Wendy Williams and her husband liked their health insurance plan. The premium and annual deductibles made sense for them, and a more “gold-plated” plan was not worth the money. Yet Massachusetts’ health care regulators disagreed, and forced the Williams to pay a $1,000 fine if they wished to keep their insurance plan — a plan they prefer to a comparable state-approved alternative.
It wasn’t always this way. When the Massachusetts mandate was first adopted, their plan was just fine. But then the rules changed. The state no longer accepts their insurance plan, even though they are fully insured and are not imposing their health care costs on other taxpayers.
If the federal government adopts an individual mandate, Ms. Williams fears her experience could soon replay itself nationwide. She’s right to fear. Once there is an individual mandate, interest groups will flock to Washington seeking to have their preferred treatment or service incorporated into the requirements for acceptable health care plans. Over time, the requirements will grow, and the cost of health care plans for many Americans will increase as a result. Consequently, many individuals who have health care plans that fully meet their needs will suddenly find themselves “underinsured” — and taxed fined as a result.
Anderson says:
Jane Jones and her husband liked their tax payment. Its small size made sense for them, and paying more taxes was not worth the money. Yet the IRS disagreed, and forced the Joneses to pay a fine if they continued to pay their low taxes.
… Underinsured people are free riders. Something catastrophic happens, and they’ll be in the ER, demanding treatment at their neighbors’ expense. The Joneses are doubtless comfortable betting that nothing like that will happen to them, but why should we agree?
October 10, 2009, 9:55 amRyan Waxx says:
Except that she wasn’t underinsured… until lobbyists moved the goalposts. Which is the point of the OP, which you apparently didn’t register.
October 10, 2009, 10:02 amjust me says:
Underinsured people are free riders. Something catastrophic happens, and they’ll be in the ER, demanding treatment at their neighbors’ expense. The Joneses are doubtless comfortable betting that nothing like that will happen to them, but why should we agree?
Actually my understanding is that in Mass the original law required catastrophic insurance which would cover the horrible things that can happen like serious injury or cancer. Mass has decided to change the bar and require the mandated plans include some of the non catastrophic things, but that are covered under many employer based plans.
If we are going to have any kind of mandate, I think it should be the bare minimum catastrophic plans only-but I think the case here is a good one reason for why I am not keen on a mandate. It is too easy to move the goalposts and place a lot of people who worked the mandate into their budgets in violation.
October 10, 2009, 10:08 amDenver says:
Adler doesn’t seem to be able to distinguish between the meaning of “will” and “could.” Methinks this is an important analytical distinction. Would he fail a student who in a paper or exam was unable to distinguish between the present and possible, but not certain, future outcomes?
October 10, 2009, 10:11 amalkali says:
There is sort of the germ of an argument here, along the following lines:
“An individual mandate for health insurance is a bad idea because regulators will unreasonably reject perfectly good insurance policies.”
However, no facts presented suggest that the Mass. regulators are being unreasonable in rejecting the Williams’ policy as insufficient — there is just Ms. Williams’ ipse dixit assertion that that is the case.
Puzzlingly, the linked op-ed notes:
Ms. Williams and her 61-year-old husband pay $300 a month for a “catastrophic care” policy with a maximum yearly deductible of only $1000? I’m not sure that’s possible, even if her husband’s former employer is subsidizing the policy.
October 10, 2009, 10:14 amCareless says:
Well, there is the fact that the state of Massachusetts believed their policy to be sufficient. Was it wrong then, or is it wrong now?
This, according to the article, was the problem
I’m going to take a stab and say that the facts (assuming this is why they were to be fined) suggest the regulators are being unreasonable
October 10, 2009, 10:27 amAndrew Hyman says:
I pay 80 bucks a month for my health insurance. The deductible is high (10K), but the plan suits my needs.
October 10, 2009, 10:28 amAllan Walstad says:
Several commenters here actually seem to think that it’s the pols’ business how or whether folks insure themselves against medical expenses or any other problems. It is not. If the Williamses have failed to insure themselves sufficiently and the worst comes to pass, then in a free society they suffer–unless, of course, some of the commenters here feel like contributing charitably to their aid. In a free and (redundantly) prosperous society, there can be lots of charity. The alternative is to let the goddam pols and bureaucrats sink their meathooks into every aspect of our lives.
October 10, 2009, 10:29 amjust me says:
Ms. Williams and her 61-year-old husband pay $300 a month for a “catastrophic care” policy with a maximum yearly deductible of only $1000? I’m not sure that’s possible, even if her husband’s former employer is subsidizing the policy.
I don’t know the exact details, but you are actually incorrect. A few years back my husband’s employer was bleeding money and he was let go, we couldn’t afford COBRA coverage for him, so we opted to purchase a catastrophic plan. It was less than $200 a month, but I can’t remember the deductible now-it wasn’t more than $1,000 but it may have been less. I do know it covered 2 doctor’s visits with a co-pay before you had to pay full price to start meeting the deductible and there was no pharmacy coverage at all and labs only kicked in once the deductible was met.
The plan certainly wasn’t a luxury plan, and I can’t say how well it would have paid out since he never had to use it during the months until he found a new job with employer based coverage, but my main point is that there are plans out there that exist in that price range.
October 10, 2009, 10:30 amShelbyC says:
Underinsured people are only free riders when they have expenses they can’t pay. In this case, the couple was predicting that if they had $2500 in expenses, they would be able to pay it. The govt predected they would not, and fined them.
October 10, 2009, 10:31 amOren says:
You would be surprised how many people that are nominally covered still end up defaulting on their medical bills. That is, it’s possible that her $300/month policy provides virtually no real coverage.
It would be nice if the WSJ could be bothered to detail precisely which MA requirements are not met by the Williams’ coverage. That would actually shed some light on the core question of whether those requirements are reasonable or not.
[ Edit: Just realized this was in Opinion, not News. OK, that's her opinion, how about the facts? ]
October 10, 2009, 10:33 amChris Bell says:
This completely ignores the state’s view of things, which was that their plan was not sufficient. It’s good that they had insurance, but if the insurance was only partial insurance then they were partial free-riders.
I don’t know if that is right or not, but let’s at least be fair. What happened to the idea that you should state your opponent’s arguments in is best possible light, then demolish it (if you still can). Anything less is straw-manning.
October 10, 2009, 10:36 amalkali says:
@just me: my understanding is that in Mass the original law required catastrophic insurance which would cover the horrible things that can happen like serious injury or cancer. Mass has decided to change the bar and require the mandated plans include some of the non catastrophic things, but that are covered under many employer based plans.
@Careless: [T]he state of Massachusetts believed their policy to be sufficient.
This is not quite correct. The individual insurance mandate was phased in over time in two ways: (1) the standard of coverage required (“creditable coverage”) phased in, and (2) the tax penalty for not having “creditable coverage” phased in.
So it’s probably true that at some point in the phase-in, the Williams’ policy fell short of the requirements, but I doubt that a policy deemed compliant in one year was arbitrarily deemed noncompliant the next year.
October 10, 2009, 10:37 amDjDiverDan says:
So many of the negative commenters here seem to completely miss the most important point – Just who ought to have the choice of what health care plan a consumer pays for out of his or her own earnings, the consumer, or a government controlled panel? And for those of you who would argue that many consumers are just too ignorant to make their own choices, and need a panel of government-appointed “experts” to tell them how to spend their own money, I respectfully refer you to the eloquent arguments made by Abraham Lincoln when he was debating Senator Douglas over the morality of slavery. I won’t take the time to give an exact quote, but his point was that it is morally wrong for one person to assert ownership over the fruits of another’s labor. Well, when the Government asserts the right to control how I spend my own earnings, first on issues like health care, perhaps later on what kind of car I can drive or what kind of house I can have, maybe on where I can send my children to school, even what food I can buy, then that is a small, but important, step toward slavery. When the Government asserts the power to tell me just how I must spend my earnings, it’s time for me, like it was for Jefferson and Adams in 1776, to seek a new government, by whatever means necessary.
October 10, 2009, 10:37 amDavid Nieporent says:
Because we live in an allegedly free society, and it’s none of our business.
Underinsured people are not free riders. People who show up in ERs demanding treatment without payment are free riders. There’s no basis for treating the former as the latter.
October 10, 2009, 10:38 amOren says:
If only there were some way they could purchase a financial instrument to back up their predication in case it’s wrong …
October 10, 2009, 10:42 amMark says:
Read the WSJ article. They have insurance via IBM. They have coverage for cancer, catastrophic. They are simply paying a higher co-pay to keep premiums down. Mass says the max. you can have out of pocket is 2k. They have 2,500.00. I do the same thing w/my auto insurance. My out of pocket for health insurance is 2,500 also. This is insane. They obviously figured out the risk of higher co-pays. If they are in good health. SO WHAT??? So NOW the state of MASS has decided what’s best for who????
October 10, 2009, 10:44 amOren says:
Except that the latter are no more than a randomly chosen subset of the former. No one chooses to get a heart attack or fall down the stairs. They chose to be un(der)insured and then, entire unintentionally, end up unconscious in admitting where we end up with 6-figure bills for taking care of them. People in the ER (in my experience) don’t “demand” anything, they mostly just lie there.
Moreover, in many cases you can’t even expect them to post-pay for the care because the cost exceeds their entire expected lifetime savings/earnings.
October 10, 2009, 10:45 amOren says:
Just who ought to have the choice of what patients to admit to the hospital? Because no one dares to attack EMTALA.
If you have the gut to propose a repeal of EMTALA, go ahead. Otherwise, you’ve already accepted that the government can direct who gets treatment or not.
October 10, 2009, 10:47 amThe Volokh Conspiracy » Blog Archive » Fined for Inadequate Insurance (via postie) | Kantaas.Com says:
[...] The Volokh Conspiracy » Blog Archive » Fined for Inadequate Insurance [...]
October 10, 2009, 10:50 ammjohns2 says:
The government already controls how you spend your earnings on health care, cars, and food. The FDA controls your spending in health care and food and CAFE regulations control what kind of care you can drive.
The government already tells you how you must spend your earnings in general. See April 15.
October 10, 2009, 10:51 amMitchell J. Freedman says:
I hate mandates for the very reason that so upset Ms. Williams, who is, sadly, unaware of the chance she and her husband are taking with a mere catastrophic plan. The mandates make people feel like they are losing their “choice.”
Every time we go down some road that is not Medicare for all, we get into these silly arguments. With Medicare for all, it’s just a straight forward issue with taxes funding the health insurance instead of private taxes known as premiums, co-pays and the like, though I would support a simple co-pay if that is the price of Medicare for all.
Have at me, the statist, if you wish, but to me, health insurance should be socialized in the way that most public utilities are socialized. Most businesses need electricity, so why put them at the whim of private profit? Most of us need health insurance last time I looked, and so why bother with private profit to receive it? I am convinced that if we had Medicare for all, there would be burst of entrepreneurial spirit unleashed for those who have been tied to jobs due to group plans, and small businesses would breathe a sigh of relief in not having to compete with larger businesses that offer group plans. And saving the high administrative costs that comes with private enterprise, and having the government negotiate pharmaceutical product purchases, would save lots of money for the payment of the insurance.
Have at me, boys…
October 10, 2009, 11:08 amAllan Walstad says:
Exactly. Where I come from (culturally), insurance is for expenses we cannot afford out-of-pocket. I have a home, a car, cash in the bank, and a working spouse (who has the same). In order to keep premiums down, I’d be happy with a catastrophic plan that doesn’t kick in unless my expenses go over 10k or even 20k. Who the hell do the pols think they are, imposing otherwise on people?
October 10, 2009, 11:15 amBecker says:
A $2500 deductible is a very different matter for a couple with substantial financial resources versus a couple who is broke and have little or no financial resources. I carry a policy that costs under $100 a month that has $10K/year out-of-pocket cap.
For those of you with employer-paid plans who may be unfamiliar with what an individual may be paying, there are many websites that will give you an idea of costs based on a plethora of options, such as eHealthInsurance.com (not a plug, just the first hit in a Google search).
October 10, 2009, 11:20 amDYSPEPSIA GENERATION » Blog Archive » Fined for Inadequate Insurance says:
[...] Read it. Wendy Williams and her husband liked their health insurance plan. The premium and annual deductibles made sense for them, and a more “gold-plated” plan was not worth the money. Yet Massachusetts’ health care regulators disagreed, and forced the Williams to pay a $1,000 fine if they wished to keep their insurance plan — a plan they prefer to a comparable state-approved alternative. [...]
October 10, 2009, 11:21 amAllan Walstad says:
Most people need food, clothing, and shelter, so why put them at the whim of private profit? Every time we go down some road that is not socialism, we get into these silly arguments about “choice.” With socialism, it’s just a straightforward issue with everybody working for, being taken care of by, and most importantly OBEYING, the state. And since socialism is proven both in theory and practice to deliver better goods at lower prices, well, Mitchell J. Freedman has really hit the nail on the head. (Or perhaps his head on the nail?)
October 10, 2009, 11:22 amMIke says:
I’m generally supportive of health care reform but I agree with the sentiment of this post. Different people value modern medicine to different degrees. Many people may prefer to gamble against certain possibilities for their future. The trick is, creating a system that doesn’t allow them to change their mind.
For instance, if X percent of health costs are typically incurred in the last few months of old life, I’d rather save X percent now and buy a plan that in effect doesn’t spare me those few months. I think that is fine and fair, unless, when the time comes, I decide I actually want those few months.
In an unregulated market, I’d be stuck with the insurance I have and I’d get what I paid for. But there are other, important reasons to equalize access to health care. This, seemingly, opens the door for me to change insurance after I’ve changed my mind, thus gaming the system. Protecting against this is a difficult challenge, one strategy of which is to have minimum requirements.
October 10, 2009, 11:29 amThe Unbeliever says:
And forcing retired IBM employees to pay $500 less out-of-pocket solves this problem… how, exactly?
October 10, 2009, 11:35 amegd says:
I figure I’ll just take this one on, because it’s symbolic of the rest of your point without addressing the moral/ethical issues of health care.
When government controls electricity, what rate does it set for each kW*hr (or base unit of energy consumed)? Or more importantly, how does it know what rate should be set for every 3.6 MJ?
Whatever rate the government sets, some businesses will be priced out of the market. Once they start setting the price below operating expenses, the government has to make up the difference by taxes. Therefore, price must be set based on a calculation of employment, potential tax returns, employment and raw material costs, and the economic impact of deficit spending.
A very difficult proposition. And the decision making is controlled by political whims.
But compare a private company running electrical companies. The private company comes out, measures its costs at $0.10/kW*hr, realizes it can make a huge profit, and sets the price at $0.20/kW*hr. Some businesses will pay it, and others will go out of business. But then someone will realize that with operating costs of $.10/kW*hr, he could make a handsome profit selling energy at $0.15/kW*hr. Maybe not as much as the last guy, but he’ll push the first operator out of business and have control over the market.
Soon, through competition in the energy market, electricity falls to $0.11/kW*hr, a price just over operating expenses with minimal profit. Market actors will then try to further refine the energy producing process to cut operating expenses even more, say to $0.05/kW*hr. At that point, profit jumps from $0.01/kW*hr to $0.06/kW*hr, without increasing prices to the consumers.
In short, Capitalism works because there’s an individual incentive to produce a better product. And consumers will seek the least expensive product to meet their expectations.
Socialism doesn’t work because there’s no individual incentive to produce a better product. There’s no incentive to lower prices, except at the expense of increasing taxes.
Even shorter: (to paraphrase XKCD) Capitalism, it works.
October 10, 2009, 11:43 amLarryA says:
My wife and I have been looking for a catastrophic policy, as she isn’t covered at work and I’m searching for a job.
Under Texas law, any standard health insurance policy must cover OB/GYN services, including pregnancy. Any plan that covers pregnancy must cover in-vitro fertilization.
As my wife and I are both in our 60s and have raised all the children we want to, we are “comfortable betting” that we won’t need coverage for pregnancy and in-vitro fertilization.
We also feel that if we want some of the other mandated services, like acupuncture, we can manage to pay for them ourselves.
But just so we won’t be “free riders,” the government is protecting us.
October 10, 2009, 11:43 amAllan says:
I have little sympathy for them. $80/month for these people is diddly-squat. If it were $800/month, they might have some sympathy.
When there are rules, there are arbitrary lines. If IBM had a $1,500 deductible plan, these guys would not be complaining. In fact, if IBM had a $2,000 deductible plan and just charged another, say, $200 a year to make up the difference (assuming 45% or so would spend the $500 extra), wouldn’t that solve the problem? There are many solutions to this…
And IBM is likely subsidizing the health care. IBM gets tax relief for the subsidy. That is, we are all paying for these people’s health care.
Finally, these guys could just leave Massachusetts. Isn’t that what conservatives predict will happen if state taxes are high? New Hampshire, Vermont, and Maine are really close.
