"But I don't need health insurance"

[Mr.Macinstache]

First, it's not a "free" market exchange when ACA mandates specifics on what insurance companies can offer in terms of their plans.

Second, it's more than just the website. Insurers are cancelling people's existing plans under ACA and only offering less coverage at a higher rate.

So far the whole thing has been a total failure. And now the White House is above the law and deciding to delay the mandate for 6 weeks? I guess its ok for them to do it, but its against the LAW when Congress petition for delay. Neat how that works.

Huh? Insurers are canceling old plans (I'm guessing high deductible but also plans that don't cover say mental health) that don't meet the law's minimum standard level. By definition, you are getting more coverage. You're paying for that, but you are getting more. You're not getting less coverage and paying more in any case I've seen.

There's literally no pleasing some people. The free market releases products all the time that don't work 100% the first day they're launched. The government releases a huge system (coded by private contractors...hmmm) and it's an outrage it doesn't work 100% the first day. Not to mention that the federal government wasn't supposed to be the one doing exchanges for over half the states in the first place! We were supposed to let each state do their own thing, but no, conservatives in these states had to take a stand against tyranny and actually gave more control to the federal government. Ironic.

Obama caves in, as usual, and delays the business mandate. Some might say he's showing some flexibility and letting "job creators" take their time. No, now he's a dictator above the law. I understand the concern with a president delaying parts of laws passed by congress, but I hardly think this is the first time it's happened and this such a weak example.

So people are forced to pay more, for more of what they might not need or want. And the insurance companies do love a windfall, and don't mind those govt mandates. Welcome to corporatism. How is this a good thing again?

ACA is a disaster... I'm wondering what is happening to the MMM's plan. I guess we will be updated soon.

We are required to have car insurance if you drive a car, why not health insurance?  This is to protect others, so when something bad happens, strangers or society don't have to pay for you. 

For one, no on has to own a car (many here don't!), so you aren't forced to buy auto insurance, but when you do, you use public roads, and put others a risk.

An individual's mere existence does not necessarily put anyone else at risk, so conflating the two is a bit of apples to oranges.

What if the govt started requiring cyclists to buy some sort of bike insurance?

[Cecil]

An individual's mere existence does not necessarily put anyone else at risk,

I'd argue that your very existence does, in fact, impose a burden on the rest of society to keep you alive. If you get a $400k case of pneumonia, and don't have $400k, it's not reasonable for you to expect us to let you die. No, we are going to try and save your life, and bear the cost of that ourselves. You've thus unjustly imposed on the rest of us by not having health insurance.

[lithy]

we are going to try and save your life, and bear the cost of that ourselves.

Why?  It seems to me like they made their choice and should live and die by the consequences, not the beliefs of others.

Medical care is a good/service just like anything else.  I always thought that this board above all others would understand the concept of, if you can't afford it, you can't have it.

The fallback for all of this is charity care, but of course there were holes in that system (as there will be in this system), and we have to fix the holes.

What I find disturbing is that people are unwilling to allow a person to go without treatment, and like so many versions of lifestyle inflation before it, inflation in what is deemed appropriate life-saving medical care will continue to grow exponentially in costs as technology and scientific breakthroughs occur.  When the day comes that we can save a single person's life by replacing their entire head at a cost of 10 million dollars, will we demand it?  What becomes the cutoff of acceptable care?  A 51% chance of survival?  If so, why is 49% not good enough?

A majority agrees that universal healthcare is what they want and in doing so, subjugates the dissenting minority and carries them along for the ride, effectively reducing their ability to pay for their own care if it becomes necessary and then later saying, "See, aren't you glad you have government healthcare?"  Like others, I suppose I have been accused of living in a libertarian fantasy land, but if we have become a democracy, I think we are on our way out.

[tooqk4u22]

An individual's mere existence does not necessarily put anyone else at risk,

I'd argue that your very existence does, in fact, impose a burden on the rest of society to keep you alive. If you get a $400k case of pneumonia, and don't have $400k, it's not reasonable for you to expect us to let you die. No, we are going to try and save your life, and bear the cost of that ourselves. You've thus unjustly imposed on the rest of us by not having health insurance.

Maybe if relieved the system of the notion that healthcare providers are "Required" to aid people in need and that ERs are there to treat people without health insurance for such minor issues as the common cold maybe then people would adjust their habits. 

A majority agrees that universal healthcare is what they want and in doing so, subjugates the dissenting minority and carries them along for the ride, effectively reducing their ability to pay for their own care if it becomes necessary and then later saying, "See, aren't you glad you have government healthcare?"  Like others, I suppose I have been accused of living in a libertarian fantasy land, but if we have become a democracy, I think we are on our way out.

First of all, I don't think the majority agrees with universal healthcare....the majority may have voted democrat but that is not one in the same.  ACA was forced through in a moment of time where democrats controlled and they moved it along with little or no regard to application or the wants/needs of the citizens - like so many others it was passed without even being written and what was written wasn't read - that is the injustice.

Also, the US doesn't operate solely on majority rules....it operates on the basis of majority rules but with the consent of the minority - very different. And even then the difference in size between the majority and minority currently is only a few perecent.

The system of government is more dysfunctional and broken than it has ever been and is not operating for the people, as it should.

Regardless, I will repeat that I like small government but also believe there should be small and limited safety nets - and for healthcare there should be a minimum level of service/plan provided by the government and then private plans beyond that.  The government plan should be bare bones emphasize primary care and preventive care, should cover a portion of the poor for some time, and should be the provider of last resort for those with pre-existing conditions...and if your on the government plan you should not expect or be entitled to royal treatment.  ACA is disasterous hybrid of the worst of public and private and was from when it was initially proposed.

As for safety nets in general, unfortunately the nets have been swallowed by safety oceans that are so large there is a large portion of the population is incentivised to not reach for their full potential......but I digress.

[randymarsh]

Why?  It seems to me like they made their choice and should live and die by the consequences, not the beliefs of others.

A majority agrees that universal healthcare is what they want and in doing so, subjugates the dissenting minority and carries them along for the ride, effectively reducing their ability to pay for their own care if it becomes necessary and then later saying, "See, aren't you glad you have government healthcare?"  Like others, I suppose I have been accused of living in a libertarian fantasy land, but if we have become a democracy, I think we are on our way out.

