Reader William H. Stoddard writes:

I'm not sure I'm in any of the four groups of uninsured people you identify. I'm 59 years old, self-employed, and uninsured . . . because I can't afford to pay for even catastrophic coverage. I have a touchy gall bladder; I haven't had an attack in several years, but it's a pre-existing condition, so it raises my premiums, which are painfully high anyway for a man my age. I've been self-employed since 2002, when my former corporate job was outsourced. Does that fit any of your categories?

If the House of Representatives proposal passes, I expect that my premiums will be right at the legal maximum of 12% where subsidies kick in . . . assuming that my income doesn't rise past the threshold where a single man is ineligible for help! It averages around $40K, so 12% is $400 a month. I know I can't afford to pay that; I used to pay that much for Blue Cross, and it left me under chronic financial stress. So I'm planning to pay the penalties; 2.5% is $1K a year, which will hurt me, but it won't completely wipe me out. On the other hand, I can't see how it's supposed to help me maintain my health.

But I'll tell you, I supported Obama over both McCain and Clinton partly because he opposed mandates. Now he hasn't said a word to stop them. I don't know if I could bring myself to vote for a Republican, but if the Democrats inflict this financial injury on me, they can forget about my ever voting for another Democrat. I didn't know if Obama was trustworthy; now I know.

The mandate may not kick in for him--at least, in the one example we actually have, Massachussetts, some people don't have to buy insurance because the formula says they can't afford it.  But there's no question that it's going to put financial stress on some of the people it covers.  I was on a panel with the fellow who runs the Massachussetts health exchange a few weeks ago, and even he said that the people who are affected by the mandate hate it.  Yet Massachussetts started off with a relatively low percentage of uninsured citizens.  When you look at a place like California, with both dramatic numbers of uninsured people, and dramatic numbers of immigrants who will require subsidy, the problems loom even larger.

So what do you do with the people in the gaps, like Mr. Stoddard?  The problem is, they're the people who need the insurance most.  People who are uninsured just because they're near the poverty line don't consume so much care.  It's the people with middle-class incomes and a chronic potential medical condition who need the care most, and are least likely to get it under whatever new system we end up with.

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