Ray, I appreciate your post #376. I didn't mean to say that people should subsidize me if they don't want to. I think that they should want to--not my career, but my ability to remain alive if I suffer catastrophic illness--, which is something different; it's a moral opinion, not a political opinion.

Now, in fact, when I do get a full-time faculty position, it may be at a state school, in which case it will be partly (in my opinion too small a part) subsidized by government money, or it may be at a private school, in which case it won't be. Both exist. And if I don't get such a position (more and more likely, since the economic crisis is drying up university funding as fast as anything, and it isn't coming back any time soon), I'll most likely be able to somehow get into the position of earning a middle-class wage by some means or another; I don't pretend that I'm in as bad of a position as millions of others, and I'm not whining. I simply support a public option, because I know that it would be a great thing for a lot of people in positions similar to mine, who I number as my friends and colleagues. Of course, it would only be a great thing for us if it were sufficiently subsidized to be affordable to us, and I'm skeptical that it would be (and even more skeptical that it would be actually affordable to the working poor with families). If it was, I think that would be a good use of tax money--unlike the vast majority of uses of tax money. It would be a bad thing for people to be required to have health insurance if it cost them any kind of significant money--I would be against that. I'm against my university's current rule that undergraduates are required to have health insurance, because the plan they offer themselves costs $1,000 a year. That's a huge hardship for many students, and they should have a choice to forgo it.

I'll ask you the ridiculously simplistic question that I just asked a bunch of my new colleagues: what kind of music do you compose?

I'm against my university's current rule that undergraduates are required to have health insurance, because the plan they offer themselves costs $1,000 a year. That's a huge hardship for many students, and they should have a choice to forgo it.

Really? $1000/year is a great deal. Would you really not add $4000 to your debt to be covered? Anyway, the Univ knows it can't turn away students seeking healthcare, so the mandate makes sense.

Just out of curiousity, how much would an individual plan cost you? A few years ago I was able to get a GHI plan with pretty good coverage in NY for about $350 per month, and I was at least 10 years older than I'd guess you are. I thought that was reasonable, and NY is one of the higher cost states due to community rating and mandated coverages.

And much as I rag on Wal-Mart and CVS, I've got to give them credit for their part in helping to establish those walk-ins.
Hey - they make money. I'm seeing standalone places like that pop-up too.

And it's best not to underestimate how much the removal of the intimidation and procrastination factors may do in prompting people to seek help for a problem that they otherwise might have let grow out of control.
I agree - heck, when I was uninsured, I was one of those people*.

It would be a bad thing for people to be required to have health insurance if it cost them any kind of significant money--I would be against that. I'm against my university's current rule that undergraduates are required to have health insurance, because the plan they offer themselves costs $1,000 a year. That's a huge hardship for many students, and they should have a choice to forgo it.
You have to mandate it - otherwise it would be prohibitively expensive for those who need it badly enough such that they'd take it anyway. Honestly, a $1000 per year in addition to the other costs of schooling isn't that big of a deal (and I say that as someone who worked/paid his way through school) ... particularly in comparison with the $4000 per year it might cost if enough people opted out. Plus, if you don't mandate it, you can have cases like my brother-in-law, who incurred such high medical bills that he had to drop out years ago and has been working off the debt ever since.

* Er, and still am - but that's unrelated to what you're describing, I'm just lazy/a procrastinator.

Of course [people with pre-existing conditions should have to pay a higher-rate].

Do people honestly not understand the very nature of the concept of insurance?

If your car's brakes have failed while you're driving down I-95, should you be able to purchase auto insurance at the same rate as all the other drivers on the road? If your house is on fire, should you be able to purchase homeowners' insurance at the same rate as someone whose house isn't on fire?

Born on third base, and deserving of a triple. Born HIV-positive, and tough ####. And facing a moral question, come up with the most spectacular non sequitur you can imagine in order to avoid it---as if a birth condition is comparable to a burning house or a car with bad brakes. That's your "philosophy" in a nutshell.

So, the answer is no: you don't understand the nature of the concept of insurance. You could have just said that, and it would have saved you some typing and the rest of us some vapid moral preening.

The fact that you think those are "non-sequiturs" merely illustrates your complete ignorance of the topic of discussion. Those are not non-sequiturs; those are exactly identical analogies. Insurance is a service. Pricing of this service is not based on moral worth. It is based on actuarial risk. It doesn't matter whether one's higher risk is one's "fault" or not; the premium is not punishment for misbehavior. It is a way to pay for expected payouts. The expected (I mean in a statistical sense) payout is based on whether one is likely to put in a claim, not why. It's the same whether one keeps piles of newspapers near candles or whether one lives in a fire-prone area; whether one smokes or one has a genetic defect. (I mean, assuming the math for those particular situations works out that way for a particular individual.)

"If it is true, wouldn't you feel really bad jumping on her?"

No. If she genuinely did not want to talk about it, or was contrained from talking about it by a secret blood oath, then she shouldn't have brought it up. I'm fairly confident that no one would've made her sad by talking about John if she hadn't started waving his bloody shirt in the middle of the discussion.

I've had people swear me to secrecy about things before, and after I've finished swearing, I don't talk about them. Ever. With anyone. Because that's how it works. If you aren't prepared to keep the secret, you shouldn't make the promise.

But I'm just one of Bernal's dickheads. What do I know?

Lisa/John - Seriously, quit it. We cared about john. We care about Lisa. She regrets, I think, bringing it up. Let it go...

But here you have one of the more interesting outcomes of the idea that government has no role to play in goosing the market in order to discourage destructive habits, such as by leveling prohibitive tobacco taxes, banning all tobacco advertising, or severely restricting the addictive properties of cigarettes. That's the classic libertarian view, and it's perfectly consistent.

Oh, I very much think the government has a role to play here, regardless of how we eventually design our health care system. (Then again, I'm not a libertarian.) Furthermore, I know people in positions of influence who are in favor of sin taxes on fast food / subsidizing healthy food on both ends of the political spectrum. I'm not sure that's practical nor am I 100% convinced it's fair (after all, what's healthy for you isn't completely what's healthy for me + this could easily be politicized), but it will eventually be on the table and maybe even implemented. (Really. Though, I'm not saying anytime soon.)

And this is why, since I am a libertarian, I'm much more horrified by "universal health care" than I am by, say, Medicaid. These people really are fascists; they don't just want to help poor people -- which they could do by expanding Medicaid; they want to run people's lives. Smoking was low-hanging fruit, because everyone "knows" that smoking is a vice, but now that they've done all the dissuading of smoking that they can without outright banning it, they have to move on to the next steps: deciding what and how we should eat, how we should exercise, etc. All in the name of "controlling health care costs."

If it is true, wouldn't you feel really bad jumping on her? Given Dan's posts, it seems she's the most likely one here to know the truth.

I think if you're going to bring up the death of a member of this community to make a point in a political thread, you should be prepared for people to react strongly.

I don't doubt the integrity of Lisa's convictions or her reasons for not providing further information. I'm just pointing out that it's unrealistic to expect others to ignore the comment, or simply accept it at face value.

David, even (most) libertarians agree on taxing externalities - the catch is deciding what's a problem and quantifying the impact. It's legit to have on the table with almost any economic/social framework.

Guapo/410: Sure. Now that's covered.

Ray, I appreciate your post #376. I didn't mean to say that people should subsidize me if they don't want to. I think that they should want to--not my career, but my ability to remain alive if I suffer catastrophic illness--, which is something different; it's a moral opinion, not a political opinion.

Well, this may come as a surprise to you and MCoA, but I do agree there should be a basic level of service available to everyone. For example, if I were given the power to decide whether we should refuse to treat people in emergency rooms, I would never agree to that. As noted above, the issue is what that basic level should be.