No sympathy from me. None at all.
October 10, 2009, 11:45 amA. Zarkov says:
While the Massachusetts legislature has the authority to pass a health insurance mandate, the Congress does not. Mere existence does constitute engaging in interstate commerce. If it does, then my two cats along with my furniture engage in interstate commerce.
Now on to the free loading issue. If medical bills were not dischargeable in bankruptcy, then individuals would have a great incentive to purchase adequate medical insurance. We should try this first before going down the road to national health insurance. I think the free loading problem is simply a red herring.
October 10, 2009, 11:51 amalkali says:
@LarryA: Under Texas law, any standard health insurance policy must cover OB/GYN services, including pregnancy. Any plan that covers pregnancy must cover in-vitro fertilization. As my wife and I are both in our 60s and have raised all the children we want to, we are “comfortable betting” that we won’t need coverage for pregnancy and in-vitro fertilization.
I may be way out on a limb here, but I’m guessing that the health insurance companies setting premiums on their policies also have some idea that 60-year-olds generally don’t wind up pregnant or in need of IVF.
October 10, 2009, 11:52 amPintler says:
I have a little hobby of seeing how little I can spend on transportation. I have two vehicles, one one 23 years old and one 31 years old. The windows work with those quaint cranks, and you have to push the lock buttons yourself. They have to meet some basic safety requirements, e.g. the lights have to work. That’s a far cry from being fined because the government thinks my transportation plan is insufficient.
As others have alluded, I think the crux of this problem is the idea of mandating the same coverage for everyone. While we as a society provide some essentials such as food and shelter to those who cannot provide for themselves – the aged, infirm, children (and as a byproduct, mothers), we don’t supply those to the able bodied. Go down to the social services office and say you are healthy but would rather be a climbing bum or artist than work, and would like to have food and shelter provided. I don’t think you’ll get too far.
For health care, though, we’re not just saying that everyone has a right to health care, we’re saying everyone has a right to the same level of care. The public housing we’re providing is better than life on the street, but it’s not a nice house in the burbs. For health care, though, the discussion doesn’t seem to be that we should expand charity public health clinics for the indigent, it is that the indigent should have access to exactly the same care that everyone poorer than Bill Gates has.
Our health care system has a lot of structural problems, but merely extending the same flawed system (the lack of individual incentive for cutting costs, etc) to all comers isn’t going to fix any of those problems.
October 10, 2009, 11:56 amPeter Twieg says:
The relevant question is how large the difference between the Williams’ defaulting on a $2500 deductible and a $2000 deductible is, and whether this is worth forcing them to change plans. Given that the former probability is probably near zero, the latter is almost surely “no.”
I’m amazed by the confused language regarding free ridership here. Usually free ridership is associated with those who aren’t insured against catastrophic coverage, not against those who could hypothetically default against any medical fees under any conditions. If “free riding” were a relevant blanket concern for requiring first-dollar insurance in any insurance market, then you could argue that we should have first-dollar mandates in all risk markets where costs can be imposed on the taxpayer. Is that really what people are arguing here? Or do we recognize that at some margin you have to trade off the moral hazard of people passing their costs to the state via default versus the moral hazard of people passing their costs on to insurance companies by having first-dollar coverage? Are we supposed to be insuring individuals here, or the government itself against the burden of having to pay for defaults?
October 10, 2009, 12:03 pmThe Unbeliever says:
I call BS. From the article, my emphasis:
$80/month is a straight 2.6% shaved off their income, without receiving any benefit except a potential savings of $500/year in the future… which they could completely cover if they tossed half of that monthly premium into a savings account.
Assuming an accurate portrayal in the article, these are the responsible people. Planned their retirement, paid off all the major life expenses that usually prevent people from financial recovery after a medical emergency (i.e. mortgage), and did a careful appraisal of their health care situation and their anticipated future needs. These are not the young kids who drop insurance to get beer money, and cost taxpayers money when they show up in the emergency room; I’d venture to say this couple has put more serious thought into their health care situation than 90% of the people criticizing them.
Why should they suffer a deadweight loss of 2.6% of their income? If the state came to you tomorrow and started taking an extra 2.6% out of your paycheck to pay for “the greater good”, do we tell you to quit whining as well?
Oh, well, if we’ve already given up on rationality in public policy, then by all means. Go ahead, turn us into state-dependant financial slaves, 3% at a time.
October 10, 2009, 12:11 pmDove says:
Except that that’s not at all what happens when “underinsured” simply means “deductible over $2000.” On a plan with a high deductible of $2500, the unfortunate may show up in the ER unexpectedly, but the plan pays for all but $2500 of the treatment. That’s the absolute maximum the public could be on the hook for, and requires assuming that the injured somehow couldn’t handle the debt.
The risk to the public seems very small to me. If it seems intolerable to you, I suggest that the cheap way to mitigate it is to require those with deductibles of any amount to prove they have equivalent savings. Or if the worry is services such a discount plan might not cover, a simple solution would be to maintain a list of treatments hospitals must provide even to uninsured along with the typical cost. The state could then require that every individual either provide proof of insurance for each treatment, buy such insurance a la carte from the state, or provide proof that they could meet the typical cost. Or perhaps even sign a DNR-style waiver refusing the treatment in advance.
If the goal is to minimize free riding and cost to the public, there are low cost (to the public) ways of doing it. But creating a one-size-fits-all list of things a plan must cover is costly to those who have the means to make another choice and prone to abuse by those who might like to interfere with the industry. Imposing hefty fines for high deductibles doesn’t even begin to make sense. These are not efficient strategies for protecting the public good. They are methods for politically attacking individual insurance players or raising money for the state.
October 10, 2009, 12:17 pmCareless says:
Among the problems with your post is the fact that these people have nothing to do with IBM.
October 10, 2009, 12:18 pmpublic_defender says:
This statement is misleading. The story has nothing to do with interest groups seeking to get the state to mandate their services. Massachusetts set a $2000 limit for out-of-pocket expenses. Their plan has a $2000 limit. If Massachusetts requires $25K in auto liability insurance, would the Williams complain that they should only have to buy $24K?
If you’re going to require private insurance, you need standards as to what’s good enough to count. Maybe the out-of-pocket limit should be $2500, not $2000. But maybe it should be $1500 or $3000, In any case, a line has to be drawn, and this line is well within the bounds of reason.
October 10, 2009, 12:24 pmThe Unbeliever says:
I call BS. From the article, my emphasis:
$80/month is a straight 2.6% shaved off their income, without receiving any benefit except a potential savings of $500/year in the future… which they could completely cover if they tossed half of that monthly premium into a savings account.
But you missed an even bigger point. From the article again:
So it is a matter of $800 a month! I eagerly await your outpouring of sympathy, triggered by an arbitrary number. It’s nice to know that confiscatory schemes’ morality is capped at 16.6% of one’s income.
Assuming an accurate portrayal in the article, these are the responsible people. Planned their retirement, paid off all the major life expenses that usually prevent people from financial recovery after a medical emergency (i.e. mortgage and credit cards), and did a careful appraisal of their health care situation and their anticipated future needs. These are not the young kids who drop insurance to get beer money, and cost taxpayers money when they show up in the emergency room; I’d venture to say this couple has put more serious thought into their health care situation than 90% of the people criticizing them.
Why should they suffer a deadweight loss of 2.6% or 16.6% of their income? If the state came to you tomorrow and started taking an extra 16.6% out of your paycheck to pay for “the greater good”, do we tell you to quit whining as well?
Oh, well, if we’ve already given up on rationality in public policy, then by all means. Go ahead, turn us into state-dependent financial slaves, 3% at a time.
October 10, 2009, 12:25 pmPersonFromPorlock says:
The idea that because the people of Massachusetts choose to provide health care to individuals, they establish some claim on those individual’s behavior is basically wrong: the health care is a gift, pure and simple, and giving it gives the state no more power to compel behavior than giving any other gift does.
October 10, 2009, 12:26 pmCT_Yankee says:
There seems to be a lack of understanding in many comments of what it means to be under-insured, or to have a high deductible. If one of this couple falls and breaks a leg, they pay out of pocket until the annual D (deductible) cost exceeds $2,500. If one gets cancer or something expensive, the policy pays everything over $2500. The only difference the govt wants is to have the policy pay anything over $2,000. Worst case, the govt is “protecting them” from paying an extra $500/year by either fining them $1,000 or forcing them to pay an additional couple thousand to the insurance company. There is no part of this situation that has anything to do with the public having to pay for thier medical care. This couple is only trying to make thier own choices on how they provide for thier own medical expenses. They believe they can afford a a few small bills out of pocket, and thier insurance will pay any large ones. As long as they can pay the maximum deductible there is no risk to anyone anywhere of having to pay for them. It does not matter at all what the deductible is, it matters only that they can afford it, and that as Americans, it is their choice.
October 10, 2009, 12:33 pmJimbino says:
I still would like someone to speak to the problem of those of us who work, study or otherwise reside overseas, who will not have access to any medical treatment or drugs while there. Does Obama expect to fine us all the while we are paying privately for treatment overseas.
That’s the way it works with Medicare, whose parts A, B, C and D are totally unavailable to expatriates who have paid lifelong into the socialist system.
October 10, 2009, 12:34 pmSnack McSnarkerston says:
I am liberal, from Mass, with adequate employer-provided coverage. Adler is exactly right in his concerns here and I certainly don’t think he is being hysterical. Moving the goalposts is a huge danger along with special interests capturing those posts.
Public_def – who draws the lines? Certainly it is not voted on as a matter of ballot initiatives. It is decided by the same legislators eating lunch with lobbyists. The judiciary does not decide a fair amount of coverage, nor does an impartial doctor/hospital group with no skin in the game. And Adler’s point here specifically is that a line was ALREADY drawn at catastrophic coverage costs, then the goalposts got moved. More like, the rug pulled out from under those who were on the right side of the line to avoid paying too much for a thing they did not choose to have…
The real point here, as someone who has been observing the state’s financials tank, is that the line will continue to creep up, until the program revenues are balancing out. Then, the revenues will be grafted into some other sagging program until the line of coverage creeps up again to cover beyond health care costs. If you’ve ever once observed Mass politics and program funding, this is the same exact path followed by all of its programs. I put up with the huge amounts of graft and waste because I still enjoy living here, which is how many Californians feel as well.
It really means as a federal model, the arbitrary line-drawing in the hands of easily-captured legislators will mean the up-creep of costs no matter how well-meant the initial implementation is. ERISA is the prime example as someone who works on pensions for employers – great idea to begin with, and now it is a total costly mess for everyone, including the pensioners it was designed to protect.
October 10, 2009, 12:39 pmJimbino says:
The uninsured who show up in the ER are not “free riders.” Since the FED covers 50 cents of every healthcare dollar spent in Amerika, the uninsured seeking treatment has already presumptively paid for half the cost of his treatment.
Furthermore, the uninsured (particularly young men) use far less healthcare than women and older folks, with the result that it is they who are subsidizing the insured, not the other way around!
Time to put a stop this uninsured “free rider” canard.
October 10, 2009, 12:41 pmSarcastro says:
Jimbino makes a strong point. The injustice to expats totally invalidates any benefits to the elderly!
And Snack McSnarkerston‘s hatred of government entitlements sure sounds like a liberal to me!
October 10, 2009, 12:44 pmRyan Waxx says:
Remember: The point here is that once the government starts deciding what a “minimum” plan is, then politics and paid-for pols will determine what the minimum of care is. And government programs seldom choose to provide less. The moving goalposts are real.
It’s not only the pols that will push for more and more “minimum”: As this very thread demonstrates, the mere possibility that MAYBE the government might, under the worst circumstance, be stuck paying 500$ more to cover someone’s default is enough to elicit enormous, panicky shrieks of “FREE-RIDER! FREE-RIDER! GET HIM!” from the peanut gallery.
Moreover, let me suggest that perhaps a majority of those supposedly outraged by possible future free-riding by former IBM employees take the opposite stance on the seriousness of free-riding when faced with the real, documented, current certainty of free-riding by illegal immigrants. Those darn deadbeat retired people! There outta be a law! And another! And another!
October 10, 2009, 12:47 pmSarcastro says:
Jimbino‘s knowledge of how the average predicts all that happens is equaled only by his awesomely witty spelling of America.
October 10, 2009, 12:48 pmFub says:
Government run insurance isn’t the only alternative to private for-profit insurance. One argument for mandated government coverage seems to be that private for-profit insurance in the USA makes much higher gross profits than insurance in other western democracies.
A law that prohibits for-profit health insurance, and permits only nonprofit organizations (as already defined by various laws including tax laws) to offer health insurance might accomplish much the same benefit as proponents expect from government run insurance.
Even in the absence of mandated nonprofit-only insurance, government could lower regulatory barriers to permit ordinary people to form nonprofit insurance cooperatives or other such organizations.
There is a long history of nonprofit or charitable organizations running hospitals and other medical practices, so why not health insurance plans?
That is not to say that such a legal regime could not have its own particular problems, but those problems might be smaller and more tractable than those of either the current for-profit regime or a government run alternative.
October 10, 2009, 12:50 pmSarcastro says:
Ryan Waxx is right. Liberals don’t want illegals to be citizens and pay taxers at all! They love the status quo! I’m pretty sure it was them that shot down that “amnesty” bill some years ago.
Damn free-rider loving libs!
October 10, 2009, 12:54 pmHan Solo says:
The real reason is they don’t WANT anyone to find out you can get perfectly good health insurance for $300 a month which is probably MUCH less than what they are charging people in taxes.
I pay ~$350 a month for myself, my wife, and 3 kids.
Its a great plan with $3000 individual/6000 family deductibles from United Healthcare.
We pay for the first $3000 of expenses ourselves, and its tax deductible, after that the insurance kicks in, including 100% prescription coverage.
This idea that decent medical insurance is EXPENSIVE is a total myth that the government wants people to believe so they can control them and make them feel helpless without a handout.
October 10, 2009, 12:55 pmHan Solo says:
There used to be these insurance companies called “MUTUALS”….they were for-profit but 100% owned only by their members.
They were basically CreditUnions for insurance.
Liberals outlawed them and they all disappeared and were forced to public and turn into full profit companies.
October 10, 2009, 12:57 pmAthelstane says:
I have little sympathy for them. $80/month for these people is diddly-squat. If it were $800/month, they might have some sympathy.
Well, apparently you’re an expert – and so is the Commonwealth of Massachusetts – at how the Williamses ought to spend their money.
What gives you the right? What gives the state that right?
Finally, these guys could just leave Massachusetts. Isn’t that what conservatives predict will happen if state taxes are high? New Hampshire, Vermont, and Maine are really close.
And that’s exactly what has been happening. Good luck to those left behind to shoulder the costs of sinking economies in the Northeast.
No sympathy from me. None at all.
I guess you can’t have progress without breaking a few eggs.
October 10, 2009, 1:01 pmThe Unbeliever says:
Unless they’re an illeg– um, undocumented immigrant getting paid under the table. But if I recall the current state of debate, pointing that out makes me a racist, an uncaring capitalist, and other variations of Very Bad Person.
If you prefer to avoid that hot-button issue, then consider that roughly 40% of Americans don’t pay income tax. I don’t know what the intersection is between the set of people who don’t pay income tax, and the set of people who don’t carry insurance, but I’ll make a bald assertion that there is significant overlap (I also fit that criteria while I was a college student). So there are decent odds that the uninsured person who arrives in the emergency room has not already paid the 50% via taxes.
FWIW, I think the free rider problem is serious, but the vast majority of health system “fixes” will cost society even more. Either find an elegant solution to free riding, or just swallow the cost and stop pushing solutions that cause bigger headaches than the underlying problem.
October 10, 2009, 1:01 pmLaura(southernxyl) says:
How about we start mandating that breadwinners carry disability insurance. And that people who have babies carry life insurance until their children are 18.
More and more I think about the irony of children, chafing under the burden of their lack of autonomy, saying that they can’t wait to grow up so nobody will be able to tell them what to do!
October 10, 2009, 1:11 pmJimbino says:
Well any person who doesn’t know what the overlap should not be making those “free-rider” assertions. What we have going on here in this blog is a sharing of ignorance like that that defines Congress.
Furthermore, many illegals do pay sales taxes, gas taxes, and FICA taxes starting with the first dollar they earn, and those who use fake SS numbers are just paying into the black hole of the Fed, never to see a cent in benefits.
Where are the Economists who could enlighten us with the real numbers?
October 10, 2009, 1:14 pmalkali says:
How about we start mandating that breadwinners carry disability insurance.
We require that workers pay FICA, which supports the Social Security disability insurance program.
October 10, 2009, 1:16 pmJimbino says:
Let’s face it: Compulsory health insurance is, like income tax in general, yet another socialist scheme to transfer vast wealth from single, childfree, healthy gay and straight young men to the old, the married and the breeders.
