How do You Make Americans Sign up For Universal Health Insurance?

How do you make Americans sign up for universal health insurance?

So, what happens when someone refuses to get the health insurance that would be mandated by two Democratic presidential candidates, Sen. Hillary Clinton (N.Y.) and former Sen. John Edwards (N.C.)?

If an uninsured patient shows up at a doctor’s office or hospital emergency room, is he refused care? Does he have to produce evidence that he can pay? Will he be required to sign up on the spot for health care coverage before receiving care?

So much for the highly touted “choice” that pervades Clinton’s recently unveiled plan. Maybe it’s just me, but hasn’t everyone overlooked one important ingredient in the latest rendering of the universal health-insurance cure-all being pushed by the Democrats? How do you force every American to sign up?

Auto liability insurance is required in some states, but as many as one in ten drivers don’t buy it. If similar, or even greater, percentages of Americans don’t sign up for health insurance, who pays for them? Further questions abound, which no one seems particularly interested in answering:

How will the government find out if everyone is covered by health insurance? Will it somehow make everyone report his policy and group number? Clinton promises that her plan won’t require any new bureaucracy; so, who will handle the record keeping for the government — the IRS? You thought that the IRS was intrusive now? Wait until they go after your medical and insurance records.

Assuming that the government does determine the insurance status of every American, if it finds someone who hasn’t signed up, will the government sign up for him? Here, the government would say, this is your insurance coverage. Now pay up.

Would the uninsured be punished, and if how so? Will they be taken to court (or more likely, an administrative law judge in the bowels of some agency) and be required prove that they have enough individual resources to be self-insured? Or, what if he simply chooses not to be covered? If convicted, will he be assessed a large fine or be dragged off to jail.

These questions are not addressed in Clinton’s summary of her plan displayed on her web site. All it says is that individuals “will be required to get and keep insurance in a system where insurance is affordable and accessible.” I would assume that she will get around to answering those questions, because many Americans, including her political base, are concerned about intrusions into their privacy.

But, I’ll be told, the questions are irrelevant because who in his right mind wouldn’t want to be covered? After all, the Census Bureau last month reported that “both the percentage and the number of people without health insurance increased in 2006. The percentage without health insurance increased from 15.3 percent in 2005 to 15.8 percent in 2006, and the number of uninsured increased from 44.8 million to 47.0 million.

(By the way, despite the widespread assumption that Americans were “losing” coverage at a drastic rate, the bureau also reported that the number covered by private and government plans actually increased, albeit slightly.)

The fact is that we don’t know how many Americans are not covered because they don’t want to be covered. We don’t know, because the Census Bureau didn’t bother to ask in its 2007 Current Population Survey upon which its estimate of uninsured Americans is based.

Who would be crazy enough to not want coverage? Maybe people who don’t want to pay the premiums. Risk-takers who don’t think they’ll get sick. Foolish young people who think they’re immortal. I know a small-business employer of more than 100 people who had set up a voluntary health insurance plan; both the employer and employee contributed but, surprisingly, not all workers wanted coverage, even though it was a good deal. Obviously, this is only one case, but one suspects it isn’t unique.

Of course, the number of intentionally uninsured has to be small compared with the total number of uninsured. Maybe “only” a couple of million, or so. Still, the question is not unimportant.

We’re expected to intelligently choose to elect those who will set public policy to affect every American, without knowing the full story. They  —  Clinton and Edwards at least  —  are expecting to forge ahead with a policy that would coerce millions of Americans to sign up for something, without knowing how.

Does anyone out there have a clue to how this is to be done?  Or why?