, and the weather.

Part of the worker decline (“dropping out of the workforce”) can be tracked to the simple math of Baby Boomers, as the first wave of the generation enters retirement. As the largest living generation begins to retire, the weight of their numbers will inevitably alter the workforce. Some forecasters offer hope that the jobs retiring boomers leave behind could soon reemerge as new hires in future months. Additionally, women are increasingly choosing not to do paid work (work outside the home) at the highest rate since before the 80’s empowerment movements drove them into the workforce in large numbers. Socially, being a homemaker or stay-at-home mom has started to reemerge as an accepted lifestyle choice for women, and in some cases the economic pressures of childcare costs has made this option the most acceptable financial situation for families.  Meanwhile, college enrollment, especially among women, is increasing rapidly. Many workers are taking advantage of training, retraining, and other educational opportunities to reset themselves for the new economic landscape, a good sign for the economy in the years ahead as a more highly-educated, highly motivated workforce begins to emerge.

The government is absolutely a factor in the current employment figures, though not in the way some people think. The combined political forces of reduced spending and reduced taxing have caused significant budget shortfalls in the public sector, which has been shedding jobs consistently since 2009. Public job losses (15,000 in April), undermine the job growth in the private sector (130,000 in April), reducing the total job creation numbers as they offset. Additionally, tight budgets cause grants and other funding opportunities to dry up, preventing many would-be jobs, both in public and private sectors, to disappear at inception.

Can we also blame it on the weather? The weather is a factor in seasonal hiring rates. The mild winter is credited with the higher than usual hiring rates during the colder months. The early onset of the hiring season could well be reflected in these spring lows, as companies jumped to hire in what was traditionally a slow-hire season and now pause to integrate their new hires during what was traditionally the season hiring picked up. Economists say the true test will be the upcoming “graduation” months, as spring-to-summer ushers in a fresh wave of job-ready graduates and (hopefully) the traditional uptick in consumer spending and business expansion.

Overall, April wasn’t great, but it’s too soon to tell if the economy is really experiencing a slowdown, or if this low is simply a part of the cycle. “My guess is the weather made job growth look too strong in the first couple of months, and now it looks too weak as payback for the warm winter weather,” said Paul Ashworth, chief United States economist for Capital Economics. “It’ll probably settle somewhere in between.” The NY Times also reports that companies are producing more these days with fewer workers, leading many o wonder just what “normal” is anymore. A fall in productivity last quarter (perhaps due to overworked employees unable to keep up the pace?) may lead companies to increase their workforces to bring production back up.

Only time will tell. Until the future reveals itself, many economists and business experts are cautioning people to reserve judgment.

Find out How to Get Your Insurance License here.

About The Author: Rose Newport is Vice President of Insurance License Express, a division of Express Schools, LLC. Since 1996, Express Schools has offered online insurance licensing courses and online real estate courses, as well as online real estate exam prep and insurance license exam prep.

One of the most common issues with commercial vehicles is an unsecured load:  when something flies off the back of a truck. While other incidents like a collision more likely to force the driver to stop, drivers are frequently unaware or unconcerned with flying debris, leaving damaged vehicles on their own. Commercial vehicles also have different informational requirements than private autos, making it sometimes difficult to locate the license plate or identify the company responsible. The following is a true story of how one savvy driver managed to take a claim to the responsible commercial owner:

The sharp sound of the rock against the windshield was a small shock, but the instant spread of the jagged crack brought instant anger; I knew I’d be stuck replacing it myself and I wasn’t having it. The cement truck was driving blissfully unaware ahead of me. I was by myself, but my phone was on the seat beside me. It has a camera feature, most do these days, and I knew the two-button sequence to trigger it easily, without ever taking my eyes off the road.  I snapped a quick photo of the truck ahead, then pulled up beside it and took a picture of the driver’s door, where I could see a company name and a DOT number.
At home, I searched for the company online. It took a few tries to find the right number, but I was able to get to a claims department. From there I emailed a stripped-down explanation of the incident, all the numbers I could read off of my photos, and copies of my photos themselves. The time-stamp and the highway signs in the distance also helped nail down the exact time and location of the incident. The claims representative was very matter-of-fact, and after sending her a copy of the windshield repair bill, I got a check in the mail for the exact amount.

