You Do Not Have Health Insurance

[flintlock]

Re: You Do Not Have Health Insurance

Make private insurance available only to those who care and take personal responsibility.

Sounds good in theory, hard to implement in real life. What constitutes "taking good care of yourself"? Who decides that? Will police monitor what you eat at home? I know skinny guys who eat horribly and smoke. Is that better than fat and eating your veggies? We need less complexity not more. Sure, tax the hell out of McDonalds. But what about the salad at Applebees chock full of high fat dressing?

I think Sunsky's problem getting health coverage may simply be that he is self-employed and not so young anymore. Insurance companies really would prefer not covering anyone over 40 for example. The odds we are going to need health care begin to skyrocket around that time. The large negotiated group policies accept the older folks in order to get the whole deal. They know they can pick and choose more easily with the self-employed. They will never come out and say its your age. They'll find something no matter how little to deny you coverage.

We applied a few years ago( self-employed also) with a new insurer. I already had coverage but was looking for a better deal. Their tactic was to continually ask for more information. This went on for over six months! They'd ask for records, my wife would dig it up, send it to them. Then they'd come back asking for more. After so long I told her to forget it, they obviously didn't want to cover us, but were probably required to go through the motions legally. I could understand if they said, " you had a bunion in 2002, we can't cover you". But they didn't . Just constant stalling. Hardly competition when you can't shop between insurers. They are all looking for Benjamin Button when you are that age.

[Zen$]

Re: You Do Not Have Health Insurance

All young people get old, and it's fair for us to pay something in our youth to get something when we're old.

If you're unlucky enough to be injured, get really sick, or have a very sick child your life is just ruined, tough luck for you. We need to admit there is an element of luck in one's health, and we'd like to insure against that.

That is not the system we have now with employer coverage--because you'll likely not be with the company until you get old. You overpay for the oldies when you are young and you have no guarantee you'll be getting coverage when you are old from the pool you are "vesting" in.

I paid into an employer based system for 6 years. I had a couple hundred dollars of claims; paid in about $16,000. Was young and healthy. They made out like bandits. Am I vested. NO! They doubled the rate for spousal coverage in 3 years and said that younger spouses could go on the open market. Indeed it was much less even considering the pre-tax benefits of the employeer coverage. So I left. I was happy to pay into a system so I could benefit later but they basically threw out young and healthy. On what planet that made sense--I dont know.

Element of luck: there is much but there is also a very large element of behavior and choice both in getting to need health care (smoking, drinking, etc) and in using it once you are sick or dying. Example: very early preme babies take a huge chunk of resources and then have serious problems for the rest of their lives--in the meantime fairly healthy kids got nothing and had problems because the net resources of the system had been spent. Many of these babies are preme due to behavior of mothers.

Huge sums are also spent to try to "save" people for another few months. Routinely more health care in the final months than they had been spent on individuals in their whole life previously. Yet how much does society have to pay to keep you going for the last few months. Palliative care sure but the endless BS "Hail Marys" that medicine presents is foolish for the system; but boy do the sick and dying merchants make out--pays for medical school. At a certain point where is the line drawn and who makes the decisions. Terry Schaivo is a great example of a huge waste of money. Instead the right wing celebrates the vegetative state. We simply will not be albe to afford this kind of crazy behavior. No one wants to talk about these issues--certainly no politician--but discussion is essential.

[labasta]

