This diary's introduction didn't fit here, so I shunted it below the fold and will just cut to the chase:
If our problem with the universal mandate is twofold -- the policy problem of it driving some people to financial ruin and the political problem of it alienating younger voters (who would be most likely to want to go without health insurance) from the Democratic Party, then we can solve that problem.
The government can loan them the money, much as it does with tuition and fees for higher education.
We can place liens on people's income until such time that they are reasonably able to pay. The liens can have generous terms without busting the bill. We can, for example, not require people to start paying back the money they would be charged for basic treatment they are making 400% of the poverty level, and then can phase in those liens progressively as their incomes increase.
The specifics are negotiable. The point is: we could choose to do this.
Update: I should have made this more clear at the outset, but this diary is not about "what would be the ideal proposal for health care. Its aim is much more modest. There are proposals within the House and Senate bill that are coming into the conference committee for what to do with people who don't (and often will say they can't) pay their premiums despite being above the multiple of the Federal Poverty Line (FPL) that indicates that they have to pay them. Those proposals say "you have to pay the amount now" -- although they don't have enforcement mechanisms. (I expect that that omission will be "fixed" either now or in future years.) So the narrow question is: should the conference committee establish a way for at least some people in those circumstances to defer paying some or all of those premiums while -- unlike the lower income people who must pay but who receive a subsidy -- continuing to owe it to the government if their income increases? This diary is aimed simply at trying to improve a bill -- a bill that I realize many people here oppose -- while it is in the conference committee. That's why I'm resisting broader discussions of whether the bill is or is not a good thing overall. I apologize for not having been more clear about that.
Now for my skipped introduction. If you want to skip this and go down to section 2 to talk about liens, feel free.
(1) The current bases for opposing the bill
People who continue to resist a "mostly like the Senate version" version of this health care generally do so for three reasons:
(A) It's premature to agree to final terms for a bill when the other side isn't done trying to make it worse -- a position most associated with Markos;
(B) The universal mandate, despite subsidies and limits on premium costs, will put too many working people into an untenable financial position (a policy problem) and will particularly piss off younger voters (a political problem) -- a position now voiced most aggressively by Jane Hamsher; and
(C) It's simply immoral, when there is a possibility of reform, to allow our for-profit health insurance system not only to stay in place, but in some senses to be strengthened -- a position that is voiced less openly by Hamsher, but that seems to drive a lot of the opposition to incremental reform.
Markos's concern in Reason (A) is a good one -- but it's too late to do much about it. We had got into the climax of this fight too early. The right strategy, given the obstructionism of Lieberman, Ben Nelson, and probably others, was to say "the Senate can pass whatever it wants, because the real game is in conference." (The exception was the Stupak Amendment, which had to be removed so it could be cut out or softened in conference.) Whatever Lieberman and Nelson wanted to do with the Senate, we should have said OK, noting that it didn't really matter. The problem with what we did is that we made this the definitive battle -- we made the Senate bill into "the bill" -- meaning that we could be robbed in the Senate and then robbed again in conference. This might yet happen, but once we decided that the content of the Senate bill really mattered, it was probably inevitable.
Reason (B) is what I address above and will address again down below in Section (2).
Reason (C) isn't stressed as much in mass e-mails, but let's be clear: it's really what's driving the bus of opposition. This isn't really a problem of policy or politics, it's that we have (or we've thought we had) our ability to truly reform the system and it looks like we're not going to take it.
Personally, I think that we still could take it and could win with a "Round 2," post-"foundational bill" strategy of working through reconciliation, but so far most critics reject that, for reasons that don't actually seem to make much sense judging by how most people think that passing a foundational bill would affect the number of Senate votes we'd later have to work through reconciliation.
(I'll note here, rather than turning it into a freestanding diary, that my great disappointment with Jane Hamsher's course of action is not that she's continued to fight against a bill that I now favor passing, but that she's done so in such a way as to take her voice out of the game when it comes to pressing for a "post-signing-ceremony reconciliation strategy" -- a time when we truly would be able to benefit from her energy and voice. I think, though, that as has happened before, she had tragically just taken herself out of the game. I deeply regret that.)
(I will also deeply regret it if most comments are about the above paragraph rather than about liens.)
But, at any rate, people whose opposition is motivated by Reason (C) and who don't believe that a "Round 2" will come about, will not be interested in the sort of fix to the policy/political problem that I offer. To them, it's appeasement of Evil, like trying to get doctors to make sure that waterboarding doesn't kill prisoners being tortured. I understand the point, but I reject its application. We get another shot here at Evil here; it makes little sense to make the Battle Royale one in which the rules make it so likely that we'll lose.
And enough of all that. Let's talk about liens.
(2) Making liens work for us
A lien is a" form of security interest granted over an item of property to secure the payment of a debt or performance of some other obligation." In other words, a lien can be placed on your property, including future income, to ensure that you pay a debt. Liens can be placed by private interests (such as a mechanic's lien placed by someone who worked on property or a judgment lien to secure an award of damages by a court. They can also be placed by government, such as a tax lien to secure payment of past due taxes.
Liens are disturbing enough, generally, that some proponents of the system have expressed pride in the fact that the current proposal avoids them. But there's no fundamental reason to reject liens when they are (1) generous rather than punitive in how they apply and (2) allow people to pay what they owe when they are better situated to do so. I offer one possible plan in the introduction up above: no payments expected until a family is above 400% (or 600%, or 800% -- this number is adjustable) of the federal poverty line, with the lien increasing from 2% of one's income once one passes an initial income threshold, then to 4%, then to 6%, etc., until the past-due amount for health insurance is paid off.
In such a situation, a lien is essentially a kind of loan: you're just a little bit over the line that obligates you to pay for your insurance, you can't pay us what you owe based on your present income, so you'll pay us a little now and you'll owe us the rest. For young people who expect an increase in future earnings, this is a good deal -- especially, again, if eventual payment terms are generous and forgiving. (And note that some people may never go into repayment, if their incomes don't rise enough. The system ends up offering them a subsidy.)
Spreading out mandatory insurance payments over a working lifetime may help people to better integrate them into their lives, reducing both the policy and the political problems we face. It does not solve the problem that many of us would prefer not to see insurers getting these funds at all -- but that's a separate problem to solve, ideally this upcoming year.
The point is that to the extent we're worried about harming people -- and our party -- with the universal mandate in its present proposed form, we can generate creative ideas to do something about that. If it's not this idea, it can be another better one. Losing the battle for the public option now does not preclude instituting real reform; it need not be more than a temporary setback.