In practical terms, because the Emergency Medical Treatment Active Labor Act says they must be treated. Reagan and Congress decided that in the United States, if you need emergency care, you're going to to get it regardless of your ability to pay. Most developed countries feel this way. On a global scale, Americans are the minority when they think that people should just be left on the sidewalk to die.

It's also ridiculous to pretend that all my health problems are the result of my own actions. I could develop cancer. I could get hit by a bus. Someone could shoot me. Who's fault was it that my appendix needed taken out?

Your argument about subjugating the dissenting minority opens the door for me to refuse to pay for anything I don't want to. I'm against the war in Iraq. I'd like to opt out of that spending.

[sandiahiker]

What the OP fails to recognize, is that even though he is young and healthy, takes care of himself and makes good decisions, like all of life, SHIT HAPPENS. You might fall and crack your skull, get some weird disease, cancer, or even a bad case of the flu. You just never know. Then what if you don't have $500k to cover your expenses? The rest of pick up your uninsured tab.

The idea that Obamacare is not a true marketplace because of all the insurance requirements is a fallacy. You could say that the car industry is not a true free market because cars have to have seatbelts, airbags and lights. "But I only drive during the day, I don't need a car with lights!" The requirements are there for our benefit. For example, it was IMPOSSIBLE to buy a plan on the current market with maternity coverage.

Several people have made the point, but I will reiterate: WE ALREADY PAY FOR THE UNINSURED. Hospitals all over the country receive billions of dollars from the federal government to make up for unpaid bills. This money is being redirected to the marketplace subsidies (and is the primary source for those funds, this is why Obamacare is projected to save money). This is also why states that declined to expand Medicaid are screwing their hospitals: the money to treat the uninsured is drying up, and the uninsured are still uninsured (and broke). So the hospitals are slowly going bankrupt.

Finally, for those that are all upset about your personal freedom being compromised, think of all of the other socialized systems in our country: police, fire, military, roads (btw, gas taxes don't even come close to paying for the highway system), airports, schools, parks, FDA, SEC, OSHA. The list goes on and on. There will always be people who pay for services that they don't use.

And back to the OP, you may be young and healthy now, but you will be very pleased that when you are 50 you will be able to get health insurance, whereas under the old system you'd either be priced out of the market or denied outright. 

[Mr.Macinstache]

In practical terms, because the Emergency Medical Treatment Active Labor Act says they must be treated. Reagan and Congress decided that in the United States, if you need emergency care, you're going to to get it regardless of your ability to pay. Most developed countries feel this way. On a global scale, Americans are the minority when they think that people should just be left on the sidewalk to die.

Before that law did we have an epidemic of people dieing on sidewalks because people refuse to treat them? You can use the emotional arguments but they don't hold water.

We already pay for the uninsured? There is a big difference when we voluntarily enter a private hospital, and having them distribute the cost of doing business, and having a government force everyone to buy a product so the corporations can reap a windfall or the govt can collect a tax. One is forced, the other is voluntary. Also, since businesses are already doing this, why then does govt need force insurance companies to do it? It's being done already on its own.

I always thought that this board above all others would understand the concept of, if you can't afford it, you can't have it.

Yes, it is a bit ironic to hear people here talk of abandoning individual responsibility in favor of a subsidized system.

[Mr.Macinstache]

Finally, for those that are all upset about your personal freedom being compromised, think of all of the other socialized systems in our country: police, fire, military, roads (btw, gas taxes don't even come close to paying for the highway system), airports, schools, parks, FDA, SEC, OSHA. The list goes on and on. There will always be people who pay for services that they don't use.

Do you have a source for that claim?

Because I am reading that federal gas tax is over .18 per gallon. Add in state tax and is an average of .48 a gallon we pay just in tax. It turns out the local and federal governments make more off of gas than the oil companies do.

However, since it is an excise tax, these are far less heinous than say a property or income tax.

[Purple Economist]

First, it's not a "free" market exchange when ACA mandates specifics on what insurance companies can offer in terms of their plans.

Second, it's more than just the website. Insurers are cancelling people's existing plans under ACA and only offering less coverage at a higher rate.

So far the whole thing has been a total failure. And now the White House is above the law and deciding to delay the mandate for 6 weeks? I guess its ok for them to do it, but its against the LAW when Congress petition for delay. Neat how that works.

Huh? Insurers are canceling old plans (I'm guessing high deductible but also plans that don't cover say mental health) that don't meet the law's minimum standard level. By definition, you are getting more coverage. You're paying for that, but you are getting more. You're not getting less coverage and paying more in any case I've seen.

There's literally no pleasing some people. The free market releases products all the time that don't work 100% the first day they're launched. The government releases a huge system (coded by private contractors...hmmm) and it's an outrage it doesn't work 100% the first day. Not to mention that the federal government wasn't supposed to be the one doing exchanges for over half the states in the first place! We were supposed to let each state do their own thing, but no, conservatives in these states had to take a stand against tyranny and actually gave more control to the federal government. Ironic.

Obama caves in, as usual, and delays the business mandate. Some might say he's showing some flexibility and letting "job creators" take their time. No, now he's a dictator above the law. I understand the concern with a president delaying parts of laws passed by congress, but I hardly think this is the first time it's happened and this such a weak example.

There are people who are getting less coverage now and paying more for it.  One reason is that the ACA restricts the difference insurers can charge the oldest people vs. the younger people.  The highest rate based on age can only be 3x the rate of the lowest based on age.  Before the ACA, the highest was more like 6x the lowest.  This means the rate for many (younger) people is going up and they are choosing less coverage because insurance is now so expensive.

There are also a lot of sick people being added to the insurance pools.  These high users of health care are forcing the healthy to pay more for insurance as there can be no differential charged based on health status (except tobacco use).

There are also new restrictions in terms of premium differential based on gender.  You can't have a differential now.  This has caused premiums to increase for many (young, male) people.

In total, there are many people who are now paying more for less insurance.

Your argument about subjugating the dissenting minority opens the door for me to refuse to pay for anything I don't want to. I'm against the war in Iraq. I'd like to opt out of that spending.