Re: You Do Not Have Health Insurance

Hi rjwjr. Thought I'd mention I'm a fellow traveler, with respect to much of your recent analysis posted on insurance costs and also aspects of the wealth distribution and the impact of global labor arbitrage (to use the fancy term). I see considerable tension between the ethical desire to provide medical care for individuals where the need for expensive treatment isn't a risk but rather a certainty, and the concept of "insurance" against a low-probability yet catastrophic event. I think a utilitarian argument can be made for public spending on health maintenance and preventive medicine at the young end of the population distribution, similar to productivity arguments that justify public schooling and other infrastructure; I think providing healthcare for retired individuals is more of an ethical issue. Likewise, with reference to your comments about labor and wages, I think there is tension between raw efficiency and social stability. Trade and immigration barriers, minimum wage laws, and the like will artificially raise the value of labor at the expense of reducing productivity and competetiveness. On the other extreme, free trade and a largely unregulated labor market will increase productivity and competetiveness, but most of those gains will go to the small strata of society who own the capital, and the disparity between labor and capital will threaten the stability of society. If you let labor costs equilibrate around the world -- both by open borders and free trade -- the net result is equilibration of living standards for labor. Equilibrium is much lower for American labor and slightly higher for the developing world. That may be the natural state to which things would trend, but from a purely self-interested American perspective, that's not something we should wish for. On the other hand, a heavily-regulated labor market (actively fighting equilibrium) is the European model, and that probably means higher unemployment and higher prices. One could argue that combining an unregulated labor market with highly progressive taxation and socialist policies of redistribution might both maximize total economic productivity, keep prices low, and stave off social unrest. However, I waffle a lot on this point, because the libertarian inside me hates redistribution with a passion. On the other hand, I hate being the first against the wall when the revolution comes, too. Is it better to artificially inflate the price of labor by erecting trade and immigration barriers, at the cost of higher unemployment and lower productivity, or is it better to run the economy at maximum efficiency, and redistribute by taxation to maintain social stability?

Good thought process, but is it either/or?

Why not mix it so we have a) low unemployment and b) high wages.
The two might not be mutually exclusive.

How could we do that? What about free trade (real free trade), but no immigration which isn't needed (like Australia maybe)? I believe we don't actually have free trade at the moment. It has been artificially skewered so that Asia manufactures. It's not just low wages (as in theory that shouldn't matter), but private debt creation in the West and artificial currency controls on both sides (world central banks and US empire dollar as the global currency) as obviously you can't sell when the buyer doesn't have anything to sell back to you. It's like a dam holding water back. It's not at all balanced.

That might be a start at least.


Actually, I'm not sure Europe has a high unemployment rate compared to the states. I'm going to use Germany as the example country in Europe as it is their economy which aparantly funds the EU.

Germany's is hovering around 8 to 9% at the moment, and that is including East Germany! and I've been told (but not certain) that they don't fudge the numbers as much as America or Britain. How does the US compare?

The prices of goods in Germany is dirt cheap as well compared to say Ireland or the UK. I don't know how it compares to the US but it is probably comparable.

Mind you, wages in some areas of German industry are extremely low.
Public transport drivers for example, also hospital doctors. Lots of them have emigrated to the NHS in Britain to get away from it. Also, I believe Germany never recovered from their 1994-ish recession which would have happened earlier if not for government money being pumped into East Germany in the early 90s. The computer boom masked it (as in the US), but East Germany has been a constant drag on Germany as a whole. The 2000s have been pretty shit for Germany too. Like the US, I also believe outsourcing (globalisation) put a great strain on Germany since the mid-90s. I heard VW nearly completely left Germany in the early 2000s except for State bribes.

When I lived there, after speaking to people, I got the impression that the German people were richest in the 70s, which isn't far removed from the US. It seems to have been a long drawn-out process on the trip down poverty lane with the first big wave breaking in 1994, then 2000 to now.

Maybe debt as money is the problem.... again. Oh the joy of banking.

[bcassill]

Re: You Do Not Have Health Insurance

"For all of these reasons, you can’t count on your health insurer being there when you need it. That’s not insurance; that’s employer-subsidized health care for the duration of your employment."
Every US citizen is free to secure health care on their own, directly with an insurance provider. Since they do not, the benefits of securing insurance through the employer must outweigh these negatives, thus this point is not truly an issue.


"Once you lose your employer-based coverage, for whatever reason, you’re in the individual market, where, you may be surprised to find, you have no right to affordable health insurance. An insurer can refuse to insure you or can charge you a premium you can’t afford because of your medical history. That’s the way a free market works: an insurer would be crazy to charge you less than the expected cost of your medical care (unless they can make it up on their healthy customers, which they can’t in the individual market)."
There are two sides to this point. Put another way, if you live a healthy life style, do not smoke, do not drink to excess, and do not engage in dangerous activities (skydiving for example), you can get much lower insurance rates in the individual market than if you had to subsidize your overweight, smoking, heavy drinking co-workers. "That's the way the free market works."