I'll ask you the ridiculously simplistic question that I just asked a bunch of my new colleagues: what kind of music do you compose?

I'm trained in classical and jazz. In college I composed mostly jazz. Since then I've focused mainly on pop rock, although I rarely have time to do anything except play anymore. I have perfect pitch, and can usually hammer out a tune on the piano (e.g., something from Elton John or Billy Joel or Waylon Jennings) after having heard it once or twice.

And this is why, since I am a libertarian, I'm much more horrified by "universal health care" than I am by, say, Medicaid. These people really are fascists; they don't just want to help poor people -- which they could do by expanding Medicaid; they want to run people's lives. Smoking was low-hanging fruit, because everyone "knows" that smoking is a vice, but now that they've done all the dissuading of smoking that they can without outright banning it, they have to move on to the next steps: deciding what and how we should eat, how we should exercise, etc. All in the name of "controlling health care costs."

I'm not a libertarian, but I also worry that turning 1/6 of the economy over to the government is the "camel's nose under the tent" for the nanny state telling us how to live our lives. We've already got CO2 classified as a pollutant. Listen to somebody like Bloomberg for a while, and see if you'd want him dictating policy for the entire health care sector.

Since there was a request for more detail about this a couple of pages back:

It turns out that in eight states, plus the District of Columbia, getting beaten up by your spouse is a pre-existing condition.

Under the cold logic of the insurance industry, it makes perfect sense: If you are in a marriage with someone who has beaten you in the past, you're more likely to get beaten again than the average person and are therefore more expensive to insure.

In human terms, it's a second punishment for a victim of domestic violence.

In 2006, Democrats tried to end the practice. An amendment introduced by Sen. Patty Murray (D-Wash.), now a member of leadership, split the Health Education Labor & Pensions Committee 10-10. The tie meant that the measure failed.

All ten no votes were Republicans, including Sen. Mike Enzi (R-Wyoming), a member of the "Gang of Six" on the Finance Committee who are hashing out a bipartisan bill. A spokesman for Enzi didn't immediately return a call from Huffington Post.

At the time, Enzi defended his vote by saying that such regulations could increase the price of insurance and make it out of reach for more people. "If you have no insurance, it doesn't matter what services are mandated by the state," he said, according to a CQ Today item from March 15th, 2006. -Ryan Grim, Huffington Post

Another "pre-existing condition" that came as a surprise to me:

Private insurers can legally reject pregnant women on the grounds that their pregnancy is a pre-existing condition. While federal law forbids group health plans from playing this sleazy trick, on the individual market, companies face no such restriction. Given the loophole, seemingly all insurers jump through it. Even though not getting prenatal care is a technically a violation of the law (according to family law experts, women could be prosecuted for neglect, though they rarely if ever are), private insurance plans for individuals aren't required to help them get it.

When looking for real help, many uninsured pregnant women encounter this utterly useless advice: get a policy before conceiving. -Sharon Lerner, NPR

So, the answer is no: you don't understand the nature of the concept of insurance. You could have just said that, and it would have saved you some typing and the rest of us some vapid moral preening.

The fact that you think those are "non-sequiturs" merely illustrates your complete ignorance of the topic of discussion. Those are not non-sequiturs; those are exactly identical analogies. Insurance is a service. Pricing of this service is not based on moral worth. It is based on actuarial risk. It doesn't matter whether one's higher risk is one's "fault" or not; the premium is not punishment for misbehavior. It is a way to pay for expected payouts. The expected (I mean in a statistical sense) payout is based on whether one is likely to put in a claim, not why. It's the same whether one keeps piles of newspapers near candles or whether one lives in a fire-prone area; whether one smokes or one has a genetic defect. (I mean, assuming the math for those particular situations works out that way for a particular individual.)

What complete bullshit. Of course I understand the logic of the insurance industry. I understand it very well. In fact, if I were screening people for risk in order to set their health insurance premiums, I'd take one look at you and estimate your life expectancy at about ten more years at most, and charge you accordingly. And then add your file to my resume when it came around to bonus time. (Though if I were a nice guy, I'd throw in an exercise bike and a fruit basket while showing you out the door.)

Now that's a nasty and rude reply, but it's also pretty much what you see as the final answer to our health care problem: Look at it only from the actuarial POV of the insurance company, and disallow any other factors from entering into the equation. And if anyone objects to that, claim that we "don't understand" insurance. That makes about as much sense as my looking at you and saying that you "don't understand" how to shed those 40-odd excess pounds that you carry around your waist.

(Of course you "understand" how to lose that excess baggage. You just don't feel sufficiently motivated to do it, because you must not "understand" how much it's likely to cost you down the road. And I certainly do "understand" the logic of insurance, but I also "understand" the human cost that it imposes on those who can't afford it, especially if they have a pre-existing condition through no fault of their own. You likely "understand" that too, but it doesn't seem to bother you.)

And I apologize in advance for the tone and personal nature of this post, and it won't happen again, but with your constant personal and patronizing comments, the latest example of which is above, you've been asking for something like this for a long time. So be it.

That's awesome, Ray. I wouldn't have thought that about you :)

I agree that $1,000 isn't that big of a deal for a lot of students, and naturally, the logic that the more people enrolled in the plan the cheaper it can be is sound. But ethically, I really think it should be a choice to spend an amount of money that large. Now, my view of this is somewhat jaundiced by the experience of having paid $1,000 for a one-year university insurance plan (offered by the university) several years ago, and then having it not pay anything for my broken foot that year. And this wasn't a matter of the cost being below the deductible, which was something like $200; the company just flat-out denied the claim, on the grounds that it was my own fault, and the treatment cost me $1,000--x-rays, cast, physical therapy. I paid the other $1,000, the insurance premium, for nothing.

Snapper, I haven't seriously looked into what it would cost me to get an individual plan, because I have no discretionary funds. But what I've gathered from observation around the edges is that it would be between $300-$500 a month, though I'm in the actuarial sweet-spot; 29 years old, non-smoker, BMI of about 21.5, totally non-dangerous occupation.

And I certainly do "understand" the logic of insurance, but I also "understand" the human cost that it imposes on those who can't afford it, especially if they have a pre-existing condition through no fault of their own.

I still don't see what "fault" has to do with this.

But ethically, I really think it should be a choice to spend an amount of money that large.
If it's a requirement of the school, I'm ok with that. More so than, say, when they require you to buy / "supply you with" a specific laptop (whose cost in rolled into your fees). This is just another fee.

I can't say anthing one way or the other about fault in the case of your foot - I have no special insight and ought offer no editorial. (Nor about the conditions Vlad is bringing up - though there's definitely things I want to say; I'd certainly never heard of what he's talking about in 414 and above.)

And I certainly do "understand" the logic of insurance, but I also "understand" the human cost that it imposes on those who can't afford it, especially if they have a pre-existing condition through no fault of their own.

I still don't see what "fault" has to do with this.

It has nothing to do with insurance within the framework of our private health insurance industry. I know that just as well as you do, as does President Obama. But it has everything to do with whether we want to see that framework as the final answer when it comes to setting insurance rates.

It gets confusing as heck if you conflate the two in a single concept of "insurance." Yes, people who keep open containers of kerosene near faulty electrical wiring should have to pay more for fire insurance than normal folks. It doesn't therefore follow that someone with Type I diabetes should have to pay more for basic health care than someone who never sees a doctor. That way of phrasing it is going to sound perverse to pay-as-you-go individualists, but it's the basic idea behind national health services.