This driver had the right idea. Commercial vehicles have insurance for these things, but it is up to the injured party to collect information and prove the claim. Cell phone cameras can be very helpful, but having a passenger write down information or memorizing a DOT number can also garner results. DOT numbers are important: they are a strong fact to back up any claim. They can also help you locate a vehicle’s owner through the department of transportation and if necessary, file a claim through the department. Company names and fleet numbers, a license plate number, or even the “how’s my driving” hotline ID number can also help. Some commercial trucks don’t have the information on the back or sides, but do have information on the cab or driver’s side door.

Safety is key: risking your own safety or causing an accident yourself is not worth the few hundred dollars of repairs. If you have to pull over and stop driving, stop. If you can’t safely collect information, you’re better off letting it go. Don’t let shock or anger cause you to drive recklessly. Following a commercial vehicle to a destination or forcing a confrontation are not recommended: these can isolate you and put you at risk of assault.

Safely and calmly collecting information can help a driver file a small claim directly to a commercial vehicle’s owner.

Find out How to Get Your Insurance License here.

About The Author: Rose Newport is Vice President of Insurance License Express, a division of Express Schools, LLC. Since 1996, Express Schools has offered online insurance licensing courses and online real estate courses, as well as online real estate exam prep and insurance license exam prep.

The Problem:
Millions of Americans do not have access to healthcare; they can’t (or won’t) pay for insurance, and they definitely can’t pay for medical services. Free Riders abuse the system by buying insurance at the last minute (only when they need healthcare), tapping into the pool of money built by others for medical costs without contributing their share. Other Free Riders are unable to do even that, so they take advantage of the doctors and medical staff, hospitals, and legal protections that are trying to save lives (remember the Hippocratic Oath: to “Do no Harm” and use their skills to preserve life? Some people take it seriously) by getting the care they need but can’t afford, and passing the costs onto everyone else.

The Situation:
The United States of America is the only westernized (i.e. wealthy) nation in the works that does not provide universal healthcare to its citizens. Our healthcare system has developed in the private, for-profit sector. It is argued (with merit) that this has helped foster the medical innovation that has made the U.S. the world leader in the field. It is also argued that is has also excluded classes of citizens from healthcare by making it a financial commodity. National (universal) healthcare has long been a hot-button issue; free-market capitalists hate and fear it, social-minded activists adore and demand it, and most Americans are caught in the middle of extremes, trying to place their values, needs, and beliefs inside the spectrum of gray and unsure of any solution.

The Past:
We won’t get into our founding on ideals of liberty and freedom, on individual choice and responsibility, or the American belief in equality, hard work, and personal achievement. We won’t talk about past wars and boogeymen, of Nazis (aka. the National Socialist Party) or the Cold War and Red Scare of communism. We won’t talk about our nation’s religions and morals, or the sufferings that fuel banding together to help our neighbors and countrymen or the responsibility felt to care for the less fortunate. These are all very present in the American psyche; these are things that shape us; they color our debates. Rather, let’s talk about the facts: what happened and when.

Nationalized Healthcare has came up several times in the 20th century (previously such matters were left to the states, who largely left it alone) and was always ultimately defeated. Healthcare industry groups and other private interests worried that national healthcare would prevent charging appropriate rates to compensate for care, limit care options, stifle innovation, and destroy the industry’s livelihoods, without improvement, and perhaps even a detriment, to the overall health of the nation. Advocates of national healthcare were unable to assuage these fears and sway enough public support.  Its biggest victory came in the 60’s with the formation of Medicare, a compromise that brought the most vulnerable to lack of private health insurance (the elderly, who’s healthcare needs increase exponentially while income-earning ability ends) into a nationalized healthcare entitlement. Later, Medicaid was formed to serve another vulnerable community, the poor (and in particular the children of the poor), based on a means-tested welfare model.
In the 1990’s President Clinton again proposed making national healthcare universal for all citizens. Efforts to prevent that and keep healthcare a private industry created the individual mandate: a Republican-backed idea that would create financial incentive to employ existing market-oriented healthcare models, with levels of government support in existing Medicare and Medicaid sectors. Little of either universal healthcare or the mandate survived the Clinton-era healthcare debate, but the mandate has been a part of other healthcare reform proposals and debates ever since. The Patient Protection and Affordable Care Act passed including the individual mandate under extreme controversy, this time with the mandate opposed by republicans and others.