The presence of armed, forced coercion in terms of being forced to pay for wars you do not support is not an argument for more armed, forced coercion in terms of purchasing health insurance.  The proper argument would be to remove the government's power to force us to pay for wars or health insurance we do not want.  The subjugation of a dissenting minority is the hallmark of the tyranny of a democracy.

[Khan]

And back to the OP, you may be young and healthy now, but you will be very pleased that when you are 50 you will be able to get health insurance, whereas under the old system you'd either be priced out of the market or denied outright.

Actually, I fully support Obamacare. I'm... my mind is absolutely blown by the Free Marketer's who feel like this is the greatest injustice in all of recent history perpetrated on them. I don't understand how if you're arguing for personal responsibility, they wouldn't see the negative externalities of the current system playing host to the current uninsured, feel compassion for their fellow man at the lower level, and see the upsides of changing the system. Also, understanding that there is no such thing as a free market, it's all about controlling the market such that there's room for innovation and companies to grow, while controlling the negative side of that growth, because, I don't know... Company Towns, worker massacre's, lack of safety regulations, sweatshop hours... We've gotten where we are from the intransigence of the past, which you can view happening in Burma and other shit holes free of those regulations "holding" industries back.

I just... don't understand. Like I said before, economic libertarianism I just don't understand ideologically.

Also, Mr. Macinstache, many of those claims of Obamacare being worse for people is overstated.  Please tell me you're not getting your news on that side from Fox News(some of who's stories were completely debunked by somebody over at Salon).
http://www.thedailybeast.com/articles/2013/10/23/the-obamacare-success-stories.html
http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sean_hannity_on_obamacare/

Also, I might remind you of some of the very great parts of Obamacare. Here's one, because insurance companies are ****ing evil.
80% of a companies insurance premiums must be used on... get this, medical care.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/18/the-obamacare-provision-that-terrifies-insurers/

Let me highlight one of those lines:

In the individual market, some health plans would spend as little as 60 percent on medical costs.

Here's another of the ACA's changes to health insurance companies:

Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick

We already pay for the uninsured? There is a big difference when we voluntarily enter a private hospital, and having them distribute the cost of doing business, and having a government force everyone to buy a product so the corporations can reap a windfall or the govt can collect a tax. One is forced, the other is voluntary. Also, since businesses are already doing this, why then does govt need force insurance companies to do it? It's being done already on its own.

Like I said earlier, many of the ACA's provisions to the insurance companies actually -reduce- profit taking and make them answerable to the product they're supposed to be providing.

[Mr.Macinstache]

"I wish these Obamacare supporters would keep their laws off my body"

[randymarsh]

The proper argument would be to remove the government's power to force us to pay for wars or health insurance we do not want.  The subjugation of a dissenting minority is the hallmark of the tyranny of a democracy.

In other words, we should all be able to opt out of taxation.

Now we really have entered a libertarian dream world.

[hybrid]

Yes, it is a bit ironic to hear people here talk of abandoning individual responsibility in favor of a subsidized system.

The part I find ironic is that I have not met a soul who opposes mandating the purchase of health insurance who would voluntarily opt out of it.  As was argued in the Supreme Court, every soul in the room had health insurance because they simply could not imagine not having it.

Personal responsibility means you own catastrophic health insurance.  Anyone who thinks they are invincible and does not require it is just a lucky idiot who hasn't rolled snake eyes yet.  Mandating something everyone ought to be doing (but don't or have not been able to afford) makes sense for the rest of us who are being responsible.

I'm no fan of the ACA right now.  The Libertarians have done a fine job pointing out all the numerous warts on it.  The trouble is, they offer nothing better in return.  Yeah, people ought to take personal responsibility.  Small comfort to the rest of us when they don't.   

[gimp]

As a society, we take care of people when they get sick.

If you complain about being forced to pay for insurance, would you also complain about being forced to pay taxes for national health care, if it were implemented?

If not - then the discussion is over, I think.

If yes - then I don't particularly care to argue the point.

Those among you who think we should simply let people die if they don't have the money, remember this: if your plan is implemented, you will have a bunch of money, and there will be many people with nothing to lose. I hope you see the consequences of that situation.

So rah rah rah freedom, you're free to not pay your taxes, and the IRS is free to throw you in jail and sell off your belongings.

[Mr.Macinstache]

Yes, it is a bit ironic to hear people here talk of abandoning individual responsibility in favor of a subsidized system.

The part I find ironic is that I have not met a soul who opposes mandating the purchase of health insurance who would voluntarily opt out of it.  As was argued in the Supreme Court, every soul in the room had health insurance because they simply could not imagine not having it.

Personal responsibility means you own catastrophic health insurance.  Anyone who thinks they are invincible and does not require it is just a lucky idiot who hasn't rolled snake eyes yet.  Mandating something everyone ought to be doing (but don't or have not been able to afford) makes sense for the rest of us who are being responsible.

I'm no fan of the ACA right now.  The Libertarians have done a fine job pointing out all the numerous warts on it.  The trouble is, they offer nothing better in return.  Yeah, people ought to take personal responsibility.  Small comfort to the rest of us when they don't.

Then that begs the question, can you force mandate personal responsibility? You really can't. Look at the drug war. People use more drugs now than ever. More laws ≠ more personal responsibility.

Libertarians are offering solutions... let the market work, let people freely associate with their doctors and health care providers, let insurance compete nationwide. Cut the bureaucracy and corporatist mergers with a state that benefit only themselves instead of the people.

So rah rah rah freedom, you're free to not pay your taxes, and the IRS is free to throw you in jail and sell off your belongings.

Wow, when did the progressive ideology abandon tolerance and embrace authoritarianism? How sad.

[hybrid]

Then that begs the question, can you force mandate personal responsibility? You really can't. Look at the drug war. People use more drugs now than ever. More laws ≠ more personal responsibility.

Oh, there is no clean answer here, I'll grant that.  I am completely on board with decriminalizing most (not all) drugs.  The trouble with decriminalization comes when a persons personal irresponsibilities impact society and not just the individual.  Want to sit in your trailer and do meth all day?  None of my business.  End up in an expensive hospital or rehab because you were doing meth all day and now you can't afford the bill for your actions?  Now I feel like I, through the legislative process, get a say when your personal irresponsibility impacts others.