Yes, but that's not insurance. That's welfare. Maybe it's a good idea for one reason or another, but it's simply not insurance. Don't say that you want insurance if what you really want is just someone else to pay for your health care.

If you don't understand why pregnancy needs to be a pre-existing condition, you don't understand insurance. Do you think insurance would work if customers only had to pay for it when they needed it? I.e. They get to skip their payments when healthy, but the moment they get sick they can get thousands of dollars of services by only paying a few hundred dollars, and as soon as they are better they can stop paying again.

Really people, it's not that hard a concept. Would you bet baseball games with someone who only told you their picks after the games were complete? Do you think that the medical costs are the same for a woman who continues to live in a physically abusive situation after previous injuries?

Restriction of what insurers can use as pre-existing conditions is one reason health insurance is so expensive. We force them to take sicker and sicker people in the same pool, raising costs, a great deal for the sick, but a hidden tax on the healthy. Then it allows people to say the insurers have failed, they are raising rates too much, they are too greedy (despite their slIm profits) and hence we need a single payer plan.

Now that's a nasty and rude reply, but it's also pretty much what you see as the final answer to our health care problem: Look at it only from the actuarial POV of the insurance company,


Well, when we're looking at it from the perspective of the insurance company, that is what matters. They're not charities.

Your argument is akin to me asking you to give me $5000, you saying no, and then decrying that you're only looking at it from your POV.

And I certainly do "understand" the logic of insurance, but I also "understand" the human cost that it imposes on those who can't afford it, especially if they have a pre-existing condition through no fault of their own.

But your solution for helping people with pre-existing conditions through no fault on their own is to simply pass the misfortune on to others.

I'm lucky to only have relatively very minor pre-existing conditions, a patellar problem with my left knee and chronic seasonal allergies. Sure, that's mildly unfortunate for me, but if I'm not at fault for it, why is my next door neighbor or the Giant Food manager or Joe Orsulak more responsible for my misfortune than I am?

I'm not saying that there aren't things that we can competently do to help in a lot of situations, but there's no Scrooge McDuck Vault of gold just waiting there to be used.

I do my best to do my part in helping people, but again, compassion is what one does, not what one forces others to do. People can be compassionate or dispassionate, not health-care systems.

If the profits are so slim why are intelligent businessmen even involved in the health insurance industry?

Komminsk, I fell down a hill walking back from the library. I was carrying one book at the time, and it was dark and raining lightly. The hill, rather steep, but heavily traveled, was the only direct route from the library to where I was going, which was the music and art building. Others were walking up and down the hill at the same time I was. I submit this scenario for consideration because I honestly have no idea how normal it is for that to be considered my fault. Theoretically, I could have gotten from point A to point B by a different route, but it would have taken more than twice as long, and denizens of the music and art building almost always took the route I was taking, so it wasn't a rash, foolish act by standard social constructions of that idea.

Bad examples, as private business were the predominant builders of our national rail system

No it isn't a bad example as the railroads still required huge amount of help from the government and because building was a huge investment loss for the initial investors. If anything the government is the best type of investors to build things like this. Most of the initial investors lost their investment in RR because RR required huge amounts of capital to build the lines. It required so much that there really was no way the initial companies were going to turn a profit so they went belly up and maybe the next guy or the next guy after that after purchases the RR on the cheap might turn a profit. The government which can absorb the cost and spread it out to millions and millions and for generations is a much better capital machine for a project that will benefit the entire country and many generations of Americans.

Is it perfect? No, but neither is free market or private industry. There are flaws in all systems and you just happen to favor the flaws in another system.

If the profits are so slim why are intelligent businessmen even involved in the health insurance industry?
Slim (as a %) >>>>>>>> 0.

Oh, I didn't mean of your specific situation, Vaux - more of how that process works and where thresholds are (I've peeked at it, but in very specific contexts which I've hinted at earlier). I'm surprised that was your outcome, I'll leave it at that.

If the profits are so slim why are intelligent businessmen even involved in the health insurance industry?

You'd have to ask them. But it's a fact that they're not highly-profitable.

I still don't see what "fault" has to do with this.

It has nothing to do with insurance within the framework of our private health insurance industry. I know that just as well as you do, as does President Obama. But it has everything to do with whether we want to see that framework as the final answer when it comes to setting insurance rates.

Well, even if your pre-existing condition is "through no fault of your own," it sure as hell ain't through my fault.

Yet, you want me to pay for it.

You think it's significant that a condition isn't "your fault," but you don't care whether it's my fault. That's... bizarre.

On a slightly related note, there's an interesting story in the today's Post about the walk-in clinics at retail stores such as Wal-Mart and CVS, which have been around for a couple of years. They're only for certain minor ailments or emergencies, and they're staffed by nurse practitioners and physician assistants, but for many people who can't afford either insurance or regular doctors, they're a godsend, especially since they're walk-ins that are often open 24/7 and don't require an appointment, and the costs are far less than they would be otherwise. Obviously it's not the solution for more serious and chronic illnesses, but it's certainly a lot better than nothing.

They are pretty good especially if you have a child and they get one of their routine illnesses. Cheap compared to going to a doctor or hospital and very easy.

I've used one once when I had strep throat and I think the visit cost me 50 bucks + medicine which was pretty cheap because if I remeber correctly it was rather basic antibiotics.

The only odd thing about it is that they put the clinic inside the fruit and vegetable section which I thought was kind of stupid and needless to say I never bought fruit and vegetables at that grocery store.

Dan, once again I understand the logic of insurance. But as a society, I don't think that the consequences of that logic, which are disproportionately borne by unlucky individuals, are necessarily the final answer. It pretty much comes down to that. I think that the risk should be borne by society as a whole, the way it is in most other developed countries, with lower health care costs and longer life expectancies than we have. I realize that you disagree with the premise.

But your solution for helping people with pre-existing conditions through no fault on their own is to simply pass the misfortune on to others.

It should be noted that this is not only Andy's position, but it is also Ray's position and snapper's position and ValueArb's position.

People who are sicker than the rest of us, due to the genetic lottery or various other factors, are going to need basic care that only a small percentage of the population are wealthy enough to afford on their own. Once we've agreed that no one should die in the street because they're sick and can't pay for medical care, the misfortune of paying for that medical care will be passed on to others. Right now it's done indirectly, the plan on the table from Obama does it directly by one method, other plans do it more or less directly by other methods, but there's no way out of this position unless you want to let folks die in the street.

No one - except maybe David - has proposed a plan which does not involve collective action, or in your terms, "passing the misfortune on to others".

Well, even if your pre-existing condition is "through no fault of your own," it sure as hell ain't through my fault.

Yet, you want me to pay for it.

You think it's significant that a condition isn't "your fault," but you don't care whether it's my fault. That's... bizarre.

Only to an American who's hooked on libertarianism as the final answer to all our problems. Most every other country would think that your POV is the bizarre one.

Only to an American who's hooked on libertarianism as the final answer to all our problems. Most every other country would think that your POV is the bizarre one.

Andy: "My pre-existing condition is not my fault. I shouldn't have to pay more."

Ray: "Your pre-existing condition is not my fault. I shouldn't have to pay more."

Andy: "No. You have to pay more. It's me who doesn't."

You'd have to ask them. But it's a fact that they're not highly-profitable.

From the extremely odd I'm only going to look at % instead of raw dollars angle. Which I always find odd to do. A billion dollars is a billion dollars regardless of whether it is .1% of your revenue or 15% of your revenue.

The only odd thing about it is that they put the clinic inside the fruit and vegetable section which I thought was kind of stupid and needless to say I never bought fruit and vegetables at that grocery store.