October 10, 2009, 1:18 pmpublic_defender says:
Snack McSnarkerston,
Who draws the line? Typically, the legislature. They draw all sorts of lines that could be higher or lower. Should the line between misdemeanor and felony theft be $100, $500, $5000, $100000 or more? Should the age of consent be 13, 14, 15, 16, 17, 18, 19, 20, 21? Again, the exact line is arbitrary, but we elect legislators to draw exactly those lines.
Many, many lines are arbitrary judgment calls. But that doesn’t mean the lines shouldn’t be drawn.
What should the out-of-pocket maximum be? $1000? $2000? $2500? $5000? $10000? If you mandate insurance but don’t draw that line, the mandate is meaningless because people could buy a policy with a $1 million deductible and say they’re covered.
October 10, 2009, 1:19 pmbyomtov says:
Something strange is going on here. I live in MA, and have a policy with a $3000 deductible.
I pay no fine.
Why? Because my policy falls under an exemption for policies that qualify for HSA’s. Based on the limited information in the article, it’s not clear why the Williams’ policy would not also qualify for that exemption.
From the site explaining the rules:
Please note: People enrolled in Medicare Part A, Medicaid, an HSA plan, TRICARE, or the VA Health System will not be subject to any tax penalties, regardless of their benefits. (my bolding)
Maybe the tale is true as told, but I would like to know a bit more.
October 10, 2009, 1:34 pmSecond Amendment Sister says:
From the article:
Compare and contrast the following examples:
“People with inadequate retirement savings are free riders. They live a hundred years and can’t take care of themselves, and they’ll be in the nursing home, demanding to live at their neighbors’ expense. Everyone other than the Joneses are doubtless comfortable betting that nothing like that will happen to them, but why should we agree?”
“People with underwater mortgages are free riders. Something catastrophic happens, and they’ll walk away from a foreclosure, demanding housing at their neighbors’ expense. People other than the Joneses are doubtless comfortable betting that nothing like that will happen to them, but why should we agree?”
“People with credit card debt are free riders. Something catastrophic happens, and they’ll be filing bankruptcy, demanding to have their debt released at their neighbors’ expense. People other than the Joneses are doubtless comfortable betting that nothing like that will happen to them, but why should we agree?”
“People with no savings whatsoever are free riders. Something catastrophic happens, and they’ll be at Social Services, demanding financial assistance at their neighbors’ expense. People other than the Joneses are doubtless comfortable betting that nothing like that will happen to them, but why should we agree?”
And one more for good measure, more closely related:
“People who engage in risky behavior — such as casual sex, smoking, drinking, riding motorcycles, eating potato chips or meat — are free riders. Something catastrophic happens, and (fill in the blank). You are doubtless comfortable betting that nothing like that will happen to you, but why should we agree?”
Mandate one personal financial decision based on this argument, and open up the floodgates to regulating all personal and/or financial decisions.
October 10, 2009, 1:37 pmyankee says:
I don’t follow how this fact pattern came about. Why was a health insurer in Massachusetts offering a health plan that didn’t meet Massachusetts’s minimum coverage requirements?
October 10, 2009, 1:42 pmMike McDougal says:
If the Mass. government is worried about the whopping $500 deductible difference between $2,000 and $2,500, why not simply let the Williamses post a $500 CD in some sort of health care account?
October 10, 2009, 1:49 pmLib says:
It’s surprising to me that the MA law doesn’t allow the purchase of a surety bond to cover the difference between the mandated out of pocket max or deductible and the coverage the insured actually carries.
In CA, for example, auto insurance isn’t required for a private party to operate a car on public roads – they can either deposit the min coverage ($35K) with the state (which would probably be stupid) or buy a surety bond in the amount of $35K. (In spite of Obama’s persistent auto insurance comparison where he misses this fact — as well as the fact that if you don’t own a vehicle that you drive on public roads, you don’t need auto insurance or an alternative).
In the case of the Williams, I’ll bet they wouldn’t have much trouble coming up with $500 (the difference between their coverage and the mandated coverage) to deposit with the state or find someone who would be happy to issue a surety bond in the amount of $500 for MUCH less than the increase in their premium to step up to an “acceptable” policy. Of course, the insurance lobby probably wouldn’t like that.
[Edit: It appears Mike McDougal types faster than I do!]
October 10, 2009, 1:53 pmalkali says:
@yankee: Why was a health insurer in Massachusetts offering a health plan that didn’t meet Massachusetts’s minimum coverage requirements?
I was wondering about this myself. (IIRC, a health insurer doesn’t have to be located in Mass. to offer policies in Mass., but one would think that an insurer offering policies in Mass. would offer compliant policies.)
@Mike McDougal: If the Mass. government is worried about the whopping $500 deductible difference between $2,000 and $2,500, why not simply let the Williamses post a $500 CD in some sort of health care account?
Or, alternatively, why doesn’t IBM (who has a lot of employees and retirees in Mass.) get its insurer to tweak the deductible and adjust the premium by a few bucks a month to reflect that? (I’m not saying that it necessarily should be on IBM to do this — I’m just wondering why in practice this hasn’t happened, given the obvious incentive for IBM to offer its Mass. employees Mass.-compliant plans.)
@byomtov: Maybe the tale is true as told, but I would like to know a bit more.
Ditto.
October 10, 2009, 2:00 pmBitterandResentful says:
Pay the fine and move on.
October 10, 2009, 2:25 pmAllan Walstad says:
Mike and Lib are spot on here. Accepting for the sake of argument that the pols have any business intruding at all, why shouldn’t someone be able to maintain, say, a $10 deductible catastrophic policy as long as they have a $10k bond posted in an account to guarantee the deductible will be met?
October 10, 2009, 2:25 pmPintler says:
Sarcastro, I think you’ve met your match.
$10K makes a lot more sense than $2K, and $50K would probably be better yet. One of the real problems with health care costs is that only a small minority pay real, out of pocket money for anything but a fraction of their care. Having a few upper middle class people with $20K deductibles shopping around for the best value care will work wonders for cost containment in a way that entire government agencies could never hope to achieve.
October 10, 2009, 2:36 pmDavid Chesler says:
Jacob Pollock, in the WSJ comments, expresses it very well:
October 10, 2009, 2:40 pmravenshrike says:
It’s a .gov program. The goalposts WILL move unless they are explicitly defined in the law. Even then, they can and PROBABLY will still be moved later in another law.
October 10, 2009, 2:47 pmLarryA says:
My response did, and shows that the process is alive and well. Whatever you think of acupuncture and IVF services for seniors, I should be able to by insurance without them.
Private sector competition will provide such policies, government mandates will prohibit them.
October 10, 2009, 3:01 pmXenocles says:
ER visits are only a free ride because the state has made them so. The current premise is basically that people are taking advantage of the free rides they’re being offered, which is somehow unfair. If this were truly the core issue someone would propose eliminating state-sponsored ER trips. Instead the left presents a false dilemma between the status quo and more intrusive regulation and subsidy. Is there any real doubt that any of the proposals out there will cost the taxpayers even more than now?
October 10, 2009, 3:03 pmAllan says:
Public Defender,
Your comments are non-sensical. These people have a choice: 1) pay $300 per month plus an $80 fine or 2) pay $800 per month with no fine. Think of the $80/month as a tax on insurance if you must. We are not talking about $800/month increase and never were.
Careless,
How can you say that these people have nothing to do with IBM? That is where the pension comes from and that is who provides the health insurance.
Bottom line:
This is an $80 per month tax. It would cost IBM less than $80/month per employee to lower the deductible. The bad guy here is just as much IBM for having a plan that does not work well for residents of Massachusetts as it is government.
October 10, 2009, 3:06 pmAbdul Abulbul Amir says:
Two things.
1. Can anyone explain how if Bill Gates had no health insurance he would put the tax payer at risk?
2. Since uncompensated health care only amounts to about 2.2% of all health care spending, does this by itself justify mandates, or is there another reason?
October 10, 2009, 3:06 pmAbdul Abulbul Amir says:
Often corporations offer the same coverage choices to all employees regardless of which state they live in or retire to.
October 10, 2009, 3:10 pmLarryA says:
I heard recently that the largest health insurer in every state is a non-profit. If the for-profits are successfully competing with them, then mandating non-profit won’t solve anything.
October 10, 2009, 3:16 pmAllan says:
Guys,
The problem is not the health insurance scheme. The problem that Mr. Adler has is that he believes that Massachusetts is limiting the freedom of their citizens. He thinks, I believe, that there is too much limitation on their freedom of choice. I disagree.
We live in a society. Choosing to live in a society, or civilization, requires us to give up some liberties. The question is how much. By living in a society, however, we are agreeing to give up some of our liberties. The reason we make the choice is that living in society is, on the whole, so much better than living alone, we are willing to sacrifice for it.
How much of a sacrifice is a good question.
Another good questions is whether a sacrifice is worth it. Take Social Security, for example. We pay 13% or so of our income to have disability insurance and retirement insurance. Some believe that it is worth it for society to provide the safety net, some don’t. But those that don’t seem to have little sympathy for those left behind without the safety net. The poor and the free riders.
Heck, some even begrudge things like public roads, arguing that priate roads would be better.
Let’s take another example: society says that minors must attend school. We can all agree that attending school through age 16 is a benefit, not only to an individual, but to society. But to force me to send my children to school (rather than cleaning chimneys, perhaps) impedes on my freedom. Perhaps we should do away with this requirement. Or not, because it is better for society.
Requiring a certain type of health insurance is similar. We can all agree that having health insurance benefits individuals and society. The question is whether the benefit is worth the loss of liberty. IMHO, in the case of the Williams’s it is. That is why I have no sympathy for them. And they agree, apparently, as they have not decided to move elsewhere.
October 10, 2009, 3:41 pmbyomtov says:
Since uncompensated health care only amounts to about 2.2% of all health care spending, does this by itself justify mandates, or is there another reason?
There is another reason. Once you require insurance companies to accept applicants without reference to pre-existing conditions, etc., you have to mandate insurance. Otherwise people will just buy it on the way to the hospital.
BTW, I continue to wonder if we really have all the facts here. It’s interesting that the commenters, many of whom I presume are lawyers, are so quick to accept this whole story. It’s not like the WSJ doesn’t have a strong point of view. Remind me not to hire of any you to represent me in a trial. “Hey, he says you owe him the money, so pay up.”
October 10, 2009, 3:54 pmBorris says:
Look Democrats are “just better people than the rest of us”. They know how we should live and they feel it is their God given right to legislate their way of life down our throats.
Instead of Democrats, they would rather be Aristocrats. [FN1]
And why shouldn’t they be? After all their intentions are good. And if your intentions are good who cares about results?
[FN1]
October 10, 2009, 4:29 pmWhich is why they love the judiciary. Why mess around with those vile unwashed masses/proles and their votes, when you can just get a philosopher-king in black robes to legislate your world view for you?
JohnV says:
I thought the proposed Federal “mandate” was the key to eliminating the “pre-existing condition” exceptions in health insurance. If everyone has insurance there will no longer be pre-existing conditions. To make this feature work there can not be big differences in benefits from the cheapest policy, compared to the policy one would switch to when one gets seriously ill. So the mandated coverage has to pretty good.
October 10, 2009, 4:31 pmRichard Johnston says:
No such thing.
October 10, 2009, 4:52 pmAllan Walstad says:
Granting your first sentence for the sake of argument, the relevant questions are what kind of liberties and on what basis. Perhaps, a la Locke, we give up the liberty to exact retribution or compensation on our own for the aggressions and frauds of others against us, relying instead on a court system. That way, people are not forced into settling disputes by violence, and the strong are not free to prey on the weak. Maybe we give up the liberty of not contributing to common defense, so that our otherwise free society is not overrun by barbarian hordes or jealous collectivist states. But it’s not clear to me on what basis we give up the right to look after our own everyday needs in free transactions with other individuals, as when we buy medical treatment from a doctor or contract with an insurance company for coverage of large, unexpected expenses. I certainly do not grant that the statement “we live in a society” can serve as camel’s nose under the tent for arbitrary levels of government interference in our lives, just because sufficient political power can be brought to bear for the purpose of imposing such coercion.
13% is a HUGE cost. Even assuming some coercively-imposable obligation to support the poor (which I do not), an actual means-tested welfare-type program for the indigent elderly would cost far less and would free up vast amounts of individual savings for capital investments that would make society (i.e., all of us generally) much more prosperous. Nor would a phony “trust fund” serve pols as a convenient slush fund by which to kick unfunded liabilities down the road onto future generations.
I’m not going to touch the issues of roads and schools here, but my having health insurance does indeed benefit me, and your having it benefits you, but the idea that people can be coerced to allocate their resources for their needs according to the priorities of pols and bureaucrats, rather than according to their own priorities, is a steep slope to tyranny.
October 10, 2009, 5:07 pmOren says:
Perhaps they want to push the employees into the gold-plated $800/month plan that probably nets the insurer a high profit?
Not asserting that as a fact but it’s not out of the realm of possibility either.
October 10, 2009, 5:12 pmLib says:
The fact that Nataline would not have been accepted by some transplant centers because her chance of survival was too low (due to complex medical conditions beyond the liver transplant) suggests that this was not as cut and dried as some people who use Nataline as a poster child would like to have everyone believe.
An interesting question is, would she have gotten a liver transplant under NICE guidelines? I don’t know the answer to that, but maybe someone does.
(Also, note that there is shortage of livers for transplant – to give one to someone with a lowered chance of survival is sentencing someone else to death – for the public good, it’s probably best that Nataline didn’t get, and waste, a liver).
October 10, 2009, 5:12 pmRichard Johnston says:
The fact that her parents could not even get in the courthouse door to have their claim heard is absurd. Perhaps they would have lost for the reason you mention. But they should have their day in court.
October 10, 2009, 5:16 pmGordon Langston says:
Well, if SS were a real program, rather than a Ponzi like, pay as you go scheme, you might get a few believers for this Health Insurance Reform.
October 10, 2009, 5:26 pmOren says:
Because a society that places intrinsic value on human life will not abide a doctor letting a patient die lawn of his ER.
Agreed. You ought to accept, however, the converse — that just because something is an exercise of government power (and decreases liberty) that it is a priori illegitimate.
October 10, 2009, 5:48 pmJoe says:
I get really annoyed at the casual use of “freeloader”. During the last half of the nineties I ran my own company. I had no healthy insurance and paid my medical expenses out-of-pocket. ALL OF THEM to the dime with no charity from the various providers. This included several late night and weekend visits to the ER for stitches (including when I sliced my finger open one Christmas Eve), the birth of my youngest daughter and an MRI for myself. The irony is that it cost me less than any plan I could have gotten. (Had my company succeeded, I had a catastrophic insurance plan lined up. It would have been $280 a month with high deductibles.)
PS. To a large extent, most health insurance isn’t insurance at all, but prepaid medical care. You could argue that many of you racking up health costs are freeloading off of my family and I.
October 10, 2009, 5:58 pmDoc Merlin says:
Thats sort of the point. I’m surprised you are making this argument. Look at what is being legislated now, trans fats in NY, soda tax in NY, increasing cigaret tax, etc, etc, etc. Any time we start socializing costs soon we will start controlling behaviors. Libertarians have said it for years, and it follows a very basic principle. The people who pay for your behavior /will/ eventually be able to tell you how to behave. Its inevitable.
October 10, 2009, 6:12 pmOren says:
You also ran the risk of incurring an expense larger than your assets. You freeloaded that risk on society at large.
October 10, 2009, 6:21 pmDavid Schwartz says:
Really all that this shows is that any system, including the health care system we have now, can be screwed up by government regulation pushed by special interests. It doesn’t really weigh for or against any particular plan, or for or against not changing things. A good share of our present problem is due to tax policy pushed by insurance companies that make it cheaper for me to ‘launder’ my money through an insurance company than pay for routine care myself.
October 10, 2009, 6:26 pmrpt says:
“Libertarians have said it for years, and it follows a very basic principle. The people who pay for your behavior /will/ eventually be able to tell you how to behave. Its inevitable.”
But what libertarian or conservative will ever turn down someone else’s payment for their expenses? Everyone wants some expenses socialized. All of the stimulus opponents (Jindal, Perry, et al) took (almost) every dollar they could get and came back begging for more.
October 10, 2009, 6:32 pmDavid Nieporent says:
Obviously. It would certainly lower medical costs if insurers had to face litigation every time they turned down a claim.
October 10, 2009, 6:54 pmDavid Nieporent says:
So what you’re actually saying is that because you don’t want to feel bad about yourself for denying me care, you’re going to force me to buy insurance I don’t want. Glad to hear it’s all about you.
That makes no sense. First, “risk” doesn’t cost “society at large” anything. Second, assuming there was an actual expense incurred, “society at large” [sic] decided to stick its nose in and assume that expense without being asked. It can’t then complain about that. If it didn’t want to pay, it shouldn’t have. But it has no right to pay without being asked and then demand repayment.