Look at motorcycle helmet laws.  Motorcycle helmets are common sense, people ought to be wearing them.  And there are very real costs society bears when an individual suffers a wholly preventable injury because they were exercising their supposed freedom to do whatever they like.  Freedom does not include the right to burden society due to personal irresponsibility.  That is where I tend to draw the line regarding when and where society can step in and mandate personal responsibility.  Motorcycle helmet laws are a slam dunk for me.  I just don't feel like paying for someone else's preventable stupidity.

So coming back around to health insurance, it is irresponsible not to own it.  The costs of the uninsured ultimately get passed on to the rest of us with insurance.  So yes, I am completely comfortable mandating it because it protects the responsible from the irresponsible.  Not that I am arguing that the ACA is my preferred solution, just that if this is the solution we're stuck with, I'm comfortable with mandating what anyone with the means and common sense does in the first place.

[Purple Economist]

The proper argument would be to remove the government's power to force us to pay for wars or health insurance we do not want.  The subjugation of a dissenting minority is the hallmark of the tyranny of a democracy.

In other words, we should all be able to opt out of taxation.

Now we really have entered a libertarian dream world.

Except that we haven't.  Most libertarians are not going to argue that there should be absolutely no taxes and no government at all.  I would say that most libertarians would be against taxes and coercion that force you into a specific activity.  The function of government, in my opinion, should be extremely limited and any power granted to a government should be heavily scrutinized.  There is a very short list of activities the federal government should be involved in.  These would be things like national defense (truly defense), intellectual property protection, treaty negotiation and limited federal courts.  As for local government, their list might include police and law enforcement (courts).  You could also maybe make an argument for fire protection.

[Marmot]

Thank you for answering the question, I respect your views.

I also respectfully disagree, as I could not countenance living in a society which allowed people to die when medical intervention could save their lives.

I don't think human beings are that heartless to turn away people in need. Hospitals do offer charitable care, doctors do work pro bono. It happens all the time.

Instead of "turning people away" in the literal sense, hospitals have been discontinuing certain services that have a high proportion of indigent care, so ambulances just end up having to go to hospitals that are further away. For example, in some of the worst neighborhoods on the south side of Chicago, there is sort of a level 1 trauma center desert. For example, the University of Chicago Medical Center (a non-profit health system) used to have a level 1 trauma center though closed it in the late '80s (and has never reopened), even though overall the hospital system has been doing really well (ie just opening up a $700 mill "replacement" hospital this year, that does not have a lvl 1 trauma ward). http://www.chicagonow.com/chicago-muckrakers/2013/05/community-keeps-pressure-on-university-of-chicago-regarding-level-1-trauma-center/

This is the less overtly heartless version of de facto "turning people away". In Chicago, 7-10 miles could mean 30+ minutes in the ambulance; the additional travel time could be the difference between life or death.

A more humane way of de facto turning people away that a lot of hospitals do is stabilizing the patient then sending them to a charity hospital. Though this is relatively safe, it is not perfect and uncomfortable for the patient.

[Mr.Macinstache]

Then that begs the question, can you force mandate personal responsibility? You really can't. Look at the drug war. People use more drugs now than ever. More laws ≠ more personal responsibility.

Oh, there is no clean answer here, I'll grant that.  I am completely on board with decriminalizing most (not all) drugs.  The trouble with decriminalization comes when a persons personal irresponsibilities impact society and not just the individual.  Want to sit in your trailer and do meth all day?  None of my business.  End up in an expensive hospital or rehab because you were doing meth all day and now you can't afford the bill for your actions?  Now I feel like I, through the legislative process, get a say when your personal irresponsibility impacts others.

Look at motorcycle helmet laws.  Motorcycle helmets are common sense, people ought to be wearing them.  And there are very real costs society bears when an individual suffers a wholly preventable injury because they were exercising their supposed freedom to do whatever they like.  Freedom does not include the right to burden society due to personal irresponsibility.  That is where I tend to draw the line regarding when and where society can step in and mandate personal responsibility.  Motorcycle helmet laws are a slam dunk for me.  I just don't feel like paying for someone else's preventable stupidity.

So coming back around to health insurance, it is irresponsible not to own it.  The costs of the uninsured ultimately get passed on to the rest of us with insurance.  So yes, I am completely comfortable mandating it because it protects the responsible from the irresponsible.  Not that I am arguing that the ACA is my preferred solution, just that if this is the solution we're stuck with, I'm comfortable with mandating what anyone with the means and common sense does in the first place.

But at the end of it all, you have the corporate insurance industry and central govt reaping all the benefits because it was a system design by and for them - the people (who can afford it) will pay for it all. It's corporatism. Libertarians want the opposite, they want the govt to protect people, not promote corporatism. So it's either that, or live in a free society, where we individually responsible, but also voluntary share societies burdens. Life involves risk, and people who are prone to it, should bear the brunt. If you want to ride sans a helmet, you get to pay higher motorcycle and health insurance personally. Again, you can mandate the laws, but you can't force people to abide..trying to do so only promotes authoritarianism, like the police state, prisons, IRS, etc while benefiting corporations who get cover from these mechanisms.

[Mr.Macinstache]

Thank you for answering the question, I respect your views.

I also respectfully disagree, as I could not countenance living in a society which allowed people to die when medical intervention could save their lives.

I don't think human beings are that heartless to turn away people in need. Hospitals do offer charitable care, doctors do work pro bono. It happens all the time.

Instead of "turning people away" in the literal sense, hospitals have been discontinuing certain services that have a high proportion of indigent care, so ambulances just end up having to go to hospitals that are further away. For example, in some of the worst neighborhoods on the south side of Chicago, there is sort of a level 1 trauma center desert. For example, the University of Chicago Medical Center (a non-profit health system) used to have a level 1 trauma center though closed it in the late '80s (and has never reopened), even though overall the hospital system has been doing really well (ie just opening up a $700 mill "replacement" hospital this year, that does not have a lvl 1 trauma ward). http://www.chicagonow.com/chicago-muckrakers/2013/05/community-keeps-pressure-on-university-of-chicago-regarding-level-1-trauma-center/

This is the less overtly heartless version of de facto "turning people away". In Chicago, 7-10 miles could mean 30+ minutes in the ambulance; the additional travel time could be the difference between life or death.

A more humane way of de facto turning people away that a lot of hospitals do is stabilizing the patient then sending them to a charity hospital. Though this is relatively safe, it is not perfect and uncomfortable for the patient.