The Options:
Leave it Alone
The idea that healthcare should be an individual responsibility, not a right or entitlement of citizens. Let it stay 100% in the free market, let people donate to private healthcare charities if they want, let people who can’t, won’t, or fail to manage their own healthcare needs suffer the consequences.
No System Change
This is not really an option; the financial issues of the existing Medicare and Medicaid systems are what prompted the last round, and the previous several rounds, of reforms. It can’t last without change.
Single-Payer
All citizens pay taxes, these guarantee a government-provided health-insurance. There is no option to opt out of taxes; taxes are paid based on income levels and other factors. This is the Medicare model expanded for everyone: national universal healthcare.
Late-Enrollment Penalty
As an aspect of various plans, this stops the last-minute Free-Riders from raiding the insurance funds without contributing. It is also how Medicare part D works: or every month of delayed enrollment the premium rate increases by one percent, making up for payment accumulations contributed by those who did not delay.
Individual Mandate
Buy private insurance or pay a fine of $695 or 2.5% of income, whichever is higher. Exemptions are available for existing Medicare/Medicaid categories (programs which would continue), and some others.
Tax Credit
Buying private insurance earns people a tax credit ($2300 for individuals, $5,700 for families under the Ryan Plan); failure to buy leaves them paying the tax. This plan would either raise taxes or cut services for funding (or some of both) and is not unlike a back-end version of the individual mandate.

A note to the debate: studies have shown people are more likely to take action to avoid penalty than to receive a reward or benefit. In Massachusetts there is an existing individual mandate that has been credited with keeping the private sector health insurance working while preventing Free Rider problems and providing an insured citizen rate of 96%, with an increase in premiums or only .5% to 1.5% (a $25-$75 increase on an average annual premium of $5000).

Engine
Big engines cost big bucks. Not only are fancier engines more expensive overall when it comes to repairs and replacement, they are much more likely to get a driver into trouble. Speeding, reckless driving, and car accidents all go up with the power under the hood. Engines with more cylinders, turbo-charging, lightning pickups, and other performance perks packed into smaller vehicles (as opposed to large work trucks or vans) can really ratchet up the premium.

Theft Rates
If car thieves target your vehicle, your rate will reflect the increased risk of theft. Surprisingly, it’s not just luxury cars that get nabbed; rare models are easier to spot (and therefore to find), and harder to fence. In most cases, car thieves aren’t out to sell a complete car anyway; they want to break it down into untraceable parts and sell those off quickly and easily, so they target plentiful, popular models, like the Honda Accord, Toyoda Camry, and Ford F-150.  You can search the National Insurance Crime Bureau’s list of most stolen vehicles each year to check your ride’s negative popularity.

Repair Costs
If the car’s parts are expensive, difficult to come by, rare, difficult to install, or require specialist handling (or all of the above), then your car insurance will go up. That’s because the more money that goes into repairs, whether it’s the cost of the parts, the cost of the labor, or the time in the shop (which also translates to time in a rental vehicle), the more money it will cost your insurer to fix it if you are in an accident.

New or Rare
You can drop premiums even lower by buying older, common models or used cars, because the overall value of a car decreases with time, and an older common model often means easier repairs, plentiful cheap parts, and lower theft rates. It may even be more cost-effective for you to decrease your insurance coverage with an older car – who needs full-coverage when the replacement cost is less than $1000?

Insurance is a for-profit business: they don’t do anything for free. If it costs the insurer money, you can be sure that that increased cost is going to be rolled into your annual premium. You can reduce your insurance premium before you ever file by being a savvy car shopper. Choose a car that avoids these top price-tippers; you can find more information comparing car models and average insurance premiums at _______.