October 10, 2009, 6:58 pmXenocles says:
That’s probably because in most cases we’re cutting our loses by taking back a portion of our own money that was extracted from us already. I oppose Social Security but when I’m 65 (assuming the program is still solvent then) I’m not going to turn down the return of my own money.
October 10, 2009, 7:00 pmSeamus says:
I think you’ve just highlighted what’s wrong with mandated health insurance: the fact that it doesn’t allow people to choose the insurance coverage that best meets their needs and circumstances. Thus Bill Gates, if he lived in Massachusetts, wouldn’t be allowed to self-insure for his medical expenses by picking a policy with a $1 million deductible, just as the Williamses aren’t allowed to pick a policy with what amounts to a deductible of $2500. It has to be assumed that everyone is living on the edge of poverty and won’t be able to handle medical expenses over $2000.
October 10, 2009, 7:00 pmRichard Johnston says:
Now we are onto something. If we just do away with contract law so every business can breach contracts with no consequences whatever then imagine how efficiently business will be able to operate. Imagine the uptick in profitability which would flow from immunizing business from legal consequences for fraud. And here I thought the rule of law was necessary to the operation of a free market.
We can’t have insurance companies face consequences for failing or refusing to live up to their contractual obligations — we can’t even let people in the courthouse door with those types of claims — because otherwise costs would get out of hand.
I find it hard to understand why the insurance industry, uniquely among all industries in America, needs to have immunity from civil liability for fraud and wrongful death if they are to offer their product at a reasonable price. What the hell kind of an industry is that?
It bears noting that for years and years, pre-ERISA, state law allowed lawsuits of they type we are concerned with and the insurance companies were doing just fine, and not getting sued “every time they turned down a claim.”
October 10, 2009, 7:21 pmAnonymous says:
Corporatism is freedom.
October 10, 2009, 7:26 pmSuperSkeptic says:
Which is why we should reject every attempt to cry “free-rider” or “externalities”
my family and me.
October 10, 2009, 7:35 pmSuperSkeptic says:
This is the heart of the debate. The compulsory safety net hanging around our necks in the form of the state in order to stomach capitalism. The (middle) majority of this country likes capitalism; it’s nice, we’re rich – comfy couches, tvs. Which is also why we like safety too. Liberty is lost in the mix of those two base needs. Liberty is (unfortunately in my view) a second order priority in light of them.
October 10, 2009, 7:42 pmDiversityHire says:
Socialists complaining about freeloading? The point of socialized medicine is to embrace freeloading. That’s the point of socialized anything.
October 10, 2009, 7:44 pmMark says:
Cut the crap. Massachusetts looked at its tax payer base, and the info filed to prove insurance coverage. They found low hanging fruit w/a bunch retiree’s that were just outside their 2k mandate. How many thousand of taxpayers got dinged? Mass knows exactly. They know ALL about your insurance providers and co-pays. Boom. They fine you an extra 1k for not complying. Knowing you have good health insurance you won’t drop from IBM or other corp. You PAY. They know it…disgusting.
October 10, 2009, 7:48 pmAllan Walstad says:
“Society” is just people and what they do. If you wish to contribute charitably to helping those who can’t afford as much health care as you’d like them to have, feel free. That’s your choice. Please do not feel free to put a gun to my head to do the same. That’s MY choice.
October 10, 2009, 8:01 pmAllan Walstad says:
What do you mean by “capitalism.” Do you mean individual liberty in a free market with private ownership of the means of production? I have no trouble stomaching that at all, thank you. Or do you mean the government-warped and -dominated mess we have now and are sinking deeper into? That turns my stomach, too.
October 10, 2009, 8:06 pmOren says:
I accept that, so long as you accept that “you” is not me personally but rather an overwhelming majority of society. Support for EMTALA is unassailable.
Reminds me of a story that a ME park ranger told me — he was conversing about the mechanics of a helicopter rescue when an intrepid backpacker loudly proclaimed that under no circumstances did he want to be choppered out. The ranger said something to the effect of “You can say that now, and yet when your leg breaks you’ll change you mind.”
In other words, why would I accept Now-David’s right to deny life-saving medical care to Future-David, if the wishes of Future-David are that he wants to be saved? What moral claim can Now-David assert over Future-David’s life?
Don’t know why you included scare quotes, but there certainly was risk and it certainly was borne by the hospitals in his area that would not have been compensated in the even of an emergency. Those hospitals would then pass the costs along to the everyone that consumes medical services, which is to say everyone.
Perhaps.
Hypothetically speaking, what do you think should be done with a serious injured person that does not have the means* to pay for treatment if he (1) arrives in the E.R. unconscious OR (2) arrives in the E.R. begging to be saved?
* Means = Current assets + (total future earnings – total future costs)** + available charity.
** With the added caveat that such earnings and costs might depend strongly on the result of the emergency medical care, which is never a guarantee. That is, this term is the weighted sum over all the possible medical outcomes, which makes things considerably worse in the unlikely case that the patient’s life is saved but he is unable to work and will require continued intensive medical care to live. Especially if he lives a long time in that state.
October 10, 2009, 8:14 pmOren says:
Every society also includes restrictions of what we allow people to do to one another. Letting a patient die on the ER lawn because he cannot afford medical care is not in that list at the moment.
You are welcome to lobby The People for the repeal of that rule but if you don’t want to abide by the rules written by The People of this country, you are free to find another one.
October 10, 2009, 8:20 pmOren says:
Indeed. And as much as we can respect your preference, you have to concede that this is not the universal preference of your fellow countrymen.
If only there were some sort of system by which individuals could express their political preferences in such a fashion as to encourage a government conducive to those ends …
October 10, 2009, 8:23 pmkimsch says:
Reading the comments it seems that many people equate using the emergency room with being un/under-insured.
On Monday night I had to take my soon to be 9-year-old son to the emergency room/acute care center. He had been running in the hall at school that evening (we were there for Cub Scouts) and he ran into a door. He smashed his left middle finger (distal phalanx), and when pulling his finger out from between the door edge and the wall, cut the pad of his finger pretty deeply. He required an x-ray of his finger to ensure he hadn’t broken it and four stitches to close the wound.
We have insurance and had to go to acute care since it was obvious that it couldn’t wait until the next day when I may have been able to get an appointment with his pediatrician.
There may be a lot of people that use the E/R as a primary care facility, but that is because of the Emergency Medical Treatment and Labor Act (EMTALA). There also seems to be a misunderstanding of what treatment is required for those that are uninsured. EMTALA requires only that the patient be stabilized.
When I was a kid, my father had catastrophic insurance through the university he worked for. Regular old doctor visits and vaccines were paid for at the visit or in a couple of payments. Insurance kicked in when my sister fell on a two by four and got a puncture wound in her thigh after running through the yard next door where they were building a house and my Dad had to take my sister to the hospital.
When my husband had a tonsillectomy as a child, his parents made payments to the hospital until the bill was paid off.
Back then we knew what we were paying for our health care. Now we pay $300 a month and a $3,000 deductible for a PPO and we don’t reach our annual deductible in regular medical costs, even with a child with chronic illnesses. We still pay for our insurance in case of a catastrophic illness or injury.
My monthly premium is lower because of the relatively high deductible. It seems that Mass wouldn’t allow me that choice. How much of an increase would there be in my premiums for a lower deductible? How much of a
taxfine? Up above some people seem to be saying that thetaxfine that the Williams must pay amounts to “only” $80 a month. But that’s if the Commonwealth of Mass will take monthly payments. I’d not be surprised if thetaxfine was due, in full, last week or face interest charges…Being forced to pay for coverage that I don’t want or need is another story. That’s like going to the store for milk and eggs and being told you must also purchase and pay for oatmeal, salmon fillets, and fresh asparagus and beets. Oh, and by the way, that whole milk you wanted to buy? So sorry, it’s skim for you.
October 10, 2009, 8:27 pmAllan Walstad says:
Whoever owns the hospital has the responsibility for making such decisions or laying down policies. For the sake of argument, here’s one suggestion: provide care until you can establish whether the person is in a position to pay or if someone else will contribute charitably. Perhaps even keep providing care, until someone arrives who can pay and needs the same equipment. Then transfer the equipment to that person. Meanwhile, another possibility is to be a bit more proactive and go out into the community asking for contributions to a fund that would help the indigent. Ask people who have received life-saving care at your hospital to donate to such a fund.
That’s disappointing, as it is a typical response by those who have no real arguments to offer: “Power is on my side, so there!” You can do better than that, I’m sure. May I point out also that the “country” is actually 50 states, each having all powers not granted by the Constitution to the feds. To some degree there is an opportunity for people to escape oppressive state governments by moving across states lines. The attempt to impose an unconstitutional federal health mandate probably arises in no small part to prevent people from so escaping.
October 10, 2009, 8:44 pmInsurance Mandates says:
[...] at The Volokh Conspiracy, Jonathan Adler brings us a story about a retired couple in Mass who are quite happy with their insurance, but [...]
October 10, 2009, 8:57 pmOren says:
No, it is already established that the person is not of means, including charity, to pay for it. That is the hypothetical — that we know in advance that the guy does not have the means (including all his future income, so no reasonable creditor will give him a loan for the amount) to pay for the care.
Who exactly is supposed to come pick the guy up? And what if no one does?
I assume you have already done this, figured in the contribution to charity and still come short.
With the added caveat that the power derived from The People’s consent is legitimate, I see no problem with this assertion. That is, it is no shame at all to claim the side of a power justly derived from the consent of the governed.
October 10, 2009, 9:06 pmricky says:
Just throwing this out there:
People are starting to notice that certain policies and programs are designed to transfer wealth from the young to the old.
We’ve already seen ethnic politics emerging to the level of outright hostility. With Obama, they said it was “finally” time to have a black president, even though this is a democracy and whites are still the vast majority of the voting populace. With Sonia Sotomayor, they said it was “finally” time to get proportional Latino representation on the Supreme Court, despite the fact that the vast majority of Latinos in America either came here illegally or were born to illegals, and the majority of Latinos in America today are not citizens. We have affirmative action laws that demand preferences for nonwhites, and even when they do not apply the discrimination laws require de facto quotas for private organizations to avoid lawsuits.
So what will happen to this pyramid scheme, this system of young-to-old wealth transfers, given the coming demographic changes? When white Americans are a minority of the young, but a vast majority of the elderly, will the voters and the politicians still look favorably on these young-to-old wealth transfers? Will the new generations of mostly-nonwhite America happily hand over a large portion of their paychecks to support the health and comfort of the mostly-white retirees?
Sure, it would be nice to think that race and ethnicity don’t matter. But it’s a fantasy. Support for Social Security and Medicare depended on people envisioning their payments supporting their grandfathers and grandmothers. For the coming generations of Americans, it will be quite obvious to most that their payments are going to other people’s grandfathers and grandmothers. Expect the system to adjust accordingly.
October 10, 2009, 9:42 pmGrover Gardner says:
This couldn’t possibly be IBM’s fault.
October 10, 2009, 9:56 pmricky says:
“With the added caveat that the power derived from The People’s consent is legitimate”
Anyone who capitalizes “The People” is a straight-up unabashed Marxist scumbag. There is no “The People”, there are only individual persons. When a large group of persons, by virtue of their numerical superiority, decides to extract property from another numerically inferior group of people, those of us with principles call it “Mob Rule” or “Multiple Offender Robbery”.
October 10, 2009, 9:57 pmAllan Walstad says:
You can pick him you if you want. You can help if you want. If he dies of his injuries or disease, he dies of his injuries or disease. Everybody dies sometime. Feel free to help or butt out.
Somebody in Africa or Bangladesh is probably dying right now for lack of medical care. Shall we all be robbed to pay for his/her care? Where does this end?
Ok, well there you go. Whatever the wheels of politics comes up with is right. So if 90% of The People vote to kill the other 10% and take their property, that’s just fine with you? If not, then there’s a right and wrong that doesn’t come out of a ballot box. What’s right where I come from is this: If I’ve provided for my needs and someone else hasn’t provided sufficiently for theirs (the olde ant vs grasshopper), then if I want to help the other person that’s my choice and if I don’t that’s my choice too. You decide what to do with your time, energy, and property and leave others to do the same, thank you.
October 10, 2009, 10:20 pmJoe says:
That’s socialist claptrap. To say someone freeloaded because of what MIGHT have happened is completely absurd. Under that philosophy, you are risking massive expenses on society–you could crash your car into a train carrying ammonium. Once we go down that speculative road, there is no end in sight.
October 10, 2009, 10:29 pmOren says:
Factually incorrect. Number of illegals is 10-20 million, number of legal Latino citizens is 40 million.
By God please don’t read the Constitution, the Declaration of Independence or the Federalist Papers authored Hamilton or Madison !
As it happens, the government of these United States is predicated on the notion of popular sovereignty, without which there would have been no power at all to enact the US Constitution in the first place.
And such persons having organized a government for the protection of their life and liberty …
You are free to have whatever principles you see fit and to call things whatever you want. Why you believe you have a God-given right to government under those particular principles, and not some other principles that your neighbor might have, remains a mystery.
October 10, 2009, 11:08 pmAndrew J. Lazarus says:
That’s not how I’ve heard it. I’ve heard that shareholder-enriching plans cherry-picked the healthy members, since they controlled enrollment, and left with only the sicker customers the mutuals were pretty much forced to convert to keep up. Do you have a cite for the law that outlawed them, that the liberals passed?
On the other hand, I agree completely with you that people who want a high-deductible plan should be allowed, as long as they can post bond as self-insurance for the difference. (That is, like California auto insurance.)
October 10, 2009, 11:14 pmOren says:
Wherever we want it to end. If the American People vote elect a Congress and that Congress votes to send $XXX to country YYY for medical care then that’s what we want to do. If we want to repeal that aid the next year, that’s fine too.
That’s popular sovereignty in a nutshell — the crazy idea that people are competent to govern themselves.
October 10, 2009, 11:16 pmtraveler496 says:
I am undecided about whether some form of mandate is a good idea, but a mandate which forces a one-size-fits-all deductible x seems like a bad idea.
It obviously leaves a potential gap wrt people who can’t afford even x. OTOH for people who can afford (and emotionally handle the risk of) 3x, say, and who are not significantly greater risks than their insurer thinks they are, the extra cost of the lower deductible is a waste of their money for which society at large gets no benefit.
October 10, 2009, 11:17 pmOren says:
You fail to make a fairly obvious is/ought distinction here. If 90% of the people want the other 10% dead, it’s going to happen independent of any law, ballot, constitution, UN-declaration-of-whatever or the obvious fact that they certainly ought not do so.
October 10, 2009, 11:18 pmAndrew J. Lazarus says:
I’ve never quite understood why I’m supposed to contribute for police to keep people disgusted with Mr Walstad’s philosophy from killing him. I mean, everybody dies sometime. All that claptrap about making an exception for “force” is because he’s more worried about getting mugged than getting too sick for his health insurance policy, isn’t it?
October 10, 2009, 11:20 pmOren says:
So I can bet your house on my weekly poker game and, so long as I don’t lose it, I haven’t subjected you to any risk at all?
It’s not what might have happened, by the way, it’s what did happen — a group of people subjected themselves to some risk (1/100, say) of creating a large ($1000) liability for the ER (and by extension everyone else). At the end of the day, the ER is down $10 because of these folks.
Yeah, it’s not like I have liability insurance for my automobile or anything.
October 10, 2009, 11:22 pmAndrew J. Lazarus says:
FTFU
October 10, 2009, 11:24 pmBrian K says:
A lot of people have expressed a sentiment above. but how comes it is never applied to conservative’s favored political expenditures? why must i be forced to spend so much on defense/military because some conservative wets his pants everytime a brown person walks by?
October 10, 2009, 11:50 pmXenocles says:
You can bet anything of mine that you want, but if anyone is stupid enough to take and win the proposition you and he will find that I’m not going to pay it. The law will also favor me in this case, so I won’t be alone in defending my interest. Therefore, you have subjected me to no risk whatsoever.
October 11, 2009, 12:10 amOren says:
Xenocles, I obviously meant “bet your house in a legally binding way”. Thanks for quibbling though, it wasn’t clear that I didn’t mean “bet an unenforceable promise”.
October 11, 2009, 12:19 amShelbyC says:
No, they’re not random. If they get a heart attack and fall down the stairs, and pay their bill, they’re not free riders. Keep in mind, we don’t know they were underinsured. They were fined b/c the state said they were underinsured. They’re only underinsured if they can’t afford to pay the deductible, and we don’t know if they can or not.
October 11, 2009, 12:31 amShelbyC says:
Correct. When you stipulate the outcome, there’s no risk.