"The basic solution is very simple. In Paul Krugman’s words: “regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance.” I know that there are lots of details that consume people who know health care better than I do, and I know those details are important. But as an individual who is worried about his or her own health insurance (and that is the point of this post), that’s what you want. You want to know that if you lose your job, you won’t be shut out because you’re too sick,*** and you won’t be shut out because you’re too poor."
To a large extent this is simply another example of those of us that take personal responsibility for our lives (in this case our health) being forced to subsidize those that don't. As a result, our society gets progressively weaker and less capable and less motivated. Why "work" for anything, why take personal responsibility for your decisions when the Federal government is so quick to provide freebies, subsidies, and undeserved assistance.


"But we won’t get there as long as people remain convinced that health care reform is for poor people. It’s for everyone – everyone, that is, who isn’t independently wealthy or over the age of 65. Because all of us could lose our jobs. (Have I repeated that point enough?)"
The author repeated his point quite enough. In fact this whole article is a fear-based fluff piece. I hope those in charge of arguing for nationalized health care can do better than this feeble effort.

rjwjr,

I get your point. However, following your logic, we should abolish medicare as well as all other federal and state run health insurance programs including congress (which I wouldn't be sad to see go), the military, and employer sponsored health insurance programs. Basically, we would cut everyone loose and let the market determine the risk and the appropriate pricing at the individual level for private insurance or you can take the choice of being uninsured and take your chances. Joined the Army and got shot up in Iraq? Suffered massive internal and neurological trauma from a roadside IED? Decided not to get that privately based health insurance (because it's going to be mighty expensive going into a war zone)? Tough luck. You should have thought about that before joining up.

We either do this or we start making exceptions for folks. Who do we make exceptions for in providing reasonable health care to? The military? Policemen? Firefighters? The elderly on limited incomes? The problem is that someone else has to pay for this (like you and me), and you just lost your "free market" concept. You want to bring health care costs down? Get rid of the bloated health insurance companies that typically pocket around 30% of premiums after paying for their "management costs" and contract instead directly with your local doctors and hospitals. You don't need the government. Just cut out the middle man.

Oh, and for those in uniform. I recommend continuing to support their government sponsored health care. Just a thought.

[Ghent12]

Re: You Do Not Have Health Insurance

rjwjr,

I get your point. However, following your logic, we should abolish medicare as well as all other federal and state run health insurance programs including congress (which I wouldn't be sad to see go), the military, and employer sponsored health insurance programs. Basically, we would cut everyone loose and let the market determine the risk and the appropriate pricing at the individual level for private insurance or you can take the choice of being uninsured and take your chances. Joined the Army and got shot up in Iraq? Suffered massive internal and neurological trauma from a roadside IED? Decided not to get that privately based health insurance (because it's going to be mighty expensive going into a war zone)? Tough luck. You should have thought about that before joining up.

We either do this or we start making exceptions for folks. Who do we make exceptions for in providing reasonable health care to? The military? Policemen? Firefighters? The elderly on limited incomes? The problem is that someone else has to pay for this (like you and me), and you just lost your "free market" concept. You want to bring health care costs down? Get rid of the bloated health insurance companies that typically pocket around 30% of premiums after paying for their "management costs" and contract instead directly with your local doctors and hospitals. You don't need the government. Just cut out the middle man.

Oh, and for those in uniform. I recommend continuing to support their government sponsored health care. Just a thought.

It is a bit of a misnomer to include the military's health care as a "government-run health care system" because although it can fit under that description, it is more aptly described as a fully-integrated part of an overall package that military service entails.

You raise some questions on what is fundamentally justified as far as health care provision is concerned. You contrast merit (service members, police, civil servants, etc.) with need (low-income elderly, etc.). I think the merited one is far smaller in quantity than the needy, and that on principle, the merited group is much more justified in benefiting from tax dollar-subsidized health care. Of course, everyone "needs" health care to an extent.

I think the debate is largely superfluous. Nobody likes to focus on the narrow issue of cost, which is essentially the main problem with the American health care system. Any reform has to focus on cost--not on the symptoms, but on the cause of the cost.