Zaniya Project: Thou shalt buy health insurance?

Bob Mercer talks about the Zaniya project today, which in its original form was little more than a state mandate for health insurance. Much like the wildly successful mandates that have been passed requiring auto insurance. (Oh, those haven't worked either? Silly me.)
The concept of getting state government more involved with the issue of un-insured citizens was brought to the 2007 session by Rep. Joel Dykstra R-Canton and Sen. Tom Dempster R-Sioux Falls.

Their original legislation called for establishing a new system for health insurance in South Dakota. They wanted to require all state residents to obtain health insurance, provide assistance to those who couldn't afford it, and penalize people who could afford insurance but didn't have it.

The legislature adopted a study instead in a much-reworked version of HB 1169.
I can't imagine why they had to rework the original measure:
FOR AN ACT ENTITLED, An Act to require that all state residents obtain health insurance, to provide assistance to those who cannot afford health insurance, and to provide penalties for those who can afford health insurance but do not have health insurance.
Section 1. This Act affects health insurance in this state.
Read that here. Now the measure is in a slightly more palatable form:
ENTITLED, An Act to establish the Zaniya Project Task Force, to prescribe its mission and composition, and to declare an emergency.
Section 1. There is established the Zaniya Project Task Force, which shall be attached to the South Dakota Health Care Commission. The task force shall develop a plan, complete with action steps and timelines, to provide health insurance to South Dakota residents who lack health insurance coverage. The task force shall seek to create efficiencies in the purchase of health insurance products. For any new proposal it recommends, the task force shall prepare cost estimates and designate funding sources. As part of its charge, the task force shall explore and pursue opportunities available from the federal government.
Section 2. The Zaniya Project Task Force shall be comprised of four legislators and other members appointed by the Governor as described in this section. The speaker of the House of Representatives shall appoint at least two legislators who are members of the House, with at least one member from each political party, and the president pro tempore of the Senate shall appoint at least two legislators who are members of the Senate, with at least one member from each political party. The Governor shall appoint no less than two representatives of each of the following groups:
(1) Health care providers;
(2) Health care facilities;
(3) Insurance carriers and producers;
(4) Employers;
(5) State government;
(6) Lay persons;
(7) Trade associations; and
(8) Tribal health professionals.
Section 3. The Zaniya Project Task Force shall provide its final report to the Health Care Commission, the Governor, and the Legislature by September 30, 2007.
Section 4. The provisions of this Act are repealed on March 1, 2008.
Section 5. Whereas, this Act is necessary for the immediate preservation of the public peace, health, or safety, an emergency is hereby declared to exist, and this Act shall be in full force and effect from and after its passage and approval.
Read that here.

It really begs the question that the Republican authors of the original measure need to take some time to think about - what is the role of government. What should be the role of government?

You note how the new measure talks about the task force being required to review costs and identify sources to pay for the whole thing. Why? That's because measures of this nature tend to be incredibly expensive.

In South Dakota we have risk pools for those otherwise uninsureable in commercial markets for workers compensation, auto insurance, and now health insurance, and they aren't necessarily cheap. But this would even be a step beyond that - this would be a government mandate.

I'm going to write more on this later, but I see my time running out before I have to scurry off to work. Discuss it among yourselves in the meantime...


Anonymous said…
We ought to just let the market take care of health care. We ought to repeal Medicare and Medicaid and the Bush Prescription Drug benefit, and just leave it up to the market. If you don't have health coverage, that's not my problem, and it's not the government's problem. Want health insurance? Get a job with health care. Want health insurance when you retire? Save your money or don't retire.
Anonymous said…
Leave it to the private sector.

They've done a fine job so far.
Anonymous said…
This is an appropriate reflection of a limited government involvement in health care. Unlike the liberal proposals to expand Medicare or otherwise create a government health insurance entitlement, this approach relies on private individuals buying private insurance in the marketplace. Competition drives the system, and competition serves as a check on price and quality.

In fact, for most consumers of health care, there isn't much competition. You get what your employer offers and you take it or leave it. Or you can't afford it because you're self employed or retired. This model would create a large market for private, individual care and would make that care available cheaply.

There will be government action on health care soon. The question is whether or not the private marketplace will be preserved or replaced by a government entitlement.

The problem most Republicans will have is with the idea of it being a mandate. Despite PP's odd statement, the auto insurance mandate has dramatically increased the percentage of insured drivers on the road. And it was passed because uninsured drivers were creating economic burdens on the people they ran into. Here, those without insurance are a drain on the health care system, and those of us with health insurance end up subsidizing their unwillingness to avail themselves to health care.