October 11, 2009, 12:32 amBrian K says:
I spent some time working in a county hospital that nearly entirely served people without insurance. i can’t even count the number of times one of my patients told this same story. they all thought there were self sufficient with their savings, their good jobs and their good insurance…but they got sick, lost their job and with it their insurance. they burned through their savings and wound on public aid or medicaid.
and to the many people above who claim that if they can’t afford life saving treatments for themselves or their loved ones that they just crawl in a hole (or shove their loved ones in a hole) and die…i call BS. the number of people who have followed through on that claim is dwarfed by the number of people who suddenly sang a different tune when they became sick.
remember, when reality and theory (or good sounding words) contradict, arguments based on theory aren’t persuasive.
October 11, 2009, 12:51 amSarcastro says:
Oren is so clearly wrong, I’m glad people are calling him out on it. For our society to get moral force from The People is totally Unamerican.
There is only one place one can get moral force: ricky from the Internet.
October 11, 2009, 1:18 amNIck056 says:
Shelby, when the bet is placed, the outcome is not stipulated — for the bet to be placed, it must be stipulated that you don’t have sole control over your house. That is the conflict.
On another note, this thread started with an excellent potential topic — how do we deal with the problem of lobbyists revising sufficiency upward — and instead turned to the topic of rehearsing a basic defense for the value of human life. (If how much money you have determines directly whether you get to keep your life, human life is less valuable than the commercial circumstances to which it gives rise. This is perverse.)
October 11, 2009, 1:30 amricky says:
“That’s popular sovereignty in a nutshell — the crazy idea that people are competent to govern themselves.”
So if a majority of The People elect a President who wants to outlaw all dissent he can do that, right? If a majority of The People decide that all weapons should be confiscated, their elected officials can do that, right? If a majority of The People decide to elect officials who want to strip blacks of all their rights and make them property again they can do that, right?
No, obviously we have a Constitution in order to limit the power of the government and thus to limit the powers that The People can exert over their fellow citizens. It’s sad that legal “scholars” like yourself are so eager to completely ignore this document when it suits your purposes. I bet you support Zelaya too.
October 11, 2009, 1:32 amricky says:
“to the many people above who claim that if they can’t afford life saving treatments for themselves or their loved ones that they just crawl in a hole (or shove their loved ones in a hole) and die…i call BS.”
Here’s an idea: Maybe we could get back to the radical idea that if you can’t afford to pay for a good or service, then no one is compelled to provide you with that good or service. Brain surgery is not a “human right”.
October 11, 2009, 1:36 amMartha says:
ricky has a point. It’s not like brain surgery could possibly have anything to do with life (. . . liberty, or the pursuit of happiness).
October 11, 2009, 1:46 amLargo says:
(1) Suppose I indelibly mark myself with a DNR mark, or some mark by which I expressly refuse consent for some certain subset of medical care.
(1a) Assume that the mark is connected with my body in such a way that it will be straightforwardly recognized by any medical staff, regardless of the type of injury. (Perhaps an RFID placed in my skull, or thoracic cavity.)
(2) If I should lay dying on an ER lawn, I expect some parties have the right to remove me to some other location, for a variety of reasons.
(3) May I expect that my refusal of consent will be honored?
(4) If so, I might argue that I have removed the possibility of burdening others with health care costs, and that it should be sufficient for opting out of any insurance scheme.
(5) This argument would fail, since ‘future-me’ is not bound to this refusal to consent. (At least it is not clear that I could bind myself.)
(6) If instead of refusing consent, the mark was the sign of a financial -release- to all parties. It is a seal of this statement: notwithstanding statutory obligations that an ER treat all comers, I release the ER from any obligation to treat -me-.
(7) Would this in fact release the ER from its statutory obligations in my case?
(8) If not, suppose the state could provide a statutory means of my ‘opting out’ in this way. (I am fairly certain that it -could-).
(9) This could take the form of a contract with the state. There would be consideration on each side. From the state: my release from having to purchase health insurance. From me: the state’s reduction in financial risk wrt my health.
(10) Put simply, I am speaking of an opt-out in which I could not -be- a freeloader.
(11) There may be transaction costs involved in this opt-out: the cost of legislative time; the costs of (say) an RFID reader at all ERs; etc. If I am the only person who wished to opt-out, there may be an argument against -accommodating- this wish based on these costs.
(12) Suppose under some proposed opt-out scheme, the transaction costs were neglegible.
QUESTIONS:
Who here would support such a scheme?
Who here would oppose such a scheme?
ADDENDUM:
David Chesler quotes the WSJ: “They want healthy people to overpay for “cadillac” plans that they really don’t want or need so that sick people can pay less than they otherwise would for the same plans.”
I make no argument about the accuracy or propriety of this statement, or of the situation it purports to describe.
Let’s assume that there is a case to me made for such plans. To speak accurately, we should perhaps describe this not as simple insurance, but an amalgam of insurance and tax, the tax portion being a kind of revenue transfer to offset the burden of those with particularly heavy health costs. “Tax” is a loaded word, so substitute another as appropriate.
I make no argument here against this. This may well be a “feature” rather than a “bug”, and a quite appropriate feature. Assume it is so. If I was allowed to opt-out of insurance, this should not mean I could opt-out of the “transfer” portion of my premiums. In answering the above questions, consider that the opt-out scheme of (12) accords with this final premise:
(13) Any “transfer” portion of my premiums I would continue to pay (the scheme would have to accommodate this). My “release” in (9) (the state’s consideration to me) would be from the “insurance” portion of my premiums only.
So, is the scheme worthy of support, or worthy of opposition? (And if I misconstrued things in such a way as to make the questions unfair in some way, let me know that too.)
October 11, 2009, 1:51 amAndrew J. Lazarus says:
That includes police and fire and military defense, right? You can always hire bodyguards!
Hint, Ricky: The fact you are more scared of muggers and fires than brain cancer doesn’t make justify these ipse dixit pronouncements.
October 11, 2009, 2:02 amricky says:
“It’s not like brain surgery could possibly have anything to do with life (. . . liberty, or the pursuit of happiness).”
The government is not denying your right to life simply by abstaining from forcing surgeons to operate on you. You seem to have fallen into the spoiled child mentality of thinking that “rights” means free stuff, rather than prohibitions against government tyranny. So you have completely inverted the intention of granting “rights”: instead of saying that the government can’t force you to do something, it now means that the government must force someone else to do something.
October 11, 2009, 2:08 amXenocles says:
I believe that in my lifetime we will have a politician elected based on his promise to ban death outright. (I’m just not sure if it will come before or after the one who promises an above-average income to all.)
Denying a service necessary for life is not the same as taking that life directly. Not saving you is not the same thing as shooting you. It is protection from the latter that that clause in the Declaration refers to, not the former.
October 11, 2009, 2:16 amDavid Nieporent says:
Now-David and Future-David are, of course, the same person. Now-David has the right to bind Future-David to all sorts of things; Now-David can buy a meal at a restaurant and Future-David is legally obligated to pay for it. Now-David can become a professional boxer and Future-David can be legally battered as a result. Now-David can quit his job and Future-David will no longer be entitled to receive a paycheck. Now-David can drop out of school and Future-David will not have a diploma as a result. Now-David can give away all his money to the ASPCA and Future-David will not be able to spend it; Now-David can give away his house to the Church of Scientology and Future-David will not be able to live there. And Now-David can decide to spend his money on cocaine and hookers rather than health insurance and Future-David will not have health insurance.
Well, if you include “available charity” in there, such that there’s nobody willing to pay for the care, then send said person on his way. Here’s what I think should not be done: compel someone to provide said care at gunpoint.
October 11, 2009, 2:21 amGuest12345 says:
Oren is wrong. There is zero cost to risk. Things that might happen don’t cost anything. It’s only things that happen that cost. It’s abominably stupid to be calling someone out for “free riding” risk onto society.
By the way Sarcastro, I picked up a piece of tash for you today and now you owe me for that service. It’s $75,000. You know, I think I like this business model — the one where I provide you a service you didn’t ask for and then expect you to pay. Awesome.
October 11, 2009, 2:25 amDavid Nieporent says:
You’re mistaken; I didn’t consent.
October 11, 2009, 2:26 amSarcastro says:
I am certainly growing to enjoy ricky‘s liberty-filled Union, where no one bands together except with explicit consent of all parties. So much freedom, you’ll swear it’s the state of nature!
October 11, 2009, 2:27 amDavid Nieporent says:
So long as you don’t lose it, you haven’t cost me anything.
So long as you can’t lose it — since it isn’t yours to lose — you can’t subject me to any risk. Similarly, so long as I can’t force you to pay for my medical care, I haven’t subjected you to any risk or “freeloaded.”
October 11, 2009, 2:38 amRuss says:
I keep seeing folks say you have a health care should be a “right”, but there’s no such thing as a right you have to pay for.
And that’s the real issue. It’s not access to the medical care – it that most folks don’t want to pay for it. They want “insurance” or “the government,” so long as it doesn’t hurt their pocketbook. As lovely a world as that would be, it simply ain’t reality.
So long as medical care takes resources and people to provide it, it’ll never be free, nor should it be. Not enough people, not even doctors, are altruistic enough to provide it at the cost of feeding their family. Didn’t it used to be seen as a path to wealth to be a doctor? Isn’t that how it used to attract the best minds?
Get “free” health care, and you’ll get exactly what you pay for.
October 11, 2009, 2:45 amLargo says:
Brian K,
“Society” is a milieu. And there are milieus within milieus. We speak of one belong to polite society, to criminal society, etc. We never speak of “the criminal society” — unless we are referring to a particular criminal organization: a Chinese triad, an American mob, etc.
The state is not a milieu, but an organization. It is no more a milieu than my family, the Lutheran Church, the Boston Celtics, and the bridge club that meets down the street. All are distinct social organizations that exist for different purposes.
The mileu of society can have a predominant sentiment, and even informal rules — especially in submilieus (don’t say f*** in polite society; don’t befriend cops in criminal society). Such sentiments and rules are not prescribed but rather (as Hayek pointed out) emerge.
In particular, society (being a milieu) does not deliberate or decide. Organizations can, and do. The International Olympic Commitee, as a body, decided to award Rio over Chicago. Congress, as a body, deliberates over legislation. “Society” does no such thing, nor can it, as society is not a thing that can do anything at all.
It is the state that gathers money through taxes, and spends it to particular ends — not society, notwithstanding that the state may be an creature of society, in the sense that it emerges from the milieu we call society. But it remains that society is not a creature, nor a body. (And “prevailing sentiment” does not mean the same things as “collective will.”)
So then, for what should the state gather and expend money? What is the state for? What is its purpoes? These things can be argued. Some conservatives call for taking and spending on defense, not because they want to “impose their will” on society, but because they see this as a (if not the) proper function of the state. You may see the proper role of the state to be something entirely different, or to encompass a great deal more. This is something reasonable people can discuss.
As for the sentiment of Allan Walstad that you quoted, and your frustration that it is not equally applied to different issues, I suggest that it reflects different of the proper role of the state. Allan perhaps thinks it does not encompass healthcare (at least to the degree that you think it should). Perhaps his view of the purpose of the state is wrong, and perhaps it could be a subject of amiable discussion between the both of you. Unfortunately, such discussion is (I think) frequently hampered my a lack of clarity on all sides, as to the distinction between state and society. If the heart of the dispute turns on the relationship between society and state, how can confusion (and frustration) not arise when discussing such matters?
Your remark about “some conservative wet[ting] his pants everytime a brown person walks by” being a cause of increased military expenditure is unfortunate I think, for this reason: the question of the proper role of state in principle (defence, healthcare, etc) is distinct from the question of the proper mechanisms by which the state is directed in particulars. If “wetting pants” and “expenditures” refers, say, to border security with Mexico, then perhaps the state is misguided both in its particular policies, and also in the influence incontinent conservatives have in informing this policy. But this is something other than a question on the proper role of the state as such. In other words, one might agree with you about the influence of incontinent conservatives, but disagree with you about the state’s role in health care. Or vice versa.
[Sorry Brian, and all, for my long posts. I seem unable to write shorter ones without feeling that I've created a two legged stool.]
October 11, 2009, 3:00 amDishman says:
Fortunately we have people like Sarcastro to warn us away from consensual interaction. Otherwise, we might start demanding that activity involving our bodies require consent. The horror! Someone might even decide that Roman Polanski was a bad man for ignoring the lack of consent!
October 11, 2009, 3:11 amDeagle says:
Damn… Why can’t anyone here understand that this is an absolute crime against individual responsibility! If the government can pass a law for health care like this, it can pass laws against just about anything! Is there not anything that the majority here will protest against? I actually doubt it and just about give up that any (much less some) of our freedoms will be available in the future.
October 11, 2009, 3:57 amRicardo says:
Current Massachusetts policy is stupid but there is an easy solution fair to both parties. Require all residents with deductibles over the $2000/year limit to deposit the difference between the deductible and $2000 in a health savings account or some similar type of account. This ensures they won’t default on their medical bills while also saving them from buying insurance they don’t need because of some arbitrary limit.
October 11, 2009, 4:28 amAlanDownunder says:
This debate just so American. Look beyond your borders for sense on health care, where it’s fairer, cheaper and better.
October 11, 2009, 5:23 amD. Ch. says:
Nobody in these sorts of discussions ever seems to suggest having the government subsidize the education of medical professionals until we have more doctors and nurses than we can shake a stick at. Labor costs in the medical profession are bound to go down, perhaps way down (just watch how upset the AMA gets at the idea), and everybody else will be better off and much happier.
October 11, 2009, 6:00 amSarcastro says:
Damn… Why can’t anyone here understand that this is an absolute crime against individual responsibility! If the government can pass a law for taxes/guns/welfare/madicare/social security/roads like this, it can pass laws against just about anything!
Remember, folks, Dishman is right. There are only 2 choices: collective decision making consent about everything or consent to nothing. Line drawing is for losers and people who like medicare or emergency room service!
October 11, 2009, 6:41 amegoist says:
Whether “underinsured” or [new] mandates or whatever they dream up next, the theme is control. We will never meet up to the whims of the control freaks; lest we’d not need the control freaks.
October 11, 2009, 6:47 amMichael Smith says:
Anderson wrote:
… Underinsured people are free riders. Something catastrophic happens, and they’ll be in the ER, demanding treatment at their neighbors’ expense.
The existence of one rights-violation by the government — in this case, the government’s law that forces emergency rooms to treat all comers, regardless of ability to pay, a dictate that is nothing less than a statement that a doctor is a slave who will do the work the state dictates at whatever compensation the state dictates — certainly DOES NOT justify a second rights-violation in the form of forcing individuals to carry insurance approved by the state.
But this is a classic statist tactic: One government intervention in the economy creates problems, which are then used to argue for additional government intervention. The noose is tightened until the victim starts to squawk, then the squawk is used to justify additional nooses. And it’s the mindless little useful idiots like “Anderson” that permit the looters/enslavers in Washington to get away with it.
But doctors are not slaves and neither are their patients — and neither are the taxpayers that are being bled to finance the welfare state in all its manifestations.
If it continues much further, it will end as all experiments in mass-statism have ended: in economic collapse and the impoverishment of millions. See the events of the 20th century for proof.
October 11, 2009, 7:07 amGaryC says:
HSAs function precisely as that bond, so why is that the Democrats’ healthcare reform plans are trying to eliminate HSAs? And why have the Democrats insisted on limiting the number of people who can participate in HSAs?
A catastrophic coverage plan (with tax-deductible payments) with a reasonable deductible, and an annual requirement to make tax-deductible payments to maintain an HSA at a level that would cover the deductible would be a good match to most families’ health care needs.
October 11, 2009, 7:44 amGaryC says:
Your solution is reasonable, except that it does not satisfy one basic requirement.
No politician gets to spend more money.
Therefore it is unacceptable.
October 11, 2009, 7:54 amTen says:
“Why should we agree” (when we, acting as a federalized mob, can tell them just how to live their lives.) Is it the ignorance or is it the arrogance of such a position?
Leadoff commenter Anderson perfectly illustrates how collectives arise, and how liberties are lost forever: The problem s/he refuses to acknowledge is that having mandated such walk-in emergency care, governments, who’ve acted in defiance of free markets and I’d argue, constitutionality, force a series of unintended consequences — or are they intentional? — who’s end result is tyranny.
I don’t know if it’s the Andersons out there or the federalistas who worry me most. Most of the time the later are comprised of the former. I hope s/he doesn’t vote with that mind.
October 11, 2009, 7:55 amWtfo says:
I present that the entire notion that the state gets to mandate my health insurance – and fine or imprison me for failing to obey – IS COMPLTELY UNACCEPTABLE.
Period. Full stop. End of story.
Anyone who disagrees is welcome to come here and try to enforce it.