The U.N. report found income inequality growing at a much faster rate than any other developed nation. While the report measures three basic factors of human well-being, life and health expectancy, education, and standard of living, placing the U.S. fourth behind frontrunners Norway, Australia, and the Netherlands, it isn’t until Chile, ranked 44th overall, that a wider income gap can be found. The IRS confirms that between 1988 and 2008 average incomes declined 1%, while Americans earning more than $380,000 saw income growth reaching 33%.

One of the greatest struggles for average-income Americans is health insurance. The Bureau of Labor Statistics reports that almost 30% of American workers do not have access to an employer-sponsored health plan, with service-related professions leading the category. Of the insured, about 60% was employer-sponsored, 30% government sponsored, and only 10% individually purchased. The three nations beating the U.S. in the U.N. Human Development Report rankings all provide national health coverage.

The very poor in the U.S. are most able to receive health insurance through the social safety net programs of Medicaid and Medicare; the Census report shows the majority of Americans falling below the proclaimed poverty line are the very young, the very old, and the disabled. The very rich can purchase any insurance they want or pay for health services directly. Of the middle class, the U.N. reports $50,000 seems to be the range of income stability, with $60,000 to $70,000 the range where households “stop living beyond their means” – aka, stop accumulating debt to make ends meet.

That leaves the average $40,000 earners feeling a significant pinch, more likely to live paycheck to paycheck, accumulate significant debt, be unable to afford higher education for their children, and be of the estimated 48 million Americans (15% of the population) unable to afford health insurance. Prior to the 2006 housing crisis, an estimated half of the bankruptcy filings in the U.S. were related to medical expenses.

All of this data suggests that the rising income gap also reflects the healthcare gap, or ‘doughnut hole,’ where Americans lack access or funds for health insurance while being ineligible for government-sponsored healthcare assistance. As both financial reform and the healthcare reform controversies continue and political factions propose different solutions, there is one thing that everyone agrees to be true: money and healthcare are problematic in the U.S.

Find out How to Get Your Insurance License here.

About The Author: Rose Newport is Vice President of Insurance License Express, a division of Express Schools, LLC. Since 1996, Express Schools has offered online insurance licensing courses and online real estate courses, as well as online real estate exam prep and insurance license exam prep.

One of the most common issues with commercial vehicles is an unsecured load:  when something flies off the back of a truck. While other incidents like a collision more likely to force the driver to stop, drivers are frequently unaware or unconcerned with flying debris, leaving damaged vehicles on their own. Commercial vehicles also have different informational requirements than private autos, making it sometimes difficult to locate the license plate or identify the company responsible. The following is a true story of how one savvy driver managed to take a claim to the responsible commercial owner:

The sharp sound of the rock against the windshield was a small shock, but the instant spread of the jagged crack brought instant anger; I knew I’d be stuck replacing it myself and I wasn’t having it. The cement truck was driving blissfully unaware ahead of me. I was by myself, but my phone was on the seat beside me. It has a camera feature, most do these days, and I knew the two-button sequence to trigger it easily, without ever taking my eyes off the road.  I snapped a quick photo of the truck ahead, then pulled up beside it and took a picture of the driver’s door, where I could see a company name and a DOT number.
At home, I searched for the company online. It took a few tries to find the right number, but I was able to get to a claims department. From there I emailed a stripped-down explanation of the incident, all the numbers I could read off of my photos, and copies of my photos themselves. The time-stamp and the highway signs in the distance also helped nail down the exact time and location of the incident. The claims representative was very matter-of-fact, and after sending her a copy of the windshield repair bill, I got a check in the mail for the exact amount.

This driver had the right idea. Commercial vehicles have insurance for these things, but it is up to the injured party to collect information and prove the claim. Cell phone cameras can be very helpful, but having a passenger write down information or memorizing a DOT number can also garner results. DOT numbers are important: they are a strong fact to back up any claim. They can also help you locate a vehicle’s owner through the department of transportation and if necessary, file a claim through the department. Company names and fleet numbers, a license plate number, or even the “how’s my driving” hotline ID number can also help. Some commercial trucks don’t have the information on the back or sides, but do have information on the cab or driver’s side door.

