

Unaffordable?
The problem with this analysis and these judgments is that "unaffordable" runs a range of personal definitions from "it's physically and financially impossible" to "I'd rather spend the money somewhere else because paying for health insurance will really cut our/my lifestyle."
There's no doubt that there are millions of people in poverty who simply can't afford any form of health insurance, but based on my observations and experience, there are also millions who choose to gamble with their health care costs for any number of reasons. The problem with this sort of gambling is that society is left with the choice of either (1) picking up the costs in one way or another, either through higher insurance premiums for those who pay, or through longer waits and less adequate care for everyone, or higher taxes on lots of someones or (2) denying care to those who cannot pay, and letting people suffer or die. It's politically quite clear that the second option is not feasible, at least not overtly.
Moreover, as health care costs continue to rise, and they will, given the remarkable advances in medical technology, insurance costs will also rise, and more and more individuals and families will be tempted to opt out of insurance as costs of care and insurance increase... because those costs will reduce the funds available for other goods and services.
Every day, my wife and I see this happening. I've mentioned how many students lack health insurance because their parents won't pay for it, although most plans will cover [if the parents will pay] students through ages from 21-25. The university discontinued its student plan because not enough students would opt for it. In many cases, the parents have incomes above the cut-offs mentioned in the plans now before the Congress, but choose not to pay health insurance. They take vacations, buy new cars, and many even have toys such as snowmobiles and ATVs. Their children also have cars and cell phones and don't have any trouble eating out whenever they want. They do protest that they can't afford sheet music and text books, but they do have all sorts of electronic gadgets.
But... many of these people are among those protesting the President's push for health care reform. People are now screaming that requiring insurance will squeeze people, force small business to close if they're required to come up with insurance for employees, and they're furious about the idea that those families who make more than $66,000 (or $88,000 in the other legislative proposal) will have to pay thousands in tax penalties if they don't buy health insurance.
But who is supposed to pay for their health costs if something goes wrong... as it often does?
Let's look at this in terms of a personal example. My wife and I are fairly healthy individuals, and for ten years after she took her position here at the university, we incurred relatively few major medical costs. Then some eight years ago, we took a vacation to
The total savings of the average 60-year old male in the
As I discussed earlier, medical cost savings are close to a red herring. The rate of cost increases may be held down, but total medical costs aren't going to decrease -- not unless we decide not to treat people or to treat them a lot less extensively.
The entire issue is about who's going to pay for what... and how, and all the arguments avoid that basic issue. Those who are covered now don't want their coverage costs to go up and their benefits to go down, and those who aren't covered seem to want someone else to pay for their care. In some cases, particularly in cases of documented poverty, it's clear that people need help, but it's also clear that there are more than a few people out there who claim that health care insurance is "unaffordable" because they want a standard of care they don't want to pay for, and they resent the possibility of being told that, one way or another, they're going to have to pay the bill one way or another.
So... the questions remain: "unaffordable" for whom, and why do so many claim it is unaffordable, given the American standard of living?
I pay a lot of money for insurance that does me little good. With a special needs child, I have learned all about pre-existing conditions and pre-approval requires and the far too frequent denial of coverage. My insurance does so little for me that it's a joke. Yet, if I drop it, I could be fined?
I am already paying outrageous doctor's fees. And rationing heath care isn't going to improve that situation at all, it will worsen it. What rationing means, in realistic terms, is that the elderly and the disabled will be denied services beyond the "routine" and "normal."
At the same time, working in the cardiac ICU, I see abuse of the current system. My tax money, and your tax money, goes to pay for bypass surgery on people who were not compliant with medication and lifestyle changes after the first heart attack. Yet somehow I am expected to believe that they'll be compliant this time? I've even seen prisoners serving life sentences come through the ICU of a private, for profit hospital, and receive life extending services. We pay for that too.
So there is no doubt in my mind that the system is broken. But I think the cure is worse than the disease. The problem is that I have yet to hear any solution to the problem that makes sense and would actually work.
This has many benefits over the current system, and in my view would be much preferable to the proposed systems.
You don't need insurance for expected, low cost problems such as auto repairs, home repairs, dentistry, or outpatient medical care. Yet, for some reason, many people insist that everyone must have full-coverage health insurance. Why? Forty years ago, almost no one had full-coverage insurance. Many didn't have catastrophic health insurance. Yet, somehow, most people got medical care without government handouts or private charity.