October 11, 2009, 7:57 amOhioguy says:
Do not attempt to apply reason or logic. Hysteria has taken over.
http://www.jerrypournelle.com/reports/jerryp/tyrant.html
An excerpt:
“Republics stand until the citizens begin to vote themselves largess from the public treasury. When the plunder begins, those plundered feel no loyalty to the nation—and the beneficiaries demand ever more, until few are left unplundered. Eventually everyone plunders everyone, the state serving as little more than an agency for collecting and dispensing largess. The economy falters. Inflation begins. Deficits mount. Something must be done. Strong measures are demanded, but nothing can be agreed to.
In Weimar Germany the price of a postage stamp went to 8 billion marks. In China, Latin America, many of the new African nations, inflation has exceeded 1000%. The middle class is destroyed. The economy collapses. Democratic institutions cannot cope.
Enter the strong man, who will save the state.
For more than two thousand years the decline of democracy has been the precursor of the tyrant, who comes on stage as the nation’s protector. Sometimes he will do no more than end the strife: better a single master than hundreds who cannot agree. Julius Caesar was such a one, Francisco Franco another. They promise no more than order. They do not seek to reconstruct the nation, and they do not construct a full-fledged totalitarian state. So long as their rule is not opposed, so long as the people are silent, then most are safe.”
Start getting ready…
October 11, 2009, 8:08 amInstapundit » Blog Archive » FINED FOR inadequate health insurance…. says:
[...] FINED FOR inadequate health insurance. [...]
October 11, 2009, 8:11 amSara says:
This talk of “choice” in insurance is pretty insane. Health insurance is among the most regulated industries in the country and has been for about a century. There is no choice in health insurance.
October 11, 2009, 8:12 amBarb says:
In a free society, nobody’s asking you to agree or to disagree. It’s not your business or the state’s whether the Jones’ satisfaction with their health insurance was well-founded; it’s theirs. No one can say whether they were right; they believed it was good enough for them and that’s all there is to it.
This “at their neighbor’s expense” argument is invalid: it’s at the hospital’s expense if someone receives care they can’t pay for, not your expense or mine…until government takes over the whole system. Then we all pay through the nose without cease: as the OP points out, the goal posts keep getting changed; the special interests flock to the center of power to urge on even more goodies for themselves; and the rest of us, whether we want to or not, end up paying more and more and more…until the whole thing collapses, which does seem to be looming more and more in Massachusetts’ healthcare future.
Maybe the Jones’ only truly bad decision was to remain in Massachusetts. Of course, if national mandated health care is passed, voting with your feet will no longer be an option either for Americans or the Canadians who now come down here to take advantage of our better system.
That’s not right, and it’s not financially reasonable, either. One nice thing about our federal system is that we can watch as other states try something, and if it works, we can do it, too; and if it fails, then we’re saved a whole bunch of trouble and expense. Let us learn from Massachusetts and not copy their mistakes. And let us remember, too, that this mess was put into place by a Republican governor there; a socialist health care system is not just a Democrat-sponsored thing, even if those are mostly the ones pushing it now.
October 11, 2009, 8:16 amSarcastro says:
Wtfo is a huuuge badass. Glad he draws the line at health insurance and not, say taxes or parking or littering (“the entire notion that the state gets to mandate my trash habits – and fine or imprison me for failing to obey – IS COMPLTELY UNACCEPTABLE.”)
Also, props to Michael Smith for at last comparing regulation of an industry to the subjugation of a people.
Other slaves: firemen (always havin’ to put out fires of the government takes their paycheck away), military person ell (gotta go here, gotta shoot this…), car drivers, unions (can’t strike whenever they like), stock traders (so much work disclosing stuff!) and really anyone under the jurisdiction of a court (positive injunctions.)
If only society would suck it up and let sick poor people die, the market would make America the sort of social darwinist place I’d be proud to live in again!
October 11, 2009, 8:19 amjso says:
the comments here scare me. are there really that many people that don’t mind seeing people fined $1000 by the government just for having health insurance that someone somewhere doesn’t approve of? that is truly repulsive.
October 11, 2009, 8:35 amAshen says:
Hey nitwit, what if they don’t use the ER, do they get thier money back at the end of the year? Of course not. Your argument doesn’t hold water. This whole idea is nothing more than an extortion scheme, the Chicago way.
October 11, 2009, 9:04 amBill Rost says:
Re: Mr Freedman
“Have at me, the statist, if you wish, but to me, FOOD should be socialized in the way that most public utilities are socialized. Most businesses need electricity, so why put them at the whim of private profit? Most of us need FOOD last time I looked, and so why bother with private profit to receive it? I am convinced that if we had FOOD for all, there would be burst of entrepreneurial spirit unleashed for those who have been tied to jobs due to FOOD plans, and small businesses would breathe a sigh of relief in not having to compete with larger businesses that offer FOOD plans. And saving the high administrative costs that comes with private enterprise, and having the government negotiate FOOD product purchases, would save lots of money for the payment of the FOOD”.
Or substitute clothing, housing, heating oil, telecom services… What, exactly, would not be the proper domain of government “oversight” in this brave new world? But, of course, it’s probably all “for the children.”
October 11, 2009, 9:18 aminsurance cheap says:
read more about insurance cheap
October 11, 2009, 9:18 aminsurance cheap says:
read more about insurance cheap
October 11, 2009, 9:21 amGaryC says:
In Zimbabwe, over the past 3 years, devaluation of the currency has dropped a total of 22 zeros from the Zimbabwe dollar. The peak rate was a doubling of prices every 32 hours. Not quite up there with Hungary in 1948, or Weimar Germany, but sustained longer, and the net impact is staggering.
October 11, 2009, 9:28 amHatlessHessian says:
And let’s be fair: people who do not pay for their health care and instead require others pay for it on their behalf, whether through the default on their ER financial obligation or through the use of government taxation, confiscation of property and implied force, through a government health care or insurance program.
Need we forget that we live in a nation where half of it consists of free riders, and 52% voted for free ridership and demands more theft from their neighbors? Any American that demands government health care is nothing more than a parasite, and this free rider argument is nothing more than one parasite exclaiming he/she is morally superior to another.
Eradicate them all: eliminate ER coverage for those who cannot pay and let the uninsured stand in line for quality VA care.
October 11, 2009, 9:56 amMikeC says:
This was a very entertaining thread. Thanks to Oren for wearing the statist hat so well. It’s a tough job but someone has to do it. Also, kudos to sarcastro for contributing nothing whatsoever although he/she may have impressed themselves with a remarkable wit and power over the language. I think it safe to say that there is no shortage of individuals self-appointed to safeguard the public pocketbook from those that choose to exercise a little sovereignty. Curious how that always seems to require an ever larger assumption of power by our trusted public servants.
October 11, 2009, 10:21 ambetsybounds says:
Well I haven’t been able to read all of the comments here, but of the ones I’ve read none mention the fact that people who have health-care expenses not covered by their insurance very (if not most) often pay their own medical bills, even if it takes them a while. I do not accept the assumption that, if someone has uncovered medical expenses, these expenses invariably get paid by taxpayers and that the uninsured or under-insured are free-loaders. I have a high-deductible policy with a health savings account, and I routinely pay medical bills myself that are not covered by either my policy or my HSA. There was a period of years during which I had no insurance, and I routinely paid my medical bills myself then as well. It sometimes took a while–I paid a surgeon who quite literally saved my life, paid his bill a bit at a time, every month, over 5 years. No one else paid it for me. I did not become a free-loader. I know I’m not the only person who’s ever been in such a position. I’m offended by the off-hand assumption some seem to make that uninsured people are automatically ER parasites on the rest of us. It is most emphatically not true .
October 11, 2009, 10:22 amDavid Chesler says:
Oren, 8:14pm:
When my family is starving I will steal bread instead of letting them die. Especially if I’ve had to pay into a bread-for-the-starving fund all my life. Does that mean we should just offer free bread, or that stealing bread isn’t stealing?
The helicopter rescue is exactly that seen and unseen issue. We can all get behind a little girl dying at the bottom of a well, ignoring not only everyone else who dies of preventable causes while they’re digging a parallel shaft, but also all the good that could have been done with that effort directed elsewhere.
October 11, 2009, 10:44 amWhat The ObamaCare Insurance Mandate Means | Axis of Right says:
[...] H/T: The Volokh Conspiracy [...]
October 11, 2009, 10:54 amNo you can't says:
What the state thinks about one’s choice of insurance is of course irrelevant in a free country.
Whether someone thinks their neighbor’s insurance is inadequate is irrelevant… unless you intend to force them to pay for their neighbor’s bill at the point of a gun. Then lots of things become relevant — like whether one smokes, or eats a certain diet, or what hobbies one engages in and what one does for exercise, or who has the ear of the politicians or, most importantly, how one votes. Then at best we can all live in a Victorian world where scolds rule the day and morality/health police run about punishing you for not having the right insurance or for not behaving in a proper fashion. Once you accept government intervention as proper in mandating personal choices you have no basis to object to any other mandate that it wishes to impose.
And all of this on the heels of the government having just wrecked the economy by guaranteeing everyone’s mortgage regardless of ability to pay. Now we intend to guarantee everyone’s health care regardless of ability to pay and we intend to have the very same architects who created the housing crisis lead the way.
We are not an intelligent people. I am ashamed and embarrassed that the blood of our Founding Fathers has so thinned in our veins that we can sit here and discuss which of our freedoms we will barter away for the false promise of a few pretty government baubles. But the concept of liberty is very much out of favor at the moment. I don’t give a fig for the particulars of any aspect of the MA plan or any other plan on the national level. That accepts too much ground that no free man would be willing to cede. We waste our time on such things like so many savages deciding what color beads we would like to have in exchange for being run off our own land.
October 11, 2009, 11:05 amAndrew J. Lazarus says:
So police protection comes free? I’ll be darned. Do glibertarians think before they post, or is there some sort of AI keyboard that writes this stuff to try to pass the Turing Test?
October 11, 2009, 11:15 amAndrew J. Lazarus says:
HSAs don’t work for many people, e.g., those who aren’t making enough to utilize them. Most proposals for HSAs see them as a replacement for safety nets. No thanks.
In actual fact, they very often declare bankruptcy. That, too, shifts the costs to the rest of us.
October 11, 2009, 11:22 amSuperSkeptic says:
So, which is it Oren? Democracy is King or it isn’t? If only southern blacks during reconstruction/jim crow could have just voted themselves into adequate circumstances. But then again, since such an overwhelming majority of whites wanted to do what they did, we should just resign ourselves to such things because, hey: “it’s going to happen independant of any law, ballot, constitution…”
October 11, 2009, 11:34 ambetsybounds says:
Andrew, I understand that some people declare bankruptcy. However, I’d have to see some pretty compelling figures to persuade me that most people do. In any case, you haven’t addressed my point that lots of people simply pay their medical bills, even if it takes them a while. Where did we get the notion that people either don’t, or shouldn’t, have to pay medical bills, anyway?
And the answer is. . . . It comes from the pernicious post-WWII policy of allowing employers to provide tax-free health insurance as a benefit of employment to get around the wage-and-price controls in place at the time. That policy has been causing massive medical marketplace distortions ever since, and it has corrupted people’s ideas of what they should be entitled to with respect to health care. It needs to be done away with. The link between employment and health insurance should be severed and the whole health insurance system returned to market principles.
As for HSAs, my employer offers them and they are widely used and popular in our Fortune 500 company. They include pre-tax employee deposits with matching employer contributions up to the amount of the policy deductible. In this way, people have their deductible available in the HSA, and after it is met the policy itself kicks in. Simple and extremely good policy. And in any case, why would the fact that HSAs replace safety nets be a reason to do away with them? You’re free to not use one if you like, but where does government get the authority to eliminate them for people who want them?
And the answer is. . . . Government simply assumes the authority. That’s the kind of thing that’s making government increasingly unpopular, unhelpful, and thuggish. It needs to be stopped.
October 11, 2009, 11:41 amShelbyC says:
BTW, with all this talk about free riders, are folks that pay less than the median amount of taxes free riders?
Of course, since the governemnt has been running deficits for years, and we’re running up debts that the next generation will have to pay, and on top of that we’re going to demand that the next generation pay us social security, I guess we’re all free riders.
October 11, 2009, 11:42 amXenocles says:
Nope. Nor is it recognized as a right.
October 11, 2009, 11:51 amConcerned Citizen says:
It’s always entertaining listening to lawyers try to explain why laws that diminish Liberty are “for our own good”.
When we see all the unintended consequences of the tens of thousands of laws that even the lawyers don’t know and can’t understand, we get frustrated. The law is corrupt.
Here is a simple solution — let everyone pay for their own health care. If someone can’t afford it, they will have to rely on the charity of their neighbors.
You should pay attention: We the People are at the breaking point. I just hope it doesn’t get violent.
October 11, 2009, 11:51 amTatil says:
Sure, in the ideal fantasy land where there are no barriers to entry, a regulator (read the government) ensuring there is vigorous competition and where producers and customers have the same amount of knowledge about the product. Otherwise, you get a single electricity producer in every big region that is ensured survival and at least a minimum profitability. Some will be managed well, their will reduce costs (without reducing the price), enhance their service and make more profits; some will not be managed well, it will have higher costs, it will drive their customers insane with bad service, but still make enough money to be quite profitable. In the end, free market may be the best alternative despite all that, but don’t expect such fantasy results in many “utility” markets.
Health care is not very suitable to a purely free market, as it fails the information symmetry requirement. The doctor knows, or at least pretend to know, a lot more about diagnosing and treating the patient’s disease. If he orders a test, the patient cannot be sure whether the test he is paying for is necessary and worth the expense. Same goes with prescriptions. Is that expensive drug really better than the cheap old one or was it prescribed because the doctor gets a sizable financial incentive? Please also consider that doctors at the moment do not publish their success rates, so you cannot do any comparison shopping based on past performance. They also don’t get paid for curing you, only for how many procedures they perform. The pharmaceutical companies do not publish tests that compare their drugs against other cheaper ones, only against the sugar pills and only when the experiment is successful. The patients also do not have the classic “substitution” possibility of Econ 101: If the butter is too expensive, switch to margarine. People do not say “The treatment costs more than my lifetime expected earnings, so I’ll just die.”
That is why HMO system was so promising early on. They gave incentives to hospitals and doctors to reduce costs so that they don’t order unnecessary tests etc. However, now you end up with people who are paid more for denying treatments as much as possible, even the ones deemed necessary by the doctor. The customer has no idea whether the insurance company will actually pay for treatments even though they are paying hefty premiums for decades. By definition most people do not get one of these rare and expensive diseases, so it is very easy for the insurance companies to portray them as rare problems that inevitably creep up in every sector, but it is actually built into their business model on purpose. Sometimes a purely free market is not the best option.
October 11, 2009, 11:59 amTatil says:
You mean we should interfere with the market, prevent companies from offering an incentive package that they thought was appropriate and force them not to offer health insurance. Sure…
October 11, 2009, 12:02 pmSuperSkeptic says:
It already is and always has been. The political process is violence masked. A breakdown in the political process, or as you say, “the breaking point,” would simply unmask it for us all to clearly see and feel. Even the ignorant could no longer deny it.
October 11, 2009, 12:07 pmSeaDrive says:
Of course the taxpayers don’t always pay. Often enough, the doctor, or other caregiver, gets stiffed.
October 11, 2009, 12:16 pmXenocles says:
“You mean we should interfere with the market, prevent companies from offering an incentive package that they thought was appropriate and force them not to offer health insurance. Sure…”
I don’t think that’s appropriate either, but note that the whole point of that post was that insurance-as-a-benefit arose from government interference in the first place; that of instituting a price ceiling on wages.
October 11, 2009, 12:18 pmbetsybounds says:
Tatil,
I don’t know for sure, but I suspect that all we’d have to do is remove the financial incentive provided by giving the employer a tax deduction for employees’ premiums. It would also be excellent to equalize the tax treatment of employer-provided health insurance and self-insurance for self-employed people. As it is now, employee health-insurance benefits are a tax deduction for the employer and tax-free income for the employee. Self-employed people, on the other hand, are forced to pay insurance premiums from post-tax income and get no deduction for it. These are manifest distortions of the market. Stop them. You wouldn’t have to “force” many employers to reconsider their benefit offerings in that light. I’m going to take a wild guess, here, and suggest that maybe–just maybe –employers aren’t offering health insurance benefits out of an excess of charitable sentiment.
October 11, 2009, 12:19 pmAndrew J. Lazarus says:
Most people with medical bills don’t declare bankruptcy. However, most bankruptcies include medical bills. (Click on previously supplied link.)
October 11, 2009, 12:22 pmSagar says:
@ Anderson
why don’t we expand your assertion about free riders –
welfare receipients are freeloaders, so they should be fined!
