"But I don't need health insurance"

[Khan]

Just thought I'd give an update to the libertarians/non insurance types that think that the individual mandate is evil. I have no idea how this guy's family "owes" anything for a dead man, but this is the cost of believing you can pay for your healthcare without insurance.
http://schealthcarevoices.org/2011/09/14/the-rest-of-the-story-ron-pauls-campaign-manager-died-of-pneumonia-uninsured-unable-to-pay-medical-expenses/
http://blog.chron.com/txpotomac/2008/07/ron-paul-adviser-dies-with-400k-in-unpaid-medical-bills/
http://kentsnyder.blogspot.com/

Edit: I didn't notice the dates on this, it was posted to another forum I frequent and I thought it was worth posting here, sorry to anyone that thinks that just because this is old it's irrelevant.

[Gin]

I wonder if they meant the medical bill went to his mother because his estate went to her.  I believe once you die your estate has to pay your debts then what is left over goes to your whoever you left everything to.

[TygerTung]

This medical insurance must be a huge headache if you live in the US. Here in New Zealand, we are fortunante enough to have public health, and I can rest easy knowing that if I have any medical problems, that it will be taken care of by the government. Dental isn't covered if over 18, unless the damage was caused by an accident. Dental is cheap enough though so it wouldn't be worth having insurance anyway, seeing as it can only cost a few thousand at the most really.

[Mr.Macinstache]

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. Everything the current health insurance industry is not.

When you force an individual to buy a product or pay a fine, that is force and extortion - not a hallmark of a free society. Health care is not a right, no more than food, housing and a job.

It's a shame what happened to Kent. He should have carried some sort of policy. That was his choice and his estate paid for it. At least his bills were NOT socialized onto society for his poor choice, because that's what the ACA is forcing insurance companies to do. And they are all too happy to abide as it's a windfall for them.

[ncornilsen]

In the US, the health care situation isn't Ideal. (and ideal is not, in my mind, single payer, for the record) but it isn't as bad as the media would have you believe.

And, going bare with regards to healthcare is a gamble. One that -most- people would win. The downsides are far to big for me to handle, so I insure.

[Exflyboy]

I'm an expat Brit to the US.. In the UK we have "socialised" medicine.

Simple fact.. in the USA we spend 17% or GDP on HC.. In the UK,Taiwa, Germany and Japan.. they pay between 6 and 9%.

And before you right wingers go off he deep end I can TELL you from personal EXPERIENCE (I have aging Parents too) the UK HC system is not bad at all.. Its not the absolute best for sure, but its good enough and no one goes bankrupt due to HC costs.

Frank

[willn]

If the decedents estate had assets, they won't go to the heirs, but the heirs won't be responsible for the debts of the deceased unless they gauranteed the debt by cosigning.

That doesn't stop predatory creditors from asking/scaring/intimidating the heirs, but they need to just say "tough luck".

So, the problem is that the bills get socialized anyway--the costs of the medical care gets passed on to everyone else who can pay.

It's not a question of if costs are going to be transferred, its a question of how?  Do we do it in an orderly, fair way?

See, the problem with the pure libertarian view is that no one (and by no one I mean so few people that it is functionally no one) is willing to let the sick and injured simply die due to the fact they don't have insurance. As a compassionate and evolved society we just give them the care and spread the costs around to the solvent insured.

ACA is almost certainly a badly implemented and over reaching law, but its probably going to be better than any alternative we've had thus far.  Criticizing it as a breech of freedom fails to recognize that freedom in this realm, didn't exist anyway--functionally you are already forced to get insurance, and pay for those who can't with your "choice" to do so.

[tooqk4u22]

Simple fact.. in the USA we spend 17% or GDP on HC.. In the UK,Taiwa, Germany and Japan.. they pay between 6 and 9%.

While this is a true statement, it doesn't do much good as in some regard it compares apples and oranges as there are a number of reasons why US healthcare spending is so high - many of which are negative and many of which are not solved by obamacare and the reality is that obamacare is continuation of the problem (read: not the problem).  What are some of the differences:

- we are fat, lazy and generally less healthy than these other nations.
- we rely on specialists whereas other countries rely on primary care generalists.
- we have far more violent crime - specifically guns.
- we are extremely litigious, whereas malpractice is virtually non-existent or not permitted in other countries.
- we have private and public systems (even before obamacare with medicare/medicaid) both of which are inefficient and have high administrative costs and given lack of open markets across state lines costs to patient are completely unknown and in many instances pulled out of thin air - which is why if you simply ask for a large discount to the bill (if you pay out of pocket) it is almost always given.

Focusing on preventive health and primary care where doctors are incentivised to spend sufficient time to complete a thourough exam and get a full understanding of the patients current,historical, and ongoing health. Likewise patients should be penalized for not following through with preventive/primary care initiatives.

And if there is a public component it needs to be via localized clinics and outpatient facilities and not large hospitals or scattered physicians - over and above this should be covered out of pocket or with private insurance.