The urge to emulate nation-wide the failed health insurance plan of Massachusetts baffles me. This approach does not save money. Health insurance dollars designed to cover routine care are mostly wasted. Government-mandaed full-coverage insurance encourages waste and rent-seeking among hospitals, physicians, and drug and medical supply companies. The way to reduce medical costs is to use the market: when everyone pays out-of-pocket, there will be more discussions about the need for expensive tests, MRI scans, or costly new drugs. Otherwise, we'll get government-controlled health care with its high bureaucratic burden, resistance to change, indifference to the individual patient, and over-regulation of clinicians and other healthcare providers.
For the basic level of insurance, you pay some 120 Euro per month (children are cheaper). Sowing your leg back on after an accident is covered, many medicins, etc. Several small things do carry a small fee just to discourage people going to the family physician twice a week. And there's an upper limit for dental care.
You can opt in for more elaborate insurance to also partially cover glasses and more dental care and so.
We're not broke yet as a country :-) And there are basically no complaints about the mandatory insurance as everyone is used to it for decades.
Everyone I talk to here in the Netherlands thinks just the opposite way: "What an idiotic health care system do they have in the US. It looks like a backward third world country. No insurance? Impossible..."
What you're used to colors your perspective. On both sides :-)
I think Mr. Modesitt is absolutely right when he says there is no way, even for America, to provide the highest level of care to everyone for their entire lifespan. It certainly doesn't happen here and I get very annoyed when our politicians prattle about having the "best healthcare system in the world", Hmmph!
What we do have is slooooow treatment for everyone during their earlier years (a bit faster for kids) but when you reach those golden years....well let's just say they'll go through the motions but that's about it. Yes, I know whereof I speak my father and both my in-laws have passed on and my mother is receiving neglect, er treatment, currently.
Also I have seen a lot of waste of money/ resources due to poor management and government bodies that are part of the health care system but which eat up a lot of money and provide zero tretment for patients.
No government run bureaucracy can ever possibly run as efficiently as a private run structure, further structure after bureaucratic structure will be added to the administration over the years. You all know it is true.
I have no answers but one suggestion - do not go for a full governmental structure. Period dot.
And one warning :-) Distrust anybody who insists there are simple answers.
The free-market is a powerful tool when the question is only about money. The problem is that health care, like social security, isn't just about money. It also deals with standards of living and the moral fabric of society and the question: How much should we help those who can't help themselves?
And I would note that Mr. Modesitt is absolutely right about some people not making health insurance a priority in their finance decisions.
And why should they buy full-coverage health insurance? All most people need is catastrophic health insurance. Everything else can be paid out-of-pocket. And, if they have enough money, they don't need catastrophic insurance.
All the government approaches to health care financing are about making people pay for something they don't want. The current Obamacare plan wants everyone to buy full coverage health insurance, which is a vast waste of money. Obamacare also wants distorted premium structures so that younger and healthier people pay more than they should so that older and sicker people will pay less. Rather perverse incentives, aren't they? But, Obamacare isn't about us, and it isn't about our health. It's about increasing the power of our national nannystate government.
As I see it, many commentators are using wedge issues to push aside the main question. It's true that society may not want to pay for every new treatment for elderly citizens who are terminally ill. And politicians who are against universal health coverage may focus on that issue to excess in order to gain votes from the older demographic. You can also focus on those who could by insurance at present, but don't. Nevertheless, this is a bit of a red herring, it isn't really the primary issue at stake.
Universal health coverage would effectively redistribute money toward low-income families. But it wouldn't simply do so in the manner of a standard progressive tax cut in their favor. The real impact would be increased security for those people, and a feeling that society is less indifferent to their fate. For many people, even the prospect of paying for a few doctors' visits and prescription drugs, let alone an MRI, is already a very troubling one, because they simply don't have any extra money to throw around. 1000$ of extra medical bills in a year could be the difference between making the rent and not making it.
Now, I'm clearly not saying that society needs to help the poor buy shinier things and bigger houses. But a few relatively small changes, like guaranteed health coverage, might make it possible for those with a low income to maintain a decent quality of life in spite of it, and consequently make society stabler and happier in general.
Safety breeds laziness and a sense of entitlement.
While I agree with this in principle, it is unfair to allow those with no choice to be afflicted by this negative feedback. One of the jobs of society (in my opinion) is to provide negative feedback which is just or fair. So, it must be both fitting and proportionate.
If people don't want to pay, they deserve to suffer: true. However, a good society should somehow remove or mitigate the consequences of that choice from others.