This is parallel to a "living wage". The truth is, if you have minimum skills, you're going to get a minimum wage. If you have a low income, you're going to only be able to afford a low level of services or depend on charity. Health care is a service, and the level of service in this country is pretty high...we are getting what we pay for, for the most part - but who knows what the unintended consequences of the ACA will be from here. It could very well artificially overwhelm the market by subsidizing and granting health care as a right, where we are going to experience shortages, which will result in the same, if not worse level of service for not just the needy, but for everyone.

[Jamesqf]

Wow, when did the progressive ideology abandon tolerance and embrace authoritarianism?

Like since forever?  Tolerance is only for those who "voluntarily" choose to behave in acceptable-to-the-ideology ways.

[sassy1234]

"Several people have made the point, but I will reiterate: WE ALREADY PAY FOR THE UNINSURED. Hospitals all over the country receive billions of dollars from the federal government to make up for unpaid bills. "

That is damn right!!!!   We already pay for the uninsured.  Now, the care that they receive will cost less, as they will be going to a primary care physician and getting preventative care, not the emergency room.  This will save each and every one of you libertarians in the end.  You are thank President Obama for that. 

[DoubleDown]

There is a very short list of activities the federal government should be involved in.  These would be things like national defense (truly defense), intellectual property protection, treaty negotiation and limited federal courts.  As for local government, their list might include police and law enforcement (courts).  You could also maybe make an argument for fire protection.

I.e., the list of things you are for, and only the things you are for. Forget the majority of the country who might add (and have added) other things to that list through their democratically elected representatives for, say, schools, libraries, or perhaps even basic health care.

That bare-bones list you proffered sounds like a very uncivilized society to me. I guess if I my next flight crashed because there are no air traffic controllers, oh well. Same if I eat some salmonella-tainted meat that was never inspected, since private industry and "the market" will always do the right thing. And I don't need to pay taxes at all, your list included no one to even collect them or enforce it. Some industry is dumping 100,000 gallons a day of chemical waste into your local water supply? Don't worry about it, nothing to see here.

[sandiahiker]

Finally, for those that are all upset about your personal freedom being compromised, think of all of the other socialized systems in our country: police, fire, military, roads (btw, gas taxes don't even come close to paying for the highway system), airports, schools, parks, FDA, SEC, OSHA. The list goes on and on. There will always be people who pay for services that they don't use.

Do you have a source for that claim?


 

Here's a link:

http://taxfoundation.org/article/gasoline-taxes-and-tolls-pay-only-third-state-local-road-spending

" Nationwide in 2010, state and local governments raised $37 billion in motor fuel taxes and $12 billion in tolls and non-fuel taxes, but spent $155 billion on highways.[3] In other words, highway user taxes and fees made up just 32 percent of state and local expenses on roads. The rest was financed out of general revenues, including federal aid."

There's a really cool table too that breaks it down by state.

In Wyoming and Alaska, user fees (gas taxes, car registration, etc.)  only pay for about 5‰ of expenditures.

If you want federal aid added back in, here's another link:

http://taxfoundation.org/blog/road-spending-state-funded-user-taxes-and-fees-including-federal-gas-tax-revenues

The point is, we don't even come close in any state. It's all subsidized.

[Marmot]

This is parallel to a "living wage". The truth is, if you have minimum skills, you're going to get a minimum wage. If you have a low income, you're going to only be able to afford a low level of services or depend on charity. Health care is a service, and the level of service in this country is pretty high...we are getting what we pay for, for the most part - but who knows what the unintended consequences of the ACA will be from here.

I agree that there are several parallels between the two topics, though I'll focus on healthcare, as I think the other topic might send us off on a tangent; would be an interesting discussion for a different thread. One of my main concerns is that a less healthy workforce is less productive, which has an impact on GDP per capita; I think there is a lot of room for improving the health of the population via various incentives/penalties, while still having a net financial benefit for society. I agree that a lot of current subsidies and penalties have unintended negative consequences (ie farm subsidies for corn); I do not think that means that subsidies and penalties are always bad though, and that if done intelligently, they can and more often than not have large net benefits.

As having a high level of service is subjective, I cannot refute your opinion on that. In my opinion, our US healthcare is suboptimal relative to what I think it could and should be based on how rich and technologically advanced the country is overall.

I would say the main unintended consequence of the ACA is people being dropped to below 30 hours per week by their employers. I think the benefits of the ACA far outweigh the negatives though, as who knows what the consequences of maintaining the status quo would have been.

[Purple Economist]

There is a very short list of activities the federal government should be involved in.  These would be things like national defense (truly defense), intellectual property protection, treaty negotiation and limited federal courts.  As for local government, their list might include police and law enforcement (courts).  You could also maybe make an argument for fire protection.

I.e., the list of things you are for, and only the things you are for. Forget the majority of the country who might add (and have added) other things to that list through their democratically elected representatives for, say, schools, libraries, or perhaps even basic health care.

That bare-bones list you proffered sounds like a very uncivilized society to me. I guess if I my next flight crashed because there are no air traffic controllers, oh well. Same if I eat some salmonella-tainted meat that was never inspected, since private industry and "the market" will always do the right thing. And I don't need to pay taxes at all, your list included no one to even collect them or enforce it. Some industry is dumping 100,000 gallons a day of chemical waste into your local water supply? Don't worry about it, nothing to see here.

It's almost like I put "in my opinion" in my post.

For the things you mention, the government does such a wonderful job on all those things.  Nobody ever eats salmonella-tainted meat, serrano peppers or peanut butter thanks to the government.  Nobody ever eats E. coli-tainted spinach thanks to the government.  Public schools all do a fabulous job of educating every student thanks to the government.

The thought of non-government air traffic controllers just blows my mind.  How could an air traffic controller even exist without the government?

You could allow for some laws regarding pollution or you could allow for private ownership of things like waterways.  Then the owner of the waterway would be able to say whether someone can dump waste into it or not.

Of course you would need a few (and I mean a few) people to collect whatever minimum taxes are required to operate the very limited government.

[randymarsh]

It's almost like I put "in my opinion" in my post.