To sum it up our system is fucked up because we fucked it up, unless the underlying issues are fixed then no public or private option will reduce costs as a % of GDP.

[footenote]

So, the problem is that the bills get socialized anyway--the costs of the medical care gets passed on to everyone else who can pay. ...

See, the problem with the pure libertarian view is that no one (and by no one I mean so few people that it is functionally no one) is willing to let the sick and injured simply die due to the fact they don't have insurance. As a compassionate and evolved society we just give them the care and spread the costs around to the solvent insured.

In a different thread, I recently asked a libertarian-arguing poster whether he was comfortable with letting hospitals off the hook for providing care for the uninsured. (He never answered.) That's the root of the challenge - unless people are compelled to take health insurance, the costs of care for the uninsured de factor become the shared burden of the insured.

[prof61820]

there are a number of reasons why US healthcare spending is so high

You forgot to mention the most obvious reason healthcare spending in the United States is so high: WE DON'T HAVE A UNIVERSAL/SINGLE PAYER HEALTHCARE SYSTEM.

If we did, our doctors could focus "on preventive health and primary care where doctors are incentivised to spend sufficient time to complete a thourough exam and get a full understanding of the patients current,historical, and ongoing health."

[randymarsh]

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. Everything the current health insurance industry is not.

When you force an individual to buy a product or pay a fine, that is force and extortion - not a hallmark of a free society. Health care is not a right, no more than food, housing and a job.

It's a shame what happened to Kent. He should have carried some sort of policy. That was his choice and his estate paid for it. At least his bills were NOT socialized onto society for his poor choice, because that's what the ACA is forcing insurance companies to do. And they are all too happy to abide as it's a windfall for them.

If we want to go the libertarian route, then we need to end the mandate that hospitals provide emergency care without checking insurance and assets first. No more pushing their losses onto the insured and public at large.

[tooqk4u22]

there are a number of reasons why US healthcare spending is so high

You forgot to mention the most obvious reason healthcare spending in the United States is so high: WE DON'T HAVE A UNIVERSAL/SINGLE PAYER HEALTHCARE SYSTEM.

If we did, our doctors could focus "on preventive health and primary care where doctors are incentivised to spend sufficient time to complete a thourough exam and get a full understanding of the patients current,historical, and ongoing health."

That is absolutely not A reason, let alone the most obvious one.  The government being responsible will not control costs anymore than it has - see medicare. 

Clearly you have your opinion - that is what I love about people who tow political lines - they always believe that their opinion is the the right one and the only one that matters - right there is the most obvious problem with healthcare costs.  There is an absolute reluctance to identidy the core problems and reasonably/thoughtfully/prudently identify solutions. As indicated in my last post, I presented some of the problems (system/socio/etc) and also feel that there should be a public component - but that it should be minimum.

I have always felt that if a public compenent, such as obamacare, were to be introduced then medicare should be dismantled - it makes no sense to have multiple government insurance programs. But with the boomers being the largest and most likely to vote no way that was an option. 


 

[Mr.Macinstache]

So, the problem is that the bills get socialized anyway--the costs of the medical care gets passed on to everyone else who can pay. ...

See, the problem with the pure libertarian view is that no one (and by no one I mean so few people that it is functionally no one) is willing to let the sick and injured simply die due to the fact they don't have insurance. As a compassionate and evolved society we just give them the care and spread the costs around to the solvent insured.

In a different thread, I recently asked a libertarian-arguing poster whether he was comfortable with letting hospitals off the hook for providing care for the uninsured. (He never answered.) That's the root of the challenge - unless people are compelled to take health insurance, the costs of care for the uninsured de factor become the shared burden of the insured.

Force is not the answer. Creating a law does not always change peoples behavior, especially when you try to force them to change. If you are uninsured, and a hospital treats you, they take on the risk. If you don't pay, they can and do file collections. Most people voluntarily have an insurance plan and do pay their bills.

Hospitals should be able to do what they like, charge what they like too. And your ins company should negotiate on your behalf to keep your business and to keep their costs down.

In my town there was a patient care center that was killing the local hospital...good competition was going on until the hospital bought them out. Ideally govt is put in place to protect consumers, not industry, so maybe this merger should have been allowed to be voted down by our county residents?

[footenote]

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. 

[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.

A true socialized system can easily overwhelm care supply, thus allowing people to wait for procedures causing illness and death, that does happen too.

[DoubleDown]

there are a number of reasons why US healthcare spending is so high

I think the list should include:

- Poorly managed care overall for the very chronically ill, uninsured

- The general unconstrained profiteering that can happen in a purely profit-driven approach to health care

A minority of patients end up constituting a very large portion of the overall costs in the U.S., through their own poorly managed treatment (often because they don't have insurance).  I forget the exact figures published a few weeks ago, but it's something like 1 - 5% of the population eats up 20% of the costs. Think of a person with a chronic condition that, instead of managing it as best as possible for a few hundred dollars a month, instead shows up in the emergency room every few days for treatment at a cost of thousands of dollars per month (not a cost to them, but to the rest of society to pick up the tab). An example would be a diabetic who does not monitor their blood sugar and keep it under control with regular insulin, but instead shows up at an emergency room every few days in a dire condition with much more expensive treatments needed to stabilize them.