Though you have to admit that it's kind of a droll subliminal suggestion, which if voluntarily acted upon by enough people would result in lower medical bills for everyone.

No one - except maybe David - has proposed a plan which does not involve collective action, or in your terms, "passing the misfortune on to others".

And, of course, by making collective action available earlier in the lifecycle of the diagnosis of a condition, the amount of misfortune for pretty much everyone can be minimized by reducing the severity (and therefore cost) of the condition when it is treated.

Might end up saving everyone money, except possibly the providers of the medical services that are needed when problems become life-threatening - but presumably we're not arguing in favor of artifically-inflating their bottom line by waiting until the last minute to treat conditions?

You think it's significant that a condition isn't "your fault," but you don't care whether it's my fault. That's... bizarre.

It's not bizarre, it's a function of basic philosophical theories of justice. The notion is that a justly organized society is one in which various things that can befall people by random chance should not impair too significantly their ability to live and flourish. If someone is born with a heart defect, it is unjust to leave them to suffer physically without care, or to start out far behind economically because of the cost of care.

It is in part by my good fortune that I don't have significant medical bills for some inborn condition, so I pass my good fortune on to others. The solution to this injustice is typically collective action. We all give something so that if we need help, it will be there for us, or if we don't need help, so that we pay back something for the luck we've profited from.

And, of course, by making collective action available earlier in the lifecycle of the diagnosis of a condition, the amount of misfortune for pretty much everyone can be minimized by reducing the severity (and therefore cost) of the condition when it is treated.

Screening for diseases won't necessarily reduce the cost of anything. If the screening of X people who could come down with the disease costs more than the treatment of Y people who actually do come down with the disease, no cost is reduced.

You might argue that pre-screening is good policy for various reasons; cost savings isn't one of them.

From the extremely odd I'm only going to look at % instead of raw dollars angle. Which I always find odd to do. A billion dollars is a billion dollars regardless of whether it is .1% of your revenue or 15% of your revenue.
Both are relevant. It means - because you're dealing with huge volumes - that you've got have a lot of money on hand to pay out claims + small errors in projecting the future can have cataclysmic effects.

EDIT: to clarify, I have little doubt that deregulation of the insurance industry would produce some low-cost plans. I also have little doubt that it would create some really terrible plans that left millions of folks without the health coverage they thought they had. (You can't shop around for a new coverage plan after being billed $8000 that you thought was covered.) We'd end up with a government plan that carried anyone deemed too risky by insurance companies, and it would see its costs skyrocket.

So having more choice leads to worse choices, hardly realistic. And yes, you can still shop around even TODAY for a new plan even after a medical condition, it just might affect how you are rated. Under this plan you'd have far more choice and ability to shop around. Currently the government forces insurance plans to cover sick people at the same rate healthy pay. Under my plan the healthy both get cheaper plans and have more choice. Texas is a min example of how greater choice and greater rating abilities for insurance companies leads to cheaper plans.

So yes you are right, the sick would have to pay their full costs if they wanted a private plan, or the government plan would be their safety net. But it's not a hand-out, they'd contribute a reasonable proportion of their income in exchange for capping their medical costs. And the best part is they'd get all of the great benefits of a single payer plan! When too many unemployed people join the plan, it will cut back on benefits. When too many sick join, they'll delay treatments. I mean it's the best of both worlds, the wonderful single payer plan only for those who deserve it, and the nasty private choice plans for those who can afford it.

Of course I understand the logic of the insurance industry. I understand it very well.

Then why did you even ask the question in the first place? It answers itself, if one understands insurance. (The problem is that you evidently don't understand it, since you sneeringly call it "the logic of the insurance industry," when it's actually the nature of insurance itself. If you don't price for risk, you aren't selling insurance. It's like disparagingly calling the failure of the airlines to sell trips to outer space the "logic of the airline industry.")

And I apologize in advance for the tone and personal nature of this post, and it won't happen again, but with your constant personal and patronizing comments, the latest example of which is above, you've been asking for something like this for a long time. So be it.

You are so full of crap. Every single one of your posts is snide and/or patronizing and/or nasty. Just in this thread we had

a notorious pinko publication,

and

Born on third base, and deserving of a triple. Born HIV-positive, and tough ####. And facing a moral question, come up with the most spectacular non sequitur you can imagine in order to avoid it---as if a birth condition is comparable to a burning house or a car with bad brakes. That's your "philosophy" in a nutshell.

If you were going to apologize for your "tone," this post was hardly the first place to start.

Andy: "My pre-existing condition is not my fault. I shouldn't have to pay more."

Ray: "Your pre-existing condition is not my fault. I shouldn't have to pay more."

Andy: "No. You have to pay more. It's me who doesn't."

Of course this conveniently omits the fact that in your hypothetical case, I might be forced into bankruptcy, whereas your "pay" would amount to a fraction of a penny, since the cost of my health care would be spread among the population as a whole. For someone who understand the logic of insurance, and who's also well versed in the logic of libertarianism, you see curiously uncomprehending of the concept of spreading risk, or the corny old left wing concept of human solidarity---you know, that quaint thing that conservatives like to trot out in wartime. Maybe a year or two in France might help you along this path, and who knows, you might even enjoy it if you could hook up to NESN.

After all, I pay taxes partly so that the fire brigade turns up to your house, even if I've never had a fire in my house, and if I've not been stupid enough to let my drapes tangle over my fireplace or leave my Xbox on for more than an hour at a time. The risk is still socialized, even if the fault is identifieable

And while these services often started due to collective risk (if we live in wooden houses and your house is on fire, mine may catch fire too), they stick around even in areas where we all live in detached housing. Socialized fire control! Oh no!

So having more choice leads to worse choices, hardly realistic.

I direct your attention to the subprime mortgage crisis.

Complex transactions + large possible profits + deregulation has long produced bad results for consumers.

So yes you are right, the sick would have to pay their full costs if they wanted a private plan, or the government plan would be their safety net. But it's not a hand-out, they'd contribute a reasonable proportion of their income in exchange for capping their medical costs.

Right, but all the sick people - with the exception of a wealthy few - would be on the public plan. This would produce a huge adverse selection problem for the public plan, which would be unable to charge enough money to cover the costs of the sick folks.

EDIT: Another way of looking at it. You're an insurance executive. You are no longer bound by regulations to give health care in big blocks to employers, or bound to provide insurance to folks whom you deem not worth the risk. You're going to price plans to maximize your profits, which means covering as few of the folks guaranteed to run up big bills as possible. There's just no profit in covering someone born with a genetic heart defect. There competition among insurance companies would be to avoid covering these folks, not to cover them. They would all, then, be covered by the public plan. You would effectively split the healthy people from the sick people, leaving government with the bill.

I tend to think that eventually, once there's a public plan with guaranteed coverage, the private insurers will struggle badly to compete except for the high-end market, and hopefully soon enough you'd get enough healthy people in the public plan that it could pay more and more of its own costs. But that would take time, and in the interim, the public plan would either go broke or require large new funding sources.

Screening for diseases won't necessarily reduce the cost of anything. If the screening of X people who could come down with the disease costs more than the treatment of Y people who actually do come down with the disease, no cost is reduced.

You might argue that pre-screening is good policy for various reasons; cost savings isn't one of them.

If, yes. I don't think either of us has demonstrated that one way or the other yet, have we? When you say 'screenings', are you talking about diagnosing a condition in the early stages, or just random check-ups?

It seems to me that early diagnosis is a strong possible reason why non-US systems seem to deliver more effective health care at a lower cost, absent the previous arguments that Americans are too chaotic and mavericky to get good health care for themselves.

It's times like these I am glad I am Amish.

