Topic: Health Care (split from I am very confused.) - page 5. (Read 4538 times)

This is bad math, and it tends to be more separated by gender among the young.

If you take all the 20 something men over the last decade, tally up every penny that got spent on health care then divide to find the mean. It will be well under the cost of insurance. 20 something men don't get very sick. They do tend to crash cars, get in fights and get injured while drunk. If you are one of those, insurance would pay of big time. If you are not, you are gambling against yourself.

20 something women's health care costs tend to differ based upon pregnancy rates. If you are going to get pregnant insurance may be a good gamble. If you hate kids, save your money.

It is important to realize that Obamacare mandates health insurance among the young to subsidize the old. Not to protect the young.

Healthy doesn't save you from accidents, infections, or cancer. That's why I said everyone is forced to gamble, and that's why healthy 20 to 30-somthings who don't buy insurance because they don't think they'll need it are incredibly dumb.

Woot! Health insurance derivatives!

It's like gambling on the odds you'll win in Vegas over time!

I don't want an award for good character.  This isn't about me.  I want people to get the help they need in an easy and fair manner.



I don't blame myself for the ones I can't help, but they still don't deserve to die or be left in the cold at the whim of my good or bad fortune.



Of course! I'm not saying there shouldn't be consequences for people's actions.  What I advocate is that no matter how badly someone screws up, the bare necessities - food, shelter, health care, education - are not in jeopardy.  Let them lose everything else and restart from dirt-poor again.  They want life to stop sucking?  They work their way out of it.  But leave them in a position where they don't have to literally fear for life and limb while they do it.

People work better and make smarter long-term decisions when they're motivated by desire rather than fear.



Actually, I have not watched the Frontline documentary.  I'm one of those "Don't own a TV" freaks.  That's how I have time to spend on these forums!  

They can tax me.  I'm not a fan of big government, but I'm much more opposed to being forced to pay big corporations.  I would have paid this money to insurance companies anyway, and they'd take 30% for themselves...  Cut them out and the same amount of money that I'm already paying will go farther.

As it is, hospitals are cutting more and more corners and are still constantly on the verge of bankruptcy.  It's mostly due to the large number of uninsured patients that are constantly defaulting.  They would much rather set their rates lower and actually get paid instead of playing roulette with each new patient that walks in.

I know this because I've talked in person to a perhaps a dozen doctors and other workers about it - My GP, ER surgeons, nurses, billing clerks, a cardiologist, psych ward shrinks... Most strongly support a switch to a single-payer system; a few are more ambivalent but think it couldn't be worse than what we have now.


Thanks for saying so.    I hope you don't mind my mostly focusing on the parts where we disagree.



The churches were asked.  They chipped in, but it won't cover it.  Who should, then?  The hospital?  That's who it's going to fall to by default.

I'd rather not have these screwups in the first place.  Do you agree that everyone should be covered some way or another?  By making it universal, we will never have to say "Well, you should have had insurance!  You screwed up!"


How would you fix this problem?


Same here.  I carry catastrophic-only coverage and just pay all my own routine bills in cash.  Sadly, they don't take coins yet.  

Sorry, I'm telling everyone: Just like anything, never pay list price.  Almost all providers will give you the same discount as the insurance companies (about half off for routine things).  You just have to ask nicely.  Some will discount farther if you're paying cash, and they'll still love you as a customer because they hate dealing with insurance companies.  This even works for ER trips that you can't negotiate up-front: they would much rather get paid a fair rate (usually less than a quarter of what you get billed) with no hassles than to have you default.


Bankers have been rigging the system since long before Fannie and Freddie.

Rework your math.

The more healthy friends and family you can gather together in a group, the more it makes sense for that group to "self insure" by saving money and paying for whoever gets sick in cash.

If more unhealthy friends and family you have, the more it makes sense for everyone to buy insurance. That is why there is so much fuss about pre-existing conditions. It's like card counting in Vegas. You can't require the casino to allow card counters. They're not being heartless, they are saying it's not gambling if you've got a sure thing.



Ta Da! You've just become a Republican!