As for profiteering, it's a little bit like if I owned the only water supply in an old west town. It's not like people in the town could choose to go without water, and short of public regulation, I'd have a free hand to charge whatever I can get out of the townspeople. Health care is largely the same -- left unconstrained, pharmaceutical companies, insurance companies, and providers are going to charge whatever they can squeeze out of the populace, and the populace doesn't have a choice to "opt out" of treatment in many cases. If I have a life-saving cancer drug, what's going to stop me from charging $10,000/month, or $20,000/month? And if you can't afford it, well, what WILL you pay? I'll likely maintain a somewhat arbitrary, opaque fee structure, and charge you whatever I can negotiate with you (this should sound familiar).

There's a reason that pharmaceutical companies, insurance companies, and health care providers in the U.S. maintain some of the largest profit margins in all of U.S. industry, usually rivaled only by oil companies as of late due to high oil prices and lots of demand/consumption.

[tooqk4u22]

DD - I feel that some of my points included your points, or at least the idea of your points and in a less detailed way.  Again I think the solution is basic level of nationalized healthcare with an emphasis on preventitive and primary care.

However, I don't fully agree with your profiteering argument. 

- Pharma Companies:
they make a lot of money because they invest a lot of money in R&D - it takes years and a ton of cash to create a drug, test it, get it approved and ultimately bring it to market.  I would argue that they could spend less on sales and marketing and maybe that could be addressed by capping how much of that is tax deductible for them.  But there is competition and they have to contend with patent expirations. Regarding the cancer example - is it better to be able to pay $10-20k for treatment or not to have an option at all because it development of the potential drug was not economically viable - there are instances where government work and funding helps with this, the problem here is that the government gives the money or resources and then the university/pharma company gets to reap the profits.  Government should be smarter and provide these resourves in a manner similar to private equity so they get to share in some of the upside or be able to implement some price restrictions. 

- Insurance Companies (specifically health)
Primary issue here is that competition is constrained as they can't go national and restricted to operating within a state. Open the borders and greater competition and diversity of insurable pools result more options, constrained/reduced prices.

-Healthcare providers
Not sure about this one, while some doctors make a lot of money there are a lot that don't.  Likewise there are hospitals that lose and those that win, much of which is influenced by their patient base (i.e. hospitals in areas with lower rates of insured people or higher rates of illegal immigrants struggle more).  On the other hand some of these hospitals have become taj-mahals and have highly paid administrations that really don't add much real value to healthcare quality.

[Jamesqf]

Seems like the unanswered - and indeed, unasked - question here should be why on earth it cost $400K to treat a case of pneumonia.  Or perhaps, why & how the hospital & other providers managed to bill that amount.   Could it possibly be that they saw an opportunity to make a lot of money off someone with (apparently) assets but no insurance, and that the cost of reasonable care would have been a small fraction of that amount?

That is really one of the major drivers of escalating health care costs, and one that Obamacare will only make worse.  The medical community doesn't look at cost-effectiveness of treatment, and so prescribes outrageously expensive treatments that are little if any better than less-expensive alternatives.  (And that's best case: the less-honest ones prescribe expensive treatments because they get a cut.)  See e.g. http://nymag.com/news/features/cancer-drugs-2013-10/#print

You're also still up against the numbers: by the government's own account, 5% of the population accounts for nearly half the money spent on medical care: http://www.ahrq.gov/research/findings/factsheets/costs/expriach/index.html#MostExpensive  Moreover, many of the most expensive to treat are the ones which can be largely avoided by lifestyle changes.

[zhelud]

Seems like the unanswered - and indeed, unasked - question here should be why on earth it cost $400K to treat a case of pneumonia.  Or perhaps, why & how the hospital & other providers managed to bill that amount.   Could it possibly be that they saw an opportunity to make a lot of money off someone with (apparently) assets but no insurance, and that the cost of reasonable care would have been a small fraction of that amount?

That is really one of the major drivers of escalating health care costs, and one that Obamacare will only make worse.  The medical community doesn't look at cost-effectiveness of treatment, and so prescribes outrageously expensive treatments that are little if any better than less-expensive alternatives.  (And that's best case: the less-honest ones prescribe expensive treatments because they get a cut.)  See e.g. http://nymag.com/news/features/cancer-drugs-2013-10/#print

You're also still up against the numbers: by the government's own account, 5% of the population accounts for nearly half the money spent on medical care: http://www.ahrq.gov/research/findings/factsheets/costs/expriach/index.html#MostExpensive  Moreover, many of the most expensive to treat are the ones which can be largely avoided by lifestyle changes.