For the things you mention, the government does such a wonderful job on all those things.  Nobody ever eats salmonella-tainted meat, serrano peppers or peanut butter thanks to the government.  Nobody ever eats E. coli-tainted spinach thanks to the government.  Public schools all do a fabulous job of educating every student thanks to the government.

The thought of non-government air traffic controllers just blows my mind.  How could an air traffic controller even exist without the government?

You could allow for some laws regarding pollution or you could allow for private ownership of things like waterways.  Then the owner of the waterway would be able to say whether someone can dump waste into it or not.

Of course you would need a few (and I mean a few) people to collect whatever minimum taxes are required to operate the very limited government.

Why is there this impossible standard that government has to meet but no one else does? We shouldn't bother with food inspections and public schools because they don't work perfectly 100% of the time time?

I used to work at a clothing retailer. Loss obviously happens - people steal. This was so well known that we had a number (10 at our store) of items that were on average taken every single day. Stores in larger markets were closer to 50. The goal was to keep theft to this number or (hopefully) less. 

We didn't get rid of loss prevention. We didn't close the store. The company didn't stop selling clothes.

If I own land that happens to have a river running through it, should I be allowed to dump oil in it? After all, it's on my property so I own it. Never mind that it feeds into a reservoir people drink from. If they don't want to drink it, they can just buy water from Nestle.

[Daleth]

So who should pay? Society, right? We should socialize his poor choices and bad risk on to other individuals, right?

I'm a libertarian and to be clear, having no health insurance isn't a way of life for libertarians, just so you know. It's a personal choice - no matter what your political affiliation. Libertarians are pro-personal responsibility, free market and voluntary exchange.

I'm all for not being required to have health insurance, as long as you have a million bucks set aside in an account that cannot be used for anything but your family's healthcare costs.

If you don't have that money set aside, then you ARE mooching off everyone else--or that is, placing your family at high risk of mooching off everyone else--because if anyone in your family has a car accident, gets in a fight, gets cancer, goes into premature labor, etc., guess who pays the tab? If you had insurance, the hospital would be paid within 60 days or so. If you don't have insurance, but you step up responsibly and agree to pay the bill off over time, maybe the hospital is finally paid off five, ten or more years from now. Where do they pick up the slack in the meantime? That is, where do they get the money they need to operate NOW? From the rest of us who have insurance (or the rare few who have piles of money available to pay their bills off right then).

[Jamesqf]

That is damn right!!!!   We already pay for the uninsured.  Now, the care that they receive will cost less, as they will be going to a primary care physician and getting preventative care, not the emergency room. 

Sorry, but this is mostly wrong.  Preventative care is, in the main, not something you get from visiting a doctor.  It starts with exercise, healthy eating, and opting out of things like smoking and excessive drinking.  This need not cost much, if anything.  Indeed, things like not smoking can save a person quite a bit of money.  Even the preventative things which do cost money, like vaccinations, generally don't cost all that much.

But most people don't do this preventative care now: what magic do you think will make them start next year?

I'm all for not being required to have health insurance, as long as you have a million bucks set aside in an account that cannot be used for anything but your family's healthcare costs.

Can't quite follow the logic there.  By that standard, no one should be able to buy a house unless they have the money set aside to pay cash for it, no?  Indeed, they shouldn't be allowed to live in it unless they have the cash to buy a second one, in case something happens to the first.

[Daleth]

I'm all for not being required to have health insurance, as long as you have a million bucks set aside in an account that cannot be used for anything but your family's healthcare costs.

Can't quite follow the logic there.  By that standard, no one should be able to buy a house unless they have the money set aside to pay cash for it, no?  Indeed, they shouldn't be allowed to live in it unless they have the cash to buy a second one, in case something happens to the first.

You buying a house and getting a mortgage doesn't cost anyone else anything. But you having a health problem that you can't or don't pay for in full when care is provided DOES cost the rest of us money. The doctors and hospitals have to make up for that shortfall somewhere, and they make up for it by setting everyone's prices higher so that the uninsured people who don't pay upon being billed (or don't pay at all) won't burn too large a hole in the hospital's pocket.

If everyone is insured, the doctors and hospitals are always going to get paid, and quickly (maybe XYZ insurance company has a 60-day turnaround once they get the bill, but that's far better than waiting 6 years for Mr. Responsible Uninsured Person to finish paying off what he owes). An extremely upstanding and responsible (and very Mustachian) relative of mine took ten years to finish paying off his wife's medical bills after she died. Don't you think the doctors and hospitals would've preferred it, and we all (including my relatives) would've been better off, if she had simply been insured? And she would've been, under Obamacare, but back then there was no Obamacare, they were self employed, and she had diabetes (through no fault of her own) so they couldn't get insurance.

[rtrnow]

Sorry, but this is mostly wrong.  Preventative care is, in the main, not something you get from visiting a doctor.  It starts with exercise, healthy eating, and opting out of things like smoking and excessive drinking.  This need not cost much, if anything.  Indeed, things like not smoking can save a person quite a bit of money.  Even the preventative things which do cost money, like vaccinations, generally don't cost all that much.

I agree with what you say about preventative care starting with a healthful lifestyle, but it goes farther than that. I would still consider a type II diabetic (yes they probably have diabetes bc they were not leading a healthy life) to be getting preventative care by seeing a PC doc and taking insulin as opposed to going into a coma and spending a month in the ICU. To me it seems the first scenario will still ultimately save the whole system money, and just maybe that PC doc can help convince this person that a healthier lifestyle would benefit their disease even more. In general, ER/hospital services as the name implies deal with emergencies so no time is given to the type discussions mentioned above. I would hope a PC doc would take that kind of time.

To the libertarian arguments, if I missed it sorry but I still don't see a single post explaining how the cost of treating the uninsured who shows up to the ER is handled, other than letting them die which is just not going to happen nor should it in my mind.

[Rickk]

To the libertarian arguments, if I missed it sorry but I still don't see a single post explaining how the cost of treating the uninsured who shows up to the ER is handled, other than letting them die which is just not going to happen nor should it in my mind.

+1

[footenote]

To the libertarian arguments, if I missed it sorry but I still don't see a single post explaining how the cost of treating the uninsured who shows up to the ER is handled, other than letting them die which is just not going to happen nor should it in my mind.

+1

One libertarian (might have been in a different healthcare thread) did respond that he didn't care if uninsured people died. He compared worrying about that to "lifestyle inflation."