Dan, once again I understand the logic of insurance. But as a society, I don't think that the consequences of that logic, which are disproportionately borne by unlucky individuals, are necessarily the final answer. It pretty much comes down to that. I think that the risk should be borne by society as a whole, the way it is in most other developed countries, with lower health care costs and longer life expectancies than we have. I realize that you disagree with the premise.

Whether one likes or dislikes the premise that this is a good idea, (as I said in post 421) that's just not insurance. You don't want us to have insurance. You want the government to redistribute wealth so that people are required to pay for each other's health care, presumably because you think it's "unfair" that some people can't afford it. That's welfare, not insurance.

That's welfare basic human decency, not insurance.

FTFY

Of course I understand the logic of the insurance industry. I understand it very well.

Then why did you even ask the question in the first place? It answers itself, if one understands insurance. (The problem is that you evidently don't understand it, since you sneeringly call it "the logic of the insurance industry," when it's actually the nature of insurance itself. If you don't price for risk, you aren't selling insurance. It's like disparagingly calling the failure of the airlines to sell trips to outer space the "logic of the airline industry.")

I know one thing, David: You know how to repeat yourself, and you know even better how to cut out the part of my reply that would negate the implication of your response. The old expression "Philadelphia lawyer" used to capture this technique quite well.

As for rhetoric and apologies, I've said my piece. If anyone's interested in researching who's been the provocateur in our various exchanges, they can do so on their own. But I'm not going to pull a Kevin on you and keep that part of the conversation going.

That's welfare, not insurance.

"Social insurance" is a perfectly cromulent term that is used by everyone in policy, to refer to something you call "welfare". You don't get to redefine terms which have perfectly normal and near-universal usage under a definition you disagree with.

Complex transactions + large possible profits + deregulation has long produced bad results for consumers.

Mortages are not "complex transactions," except when government perverts the process.

"Deregulation." If only. There were plenty of regulators involved.

And while these services often started due to collective risk (if we live in wooden houses and your house is on fire, mine may catch fire too), they stick around even in areas where we all live in detached housing. Socialized fire control! Oh no!

Of course, fire control started as private and volunteer; history shows that "socialized fire control" sprung up primarily as patronage for politicians.

"Social insurance" is a perfectly cromulent term that is used by everyone in policy, to refer to something you call "welfare". You don't get to redefine terms which have perfectly normal and near-universal usage under a definition you disagree with.

Social insurance is a deliberate miscoinage to confuse people as to the nature of the issue; even if one feels the usage to be more innocuous, the point stands that it does confuse people. They want insurance -- which is not "social insurance," but insurance -- to be something other than insurance.

You don't want us to have insurance. You want the government to redistribute wealth so that people are required to pay for each other's health care, presumably because you think it's "unfair" that some people can't afford it. That's welfare, not insurance

That's fine with me. As Saxman notes, we have redistributed wealth so that we're required to pay for putting out each other's fires. We have redistributed wealth so that I pay for 911 dispatchers that other people call and I never have. We have redistributed wealth so that the property taxes of the childless and elderly pay for the schooling of other people's kids. We have redistributed wealth so that Jerry Jones can build a freaking enormous football stadium that I can't afford to go see a game in. Where was I ...

It's just a matter of priorities and drawing the line when it comes to welfare and redistribution. Some people go apoplectically ape#### about the existence of public schools. Others wouldn't mind a little redistribution to bring greater health to a greater number. There's no real philosophical chasm in principle, unless you really want to bill burnt-out individuals per fire.

One might object that fires can spread to other people's houses. Ignorance and disease can do that too.

If the profits are so slim why are intelligent businessmen even involved in the health insurance industry?

In some cases it's used as cash flow for other investments.

fire control started as private and volunteer; history shows that "socialized fire control" sprung up primarily as patronage for politicians

History shows that baseball clubs sprung up as amateur social organizations of artisans and tradesmen (sometimes paralleling those early fire companies, in fact). That would seem to have as little to do with MLB as the history of fire departments has to do with the realities of how they get paid for and fires get extinguished at the present day.

Dan, once again I understand the logic of insurance. But as a society, I don't think that the consequences of that logic, which are disproportionately borne by unlucky individuals, are necessarily the final answer. It pretty much comes down to that. I think that the risk should be borne by society as a whole, the way it is in most other developed countries, with lower health care costs and longer life expectancies than we have. I realize that you disagree with the premise.

Whether one likes or dislikes the premise that this is a good idea, (as I said in post 421) that's just not insurance. You don't want us to have insurance. You want the government to redistribute wealth so that people are required to pay for each other's health care, presumably because you think it's "unfair" that some people can't afford it. That's welfare, not insurance.

Here's one of many definitions of "insurance," taken from the InvestorWords.com web page:

A promise of compensation for specific potential future losses in exchange for a periodic payment. Insurance is designed to protect the financial well-being of an individual, company or other entity in the case of unexpected loss. Some forms of insurance are required by law, while others are optional. Agreeing to the terms of an insurance policy creates a contract between the insured and the insurer. In exchange for payments from the insured (called premiums), the insurer agrees to pay the policy holder a sum of money upon the occurrence of a specific event. In most cases, the policy holder pays part of the loss (called the deductible), and the insurer pays the rest. Examples include car insurance, health insurance, disability insurance, life insurance, and business insurance.

There is absolutely nothing in that definition of insurance that says we cannot, as a society ("other entity"), choose to distribute the risk among the entire population. All you're doing is extrapolating one particular form of insurance---the type of private health insurance we have in the U.S. today---and pretending that it's the only valid model, or the only "definition." That's like saying that Catholicism is the only definitional form of Christiantity.

I know one thing, David: You know how to repeat yourself, and you know even better how to cut out the part of my reply that would negate the implication of your response. The old expression "Philadelphia lawyer" used to capture this technique quite well.

As for rhetoric and apologies, I've said my piece. If anyone's interested in researching who's been the provocateur in our various exchanges, they can do so on their own. But I'm not going to pull a Kevin on you and keep that part of the conversation going.

So you're going to make yet another snide comment, and then after making the comment claim that you're not actually going to keep up the conversation about your snide comments. Convenient, isn't it? I'm not interested in meta-conversation either, but don't make a meta-comment and then act like you're magnanimously refusing to engage in such discussion.

"Deregulation." If only. There were plenty of regulators involved.

Never understood this argument, though I sadly hear it often enough. 'Deregulation' means less regulation (in terms of fewer net restrictions on your actions), not no regulations at all. There are always regulations in real life, if only because of the law of the land. Can we stop pretending that any rules at all mean that deregulation hasn't occurred? Unless we're of the opinion that fraud, etc. should never be punished?

It's just a matter of priorities and drawing the line when it comes to welfare and redistribution. Some people go apoplectically ape#### about the existence of public schools. Others wouldn't mind a little redistribution to bring greater health to a greater number. There's no real philosophical chasm in principle, unless you really want to bill burnt-out individuals per fire.

Actually, I do... of course, if we did that, it would be covered by homeowners' insurance and built into the premiums, which seems like only justice.

If the profits are so slim why are intelligent businessmen even involved in the health insurance industry?

1% of billions is better than running a Mickey D's. However, if one were to assume (this is not the case) that their cost structures are the same as other thin-margin businesses, then they face the exact same problems. If your independent grocery store has a 2.5% profit margin and your fixed costs rise significantly, that impacts you no differently than if fixed costs at hypothetical Insuro-justlikegrocerystore Co. rise. The differences do impact the final analysis, which is why it's correct to say that while insurance companies make billions, or record profits, their margins are still very thin and therefore they are hypersensitive to cost fluctuations wrt their business health.