My friend's mom died a few years ago from pneumonia. She spent more than 2 months in intensive care, as they tried to cure her. I guess pneumonia can take its time to kill you. I'm sure her care cost at least $400 k if not more.
She wasn't a hopeless case- she was fairly young and no one had any idea that she ultimately wasn't going to make it.

[Khan]

Mr Macinstache/others, I agree with several parts of the libertarian movement, pretty much anything to do with the scope of the government(end drug war/legalize them all and provide treatment, not criminalization, reduce military, reduce/eliminate domestic spying, dismantle the TSA and DEA), etc, so don't think of me as entirely opposed to the movement.

That said, the Free Market worship is something I do not agree with(Sorry, I like the FDA, the EPA, OSHA, etc.). I find it absolutely ridiculous, doubly so in an arena such as healthcare, where there is no freedom of choice. If I break my leg, there is no longer any freedom of choice, I'm going to the closest point to attempt to fix it. Now, if you are imagining a US where people are turned away at the door because "personal responsibility", you're welcome to that. I imagine such a country as more of a dystopia myself. I think America is best when each of us has a fair shot at a decent life, it's fine to me that people have more then me. Some of them came about it unethically, some worked harder, some were gifted it by circumstances, whatever, but the America I want to live in is one in which each of us has a fair shot at a good life.

Being worried that Wal-Mart is your only employer, that the minimum wage they pay you can't provide enough for you to live on, that if you injured they'd drop you in a second, that they'll reduce your hours or do anything else to attempt to wring every penny from their position, and then ask for tax breaks/benefit cuts whilst paying the investor class and executive class every penny from that endeavor is not the America I want to live in, and that to me is the cost of the "free" market. A return to the robber-barons of old(Hey, wassup Koch brothers?).

Is the ACA the best option? No. Can it be made better? Absolutely. But is it wrong to require every adult person to get health insurance(all the young invincible types like myself[also an originally Republican idea, I'd rather take single payer thank you very much]) in return for having accessible treatment options for everyone? No, I don't think that's wrong at all. Taxes(and in this case, insurance) is the price I happily pay for civilization.

Healthcare is not a free market:
http://www.policymic.com/debates/6445/the-fallacy-of-free-market-healthcare
http://dailyreckoning.com/debunking-the-myth-of-free-market-american-health-care/

[hybrid]

And since we know that won't happen....

I sympathize with much Libertarians point out that is not working well (and occasionally vote with them), the issue I have is too often the Libertarian solution is often unworkable, utopian fantasy, or nonexistent.  People are not going to be turned away at hospitals, we do live in a society that values healthy life, and those costs will be spread about one way or the other.  It's an unavoidable cost of living in our society so we may as well do the responsible thing and mandate insurance since we won't adopt single payer and people will seek and get health care anyway.  It's the least worst solution. 

Libertarians aren't being forced at gunpoint to do things they don't want as they often claim, they are playing by the same rules all of us do to live in the US.  I think they overplay their hands about the supposed tyranny they live under.  They are always free to emigrate to some Libertarian utopia (which does not exist, of course).  Emigration sound far fetched?  No more far fetched than many Libertarian solutions I read.   

[Khan]

  They are always free to emigrate to some Libertarian utopia (which does not exist, of course). 

There's always somalia ;)
No government regulations/interference in the free market there ;)
http://www.youtube.com/watch?v=7QDv4sYwjO0

[randymarsh]

People are not going to be turned away at hospitals, we do live in a society that values healthy life, and those costs will be spread about one way or the other.

I hate that I've become this cynical, but I believe there's a sizable portion of people who would in fact have no problem with turning people away from the ER if they didn't have any money.

The rhetoric that's come out during the healthcare "debate" over the past few years has shown that some people really do believe everyone should be on their own.

[Loud Noises]

At 28, fit and healthy, I only have a desire to carry a cheap catastrophic plan, one that will mitigate risks outside my control.  But now that plan will cost a lot more.  I am no longer naturally rewarded for taking care of myself and leading a healthy lifestyle.  This system does not distinguish enough between the folks that make good healthy choices and those that don't.  Some dumbass becoming obese and developing any number of related health problems is really a product of his own bad decisions.  It's simple cause and effect, they don't deserve my "help," other than some health advice to realize that they have chosen to do that to themselves.  I wouldn't feel so strongly about this if there weren't tens of millions of people doing exactly that.

[Mr.Macinstache]

I just want to know, who's going to pay for the disease caused by my obesity, years of eating junk food, smoking, drinking and outright neglect of my body. Who here is going to pay for that? Well everyone but me should of course!