Yes! Employee health insurance has always been a way for employers to reduce payroll. That was the whole point of it. If it increased payroll, they would simply pay the employees a little more, and let the employees buy their own. It has been that way since the invention of employee health insurance. It is a perk to attract a certain class of employees to the company for a lower salary.

Minimum wage companies never offered the perk because it does nothing to lower their payroll. It's not that they're cold unfeeling bastards. It's just that they are in business to make a profit, just like the employers who do offer health insurance.

It is illegal to say, I'm going to give you $3 an hour but free insurance. It is easy for a company to say to higher level employees, you get 10K less in salary, but good insurance. It's not really a deal, but higher level employees are not really that smart either.



If you go to private practices you will find them more negotiable than they let on. It's only business. It's nothing personal.

Why can't I buy this? 

The gap could perhaps be covered by health status insurance.
http://reason.com/archives/2009/03/03/the-health-status-insurance-so.

The short version of the way this insurance works is this: You pay a reasonably low premium. The policy pays out only if you are diagnosed with a new, long-term medical condition. The policy pays out the net present value of the difference between your expected medical costs without the condition and your expected medical costs with the condition over the rest of your life. The payout goes into an interest-bearing trust that can only be used to pay your medical bills or medical insurance premiums.

Essentially, this protects you from getting priced out of the market for catastrophic health care insurance and it protects you from getting into a situation where you can't reasonably afford your non-catastrophic health costs.

Single payer would still be insurance, and thanks tyo insurance being greatly affected by economies of scale, a single insurance monopoly would indeed be the most efficient system. Though I'm not sure if people would be ok with not having a choice as to which insurance company screws them.


The difference is that with healthcare, EVERYONE is forced to gamble, whether you have insurance or not. So, if you are lucky, you'll never need it, and if not, you may be bankrupt. Even if the total cost = total amount paid in, the odds if you needing it are way above the odds of you wasting all the money you put in. So, just from a risk-reward aspect, it's still worth it.
Though, when I was selling life insurance, our recommendation was to buy declining coverage amount that dropped the layout every year, and invest money into a personal insurance fund. After a few year (15+) the client would have enough save up that they no longer need life insurance, since they are self insured. Maybe that could work with health insurance, too, though due to some costs that may arise, that may not be easy.

That's not true, at least for the health care system in the United States today. It should be true in theory, as the insurance companies have to make a profit, but it's not true in practice for two reasons:

1) Tax policy heavily favors medical insurance. Employers can pay their employees in the form of medical insurance and the employer does not pay payroll tax and the employee does not pay income tax or social security tax on the amounts.

2) Insurance companies have negotiated low rates with health care providers while the rates paid by people paying for their own care are kept artificially high by a variety of factors. Essentially, it is not practical for an individual to negotiate for the cost of his health care because you don't know what care is needed soon enough, while it is worth the cost for insurance companies to negotiate the price of each item.

Both of these factors could easily be fixed if there was the political will to do it. In that case, your argument would be correct. Then it would be rational to only purchase health insurance for catastrophic health care or for long-term health status changes. You still need insurance in case you need dialysis for the rest of your life or a heart valve replacement, but there's no reason your insurance company should get a cut of your $40 checkup. (Much as we do with every other form of insurance such as auto, home, and so on.)

This is the most corrupting fallacy.

Total medical insurance cost for everyone is a really simple function to calculate. It is total healhcare costs for everyone, plus considerable overhead.

Over their lifetimes, the vast majority of people will pay significantly MORE for medical insurance, than they would have paid for health CARE had they chosen to save their premiums and pay in cash.

Buying medical insurance is exactly the same as playing the lottery or gambling in Vegas. Sure you might score a big "win!" But in this case "win" means you get horribly maimed or are rewarded with prolonged illness. As Charlie Sheen would say, "Duh! Winning!"

Some people like to complain that most rich people don't gamble enough in Vegas. Middle class people can gamble in Vegas whenever they want. But there are lots of poor folks who want to go gambling in Vegas but can't afford it. That seems unfair. If we mandated that all rich people go gambling in Vegas, then we could use the extra revenue to send free slot play vouchers to the poor so they could go gambling in Vegas too!