Safety is key: risking your own safety or causing an accident yourself is not worth the few hundred dollars of repairs. If you have to pull over and stop driving, stop. If you can’t safely collect information, you’re better off letting it go. Don’t let shock or anger cause you to drive recklessly. Following a commercial vehicle to a destination or forcing a confrontation are not recommended: these can isolate you and put you at risk of assault.

Safely and calmly collecting information can help a driver file a small claim directly to a commercial vehicle’s owner.

Find out How to Get Your Insurance License here.

About The Author: Rose Newport is Vice President of Insurance License Express, a division of Express Schools, LLC. Since 1996, Express Schools has offered online insurance licensing courses and online real estate courses, as well as online real estate exam prep and insurance license exam prep.

About 60% of Americans receive their insurance through their employer. Most of these insurance policies are written under group health plans; insurance plans sponsored under the employer allowing them to receive a group discount rate and employment contract and is used to attract and maintain employees. Employers sponsoring group plans not only provide the insurance company with an increased volume of business, they also pay a portion of the premium, making these contracts attractive to insurers. The remainder of the premium is paid by the employee, allowing health insurance the employee might not have been able to afford as an individual policyholder.

Previously, an employee’s employer-sponsored group health insurance ended when their job did. Eligibility for these insurance plans could also be threatened by reduction or loss of hours.  Many employees under group health coverage also sponsor the inclusion of their spouse and children in the plan, making the entire family’s health coverage a powerful concern for the employee. This was seen as an added pressure to force employees to maintain their jobs and hours that could at best force employee’s choices, and at worst lead to abuse. COBRA was designed to help protect qualified employees by allowing them to continue their health insurance coverage if they resign, quit, or are fired.

COBRA is not a type of insurance; it is a law that applies to insurance. Receiving COBRA coverage simply means transferring existing group health insurance coverage into a different payment category. COBRA allows the former employee to pay the employer’s share of the insurance premium in order to keep insurance coverage for up to 18 months after termination. Qualifying for continued coverage under COBRA is outlined in each individual health plan, and some may provide coverage for extended time or situations. In general however, an employee (and any dependant, if applicable)has to have been a full member of the group health insurance plan at the time of the termination of employment, and the termination cannot have been for “gross misconduct.” The reduction of work hours necessary to maintain group plan membership is also a qualifying factor. COBRA applies to group health plans of employers with 20 or more employees in both the private sector and in state and local governments (it does not apply to the Federal government or religious organizations).

Though premiums under COBRA are significantly higher without the employer’s contribution, paying the full plan premium is frequently sill much more affordable (because of the group rate) than acquiring health insurance individually. Insurance coverage under COBRA is identical to the group plan coverage before it; group coverage changes will apply to COBRA beneficiaries exactly the same as for active employees, and open enrollments and other periods of choice are provided to both equally.

Information about COBRA can be provided by the employer’s Human Resources Department, the U.S. Department of Labor, and the Department of Health and Human Services.

Find out How to Get Your Insurance License here.

About The Author: Rose Newport is Vice President of Insurance License Express, a division of Express Schools, LLC. Since 1996, Express Schools has offered online insurance licensing courses and online real estate courses, as well as online real estate exam prep and insurance license exam prep.

The Problem:
Millions of Americans do not have access to healthcare; they can’t (or won’t) pay for insurance, and they definitely can’t pay for medical services. Free Riders abuse the system by buying insurance at the last minute (only when they need healthcare), tapping into the pool of money built by others for medical costs without contributing their share. Other Free Riders are unable to do even that, so they take advantage of the doctors and medical staff, hospitals, and legal protections that are trying to save lives (remember the Hippocratic Oath: to “Do no Harm” and use their skills to preserve life? Some people take it seriously) by getting the care they need but can’t afford, and passing the costs onto everyone else.