But the way the system is currently set up health insurance companies can raise their rates to cover the extra costs and there is not a damn thing the consumer can do about it but opt out.

I'm no defender of the health care system we have, but that's no different than McDonald's raising their costs. Sans that regulation/reform, that's a feature of capitalism.

"Deregulation." If only. There were plenty of regulators involved.

Never understood this argument, though I sadly hear it often enough. 'Deregulation' means less regulation (in terms of fewer net restrictions on your actions), not no regulations at all.

I disagree; I think deregulation refers to the removal of substantially all regulations, not simply a change in the specific behaviors you're permitted to engage in. If the government says that grocery stores can't sell alcohol, and then the rules are amended to say that these stores can sell beer, I don't think that's "deregulated" merely because one particular rule has been changed and one additional action is permitted.

There are always regulations in real life, if only because of the law of the land. Can we stop pretending that any rules at all mean that deregulation hasn't occurred? Unless we're of the opinion that fraud, etc. should never be punished?

Outlawing fraud is different in kind, not just degree, from regulation. Outlawing fraud says that you can do whatever you want, as long as you're honest about it. The government doesn't tell you what products or services you may or may not offer, or to whom, or when; it doesn't tell you what you can or can't charge or what features it must or must not have, or what the paperwork must look like.... It just says, don't lie.

It is in part by my good fortune that I don't have significant medical bills for some inborn condition, so I pass my good fortune on to others. The solution to this injustice is typically collective action. We all give something so that if we need help, it will be there for us, or if we don't need help, so that we pay back something for the luck we've profited from.

I have no problems paying for someone elses inborn condition, I just don't like doing through higher insurance premiums, just tax me please.

But you are confusing the wide variety of situations that are classified as pre-existing. Some are inborn and unfortunate, some are by choice.

If a healthy person gets cancer, or AIDs, or is injured in a horrible crash, they should have insurance coverage to pay for the costs they can't. I think we all agree that if an insurance company tries to get out of paying for a legit claim, they are scum. And the formerly healthy person should be allowed to keep their insurance at similar rates. The whole point of rating them upon entry into a pool is that they are paying premiums to "insure" against misfortune, some in the pool never need it, and the total premiums are enough to cover the cost of those who do in the pool.

But if you want to force insurers to accept pre-existing conditions like Pregnancy, you break the model. Now you have an influx of new pool members who immediately need extremely expensive care, and are paying only the same small premiums as everyone else. Costs skyrocket, so premiums have to as well. You essentially want people to be able to game the system, you want to allow them to be free riders who only pay for insurance when they need it, but never contribute when they don't. So healthy would never pay insurance premiums, they'd wait until they become sick people, and what do you think insurance would cost then?

All we are asking is that the young woman who wants to have her pregnancy covered by insurance, buy insurance before she's pregnant, not after. If she doesn't want to be rated into a higher pool because her boyfriend regularly sends her to the hospital, leave the boyfriend.

My wife actually got pregnant almost immediately after we joined a new HSA plan. They didn't argue, they paid everything. I had a cardiac scare than involved expensive testing right before my childs birth, no arguments, all paid. Of course the difference was that I had a $5,000 deductible, so the insurance company had a little protection from me gaming the system by only buying the insurance as soon as I thought she was pregnant, or from getting too many expensive tests for my ticker. They knew I was serious if I was putting out $5,000 out of pocket first. The horror stories I've heard about rejected claims seem almost exclusively from health insurers trapped into accepting wide groups with little control over rating, so they hyperfocus on fraud/waste, and even if they get 1000 rejections right, they create a media firestorm with the one they got wrong. Big deductible plans have much less incentive for fraud, so insurers don't have the same incentives to push the envelope on claim rejections. I've never had a claim rejected, through two births, multiple medical scares, emergency room visits, cancer diagnoses, etc.

And as an aside, I love my HSA. It originally cost only $200 per month for myself and wife, so I capped all my costs at $7,500 per year. A full coverage policy would have been about the same cost, but since most years I don't hit my deductible I save money with this plan, essentially my medical costs are fixed in a range from $2,500-$7,500 per year. I can see any doctor without restriction. I have negotiated cash payments before, but I don't have to. Blue Cross ensures that I'm billed at the same rates as anyone on the rest of their plans. I had a $5,000 emergency room visit with ambulance ride a year ago, Blue Cross knocked it down to $1,000 without me lifting a finger.

I'm no defender of the health care system we have, but that's no different than McDonald's raising their costs. Sans that regulation/reform, that's a feature of capitalism.

Understood. But if I don't like Mcdonald's food or their price I am free to go to Wendy's or Burker King. My employer is not telling me, go to McDonald's or you are SOL.

I'm no defender of the health care system we have, but that's no different than McDonald's raising their costs. Sans that regulation/reform, that's a feature of capitalism.

And yet somehow there are many capitalist countries that manage to avoid leaving individual health care dependent on financial circumstance. But perhaps we're the only capitalist country left on Earth.

There is absolutely nothing in that definition of insurance that says we cannot, as a society ("other entity"), choose to distribute the risk among the entire population. All you're doing is extrapolating one particular form of insurance---the type of private health insurance we have in the U.S. today---and pretending that it's the only valid model, or the only "definition." That's like saying that Catholicism is the only definitional form of Christiantity.

You're missing the point entirely. Whether we "distribute the risk among the entire population" or just some subset of the population isn't the defining issue; the defining issue is whether we charge people premiums for their insurance policies based on their actual risk.

EDIT:

And yet somehow there are many capitalist countries that manage to avoid leaving individual health care dependent on financial circumstance. But perhaps we're the only capitalist country left on Earth.

We're not capitalist either, but we're more free than most other countries, yes.

And as an aside, I love my HSA. It originally cost only $200 per month for myself and wife, so I capped all my costs at $7,500 per year. A full coverage policy would have been about the same cost, but since most years I don't hit my deductible I save money with this plan, essentially my medical costs are fixed in a range from $2,500-$7,500 per year. I can see any doctor without restriction. I have negotiated cash payments before, but I don't have to. Blue Cross ensures that I'm billed at the same rates as anyone on the rest of their plans. I had a $5,000 emergency room visit with ambulance ride a year ago, Blue Cross knocked it down to $1,000 without me lifting a finger.

That's great but there are a ton of folks who can't afford $200 for health insurance. What should they do?

But the way the system is currently set up health insurance companies can raise their rates to cover the extra costs and there is not a damn thing the consumer can do about it but opt out.

No, you can switch insurance companies. Another company just rated my family at nearly half the cost of my Blue Cross plan for almost the same coverage, so despite all the nice things I said about it I'm mulling a switch. And I'm an individual, not a business, I have two kids now and no perfect medical history.

And what do you expect them to do if costs increase? Start losing money, and ask investors and banks to give/loan them money so your premiums don't rise?

Insurance can be a fabulously profitable business, ask Warren Buffett. But right now, health insurance is not a very profitable segment. I'd bet it was substantially more profitable a few decades ago, but bit by bit this creeping regulation has caused costs to skyrocket and compressed their profits. As long as the business is still thinly profitable they'll stay in it, but they want be reinvesting much, and they'll probably take profits out any chance they get to minimize the risk that that regulatory changes kill the business, and reinvested profits disappear in bankruptcy.

I disagree; I think deregulation refers to the removal of substantially all regulations, not simply a change in the specific behaviors you're permitted to engage in. If the government says that grocery stores can't sell alcohol, and then the rules are amended to say that these stores can sell beer, I don't think that's "deregulated" merely because one particular rule has been changed and one additional action is permitted.