Don't get me wrong - I strongly support the individual mandate given the assumption that we need to channel all the funds through insurance companies.  But I think that system of collecting money from employeers, individuals, and generating refundable tax credits is convoluted and inefficient.  I think we'd be better off taking all the money that's spent purchasing insurance and using it to fund a single-payer system.

I wonder how many more people need to die from lack of insurance before people realize that having insurance is a must? Also, the more people buy insurance, the cheaper it gets for everyone. One big reason I am for the individual mandate.

Study links 45,000 U.S. deaths to lack of insurance:

http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917

Then again, you think that cash-strapped churches can pay the medical bills of 50 million uninsured people under the most expensive medical system in the world, so you're really beyond reasoning with.

All of those are quite understandable. Aside from the orphan, I've been on both sides of the family and friends issues.

It is really quite hard when you have to kick out a family member. I'm not going to go into long personal stories on an open forum, but know I've taken people in when they were rightly kicked out by their family. I've helped them get their act together and go back. I've also had to give family members the boot to avoid them taking advantage of other family members. Sometimes we've even turned to government programs for help. They never helped solve anything. But they did help "our burden" to feel better about hemself, by getting off the family's back and onto the back of random government strangers.



The truth is while you were wondering "what if I wasn't here?" Hundreds of folks you don't know took in hundreds of others. All asked themselves the same rhetorical question. It is a great question. It helps us all do the right thing. If you give that rhetorical question a trivial answer you change human character.


"Good character" is an award we give ourselves for doing the right thing. When the trivial answer becomes, "See someone in need? Dial 811" we all lose our test of character.


There is a rule of the sea that says, "Captains must render aid in times of distress. Unless it puts their crew in jeopardy. Then aid is rendered at the Captain's discretion." It's a really good rule. It has been around for a really long time.

You can't blame yourself for not being able to help. You can second guess other captains who worry about their own crew. But you don't get to override them.



I have to admit, among myself, family, and friends when one of us is down on our luck, there is a 90% chance we screwed something up ourselves to cause it. This doesn't excuse extreme interpersonal callousness. But acknowledging the problem is the first step to recovery.



Quite frankly I watched the Frontline documentary too. At the end they point out that no existing universal healthcare program pays for itself. They all run in the red. And every time they try to raise healthcare rates, the people protest in the streets. So they cut medical provider's pay, cut services, and raise taxes. We are already there.


Woot!



That's not how churches work. They help people who ask for help. They don't just send random checks.

But either way, if his mother paid for his screw up or the hospital did neither is right. If the government mandates that you and I pay for his screwup, that doesn't make it right either.



You summarized things quite nicely. But I think the root problem is people all ready feel they are "entitled" to not pay their medical bills. This causes the pricing problems you noted.

There is a brilliant guy named John Wanamaker. He invented most everything you see in retail life. Clothing stores had the same credit problems that healthcare providers currently have. It turns out stores invented credit before they invented regular payment plans. Wanamaker fixed the situation by only transacting in cash. That gave him the lowest prices and he ran everyone else out of business. His book will blow you away! He invented price tags, labels on clothing and the money back guarantee for christ sake! Before that retail was a complex scam of salesman bullshit on quality and customer haggling ability on price.

I go to the dentist and doctor and pay cash. It is amazing the prices you get and how good the service is. (Shhh! Don't tell anyone!)



Once the policy was established that the government must guarantee these "entitlement" loans, absolutely it was game on for the bankers. I don't believe, however, it was the bankers who invented the concept of mortgage entitlement. That is not in their nature.

Clearly there were "good intentions" paving the Fannie Mae Freddie Mac road to hell.



Me either!

One was disowned by his family when he came out of the closet.  Neighbors?  They don't care about some guy they've never met renting a room in an apartment in the city where he recently came to take a job.  Friends?  Well, I stepped in, but I was the only one.

Another was dropped by his quite Christian family who felt that his mental health problems were a personal failing and so he didn't deserve their help.

Another one is an orphan, no family to fall back on at all.