At 28, fit and healthy, I only have a desire to carry a cheap catastrophic plan, one that will mitigate risks outside my control.  But now that plan will cost a lot more.  I am no longer naturally rewarded for taking care of myself and leading a healthy lifestyle.  This system does not distinguish enough between the folks that make good healthy choices and those that don't.  Some dumbass becoming obese and developing any number of related health problems is really a product of his own bad decisions.  It's simple cause and effect, they don't deserve my "help," other than some health advice to realize that they have chosen to do that to themselves.  I wouldn't feel so strongly about this if there weren't tens of millions of people doing exactly that.

Yep.

We can use fallacies to attack libertarianism all day, but what some of the bleeding heart progressives are proposing is: for everyone to pay for someone else's bad choices, corporations monopolizing the market, profiting off of that model and government protecting them, while taxing me if I want to "opt" out. So slowly but surely the people who backed this ACA are souring to it once they figure out they're the one paying for this "free" healthcare.

Talk about a living in a some kind of progressive utopia, a government mandated, corporatism healthcare system ain't it.

[Jamesqf]

There's always somalia ;)
No government regulations/interference in the free market there ;)

Completely wrong.  There are dozens, perhaps hundreds, of very repressive de facto governments in operation there.

[footenote]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

[Jamesqf]

At 28, fit and healthy, I only have a desire to carry a cheap catastrophic plan, one that will mitigate risks outside my control.  But now that plan will cost a lot more.  I am no longer naturally rewarded for taking care of myself and leading a healthy lifestyle.

Yes.  Just look at the economics of the original example.  Say there is a 1 in 100,000 chance that in any given year you will be stricken with some condition that will require $400K in medical care.  What would be a reasonable cost for insurance against that?  A bit over $4/year, no?

Now of course the actual math is going to be rather more complicated, since there are a range of possible costs, but catastrophic medical insurance that would cover anything over what I could reasonably pay out of pocket (or take out a loan/make payments on) shouldn't really cost all that much, expecially for someone like me who doesn't smoke or drink to excess, stays in good physical condition, etc.  I might not object nearly as much if asked to pay for such a plan.  The problem is that I'm not being asked to pay based on my own actuarial needs, but to cover all the costs incurred by everyone else.

And then we've still got the other basic problem of why it costs $400K to treat a case of pneumonia.  Surely it should be obvious that if the cost was $40K, or even $200K, we'd all be far better off.  But far from addressing costs, insurance gives the health care industry every incentive to keep driving them higher.

[Mr.Macinstache]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

It's still a valid point, parents not taking care of their kids, or the elderly who might have neglected themselves all their lives start to suffer the consequences. Age is irrelevant, you're still socializing the burden of other peoples responsibility, no matter how one tries to emotionally frame the argument.

By the way, there can be a public system, and if it's so great, many will be part of it. But it's not, so they make it mandatory. What's wrong with letting people opt out without punishing them?

[tooqk4u22]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

I don't view it as "you don't want to contribut for the to care for the very young and old" (such a liberal pull on the heartstrings statement BTW), I view it as I don't want to contribute for those who failed to plan and insure themselves properly prior to having children and for those that failed to plan and prepare themselves properly prior to getting old (BTW not hardest thing to plan for as it is such a long way off from birth, or working age for that matter)

[willn]

And then we've still got the other basic problem of why it costs $400K to treat a case of pneumonia.  Surely it should be obvious that if the cost was $40K, or even $200K, we'd all be far better off.  But far from addressing costs, insurance gives the health care industry every incentive to keep driving them higher.

By the way, pneumonia has a range of very dangerous complications, including septicemia, meningitis, and other infections that can cause organ failures.

And its more complicated than your statement suggests, insurance doesn't necessarily drive up costs per se, it is just another market force that may increase demand, which can drive up price, other things being equal the market could then  increase supply which drives cost down. Many costs may disappear or drop because of insurance leading to increased incidence early stage care for things like diabetes and high blood pressure, where better early stage care prevents high cost complications down the road.

No offense intended but lets keep in mind how complex health care is.  Many, many factors contribute to the costs of supply and the amount of demand.  I'm reminded of the Onion article:  Man Who Understands 8% Of Obamacare Vigorously Defends It From Man Who Understands 5%

http://www.theonion.com/articles/man-who-understands-8-of-obamacare-vigorously-defe,34022/

[footenote]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

I don't view it as "you don't want to contribut for the to care for the very young and old" (such a liberal pull on the heartstrings statement BTW), I view it as I don't want to contribute for those who failed to plan and insure themselves properly prior to having children and for those that failed to plan and prepare themselves properly prior to getting old (BTW not hardest thing to plan for as it is such a long way off from birth, or working age for that matter)

I actually didn't mean it to be a heartstring-tugger, just factual, btw. Under pre-ACA insurance rules, one could plan quite well and easily be stuck with preemie bills that would bankrupt your family. Plus the child could be uninsurable-for-life with pre-existing conditions. So your planning argument doesn't hold water there.

I think you have a more valid argument for old-age planning.