This is a personal responsibility issue. If you can afford health care, you ought to buy it instead of sticking the rest of us with the bill. But because everyone can get care at the emergency room, there is no incentive to get everyone in the market. We can either 1) stop providing medical care to those without insurance (which is, I think, immoral and opposed to conservative philosophy), 2) expand the current entitlement programs (which is not in line with conservative philosophy), or 3) put structures in place that require those who can afford it to pay for coverage.

While none of these are great options, the third is much more in line with Republican ideology than the other two.
Anonymous said…

Do you think the legislature should deal with health care (outside of Medicaid and SCHIP)?

If so, what would you propose that the legislature do?

This proposal is not a solution without a problem (like the booster seat bill), but rather a reasoned solution to a complex problem.

If you're going to attack it, I think it fair to those actually putting their necks out to find limited government solutions to that you put forth your ideas to address issues we have in health care.

Or do you think our party should ignore health care as an issue and hope that voters anger about the health care system will subside?
Anonymous said…
9:03 Let's be clear, here. You don't "let the market" take care of anything. The unrestrained market "takes care" of you. And if you end up on the wrong side of it, you're toast. Be as Freidmanesque as you want, but just don't kid yourself. If you fall on hard times, or never have the opportunity to make good, you are going to get shafted by the marketplace. Period. End of story.
Anonymous said…
9:03, i think that's a shortsighted view of things. to me "the free market" includes charity. if you "get shafted" in one place, you can find help in another.

the market need not be, nor should it, restrained by the state. though in this instance where the state is already deep into healthcare, dempster's and dykstra's plan may make the best of a bad situation.

my own personal jury is still out on this.

Anonymous said…
sorry, i meant 9:25, the one who talked about the market giving some people the shaft.

Anonymous said…
can we say 'nanny state'???
Anonymous said…
10:07 Then why have health insurance at all?
Let's just let those generous, rich capitalists take care of us. Right.
Anonymous said…
Keep in mind that there is a current mandate in state law for counties to pick up the tab for medical expenses for indigent residents. The more residents who are insured, the less that bill will be. The less residents insured, the higher that bill.

The point is that decisions in the health care arena have an impact that stretches beyond the immediate.
Anonymous said…
9:25 and LEXREX, even talking about the market shafting people is immoral. Maybe "the market" needs a mandatory class on abstinence. You take care of arranging that one LEXREX.
Anonymous said…
We do NOT want "social medicine" and that is just were this is heading. I don't even want to say just wait and watch because it will be too late then.
People who can afford health insurance should get it plan and simple. If those who can afford it the price/cost of insurance would level off and decline over time.
Of course if states keep mandating what insurance companies have to cover this will also keep some of the cost higher.
I truly believe that even though health insurance is high, very high, if people would purchase it instead of some of their "toys" or keeping up with the "Jone's" cost factors would start leveling.
I am self employed and I know just what it cost and it is a bundle with jumps every year, major jumps.
consider it.
Anonymous said…
PP - The challenge is this: The gov't is ALREADY inserted heavily into health care. If people don't have health insurance, they end up on Medicaid or costing the county. They lose everything to bill collectors and go on public assistance. By requiring people to be responsible up front, and helping them to do so, we save a lot of grief and expense - both for the person and for the government.

Your point about small gov't is not illegitimate, but in that case you need to start about repealing some programs. It doesn't make sense to only be involved at the back end, when it is most expensive. We should get out or get in.
Anonymous said…
Dykstra. Dempster. Dumb.
Anonymous said…
What's this provision in the U.S. constitution that says "promote the general welfare"?
Anonymous said…
Part of the problem is that some people just plain refuse to be responsible for themselves. They know if they end up truly needing care or end up pregnant that they will not be refused care. They know that they will not have to pay the bill either. I am thinking of persons I know who could get a job with benefits but refuse to do so, but still go ahead with their lives with pregnancies and kids and stick the rest of us with their medical bills. They could make wise choices but just don't want to.
Anonymous said…
10:23 o how right you are.

What thanks do we get. None just that "give me some more" from the same crowd. Not all but some.

It's like those who end up with a medical problem who have been in jail and or prision (there is a difference) and do something to get thrown back in so joe public has to cover the condition.
Anonymous said…
What's this provision in the U.S. constitution that says "promote the general welfare"?

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