So yeah, I took up the slack, and it worked out for them.  But what if I wasn't here, or what happens during the lean years when I can't afford to keep a spare room open for charity?  Sometimes the support network is there to take care of people, but sometimes, through no fault of their own, it just isn't.  This is too important to leave to a game of chance where some people just get screwed because no one wants to help.


I think you missed mine: While I'm doing this, everyone has treated me like I'm an absolute freak for wanting to help people.  It was really crystallized for me when I was talking to someone's mother to help cover the $15k of costs we were looking at.  She couldn't afford to help - fair enough - but could not understand why someone who was "just a friend" would even be trying.  That blew my mind.  (And in that case we ended up unable to do anything for him...  It was tragic.  )

It is completely inconceivable to most people in the United States - not all, but most - to help each other when they're down on their luck.  The persistent attitude is "Well, they must have screwed up to get there.  It's their own fault!"  I am fighting that cultural flaw, but until it's fixed, we need some systematic way to deal with this.


Of course not.  These things have to be carefully designed or they go wrong.  Obamacare is a mess - all the worst of big government bureaucracy, insurance companies, hospital billing practices, useless oversight, and so on all rolled into one big steaming log.  It's another screwup like Fannie and Freddie, just a thin veil of a worthwhile program in front of something designed to funnel a bunch of money for some particular group (insurance companies in this case, who're going to be raking in the dough from the absurdity of mandatory insurance.  What possible economic sense can that kind of market distortion make?  Cut out the middleman who has a vested interest in taking a percentage of ever increasing costs, and just pay the damn bills).

But that doesn't mean it's impossible for the government to do it right.  Every other first world nation manages a national health care program.  Why can't we?


I'm absolutely in favor of this - basically any program that can be pushed to a more local level will do better there.  When I say we should have the government involved, I don't mean the feds.  The more competing systems we can have, the better.  Health care has some ugly jurisdictional issues that make it hard to do locally, but it's not impossible.  Regardless, I completely support the principle.


The libertarians called on the churches to help out.  The churches failed to deliver.  His mother ended up with the bill.  Either she paid for his screwup, or she defaulted and the hospital eats the cost.  Either way, how is that right?


They can't deny emergency care, but there's no mandate to provide preventative care.  People get a minor infection that could be treated with a simple round of antibiotics, but it goes untreated until the infection goes systemic and they have to put them up in the ICU for $5,000.  Of course most of the time people are defaulting on hospital bills, so they jack up his (and everyone's) bill to $30,000.  They default, the hospital writes off the losses, we all end up paying for some of it, and the occasional guy who had some money but no insurance gets stuck with a $30,000 bill for some random 1-day ER visit.

"Entitling" the doctors to get paid means we can deal with this with for a $70 doctor visit plus $30 of antibiotics.


Indeed, how could it not?  Given such, how can you not see that this was intentionally, maliciously a creation of rent-seeking bankers?


Absolutely.  I wasn't trying to single out the irresponsible buyers.  The whole system is a self-perpetuating mess designed to keep raising prices to extract ever more money into the hands of bankers, realtors, and all the others you mentioned, while people own ever diminishing percentages of their homes...  The buyers are just useful idiots.  I still don't feel sorry for the idiots. 

I respect you for doing the right thing. Everyone should do the right thing. The government should not give people easy excuses to avoid personally doing the right thing.

But I also trust, that someone as righteous and intelligent as you, asks questions and evaluates people in the process of taking them into your own home. So I put the question to you, "How come nobody else saw fit to help the folks you took in?" Where were their family members, friends, and neighbors?

But realize you made my point. Failing, family, friends, and neighbors. Community members step in. Helping community members is in every community's self interest.


I respect you for creating this safety net. I'm thoroughly in favor of the way you implemented your safety net. It was practical and I presume had demonstrably successful results.

The same is not true of *any random* safety net implementation. And the broader you make one single net, the weaker it becomes.

I propose each individual community should provide their own safety nets. That gives lots of examples to aid evolving toward the optimal configuration. There is a lot to be said for people voting with their feet. Curiously, the net migration patterns depicted in the census seem to show people moving from high safety net states, to states with lower safety nets. Correlation is not causation. But over time, evolution favors what works.