While (like rtrnow and Rickk), I disagree with that poster, at least he had the intellectual honesty to admit that this is where his libertarian line of thinking ends up. Our choices are:

1) Have enough people insured to spread the risk (and statistically "enough" doesn't have to be 100%, so conscientious objectors can pay a fine)
2) Don't push insurance, maintain the current law (everyone gets care regardless of whether they have insurance or not), and spread the cost of caring for the uninsured to the insured
3) Go full-on libertarian and release hospitals from the obligation to treat the uninsured

[Jamesqf]

To the libertarian arguments, if I missed it sorry but I still don't see a single post explaining how the cost of treating the uninsured who shows up to the ER is handled...

You missed mine (maybe in another thread) about the 2.9% tax on my income which is specifically for this purpose.

I also seem to have missed any posts which provide a good reason why I shoould be forced to work my butt off to provide for other people, not one of whom has ever shown the slightest consideration for my needs.

[Mr.Macinstache]

To the libertarian arguments, if I missed it sorry but I still don't see a single post explaining how the cost of treating the uninsured who shows up to the ER is handled, other than letting them die which is just not going to happen nor should it in my mind.

The cost is still put on them, if they cant pay it goes into collections and so on. Before the mandate that forced hospitals to treat the uninsured... there was no mass epidemic of people dying in the streets. As humans we do have compassion.. and we will take care of each other. We don't need threats of force to do that.

Here's a link:

http://taxfoundation.org/article/gasoline-taxes-and-tolls-pay-only-third-state-local-road-spending

" Nationwide in 2010, state and local governments raised $37 billion in motor fuel taxes and $12 billion in tolls and non-fuel taxes, but spent $155 billion on highways.[3] In other words, highway user taxes and fees made up just 32 percent of state and local expenses on roads. The rest was financed out of general revenues, including federal aid."

Thanks for the link. The key word there is spending. They are spending 2/3 more than they have resources for. So once again govts overspend on what they don't have. And of course there's no incentive to be frugal when you can just raise taxes, take it elsewhere or kick the can down the road. Many times the overspending is done just to keep the budgets inflated.

[footenote]

To the libertarian arguments, if I missed it sorry but I still don't see a single post explaining how the cost of treating the uninsured who shows up to the ER is handled, other than letting them die which is just not going to happen nor should it in my mind.

The cost is still put on them, if they cant pay it goes into collections and so on. Before the mandate that forced hospitals to treat the uninsured... there was no mass epidemic of people dying in the streets. As humans we do have compassion.. and we will take care of each other. We don't need threats of force to do that.

Here's a link:

http://taxfoundation.org/article/gasoline-taxes-and-tolls-pay-only-third-state-local-road-spending

" Nationwide in 2010, state and local governments raised $37 billion in motor fuel taxes and $12 billion in tolls and non-fuel taxes, but spent $155 billion on highways.[3] In other words, highway user taxes and fees made up just 32 percent of state and local expenses on roads. The rest was financed out of general revenues, including federal aid."

Thanks for the link. The key word there is spending. They are spending 2/3 more than they have resources for. So once again govts overspend on what they don't have. And of course there's no incentive to be frugal when you can just raise taxes, take it elsewhere or kick the can down the road. Many times the overspending is done just to keep the budgets inflated.

You are incorrect in your first assertion. I worked for a major hospital system and know for a fact that insured patients' bills are inflated to offset uninsured care that is never collected upon. (Yes, the hospital does try to collect. But the bad debt rate that is never paid is very high.)

[rtrnow]

The cost is still put on them, if they cant pay it goes into collections and so on. Before the mandate that forced hospitals to treat the uninsured... there was no mass epidemic of people dying in the streets. As humans we do have compassion.. and we will take care of each other. We don't need threats of force to do that.

So, why is trying to force those people to have insurance bad then? When collections fail, you and I pay for it anyway. It sounds like you are just agreeing with me. You're right, people are generally compassionate and will help others. Then those people will file bankruptcy and we will pay for their care through higher costs anyway.

[rtrnow]

I also seem to have missed any posts which provide a good reason why I shoould be forced to work my butt off to provide for other people, not one of whom has ever shown the slightest consideration for my needs.

Not generalizing at all there.

[Khan]

Here's a link:

http://taxfoundation.org/article/gasoline-taxes-and-tolls-pay-only-third-state-local-road-spending

" Nationwide in 2010, state and local governments raised $37 billion in motor fuel taxes and $12 billion in tolls and non-fuel taxes, but spent $155 billion on highways.[3] In other words, highway user taxes and fees made up just 32 percent of state and local expenses on roads. The rest was financed out of general revenues, including federal aid."

Thanks for the link. The key word there is spending. They are spending 2/3 more than they have resources for. So once again govts overspend on what they don't have. And of course there's no incentive to be frugal when you can just raise taxes, take it elsewhere or kick the can down the road. Many times the overspending is done just to keep the budgets inflated.

And your second assertion is wrong as well. They are not overspending by 2/3, they are controlling the negative externalities that would come with raising gas prices(decreased economic activity, transportation, etc.) and balancing that with the public good of providing good transportation routes, something which everyone(those not owning cars or using their cars less[as is oh so mustachian]) benefits from. Gas taxes aren't -meant- to pay 100% for the national highway system, and raising gas taxes too much would just offload that costs from one sector to another(railway + shipping, bicycle transportation, increased costs of economic goods as more people choose to stay out of the car, thus shifting the burden to freight services).

Look, my biggest problem with you is this: Dogmatic adherence to -ANY- principle is a path to failure as surely as anything else. Dogmatic libertarianism would most likely bring about a new sweatshop-walmart underclass. One in which due to the "freedoms" the ruling class is given, they are able to throw away workers broken by the system. If your ideology believes that they're there because of their "own damn fault for being lazy", and should "bootstrap themselves out of the gutter", I believe you have a hilariously misdrawn view of the world from your own little middle class bubble, so comfortably middle class that you can even contemplate not working in the future.

You know what's impacting my freedom? City regulations preventing me from firing my fire-arm within city limits, into the air in celebration. Noise ordinances and smog requirements requiring me to have mufflers and updated catalytic converters, which is costing me money. Speed regulations on a deserted road with nobody around but myself. Electronic waste disposal regulations forcing me to figure out where to get rid of old cell phones and other old electronic gear.