Simply put, this isn't how the word is used in industry, at least in those I work in (energy and banking) - enough to the extent that I tend to side with my life experience over a philosophical absolute. The London Stock Exchange deregulated in the 1980s. The English electricity market deregulated in 2001. These are sentences that capture perfectly the nature of the event.

We've had this discussion before, and ended up at pretty much this point - for trading floors around the world, 'deregulation' means a change in behavior such that commercial activity is less restricted as it was previously. I can only assume the same is true of property.

In the same way, 'deceleration' doesn't mean to come to a complete stop, and 'decreasing' doesn't mean removal entirely. And those who claim that the credit crisis wasn't enabled/exacerbated by 'deregulation' need to do more to justify this than just redefine the word out of all real-life meaning.

No, you can switch insurance companies. Another company just rated my family at nearly half the cost of my Blue Cross plan for almost the same coverage, so despite all the nice things I said about it I'm mulling a switch. And I'm an individual, not a business, I have two kids now and no perfect medical history.

Good thing you don't have any pre-existing conditions. Or your children or your wife.

That's great but there are a ton of folks who can't afford $200 for health insurance. What should they do?

Ask why you, Andy, and MCoA haven't paid for their health insurance already?

Ask why you, Andy, and MCoA haven't paid for their health insurance already?

I pay for my MIL and BIL because they can't afford it on their own. But thanks for trying.

Understood. But if I don't like Mcdonald's food or their price I am free to go to Wendy's or Burker King. My employer is not telling me, go to McDonald's or you are SOL.

Technically they're not telling you that. They're telling you "We're providing X to provide for your health care or to give you a better/different option. If you don't like who we choose or what plan, buy it yourself." They don't tell you about McDonald's because they aren't partially paying for or involved in your dinner decisions.

That's great but there are a ton of folks who can't afford $200 for health insurance. What should they do?

Stop gambling and drinking away their money? Are you serious? The median income is $4,000 per month, they can't afford $200 per month? There aren't a ton of folks making less than $1,000 per month, so I'm trying to figure out where a "ton of people" come from.

But let's assume you make $1,000 per month. Your needs should be in order, food, shelter, and medical care. Are you telling me that $1,000 per month can't do that? Sure it can't if you put nintendo, vodka, slot machines, cigarettes, cable tv, or a variety of other things ahead of it. Any single person who makes at least that can afford to buy some type of insurance, any excuses otherwise is just a lack of priorities looking for a handout.

Again, I have no trouble having a government plan that takes care of those who can't afford insurance, the couple with four kids and a $20,000 income, the very sick, etc. But EVERYONE should first ante up a significant part of their income, be it 15% or some other figure because medical care is a priority that has to be paid first, along with food and shelter.

That's like saying that Catholicism is the only definitional form of Christiantity.

It is.


{and Oh look at that, I violated my promise not to post in this thread again- I'll go away now)

You're missing the point entirely. Whether we "distribute the risk among the entire population" or just some subset of the population isn't the defining issue; the defining issue is whether we charge people premiums for their insurance policies based on their actual risk.

sorry I couldn't resist, but this is classic DMN, he misses the point- while leading off with the claim that the other person missed the point-
in fact what you "proved" was that the comment you were responding to:

All you're doing is extrapolating one particular form of insurance---the type of private health insurance we have in the U.S. today---and pretending that it's the only valid model, or the only "definition."

was an accurate description of your position.

No it isn't a bad example as the railroads still required huge amount of help from the government and because building was a huge investment loss for the initial investors. If anything the government is the best type of investors to build things like this. Most of the initial investors lost their investment in RR because RR required huge amounts of capital to build the lines

You are talking about the railroad bubble, which was mostly built by private money and created huge losses from massive over-compeitition.. The fact that entrepeneurs lobbied for and got subsidies isn't evidence they were needed, just that they could be had. The real evidence is that many railroads were built without out it, which means all railroads could, if they were economically viable. Without government subsidies some of the worst could not be built, and the transcontinental would have had to wait another decade or so, but it would have been built.

And as an aside, I love my HSA. It originally cost only $200 per month for myself and wife, so I capped all my costs at $7,500 per year. A full coverage policy would have been about the same cost, but since most years I don't hit my deductible I save money with this plan, essentially my medical costs are fixed in a range from $2,500-$7,500 per year. I can see any doctor without restriction. I have negotiated cash payments before, but I don't have to. Blue Cross ensures that I'm billed at the same rates as anyone on the rest of their plans. I had a $5,000 emergency room visit with ambulance ride a year ago, Blue Cross knocked it down to $1,000 without me lifting a finger.

It blows my mind that you think this is a good deal.

There is absolutely nothing in that definition of insurance that says we cannot, as a society ("other entity"), choose to distribute the risk among the entire population. All you're doing is extrapolating one particular form of insurance---the type of private health insurance we have in the U.S. today---and pretending that it's the only valid model, or the only "definition." That's like saying that Catholicism is the only definitional form of Christiantity.

You conveniently ignore this part

agreeing to the terms of an insurance policy creates a contract between the insured and the insurer. In exchange for payments from the insured (called premiums), the insurer agrees to pay the policy holder a sum of money upon the occurrence of a specific event. In most cases, the policy holder pays part of the loss (called the deductible), and the insurer pays the rest.

If the insured isn't signing a contract and isn't paying premiums, it's not insurance, it's welfare. Any scheme that tries to insure an event that's already occured isn't really insurance either.

There aren't a ton of folks making less than $1,000 per month, so I'm trying to figure out where a "ton of people" come from.

Figures?

But the way the system is currently set up health insurance companies can raise their rates to cover the extra costs and there is not a damn thing the consumer can do about it but opt out.
To be clear - rates are locked in for a period of time (a year, most commonly), not truly floating. As for opt-in or opt-out - you could always buy individual coverage (very likely a worse deal, as employers hide part of their workers' salaries in health coverage). Anyway, what you're upset with here (specifically) is how insurance is linked to employment (and the lack of choices employers generally offer - that said, I had my choice of a few dozen plans from one company - my wife got to pick between 'x' number of plans from three firms).

But let's assume you make $1,000 per month. Your needs should be in order, food, shelter, and medical care. Are you telling me that $1,000 per month can't do that? Sure it can't if you put nintendo, vodka, slot machines, cigarettes, cable tv, or a variety of other things ahead of it. Any single person who makes at least that can afford to buy some type of insurance, any excuses otherwise is just a lack of priorities looking for a handout.

You're insane. Where I live, you can't get an efficiency apartment for under $800 a month. You can't share a two-bedroom apartment for under $600. You can survive from an eating standpoint on the difference, but where in hell does the insurance money come from?

That notwithstanding the fact that most people have to get to and from their jobs, which costs money; most jobs expect you to be able to be contacted by phone, which costs money; your dwelling has utilities to be paid for, which costs money . . .

and if you work full-time at $6 an hour, you don't make $1000 a month, and they take taxes out of that!

I direct your attention to the subprime mortgage crisis.

Complex transactions + large possible profits + deregulation has long produced bad results for consumers.

Which has to do with, what? First of all, you are confusing "deregulation" with "regulatory imperative" by government leaders to ensure everyone, no matter how fraudulant, could get a loan and buy a home.

Second, we are talking health insurance. States with less regulation have more choice, and cheaper plans than states that don't (Hello New York!). Many people already buy individual plans, like me. We are doing okay, choice is never perfect but always better.

So yes you are right, the sick would have to pay their full costs if they wanted a private plan, or the government plan would be their safety net. But it's not a hand-out, they'd contribute a reasonable proportion of their income in exchange for capping their medical costs.
Right, but all the sick people - with the exception of a wealthy few - would be on the public plan. This would produce a huge adverse selection problem for the public plan, which would be unable to charge enough money to cover the costs of the sick folks.