I'm pretty sure I wouldn't call libertarians those who dedicated their mortal soul to helping the needy. However, he died in the hospital after receiving proper care. There was nothing additional medically that could have been done for him. The safety net worked.


He didn't take responsibility for his bills before he died. He didn't leave money to pay his bills after he died.

You are claiming he is entitled to not pay for his healthcare.


That makes your point is moot. In your view, he got what he is entitled.

My view is that he acted irresponsibly. As such he was a drain on his family, friends, neighbors, and community. Someone did pay for his care. I don't know who. But it was either family, friends, neighbors, community, all of us as citizens, or the doctor and hospital simply donated his care.

Curiously, doctors and hospitals are mandated by law to provide this safety net. They don't get the luxury of deciding to only work for paying customers. So in reality, the remainder of the safety net only "entitles" doctors and hospitals to get paid. However, now you have a situation where the government decides both whom is allowed to perform a service AND how much they are entitled to get paid for their services.

If this concept was applied to my chosen profession. I would quit practicing and change professions. But I'm just an asshole who thinks I'm entitled to personal free will.



Quite frankly there was plenty of corruption to go around, but I don't think any of it originated in malicious intentions. Congress and multiple administrations mandated that people be relieved of the responsibility of having to qualify for a traditional mortgage. Once they created a mortgage entitlement, all the corruption follows naturally. How could it not?



Woot!

I actually hold a whole lot of people MORE responsible than I do the mortgagees. Curiously, houses do not cost what people are willing to pay. They cost what banks are willing to loan.

There are endless experts involved in purchasing a home. They all gave corrupt advice. Banks are supposed to be experts in how much to loan. Real estate agents, loan brokers, title companies, appraisers, inspectors. All of these people hold themselves out as "experts" in the industry. It is impossible for them not to realize that prices were in a bubble. All of them advised against what should be common industry practices.

You wouldn't let doctors get away with advising healthy patients to take out healthy kidneys. Then blaming the patient for their stupid decisions because they didn't disregard the evidence presented to them by a series of expert physicians.

No, they do not.  A lot of people fall on hard times and nobody helps.

I do my part.  I've taken people into my home until they could get back on their feet.  I've paid hospital bills.  I've bought the medicine to save someone's life.  But it's not the norm, and so much so that when helping people I frequently get asked, "Why are you doing this?  What's your angle?"  There's no scam, I'm just doing what's right, and people cannot believe that's the case because they've never seen it happen before.

People should be entitled to a minimum safety net.  Food.  Shelter.  Health care.  Education.  From there, go earn the rest of what you want.  Having those things as a given makes people more productive because they'll start ventures that they could not risk if they were afraid to quit their job and lose their insurance, or be afraid that they'll starve to death if their business fails.


Apparently those people are enormous hypocrites.  Last I heard they'd only covered about 10% of the bill.


This is not a "left" problem.  This is a "corrupt politician" problem, and they're available across the spectrum and from all parties.

I'm not saying that to defend the left.  I consider myself neither leftist nor a Democrat.  I own too many guns for that.    And I have a load of other issues with the Democrats, but I'd rather not divert there.  In many issues I swing libertarian, but I don't take that label either; they foam at the mouth when I talk about social safety nets.  The fact is I have complex views that defy all the common labels.  Anyway, my point is that I'm pretty neutral, and not just knee-jerk defending one side.


This isn't leftists/liberals/socialists.  This is immoral bankers who bought corrupt politicians (across the whole spectrum) and created a system where they could make money by creating piles of terrible loans, skimming off some fees, and dumping them before they ended up with any responsibility.

This was never about helping people get housing.  That's the cover story, but it was always about making bankers rich.


I ask no such thing.  They fucked up too and bear the moral responsibility for taking on debt they couldn't possibly pay.  I don't feel sorry for them.  They were being irresponsible too, so fuck 'em.  I still think they're entitled to have some kind of cheap roof over their head, but they deserve to lose their house and go spend some time in the projects until they can get their act together and start paying for something better.