[GuitarStv]

At 28, fit and healthy, I only have a desire to carry a cheap catastrophic plan, one that will mitigate risks outside my control.  But now that plan will cost a lot more.  I am no longer naturally rewarded for taking care of myself and leading a healthy lifestyle.  This system does not distinguish enough between the folks that make good healthy choices and those that don't.  Some dumbass becoming obese and developing any number of related health problems is really a product of his own bad decisions.  It's simple cause and effect, they don't deserve my "help," other than some health advice to realize that they have chosen to do that to themselves.  I wouldn't feel so strongly about this if there weren't tens of millions of people doing exactly that.

Yep.

We can use fallacies to attack libertarianism all day, but what some of the bleeding heart progressives are proposing is: for everyone to pay for someone else's bad choices, corporations monopolizing the market, profiting off of that model and government protecting them, while taxing me if I want to "opt" out. So slowly but surely the people who backed this ACA are souring to it once they figure out they're the one paying for this "free" healthcare.

Talk about a living in a some kind of progressive utopia, a government mandated, corporatism healthcare system ain't it.

I haven't been robbed recently.  I'd like to opt out of police services.  Heck, I don't live in a high crime area.  Why should I pay for this?

I haven't had my house burn down recently.  I'd like to opt out of fire coverage.  Heck, I have a fire extinguisher.  Why should I pay for this?

I haven't had anyone make war on me recently.  I'd like to opt out of paying for the military.  Why should I pay for this?

I don't drive on all of the highways in my country.  Heck, I try to drive very little.  I'd like to opt out of paying for transportation infrastructure.  Why should I pay for this?


Look at these ridiculous, government mandated utopic entitlements!  I want to go somewhere that I can truly be free to do anything I want whenever I want with no rules and regulations, or burden to society.  A paradise like Somalia!  Why can't we become closer to the government free Libertarian ideal of Somalia?

[tooqk4u22]

The reality is that whether you are on the extreme left and believe in socialism and socialized healthcare or you are on the extreme right and therefore don't or anywhere inbetween......ACA sucks and is a disaster as it takes the worse possible attributes of government and private....not the best, which is why there are higher costs now that will only get higher.

Per my other posts if its to be done then lets do it right, but unfortunately political sides aren't capable of being rationale.

[hybrid]

At 28, fit and healthy, I only have a desire to carry a cheap catastrophic plan, one that will mitigate risks outside my control.  But now that plan will cost a lot more.  I am no longer naturally rewarded for taking care of myself and leading a healthy lifestyle.  This system does not distinguish enough between the folks that make good healthy choices and those that don't.  Some dumbass becoming obese and developing any number of related health problems is really a product of his own bad decisions.  It's simple cause and effect, they don't deserve my "help," other than some health advice to realize that they have chosen to do that to themselves.  I wouldn't feel so strongly about this if there weren't tens of millions of people doing exactly that.

You make good points, but here is how your health insurance will differ going forward.  One of these days you will be 58 with who knows what kind of medical conditions and what insurance provider is going to want to cover you then and at what cost?  The good risk you are now becomes increasingly worse with each and every year (just like with life insurance).  Whereas life insurance is a completely optional vehicle, health insurance by and large isn't.  Health care costs, by necessity, are spread amongst the whole populace so that the person with cancer isn't bankrupted, just like any other kind of insurance vehicle.  And what insurance company is going to want to insure our retired Grandma, and at what cost?  That's what Medicare is for, and we as a society pick up much of that tab for all of our Grandmas out there.

Yep, you will pay more now to insure the fat guy who could have kept himself in better shape (or the thin guy who got cancer).  Just like my car insurance premiums have been covering shitty drivers and good drivers whose car got caught in a flood (like Sandy) while I have been accident free for 18 straight years.  It sucks knowing some people could be doing more to keep themselves healthy (just like some people could drive a lot more carefully), but better to count your blessings than lose sleep over the things you cannot control.

One thing I would like to see going forward are discounts for people who keep themselves healthy like the poster.  People respond to incentives, Progressive has demonstrated that with the Snapshot monitoring device people have put in their cars to get better rates.  For most folks who have health insurance there just isn't that much positive financial incentive to stay healthier, like getting a small check back if you use Allstate and don't have an accident.
         

[randymarsh]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

Was about to mention this.

It's a lot of fun to complain about fat people who smoke 3 packs a day, but the data doesn't seem to support them being the main driver of costs. There's at least one study showing that smokers actually save money because they die so much sooner.

I don't know how many times this has to be said: We are already paying for people who make bad choices! We just do it in the most expensive and inefficient way possible.

[smalllife]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

Aside from being healthy and general preventative care, redefining how we as a culture view and approach death would be the most cost-effective way to battle health care costs.  We spend so much to extend life a few more, and in many cases painful, months instead of embracing death in old age or against  deadly cancers.  What is the cost of a human life?  Would you spend $300,000 for a possible extra two months, most spent in a hospital?   Why should that be "normal"?