October 11, 2009, 12:25 pmbetsybounds says:
SeaDrive,
There’s a fine line somewhere between the doctor getting stiffed and the doctor donating care he knows is both needed and unaffordable for the patient. I think the latter happens more frequently than many people suspect, and it is not a bad thing. Nevertheless, I maintain that there is a not-insignificant number of people in this country who pay for their own health care, even if it takes them a while. My husband was a working musician for a number of years, and not an employee. We couldn’t afford insurance ourselves, partly because of the tax treatment, but we could afford to go to the doctor when we needed to and avail ourselves of medical care at our own expense. We were not the only ones who did so–we knew lots of musicians and others in the same position. My point is that it is not inevitable that the uninsured are social burdens. I don’t even think it is usual. It certainly wasn’t for us or for lots of others we knew.
October 11, 2009, 12:32 pmbetsybounds says:
Anderson,
Hmmmm. Well I don’t know how important that is–it would depend on the bankruptcy rate in the general population. My first impulse is to think that it reminds me of what the drug warriors always say about marijuana: It’s a gateway drug whose use must be suppressed with force because its use leads too other, harder drug use. I don’t advocate marijuana use, but that’s always struck me as a not-very-useful metric. We may have some handle on how many hard-drug addicts started out with marijuana, but we haven’t a clue how many people use marijuana for a while in their youth and never move on to anything else at all. It may or may not tell us anything about cause-and-effect, you see. It may be that most bankruptcies have a medical cost component. I’m not sure that tells us anything about cause-and-effect, though. If you are aware that most people with medical bills don’t enter bankruptcy, what is your point? Do you think we need to undertake and enforce a full government take-over of that entire segment of the economy because a small percentage of uninsured individuals enter bankruptcy as a result of catastrophic illness or accident?
October 11, 2009, 12:40 pmAndy Freeman says:
> Underinsured people are free riders. Something catastrophic happens, and they’ll be in the ER, demanding treatment at their neighbors’ expense.
Their neighbors could say no.
This whole argument starts from the premise that if some decide to “do good”, other people are obligated and can be forced to minimize the costs of said goodness.
That’s absurd.
October 11, 2009, 12:45 pmJB says:
It’s time for Obama to step down.
He’s not my President; he can go be President of a paper bag.
October 11, 2009, 12:46 pmSwede says:
When are you people going to realize that the government is just trying to do the right thing here? Maybe if the governed weren’t so infantile they would just stfu and get on the bandwagon. If the government doesn’t take care of you, who will?
Jesus, it’s like you people need to be put in re-education camps or something.
For your own good.
October 11, 2009, 12:46 pmBobK says:
Low deductibles are a ripoff. The insurance company ALWAYS comes out ahead in the long run.
What’s puzzling is that reformers keep promoting lower deductibles as an answer to the cost problem. Heck, they’re the SOURCE of the cost problem.
October 11, 2009, 12:56 pmbetsybounds says:
Swede,
LOL! Are you serious? Since when does wanting to take care of yourself, accepting responsibility for making your own choices, equate with being infantile?? It strikes me as being fairly adult, actually. It’s the infants amongst us who want the government to do the care-taking. Those who depend on government will be forever supplicant, will be deprived of choices to exercise, and they will have deserved what they get.
I knew things were different in European Baby-Land, but Jeez! Camps? For wanting freedom? Jeez!
October 11, 2009, 1:00 pmJoe says:
A bit of a delay, but I find it rather humorous that Oren believes his liability insurance doesn’t have a cap (and a relatively low cap at that.) Of course, that begs the questions as to why he is freeloading off his insurance company. Surely he hasn’t paid in to his policies what he MIGHT take out.
October 11, 2009, 1:07 pmRuss says:
Andrew,
The question is whether you think before you post. Police are there to protect your rights, but police protection is not a right unto itself. Witness a few of the townships that have no police.
A right is something that requires no exertion on the part of another – the right to free speech, the right to privacy, etc. I notice you never answer whether the rights of the doctor are violated when he is forced to provide you a service of his work without adequate compensation. When I can force him to work at whatever I decide is fair, how long until he decides not to work? And bringing up police and fire are pathetic examples – aren’t we always complaining about a lack of police or teachers, and shouldn’t we pay them more? People do not become police for the pay, but for decades people explicitly have become doctors for the pay. I wish idealistic altruism was the norm, but that doesn’t account for human nature. Force doctors to take government pay and you’ll force a lot of the best and brightest into other fields where they can make money. But hey, as long as you have free health care…wait…with no one around to provide the service, you’ll have nothing. Great way to cure the headache by cutting off the head.
Under your example, we should have the government pay for everything required for survival – housing, clothing, food, etc. After all, don’t I have a “right” to survive? Why should any of this stuff be allowed to make a profit at my expense?
October 11, 2009, 1:11 pmRuss says:
betsybounds,
I think Swede was being sarcastic and mocking. The “re-education camps” statement should have given that away.
October 11, 2009, 1:13 pmGrover Gardner says:
That’s not true at all. When I was self-employed I routinely deducted my health-insurance premiums.
Employer-provided health insurance is a very good idea. It’s much cheaper than individual insurance, and it does not lower wages, as some claim. I checked with the HR person at my company. They pay $2400 a year to insure each employee, regardless of risk–because the pool is large and risks are spread. Each employee pays $600 a year. That’s $3K a year. A similar private plan would cost me about $6000 a year in the private market. So even if I got that $2400 from my employer I’d still be paying another $3000 a year for similar coverage–and I’d be taxed for that money, raising my costs another $1200 or more. Depending on the state I live in, a fellow female employee of child-bearing age would pay even more than that. Someone older than me with pre-existing conditions would be out of luck altogether.
Another benefit is that we are given annual seminars on the status of our policy and instructed how to reduce claims and therefore costs to the company as well as ourselves. We are encouraged to seek preventative care and use generic drugs whenever possible, among other things. This year our claims went down considerably.
“Nevertheless, I maintain that there is a not-insignificant number of people in this country who pay for their own health care, even if it takes them a while. My husband was a working musician for a number of years, and not an employee. We couldn’t afford insurance ourselves, partly because of the tax treatment, but we could afford to go to the doctor when we needed to and avail ourselves of medical care at our own expense.”
I take it your husband is now an employee (I’m not trying to be personal). Which situation do you prefer (bearing in mind that you should have been able to deduct your insurance when he was self-employed)?
Of course there are a lot of people who pay their bills. But any hospital administrator will tell you that a significant percentage of their bills for uninsured patients go unpaid. They don’t eat this cost. It’s passed along to the rest of us.
October 11, 2009, 1:16 pmShelbyC says:
Or maybe just eliminate the discriminatory tax treatment of employer-provided health insurance.
October 11, 2009, 1:19 pmGrover Gardner says:
Just when I think libertarian arguments can’t get any sillier–they do. Do you really think it takes no “exertion” from the rest of us to protect your right to privacy?
October 11, 2009, 1:20 pmRichard Johnston says:
Perhaps it would be if it were actually insurance and if it were enforceable in court. The way it is now it’s just a piece of paper saying some insurance company will pay your claim if it feels like it, and if it doesn’t feel like it there’s precious little you can do.
October 11, 2009, 1:24 pmTatil says:
I know, I was in a kidding mood. Yes, that is an unfair distortion. Even though I am on the receiving end of that subsidy, I agree that unfairness should stop. However, just like mortgage interest deduction, politically it is almost impossible to lift that distortion by removing the subsidy. They will have to come up with a way to provide tax deduction for the self-employed as well, increasing the budget deficit. In any case, you’d still be left with health insurance companies which has perverse incentives. They are allowed to refuse coverage to people born with bad genes. Is that really insurance? Besides, if they spend money for preventive care, the patients may bolt for a competing company before the reduced medical expenses of that patient materializes. That is not fair for them, either.
October 11, 2009, 1:28 pmGrover Gardner says:
That’s a problem with all health insurance right now, isn’t it? I mean, would private insurance offer me any more of a guarantee than my employer-based insurance? At least right now I have my employer to go to bat for me.
October 11, 2009, 1:35 pmGrover Gardner says:
The self-employed get a tax break. That’s not where the discrimination occurs–it’s when you’re not part of a larger pool and pay twice as much in premiums.
October 11, 2009, 1:36 pmpunditius says:
Y’know, maybe subsidizing free riders through increased health costs is actually a better way of dealing with the “free rider problem” than additional government interference in our lives through mandated health insurance subject to manipulation by vested interests. Just a thought…
October 11, 2009, 1:39 pmSuperSkeptic says:
A lot of talk about rights going on, and although I’m on the non-mandate side of this specific argument, I cannot accept some of the rights defining that’s going on. Does not a right to property require restraint on the part of others, unless we all universally accept Locke’s labor theory? – I’m sensing not everyone here does. Life, Liberty and Property did in fact morph into Life, Liberty and the Pursuit of Happiness.
October 11, 2009, 1:40 pmRichard Johnston says:
Grover Gardner:
That’s a problem with all health insurance right now, isn’t it?I mean, would private insurance offer me any more of a guarantee than my employer-based insurance?At least right now I have my employer to go to bat for me.
ERISA preempts state law, and in its place provides very stingy remdies for insurance company bad behavior. Under ERISA they have immunity from liability for anything up to and including fraud and wrongful death.
Individual policies are governed by state law, which varies from state to state of course but generally allows suits against insurers for bad faith, and allows recovery for consequential damages and in an appropriate case punitive damages.
Beyond stingy remedies, ERISA makes it unduly difficult to recover anything in court, because in order to prevail you generally have to show the claim denial was not just incorrect but that it was arbitrary and capricious, a standard of review generally applied to lower courts’ discretionary decisions. Insurance companies are not Oliver Wendell Holmes.
See here for an overview, from my perspective anyway.
October 11, 2009, 1:42 pmShelbyC says:
Silly or not, this is the conception of “rights” that this country has had from the begining. The Declaration of Independance talks about rights endowed by the creator. The problem with so-called positive rights is that they imply an obligation of the part of someone else. So the right to an education implies the obligation of someone else to be a teacher. The right to, say, free speech implies no obligation other than for others not to violate that right. Now of course, requiring others not to violate that right requires action, and that’s why we have government.
October 11, 2009, 1:42 pmRuss says:
“Do you really think it takes no “exertion” from the rest of us to protect your right to privacy?”
What extertion is required from you to leave me alone?
Restraint? Doesn’t the lack of restraint imply action on someone’s part?
Geez, and I thought people here had at least a modicum of some understanding of what a right is. Nice to know a lot of people consider the imposition of will against another to be something that occurs without action…
October 11, 2009, 1:51 pmGrover Gardner says:
All this free-wheeling talk about “rights”! Of course I have the “right” not to pay for someone else’s health care. But that right isn’t taken away by the government. It’s taken away by the very nature of the society we live in. You’d think we’d be proud to live in a society that doesn’t let people die in the street. I know I am. But of course I’m going to end up paying for some of that. If there’s a way to reduce the costs to myself, why wouldn’t I be in favor of that?
No, health care isn’t a “right.” It is a benefit of the society we live in, and it’s one we should all be proud of. But it isn’t free, for anyone. Hospitals, clinics, emergency services, etc. cost money. Medical research and development cost money. New cures and treatments cost money. We have three options, as I see it:
1) Reserve the best care for those who can afford it;
2) Spread the costs around so more people can afford it;
or
3) Reduce our expectations for good health and longevity.
October 11, 2009, 1:56 pmShelbyC says:
And the reason the pool is so small is that the vast majority of people don’t get a tax break. If you get insurance through your employer, it’s not taxed. If you don’t, it is. That is where the discrimination occurs.
October 11, 2009, 2:06 pmkimsch says:
Actually something similar did happen to me about a decade ago. The IRS decided that the amount of withholding my husband had was too small. They wanted more to use interest free during the year. So they fined him for having too little withheld from his paychecks.
October 11, 2009, 2:07 pmGrover Gardner says:
Part of that might depend on where you live. Next door to me? In that case, I probably exert a considerable amount of effort to “leave you alone” and respect your privacy. There are a lot of things I can’t (or shouldn’t) do that would infringe on your right be be “left alone.”
Live far away from me? I’m still paying something and exerting some effort to respect your privacy. Have an accident on a lonely road? Sure, I could leave you to die, or I could pay the taxes that send the sheriff out to rescue you. Of course, I only do that in the hope that you consider my life worth a bit of cost and effort on your part as well.
If you think that no one pays a dime for other people’s right to be left alone, you’re kidding yourself.
October 11, 2009, 2:08 pmagmartin says:
They already do as part of Social Security
October 11, 2009, 2:10 pmGrover Gardner says:
They just “decided,” huh? Sure there’s a penalty for underpaying estimated taxes. So your husband got to use the money interest-free instead of the government.
October 11, 2009, 2:15 pmGrover Gardner says:
Almost 60% or Americans get their health insurance through their employers. Non-group insurance is about 9%. Public insurance in some form makes up most of the rest. I don’t know the percentage of non-group workers who are self-employed, but if they are self-employed they can deduct their insurance premiums under most conditions. Why do you keep insisting they can’t?
October 11, 2009, 2:22 pmAndrew J. Lazarus says:
This is a joke, right? Those townships are covered by county sheriffs, state police, and the FBI. Other than that, they have no police. (Now, there are libertarian paradises with no police, like much of Somalia, and I just don’t know why you aren’t touting their benefits.)
Now that we have settled the fact that everyone has police protection, I suggest that having police to protect your (other) rights is itself a right. The distinction you are trying to make is entirely artificial and rooted largely in subjective belief about “rights” to which you wish to be entitled, and “non-rights” you don’t wish other people to enjoy unless they can afford them.
Defense of your property rights most certainly requires exertion from me: you expect me to pay taxes for it. And just as a “right” to education entails the government hiring teachers, your property rights entail hiring police, judges, soldiers, etc.
BTW, I think you would be surprised how few doctors are in it for the money. Many seem more than willing to trade a little salary for getting rid of their insurance administrators.
October 11, 2009, 2:27 pmShelbyC says:
I don’t. I’m talking about folks who are not self employed. If your employer provides you with insurance, neither what you pay nor what your employer pays is taxed. So if my employer provides a $15000 a year health plan, and he contributes $7500 a year, and I pay $7500 a year, neither what I pay nor what he pays is taxed. But if my employer gives me $7500 additional salary, and doesn’t provide health insurance, and I buy my own $15000 policy, it’s going to cost me significantly more. So of course employers end up providing health insurance.
And that makes insurance companies responsive to the employers, not the insured.
October 11, 2009, 2:34 pmShelbyC says:
Every once and a while someone sues the police for failing to protect them. It doesn’t usually work out very well.
October 11, 2009, 2:36 pmOren says:
Not everyone has $500,000 to pay for a trip to intensive care. I’m explicitly talking about the people that incur a liability in excess of their total present and future assets.
What would you have us do? Squeeze blood from a quadriplegic turnip? These folks just don’t have the money.
October 11, 2009, 2:52 pmOren says:
Of course they could. As it happens, we chose not to.
October 11, 2009, 2:58 pmOren says:
Which they pass on to the consumers of medical services. Which happens to be more or less everyone that is alive.
October 11, 2009, 3:02 pmGuest12345 says:
Are you also proud to be part of a society that deprives my children of the best education I can provide? Are you still proud when you consider that the reason that deprivation occurs is because some forty year old, ex-gang banger couldn’t be bothered to take responsibility for his life and give up the Friday night parties, drug usage, daily six-pack and his three packs a day smoking habit? That the wastrel still expects his mommy to pay his bills, except that his mother finally kicked his ass out of the house. So you’re proud that the rest of us are now filling that role of mommy, only we’re not able to assert even minimal control over the lifestyle choices of those demanding that we support their lives?
Why are you proud of the fact that we spend so much money attempting to provide some quality of life for people who refuse to do anything for themselves? Who take pride in being uneducated and sociopathic. Makes no sense to me. The freedom to not finish high school requires the freedom to not have the same quality of life that someone who does sacrifice for an education is able to enjoy. Once you take away the consequences of bad choices, there is little incentive to avoid making bad choices.
October 11, 2009, 3:04 pmShelbyC says:
Well, it’s kind of a leap from underinsured to what you’re talking about. Isn’t the article about someone who was fined $1000 for carrying a policy with a $2500 deductible when the state required $2000?
October 11, 2009, 3:11 pmGuest12345 says:
Don’t forget the added bonus that, if they happen to make any attempt to be a productive member of society[1], we now get to tell them what to eat, how to dress, what to drive, what hobbies to have, how to spend their earnings, etc. because otherwise it’ll be too expensive for you to pay their bills for them. It’s a win-frickin-win situation all around.
[1] The “poor” on the other hand can’t help it and get a free pass on their behavior.
October 11, 2009, 3:13 pmAss of Catalonia says:
See The World’d Greatest Sinner
October 11, 2009, 3:21 pmJohn C. Randolph says:
This statement illustrates the tragic state of our schools, and their inability to teach logic or economics. Money paid for your labor that doesn’t end up in your pocket lowers your wages. Pretending otherwise is sophistry.