[lithy]

You will find that libertarian minded people don't care if restrictions are made at the local and state level.  Everything argued against in this thread so far has been at the federal level.

[hybrid]

You are incorrect in your first assertion. I worked for a major hospital system and know for a fact that insured patients' bills are inflated to offset uninsured care that is never collected upon. (Yes, the hospital does try to collect. But the bad debt rate that is never paid is very high.)

So you are saying that all too often hospitals can't get blood from a stone?  Go figure.....

[rocketman48097]

This article is nonsense.  My dad had prostate cancer, died from it and never had insurance yet still got expensive care.  Also, estate is not billed to the descendants.  Bills die with the dead unless there are assets to cover the bills left over.  If married, these are protected, there is no recourse.  Eventually he probably qualified for Medicaid I am sure but I do not believe those who don't pay premiums should get free coverage if they have assets. 

This is pre Obamacare back when premiums WERE affordable.  Now they are not with the new law.  Thank God I have employer coverage, though much pricier than it used to be prior to Obamacare mandates and taxes. 

[Jamesqf]

I also seem to have missed any posts which provide a good reason why I shoould be forced to work my butt off to provide for other people, not one of whom has ever shown the slightest consideration for my needs.

Not generalizing at all there.

No more than the people holding opposing views have been generalizing about me :-)

[randymarsh]

This article is nonsense.  My dad had prostate cancer, died from it and never had insurance yet still got expensive care.  Also, estate is not billed to the descendants.  Bills die with the dead unless there are assets to cover the bills left over.  If married, these are protected, there is no recourse.  Eventually he probably qualified for Medicaid I am sure but I do not believe those who don't pay premiums should get free coverage if they have assets. 

This is pre Obamacare back when premiums WERE affordable.  Now they are not with the new law.  Thank God I have employer coverage, though much pricier than it used to be prior to Obamacare mandates and taxes.

Your first paragraph isn't exactly a ringing endorsement for our healthcare system.

Regarding your second, I didn't realize that insurance premium increases had been flat until Obamacare. I was under the impression that costs have been rising faster than inflation for decades.

[Jamesqf]

Regarding your second, I didn't realize that insurance premium increases had been flat until Obamacare. I was under the impression that costs have been rising faster than inflation for decades.

Rising, perhaps.  Having your (perfectly satisfactory to you) old plan canceled, and replaced with an Obamacare-compliant plan that costs 10 times as much, though?

Weren't its supporters claiming that it would actually reduce insurance premiums, and that people with insurance they liked would be able to keep their existing plans?

[randymarsh]

Your plan rose by 10X? I found a high deductible plan ehealthinsurance.com a few months ago for about $80. Healthcare.gov gave me a catastrophic plan for ~$150 with $0 subsidy. That's a 1.8X increase, not 10, and it's not even apples to apples because the new plan covers more, no lifetime cap, and I'm eligible even I have a pre-existing condition.

[Jamesqf]

Your plan rose by 10X?

Not mine, but per various news reports some have risen that much, and more.  E.g. http://www.weeklystandard.com/blogs/florida-womans-insurance-rate-increases-10x-under-obamacare_764837.html http://www.latimes.com/business/la-fi-health-sticker-shock-20131027,0,2756077.story#axzz2j2jMiyve
http://hotair.com/archives/2013/10/28/cbs-millions-of-cancellations-and-skyrocketing-costs-the-big-problem-of-obamacare/

(Note that I don't guarantee these are 100% accurate: they're news reports found in a quick search.)

I found a high deductible plan ehealthinsurance.com a few months ago for about $80. Healthcare.gov gave me a catastrophic plan for ~$150 with $0 subsidy. That's a 1.8X increase, not 10...

But it IS a significant price increase, is it not?

...and it's not even apples to apples because the new plan covers more, no lifetime cap, and I'm eligible even I have a pre-existing condition.

Sure, but supposing you WANT apples, but they're forcing you to take mangos instead, which you hate?  As for instance, I don't have a pre-existing condition, so why should I want to pay for an insurance plan priced on the likelihood that I do?

[CDP45]

Why is health insurance much different from auto insurance? Please don't equivocate health care with health insurance, which is a means to finance unforeseen events. This is nothing more than a power grab for the federal government to waste more money. Obamacare will raise the cost of healthcare so more and more people will be dependent on the government to pay for it. 

"Four sources deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a “cancellation” letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience “sticker shock.”

Khan jar, regarding you're baseless attacks against people who want to live with less theft, graft, and violence, your comments are easily debunked as the acts are violations of property rights and the basic golden rule. No man is an island and if you're being an asshole good luck gaining cooperation to survive. The greatest growth economically has been on areas with little government theft and strong protection for property rights, that's the truth and the more we diverge from that the less prosperity and more poverty we will suffer.

[CDP45]

I found a high deductible plan ehealthinsurance.com a few months ago for about $80. Healthcare.gov gave me a catastrophic plan for ~$150 with $0 subsidy. That's a 1.8X increase, not 10...

But it IS a significant price increase, is it not?

oh please, it's only an 80% increase! This year...

I can only laugh at those who carry water for this travesty, your man signed a massive protection/oligopolistic for Heath insurers that lets them cancel policies and raise the price like crazy! They don't need to compete anymore because everyone offers the same product.

[mod edit: removed derogatory name]

[Khan]

I found a high deductible plan ehealthinsurance.com a few months ago for about $80. Healthcare.gov gave me a catastrophic plan for ~$150 with $0 subsidy. That's a 1.8X increase, not 10...

But it IS a significant price increase, is it not?

oh please, it's only an 80% increase! This year...

I can only laugh at those who carry water for this travesty, your man obongo signed a massive protection/oligopolistic for Heath insurers that lets them cancel policies and raise the price like crazy! They don't need to compete anymore because everyone offers the same product.

Obongo... yup, you lost me there. As for the health insurance, might I remind you that A: The individual mandate is a Republican idea, liberals would prefer single payer and B: 80% of insurance premiums have to be spent on care, I'm looking forward to seeing what the actual effect of that is at the end of the year.

But I can see that I probably have little interest in carrying on any conversation on this subject with you. Good day good sir.