[Mr.Macinstache]

At 28, fit and healthy, I only have a desire to carry a cheap catastrophic plan, one that will mitigate risks outside my control.  But now that plan will cost a lot more.  I am no longer naturally rewarded for taking care of myself and leading a healthy lifestyle.  This system does not distinguish enough between the folks that make good healthy choices and those that don't.  Some dumbass becoming obese and developing any number of related health problems is really a product of his own bad decisions.  It's simple cause and effect, they don't deserve my "help," other than some health advice to realize that they have chosen to do that to themselves.  I wouldn't feel so strongly about this if there weren't tens of millions of people doing exactly that.

Yep.

We can use fallacies to attack libertarianism all day, but what some of the bleeding heart progressives are proposing is: for everyone to pay for someone else's bad choices, corporations monopolizing the market, profiting off of that model and government protecting them, while taxing me if I want to "opt" out. So slowly but surely the people who backed this ACA are souring to it once they figure out they're the one paying for this "free" healthcare.

Talk about a living in a some kind of progressive utopia, a government mandated, corporatism healthcare system ain't it.

I haven't been robbed recently.  I'd like to opt out of police services.  Heck, I don't live in a high crime area.  Why should I pay for this?

I haven't had my house burn down recently.  I'd like to opt out of fire coverage.  Heck, I have a fire extinguisher.  Why should I pay for this?

I haven't had anyone make war on me recently.  I'd like to opt out of paying for the military.  Why should I pay for this?

I don't drive on all of the highways in my country.  Heck, I try to drive very little.  I'd like to opt out of paying for transportation infrastructure.  Why should I pay for this?


Look at these ridiculous, government mandated utopic entitlements!  I want to go somewhere that I can truly be free to do anything I want whenever I want with no rules and regulations, or burden to society.  A paradise like Somalia!  Why can't we become closer to the government free Libertarian ideal of Somalia?

As James already pointed out, Somalia has a government, but nice try. But, hey, look at the utopian paradise that is Detroit. Why can't our country have more welfare like Detroit, and gun bans like Chicago - we would all be safe, healthy and prosperous. Idea's so good, they're mandatory.

[Jamesqf]

I haven't been robbed recently.  I'd like to opt out of police services.  Heck, I don't live in a high crime area.  Why should I pay for this?

If you are robbed, the police will do pretty much nothing beyond telling you to file a report for your insurance company.  They're too busy running undercover drug busts, stings for underage drinking & tobacco sales, and the like.  Just as with Obamacare, if we could opt out of the 90% of police activity that is inimical to us, we'd be far better off.

I haven't had anyone make war on me recently.

Actually, you have.  If you choose not to pay attention to current events, that's your problem.

I don't drive on all of the highways in my country.  Heck, I try to drive very little.  I'd like to opt out of paying for transportation infrastructure.  Why should I pay for this?

Highways are mostly funded (and in a more perfect world, it'd be 100%) by gas taxes & other user fees.  If you don't drive very much, you aren't buying much gas, and so are effectively opting out.  Indeed, doesn't MMM make a point of doing this, by biking &c?

So why exactly is this ridiculous?  And why is it ridiculous for me to object to paying for medical care that I will never need?

Why can't we become closer to the government free Libertarian ideal of Somalia?

But again, Somalia is the exact opposite of government-free.  It has many governments (most of which are theocracies) ruling various parts of the country.  You have to remember that "Somalia", like most countries with straight-line borders, is an artificial construct imposed during the colonial era.  Why should we expect the people living there now to respect that alien construct?

[Khan]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

Aside from being healthy and general preventative care, redefining how we as a culture view and approach death would be the most cost-effective way to battle health care costs.  We spend so much to extend life a few more, and in many cases painful, months instead of embracing death in old age or against  deadly cancers.  What is the cost of a human life?  Would you spend $300,000 for a possible extra two months, most spent in a hospital?   Why should that be "normal"?

That is a problem regardless of government intervention. And its one that has been in the process of being fixed for a long time. The problem is our doctors haven't been trained in EOL and palliative care, and it's a hard fucking thing to have a conversation about. The good news is we -are- making strides in this area.

[smalllife]

The vast majority of healthcare spending in the U.S. occurs at the beginning of life (preemies) and at the end.

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

Aside from being healthy and general preventative care, redefining how we as a culture view and approach death would be the most cost-effective way to battle health care costs.  We spend so much to extend life a few more, and in many cases painful, months instead of embracing death in old age or against  deadly cancers.  What is the cost of a human life?  Would you spend $300,000 for a possible extra two months, most spent in a hospital?   Why should that be "normal"?

That is a problem regardless of government intervention. And its one that has been in the process of being fixed for a long time. The problem is our doctors haven't been trained in EOL and palliative care, and it's a hard fucking thing to have a conversation about. The good news is we -are- making strides in this area.