The Situation:
The United States of America is the only westernized (i.e. wealthy) nation in the works that does not provide universal healthcare to its citizens. Our healthcare system has developed in the private, for-profit sector. It is argued (with merit) that this has helped foster the medical innovation that has made the U.S. the world leader in the field. It is also argued that is has also excluded classes of citizens from healthcare by making it a financial commodity. National (universal) healthcare has long been a hot-button issue; free-market capitalists hate and fear it, social-minded activists adore and demand it, and most Americans are caught in the middle of extremes, trying to place their values, needs, and beliefs inside the spectrum of gray and unsure of any solution.

The Past:
We won’t get into our founding on ideals of liberty and freedom, on individual choice and responsibility, or the American belief in equality, hard work, and personal achievement. We won’t talk about past wars and boogeymen, of Nazis (aka. the National Socialist Party) or the Cold War and Red Scare of communism. We won’t talk about our nation’s religions and morals, or the sufferings that fuel banding together to help our neighbors and countrymen or the responsibility felt to care for the less fortunate. These are all very present in the American psyche; these are things that shape us; they color our debates. Rather, let’s talk about the facts: what happened and when.

Nationalized Healthcare has came up several times in the 20th century (previously such matters were left to the states, who largely left it alone) and was always ultimately defeated. Healthcare industry groups and other private interests worried that national healthcare would prevent charging appropriate rates to compensate for care, limit care options, stifle innovation, and destroy the industry’s livelihoods, without improvement, and perhaps even a detriment, to the overall health of the nation. Advocates of national healthcare were unable to assuage these fears and sway enough public support.  Its biggest victory came in the 60’s with the formation of Medicare, a compromise that brought the most vulnerable to lack of private health insurance (the elderly, who’s healthcare needs increase exponentially while income-earning ability ends) into a nationalized healthcare entitlement. Later, Medicaid was formed to serve another vulnerable community, the poor (and in particular the children of the poor), based on a means-tested welfare model.
In the 1990’s President Clinton again proposed making national healthcare universal for all citizens. Efforts to prevent that and keep healthcare a private industry created the individual mandate: a Republican-backed idea that would create financial incentive to employ existing market-oriented healthcare models, with levels of government support in existing Medicare and Medicaid sectors. Little of either universal healthcare or the mandate survived the Clinton-era healthcare debate, but the mandate has been a part of other healthcare reform proposals and debates ever since. The Patient Protection and Affordable Care Act passed including the individual mandate under extreme controversy, this time with the mandate opposed by republicans and others.

The Options:
Leave it Alone
The idea that healthcare should be an individual responsibility, not a right or entitlement of citizens. Let it stay 100% in the free market, let people donate to private healthcare charities if they want, let people who can’t, won’t, or fail to manage their own healthcare needs suffer the consequences.
No System Change
This is not really an option; the financial issues of the existing Medicare and Medicaid systems are what prompted the last round, and the previous several rounds, of reforms. It can’t last without change.
Single-Payer
All citizens pay taxes, these guarantee a government-provided health-insurance. There is no option to opt out of taxes; taxes are paid based on income levels and other factors. This is the Medicare model expanded for everyone: national universal healthcare.
Late-Enrollment Penalty
As an aspect of various plans, this stops the last-minute Free-Riders from raiding the insurance funds without contributing. It is also how Medicare part D works: or every month of delayed enrollment the premium rate increases by one percent, making up for payment accumulations contributed by those who did not delay.
Individual Mandate
Buy private insurance or pay a fine of $695 or 2.5% of income, whichever is higher. Exemptions are available for existing Medicare/Medicaid categories (programs which would continue), and some others.
Tax Credit
Buying private insurance earns people a tax credit ($2300 for individuals, $5,700 for families under the Ryan Plan); failure to buy leaves them paying the tax. This plan would either raise taxes or cut services for funding (or some of both) and is not unlike a back-end version of the individual mandate.

A note to the debate: studies have shown people are more likely to take action to avoid penalty than to receive a reward or benefit. In Massachusetts there is an existing individual mandate that has been credited with keeping the private sector health insurance working while preventing Free Rider problems and providing an insured citizen rate of 96%, with an increase in premiums or only .5% to 1.5% (a $25-$75 increase on an average annual premium of $5000).