For example, children could be removed from family units that do not properly care for them or those foolishly choosing family units could be prevented from procreating. Or, government could just pay for it by taxing every other citizen to pay for the inability or foolishness of those few. Unfortunately, no solution to that problem is free. Even ignoring the problem engenders a societal cost in terms of a damaged and/or underperforming citizenry.
Many solutions exist, and none will satisfy every citizen, but, solutions DO exist. True economics must account for the realities of human nature and not pretend that moral ideals are the solution; they are the goal.
This is where I differ from libertarianism: unfettered human nature must devolve into a demagogue-driven chaos just as surely as pure democracy. Societies need a dream or set of moral ideals to pursue.
It's as if I told a crowd of a hundred men that whoever could survive the most lashes from a whip would win a piece of chocolate cake and a medal. And everyone becomes so focused on the medal and the cake that they just line up to get whipped, and pat each other on the back for their ambition and their work ethic. In the end one person is eating the cake and everyone else is lying on the ground bleeding, thinking if they had just worked a little bit harder, just stood a little more pain, they could have had the medal. And what does the man with the cake say while he's soaked in blood and has chocolate dribbling down his chin? He says, you people shouldn't have such a sense of entitlement, and proudly shows everyone the medal pinned on his lapel.
Perhaps I can quote an earlier post of yours, "... belong on radio talk shows or a political blog, and make me disinclined to take his argument seriously." Believe me, I sympathize with your point, but I believe you do it an injustice by making your response so emotionally charged.
Also, please note that I specifically stated that negative societal feedback should be proportionate and fitting. I don't believe that "... soaked in blood and has chocolate dribbling down his chin" fits that description.
I'll agree with this only on one condition. If this is in reference to anything but capitalism it is true. If not...
Productivity is the choice of the producer. The benefit ought go to the producer, call me Randian, but I don't think its the place of society to dictate the 'value' or 'meaning' of something other than what they are willing to pay for it.
Productivity in Capitalism has immense meaning to the producer, because they benefit directly.
The whipping arguement above seems a little out of context with the current U.S. system, because we don't actually have whips involved in our system. Our system uses money, the sting of which I prefer. With any system other than capitalism the whip becomes all too literal.
With healthcare though... you get what you pay for.
In my whipping argument, the money is clearly supposed to be represented by the cake, prestige by the medal, and labor by--being whipped. My point was actually that people will sometimes go through a great amount of pain for things that really aren't worth that much (prestige and large quantities of money), when a good life could be obtainable with more imagination and less effort--for instance, vacation time and a public library card. Most Americans, despite, or indeed because of, their labors, seem to lack both. American capitalism isn't the root of these problems, but it can encourage and even demand a similar attitude from anyone who wants to live a decent life. I have to ask if it's really necessary. And of course... those at the bottom, who don't possess the talents needed to get ahead still wind up getting whipped anyway.
It is not the governments job to subsidize a lack of talent. If we are defining happiness by vacation time and lack of labor, then technically those in our welfare system must be quite happy. I mean, thinking about it, work isn't neccesary and yet their needs are still met.
Hard work is not the problem. Never has been. Lack of motivation to work, now theres your malfunction.
We have socialized police, fire, military, school systems, etc. So it has been deemed that it is ok for everyone else to pay the police for the investigation and apprehension of a robber of a wealthy person. But it is apparently not appropriate for us all to pay for cancer treatment for an uninsured single mother of four living from paycheck to paycheck?
America is supposed to be about the right to pursue life, liberty, and happiness. I feel that it is hard to do that if you have to balance the needs of paying for shelter/food vs. insurance against something that may happen to you or yours down the line. Are there many out there that waste their money on frivolous goods? Of course, but how can we punish others for their waste?
Even having good insurance as Modesitt pointed out is not a guarantee, how can anyone tell a parent they must weigh the choice of expensive life-saving treatment for a child vs. their share of the cost? Something that will inevitably lead to them falling behind on payments and gaining bad credit, in turn losing their house or worse. All because they chose to save their child. I know their are programs out there to help, but it is a guarantee that not all are saved from financial catastrophe. Making a decision like that is not one that should ever have to be made.
If your house is on fire the firemen don't wait until you pull out your fire protection insurance card to verify that you have paid for insurance to put the fire out. They just do it, because we all pay into the system so that everyone is guaranteed some basic level of protection against calamities that impede our ability to pursue life, liberty, and happiness.
So yes, I believe we should socialize health care. Why don't you?
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