I agree that this is outside of government intervention, but I would counter that the topic is only hard to talk about because it has been ingrained upon us that death must be sad, bad, and taboo.  As I age I hope to make my own desires known and I have no qualms about discussing death, end of life plans, and drastic life saving measures - hopefully I can help move the change along.

[Jamesqf]

So based on the data, it is not a logically valid argument to say "I shouldn't have to pay for people who don't take care of themselves." Instead, you would need to argue that you don't want to contribute to care for the very young and old:

For most of my working life, I've paid a chunk of my income (2.9% currently, since I'm self-employed) precisely to fund the Medicare/Medicaid programs that are supposed to do just that.  (In fact, it's you early retirement types who'll avoid paying for that :-))

We could also look at the rationale of e.g. paying for fertility treatments that lead to higher rates of premature births (getting us going & coming, as it were), or expensively keeping people on life support against their expressed wishes.

[PurposelyVague]

I'm a Libertarian and one of the biggest issues that I have with Obamacare is not whether the government should be providing health care for everyone, because let's be clear, Obamacare doesn't really do that, but does the government have the right to require all citizens to buy health care? I don't think it does.
Obamacare opens up accessibility to everyone, but it puts the ownership on the individual to buy it and businesses who employ individuals to provide it to their employees. It doesn't actually provide healthcare for anyone. But it does mandate that everyone have it, via the form of a tax you incur if you don't. And the tax is less expensive than coverage.. so for those who already can't afford health care, guess which one they will pick.

[Lackland]

I'm a Libertarian and one of the biggest issues that I have with Obamacare is not whether the government should be providing health care for everyone, because let's be clear, Obamacare doesn't really do that, but does the government have the right to require all citizens to buy health care? I don't think it does.
Obamacare opens up accessibility to everyone, but it puts the ownership on the individual to buy it and businesses who employ individuals to provide it to their employees. It doesn't actually provide healthcare for anyone. But it does mandate that everyone have it, via the form of a tax you incur if you don't. And the tax is less expensive than coverage.. so for those who already can't afford health care, guess which one they will pick.

The Supreme Court says that the government does, indeed, have that right.

[PurposelyVague]

The Supreme Court says that the government does, indeed, have that right.

I get that, but they said only because the penalty is in the form of a tax; they said the government has the right to tax citizens. I still question the decision. At any rate, that aside, it still doesn't fix anything about health care here, other than removing pre-existing conditions.

[Jamesqf]

The Supreme Court says that the government does, indeed, have that right.

Yes, and for many years it said that slavery was legal, women were inferior, it was ok to ban alcoholic beverages, and so on.  The Supreme Court decides what is and is not legal: it's a happy accident when that coincides with what is right.

Another possible issue which I've just noticed in reading accounts of how the on-line health insurance exchanges are supposed to work (but don't).  From the descriptions, apparently you have to surrender pretty much every vestige of personal privacy in order to enroll.

[Lackland]

I get that, but they said only because the penalty is in the form of a tax; they said the government has the right to tax citizens. I still question the decision. At any rate, that aside, it still doesn't fix anything about health care here, other than removing pre-existing conditions.

Actually, we don't know if it will fix anything about health insurance prices or not. The entire thing is based on the idea that forcing healthy customers into the private insurance market will offset the costs of forcing insurance corporations to accept all customers, including those with costly preexisting conditions. This in turn is based on the idea, which I assumed many free-market types agreed with, that robust competition for customers by companies produces more product innovation and more efficient prices. Neverthless, many people seem to have already made up their minds based on ideology, without waiting to see the facts of what really happens. They are already telling themselves that Obamacare has failed utterly, even though it hasn't been fully implemented. What evidence do they have? A website that doesn't work? Saying that the failure of the national exchange website means the entire system has failed is like saying that a car will never work again because the battery is dead. At least wait until you fix the battery.

[Mr.Macinstache]

I get that, but they said only because the penalty is in the form of a tax; they said the government has the right to tax citizens. I still question the decision. At any rate, that aside, it still doesn't fix anything about health care here, other than removing pre-existing conditions.

Actually, we don't know if it will fix anything about health insurance prices or not. The entire thing is based on the idea that forcing healthy customers into the private insurance market will offset the costs of forcing insurance corporations to accept all customers, including those with costly preexisting conditions. This in turn is based on the idea, which I assumed many free-market types agreed with, that robust competition for customers by companies produces more product innovation and more efficient prices. Neverthless, many people seem to have already made up their minds based on ideology, without waiting to see the facts of what really happens. They are already telling themselves that Obamacare has failed utterly, even though it hasn't been fully implemented. What evidence do they have? A website that doesn't work? Saying that the failure of the national exchange website means the entire system has failed is like saying that a car will never work again because the battery is dead. At least wait until you fix the battery.

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.

[sassy1234]

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. 

Weather you like it or not, this is happening.  The majority of this country has voted so, that is how a democratic society works. 

Our healthcare system is broken.  At least someone is trying to fix it. 

[randymarsh]

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.