We'll see, we can always ratchet up the payroll tax on the beneficiaries, say to 25%. We can always institute copays, and deductibles. We can always institute waiting lists for non-health threatening illnesses. We can do what every single payer system does, which adherents tell me results in wonderfulness.

The truth is that this is a better system for almost everyone. The uninsured will be insured. Most people will get better plans at cheaper prices.

And you ignore that any one size fits all plan will have the same sick people being covered, and the same costs. The difference is that there will be little incentive to go to private plans, which the payroll tax produces lots of incentive, especially for higher income earners. There will be little incentive not to make lots of claims over every little thing, so actually higher costs. You ignore that government employees processing every single claim means lots of waste, fraud and injustice. Let's let the IRS handle the processing, you're happy with their abilities aren't you?

It blows my mind that you think this is a good deal.
They work really well for some people, not so well for others. They're also what that Atlantic article I linked to on page 1 (if you haven't read it yet, please do - I don't agree w/ all of it, but it's got a lot of useful ideas in it) advocates.
I use an HSA. I probably wouldn't if my wife and kids (meaning my specific family - they work well for lots of families too) were also on my plan, not sure. They require more work/thought to optimize your plan (probably a good thing); healthy and relatively sick people do well with them.

If you work full time at $6 an hour your employer is breaking the law.

You're insane. Where I live, you can't get an efficiency apartment for under $800 a month. You can't share a two-bedroom apartment for under $600. You can survive from an eating standpoint on the difference, but where in hell does the insurance money come from?

My forty year old brother lives on less than $1.000 per month, and lives quite well. Your could move out of NYC. Or...

$600 per month to share an apartment.
$150 per month for food (sorry no McDs)
$50 per month for shared utilities
$200 per month left over for health insurance.

and if you work full-time at $6 an hour, you don't make $1000 a month, and they take taxes out of that!

And that stops you from working more than 40 hours a week because? Laziness or a commitment to poverty?

Again, if someone legitmately can't afford health insurance I'd like to see a government plan for them. Maybe the line of $1,000 is too low for the North East, but the vast majority of working people can, and should, afford to contribute substantial amounts to their coverages. We are talking about medical care people, you claim it's important then you turn around and say it's not a priority high enough to pay for.

I think everyone should pay into "the system" - it gives them a sense of responsibility/culpability.
I don't think we should be badgering people below the poverty line for lots of money they can't afford to be without.
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ValueArb - so they're sharing an apartment, eating for $5/day, and have no discretionary/emergency funds or savings.

Good thing your brother never has transportation costs, or has to buy clothes. And I call BS on the utilities. $100 is very low.

You conveniently ignore this part

No, you conveniently did what DMN did, you have decided that only Privately contracted insurance along the US Model is the only form of insurance period.

By absurdly narrowing the definition of "insurance" down, you are then able to denigrate other forms of insurance by giving them aesthetically unattractive labels like "welfare"...

IOW you (and DMN) are engaged in spin rather than substantive discussion...

There's no real philosophical chasm in principle, unless you really want to bill burnt-out individuals per fire.

Actually, I do... of course, if we did that, it would be covered by homeowners' insurance and built into the premiums, which seems like only justice.

I actually agree with DMN here...

There aren't a ton of folks making less than $1,000 per month, so I'm trying to figure out where a "ton of people" come from.

Figures?

I've done it actually and yeah if I wanted to I could afford $200 a month health insurance. When I went back to school I worked about 10 to 20 hours a week and it netted me what amounts to $1,000 a month pre tax. With that money I had made a car payment, paid for rent, alcohol, clothes, gas, auto insurance, and food. Oh and I lived in the Northeast.

I remember in class we had to read Nickel and Dimed and how is showed how it is all stacked against poor people. But what it failed to mention and what some people are failing to mention here is that it isn't your birthright to have all the goodies and to live in a single occupancy apartment with no other people living in the apartment. When I was making crap money I lived in a two bedroom apartment that charged us 1150 a month for it. Did we just have two people living there? No we in fact had three people living there to cut down on rent. In Philadelphia my friend rented a house for about 1500 a month and they had something like 8 people living there.

A phone? A phone costs almost nothing when you have multiple people splitting the bill. A personal cell phone isn't a birthright.

A car? I can get you a car for $500 and you can run it into the ground over the next two or three years or I can get you a bus pass. A brand new Toyota isn't a birthright.

We are talking about medical care people, you claim it's important then you turn around and say it's not a priority high enough to pay for.

He's not claiming that it's not important enough to pay for. He's claiming that, after the higher priority things like food and shelter, for a decent percentage of the population, there's not enough left over to pay for it - food, shelter (and associated costs), clothing, and transportation (to and from the job that allows people to afford food, shelter, and clothing), then health care. For a lot of people, once they get past those first four, there's not enough left for the last, even if they're living in a frugal manner.

It blows my mind that you think this is a good deal.

A plan that caps all medical costs for two 40-ish year old people at between $2,500 and $7,500 per year, and ensures we'll get virtually any medical care we need?

What do you think it should cost to have that incredible level of coverage? Again if I wanted to eliminate deductibles I'd probably have to pay close to $7,000 per year, why is that a better deal?

BTW, my new plan is going to cost about the same, with a slightly higher deductible ($7,500) so I'll be paying between $2,500 and $7,500 per year for all medical expenses for two 40 year olds, a 5 year old, and a 2 year old, with no waiting periods, and no restrictions on doctors. I'm sure it would be a little cheaper in Texas, but I think that's a pretty good deal.

In fact I no it's a pretty good deal because I shopped online, and compared about a dozen insurers offerings. FYI, if I was in NYC, I would be paying about double those rates. Thank god for the NY Commissioner of Insurance and the heavy regulation his office provides to "protect" the citizens of that great city.

Also, what's the deductible on this $200 per month health insurance plan?

Number 488 pretty much sums up why I switched from republican to independent, I realized that most Repubs my age were basically unreasoning judgmental ########...

I didn't join the demos because most seemed like touchy feely unreasoning twits... (not counting those who simply had their hands out)

When I went back to school I worked about 10 to 20 hours a week and it netted me what amounts to $1,000 a month pre tax. With that money I had made a car payment, paid for rent, alcohol, clothes, gas, auto insurance, and food.

Where on earth did you live? Around here, someone living on $1000 a month would, at best, be able to rent a room in a boarding house, and certainly wouldn't be able to afford either a car payment or car insurance.

The solution to the health care debate is simple. Move to where everything costs 17 cents.

It also varies wildly by market. In Springfield, MO, I could easily live on $1,000 a month and buy a crappy health insurance plan. But not everyone lives there, and lo and behold, if everyone did live there, it would cost twice as much to live there. That's part of how markets work.

(And then there are more and more unemployed people each day . . .)

But let's assume you make $1,000 per month. Your needs should be in order, food, shelter, and medical care. Are you telling me that $1,000 per month can't do that?

Not in most places in the North East you can't.

But every area is different, I have a brother in law who lives outside Lubbock, $1,000 month THERE goes further than $2,000 a month in NYC....

This would produce a huge adverse selection problem for the public plan, which would be unable to charge enough money to cover the costs of the sick folks.

Which, of course, is exactly what you guys wants to cause to private companies through guaranteed issue.

Good thing your brother never has transportation costs, or has to buy clothes. And I call BS on the utilities. $100 is very low.

In an apartment? $100 is rather high actually. I guess if you count a cell phone and cable along with electricity 100 bucks is low but there is no real reason to have cable and a cell phone.