-jcr
October 11, 2009, 3:45 pmanonlawstudent says:
In actual fact, they very often declare bankruptcy. That, too, shifts the costs to the rest of us.
October 11, 2009, 4:08 pmOren says:
Yes, it is unfortunate that the policy offered by IBM is just short of the arbitrary limit set by MA. The fact that a particular limit is arbitrary does not mean it doesn’t have to be made at all.
October 11, 2009, 4:21 pmAZBlondie says:
Even if we were to agree that ‘underinsured’ people are free-riders, where is it in the linked article that states that the Williams’ coverage qualifies as ‘underinsured’? For all we know, they may have very good coverage for expenses above the $2500 deductible.
Personally, I’m in the camp that supports high-deductible policies with HSA’s. I strongly believe that simply making people aware of the true cost of medical care will cause people to be more discerning in what care is consumed. Along with this, however, I think that preventive and routine care should be readily available and less expensive. At least in my area, grocery store and drug store clinics are starting to do this.
One think I would like to see… If we were to take the total cost of health care spent in the US on an annual basis and divide it by the number of people, what would that cost be? And if we were to exempt those at 1, 2 or 3x the poverty level and divide by the rest?
October 11, 2009, 4:33 pmanonlawstudent says:
Actually, the evidence you cite doesn’t provide as much support as you believe. Let’s take a look at the study itself. Focusing in on Exhibit 2, we find that only 28.3% of bankruptcies are attributable to “illness or injury,” with the remainder due to “medical cause[s]” such as “uncontrolled gambling,” “alcohol or drug addition,” “death in the family,” and “birth/addition of a new family member.” Notably, the study also sets a threshold of only $1,000 in uncovered medical bills for attributing the bankruptcy to a “major medical cause.” Also notable is the fact that only 2% of homeowners who declared bankruptcy “mortgaged [their] home to pay medical bills,” thus implying that many of these filers were gaming the bankruptcy system rather than exhausting their assets. Of course, given the widespread criticism of misleading “OMG!” press coverage of the study, e.g., here, one can only assume that you either knew the CNN article was misleading, or you simply sought a superficial headline to support your views.
October 11, 2009, 4:35 pmThe Volokh Conspiracy » Blog Archive » Fined for Inadequate Insurance | insurance says:
[...] the original: The Volokh Conspiracy » Blog Archive » Fined for Inadequate InsuranceSHARETHIS.addEntry({ title: "The Volokh Conspiracy » Blog Archive » Fined for Inadequate [...]
October 11, 2009, 5:21 pmSeamus says:
That includes police and fire and military defense, right?
Yes, it does. That’s what cases like DeShaney v. Winnebago County have held.
October 11, 2009, 5:30 pmpunditius says:
Way back in WWII, the government switched us over from a “calculate your tax and send in the payment” method to “withholding,” which is a “calculate your tax and get a refund from what you’ve already paid” method. The net result of that was that taxpayers’ perception of paying their taxes switched from one in which they really understood that the government was getting real money from us, to one in which most wage-earners tend to think of taxes in terms of getting money from the government. This is the point at which we lost control of our government, and the result has been over half a century of overtaxing and overspending.
Now, in the health care arena, we are facing the same thing. Once the government gets control of our health care dollars, we will find ourselves spending more, not less, for health care. The government will chose what choices are available to us, and the lobbyists will make sure that those choices create more and more dollars to flow to Big Health. On the one hand, costs will go up as coverage expands to include more things that represent profit centers for Big Health. On the other, coverage will not include health care that is not cost effective from a profit point of view. Hence, death panels.
Of course, in a sense, this is what happens in the private market. But there is one big difference, which is that when the government takes over, Big Health will be able to use government regulation to prevent the free market from reacting to the situation.
But from the consumer’s point of view, just as from the taxpayer’s point of view, the government will be giving us all refunds. In the health care arena, the “refund” will be in the form of yearly “free” physicals (which will eventually become mandatory. Don’t think so? In many states, you can’t buy a pair of glasses unless you have had your eyes examined in the last year. Whether you need a new prescription or not. In other words, mandatory eye exams), inoculations, hearing examinations, &c. These things will eventually require copays, and the copays will go up. Meanwhile, if you are outside the system, coverage mandates will drive up the cost of private insurance to the point where only the genuinely rich (as opposed to the Obama rich) will be able to afford it.
So yeah, AZB, HSAs do exactly what you say. Which is why they will probably be eliminated. Government and Big Health do not want us to know what our actual costs are, any more that our Congress wants us to know what they are really spending, or how much we are really paying.
October 11, 2009, 5:46 pmDavid Chesler says:
Most people have medical bills.
People who are having trouble paying their bills are no doubt more likely than average to have medical bills, both because people with no bills don’t have medical bills, and because some of those medical bills are due to situations that also preclude working.
And if declaring bankruptcy is in your best interest (“gaming the bankruptcy system” as anonlawstudent just put it, which I guess means declaring bankruptcy under the matrix of rules in which you incurred those debts, which matrix was used as an excuse for the interest rates etc., even if it might be physically possible to sell your homestead and IRA and eventually pay off more of those debts) you’re going to, in fact you are required to, throw every medical bill you’ve got into the bankruptcy.
That doesn’t mean the medical bills caused the bankruptcy, or even that if all else were equal except the medical bills magically went away, bankruptcy wouldn’t still be in the best interest of the declarer.
October 11, 2009, 5:51 pmwilky says:
It’s interesting to note that when those that complain about free riders have this brought up, they scatter like cockroaches that caught a glimpse of a can of Raid.
I don’t need you fella, while it may be a bit brutish, I’ve got the Second Amendment to insure that.
October 11, 2009, 5:53 pmDavid Chesler says:
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It’s interesting to note that when those that complain about free riders have this brought up, they scatter like cockroaches that caught a glimpse of a can of Raid.
Hand-in-hand is the notion that those who oppose health care reform are “greedy”, because we should support it so we won’t have to pay as much for drugs and medical care, but that wouldn’t be greedy.
October 11, 2009, 6:13 pmDavid Nieporent says:
Moreover, note that the fact that a particular bankruptcy is caused by “illness or injury” does not mean it was caused by lack of health insurance; if one gets sick or injured and can’t work and loses one’s job as a result, health insurance won’t prevent bankruptcy.
October 11, 2009, 6:27 pmMark says:
When health care is “free.” You will have every low life scum, lazy, non-productive slug at the ER door. For you who have decided this a RIGHT. They will let us know (I’m an ER nurse, Medicaid patients are already this way…) that they have a RIGHT to motrin, tylenol, diapers, car seats, food, taxi fare, bandages, meds, (after hour narc dispensing) scrubs,(they threw up on themselves, got no clothes)shower, find them a flop house for night, phone use, give them a ride just to get them out. And now you want to grant this RIGHT to the rest of the country??? God help us. You have no idea what you are unleashing…
October 11, 2009, 6:55 pmGaryC says:
No, we should eliminate the special tax advantage given to employer-paid health insurance. Either allow individuals the same tax benefit, or eliminate it entirely. That isn’t “interfering” with the market, it’s removing interference.
October 11, 2009, 7:27 pmGaryC says:
If you itemize your deductions on Schedule A, then you can deduct medical expenses (including health insurance premiums) that exceed 7.5% of your adjusted gross income. Any medical expenses up to that 7.5% threshold are not deductible. For a family of 4 with an AGI of $40,000, that means that they get no deduction for the first $3,000 of health insurance premiums. In some states, that might be their entire bill.
Of course, for that family of 4, it might not be beneficial to itemize deductions at all, so they would get no help paying their health insurance premiums. It would depend on how many other deductions they can find, such as property taxes and state income taxes.
October 11, 2009, 7:40 pmpublic_defender says:
So it’s OK for the government to protect me from robbers and fires, but not a brain tumor? And you’re a “spoiled child” if you want life-saving brain surgery but can’t afford it? No wonder y’all lost the last election.
October 11, 2009, 7:48 pmkimsch says:
It’s also a canard that your employer “subsidizes” your health insurance premiums just as the “half your social security taxes are paid by your employer”. Neither one is true. Your employer takes those costs into consideration when deciding how much cash compensation you will receive and how much non-cash compensation you’ll receive.
Now if we were able to purchase our own health insurance (with the tax benefits employers currently get for providing such) we’d be able to get the benefits we want or need, from anywhere, and we wouldn’t need to have our health insurance tied to our employment.
October 11, 2009, 7:54 pmAndrew J. Lazarus says:
That group was listed separately and comprised roughly half of the illness-related bankruptcies. Of course, there were other cases where the victim found a new job, but was uninsurable because of the pre-existing condition, and went bankrupt.
The number appears to be larger as I read the data.
The total sample includes the non-homeowners (i.e., renters), and of course there is no a priori reason to believe that the others had sufficient equity to make re-financing their house worthwhile.
October 11, 2009, 8:07 pmObamacare: A Preview « The Universe Exists for My Amusement says:
[...] The Volokh Conspiracy » Blog Archive » Fined for Inadequate Insurance. Wendy Williams and her husband liked their health insurance plan. The premium and annual deductibles made sense for them, and a more “gold-plated” plan was not worth the money. Yet Massachusetts’ health care regulators disagreed, and forced the Williams to pay a $1,000 fine if they wished to keep their insurance plan — a plan they prefer to a comparable state-approved alternative. [...]
October 11, 2009, 9:20 pmpunditius says:
Actually, the government doesn’t protect you from robbers. It catches them, but only after you’ve been robbed. As for fires, the government only protects you from fires that are spreading, not from the initial fire.
What you want is for the government to give you back the money the robber took, and rebuild your house. And remember, when you say “the government” what you really mean is “all the people who still pay taxes.”
So no. I don’t want the government to “protect” you- or me – from a brain tumor.
And yeah, that viewpoint is not consistent with electoral victory, because it seems more and more clear that the majority of Americans prefer the illusion of security to the risks of liberty.
October 11, 2009, 9:26 pmOren says:
The odds of being robbed are significantly decreased by policing. That is, what we pay for is an average effect of deterring crime.
October 11, 2009, 9:32 pmGrover Gardner says:
Yes, you’re right, that is true. However, it doesn’t compel me to drop my employer-based insurance, because there are other factors that weight in favor of it.
My employer-based health insurance saves me thousand of dollars a year that I’d otherwise be paying for the same level of coverage. And the pre-existing conditions I had when I joined the company are covered. Despite your disparaging remark about my education, I’ve done the math and I’m satisfied that I’m getting a good deal–at least in terms of the current market.
…etc. Yes, that’s true. But a couple of commenters claimed that self-employed people were not able to deduct their insurance. That’s not true.
Perhaps because I’ve actually met very few people like that. And/or because I don’t keep a tally of who “deserves” my help and who doesn’t. I don’t think in terms of some faceless mob of good-for-nothings. I realize that there will always be some “waste,” in terms of people who don’t take care of themselves. I consider myself an extremely fortunate person. I’ve also made a lot of mistakes in my life and had some close calls due to my own carelessness or thoughtlessness. I don’t consider myself the ultimate arbiter of who is worthy and who isn’t.
I wasn’t aware that anyone was proposing “free” health care. Every proposal I’ve seen involves mandating that everyone contribute to the system.
That’s true to some extent. OTOH, my employer pays half of what I would pay to insure myself. If I opted for private insurance, I’d need to ask for a raise to compensate for the costs. I also think the employer based system is good. The coverage is cheaper and more comprehensive than what I could afford on the open market, young women in the company aren’t penalized for having babies, and pre-existing conditions are covered, albeit after a brief waiting period.
I can see providing some tax parity for individuals, but basically I think incentivizing employer-based coverage is a good thing.
October 11, 2009, 10:07 pmAndrew J. Lazarus says:
Libertaria is such a strange world. In my world, for example, the government requires my neighbor to have fire-retardant roofing. And that both my house and my neighbor’s have electrical wiring up to code. And, of course, government’s police patrols inhibit robbers. What a bummer—how much better to live red in tooth and claw.
October 11, 2009, 11:13 pmanonlawstudent says:
In my world – what I like to call the real world – many jurisdictions don’t have such codes. See, e.g., here (noting that as of July, 60 of Tennessee’s 95 counties lacked minimum residential building standards). Isn’t it amazing how consumers (along with construction lenders and insurance companies) have managed to keep all of the houses from burning down . . . and without government regulation? Indeed, in my corner of the world (Washington, D.C.), it is government regulation that impedes the replacement of decades-old electrical wiring with modern systems. It’s almost as if we have experience with which to inform the debate over problems with the heavily-regulated insurance industry . . . .
October 11, 2009, 11:46 pmNY Lawyer says:
The American Bar Endowment’s excess major medical policy, underwritten by AIG, provides $2 Million of health insurance coverage with available deductibles of $10,000, $15,000, $20,000, $25,000, $50,000 or $100,000. I have the $15,000 deductible policy. My insurance costs $641.28 per year per person for myself and my wife, and there are policy dividends about every other year. This year’s 20.58% dividend reduced the per person annual cost to only $509.31. The policy covers almost everything in full – doctors, hospitals, drugs, etc. – once the deductible is exceeded, and there is no requirement to use any designated doctors or hospitals.
This $500 policy with $2 Million of coverage is evidence that most of the cost of health insurance goes for small claims processing and not catastrophic coverage. And remember, I live in New York, a state with onerous insurance mandates including community rating, and some of the world’s wealthiest plaintiffs’ lawyers.
ABE insurance, which fully meets my needs, apparently would not satisfy the unconstitutional requirements of Obamacare. The writers of the script appearing on Comrade Hussein Obama’s teleprompter would require me to buy an expensive, low deductible policy or pay a fine. This is corporate welfare for the insurance industry. Low deductible policies result in more claims, requiring more claims adjusters and more claims work, and this results in larger insurance companies with more highly paid executives. If I were to pay more for insurance, I would much rather pay for additional coverage above the current $2 Million limit than to reduce the deductible.
I also have a $15,000 deductible home insurance policy, and I don’t buy collision or comprehensive insurance on my cars. Over the long run, it’s much less expensive to take care of your body and safeguard your property and simply pay for small claims as they accrue than to buy expensive, low deductible insurance.
October 11, 2009, 11:48 pmAndrew J. Lazarus says:
You know, in the Oakland/Berkeley Hills fire of 1991, the houses all did burn down. Funny thing, the fire code got tightened up afterwards. The lenders and insurance companies didn’t manage to stop that disaster on their own, before. When libertarian theory gets marked-to-market, it usually comes up short. I don’t want to say always; I’ve heard that cap-and-trade originated with a libertarian economist and I think it has potential. But usually.
In 60 of Tennessee’s counties are houses close enough to each other to be a hazard?
October 11, 2009, 11:56 pmAndrew J. Lazarus says:
As I wrote upthread, I think that high-deductible insurance makes sense—for people who can post surety for the difference. I have no problem with that. On the other hand, NY Lawyer, if you have any poor or lower middle class clients, ask them if they can afford a $14,999 medical bill.
October 12, 2009, 12:06 amMarty says:
When my daughter graduated from college (2001) and went off the student medical and was no longer eligible as my dependent, but didn’t have a full-time job with medical, we shopped for medical coverage for her. She was healthy, no significant medical issues. We all agreed, no need for maternity coverage as she wasn’t married and wasn’t about to have a baby, and no drug abuse coverage because we weren’t gonna pay for that and if she couldn’t stay clean the cost would be on her. $2K annual deductible and 80/20 copays, cost about $100/month in Austin, TX. Adding maternity and drug abuse would have increased the cost by about 50%.
What was wrong with that?
October 12, 2009, 12:16 amRicardo says:
That’s only partly true. If you try to buy exactly the same coverage as an individual that your friend has as part of a group plan, you won’t be able to. That’s because HR departments have bargaining power that you as an individual do not have and also because a group plan pools risk among the employees so the expected cost to the insurer is lower. That cost savings is passed along to your employer who in turn passes on part of the cost savings to you in the form of higher net compensation.
Incidentally, this is why COBRA was passed in the first place. If it was so easy to obtain individual coverage at the same price your employer pays on the health insurance market, there would be no need for COBRA except to deal with pre-existing condition exclusions.
October 12, 2009, 12:19 amRicardo says:
Only in NY Lawyer’s world is a claim of $14,000 considered a “small claim.” Uninsured in the U.S. are disproportionately young which means they probably do not have adequate liquid assets yet to pay off a $14,000 medical bill.
October 12, 2009, 12:26 amRicardo says:
Who said there was anything wrong with it? It seems her policy would have been considered adequate insurance by the State of Masachusetts. Once she gets older and gets married and has children, the benefits of an employer-sponsored group plan will become clearer, though.
October 12, 2009, 12:30 amGuest12345 says:
I’ve met plenty. Not total tweekers but, for lack of a better term, chronic losers. In person they are perfectly charming. They just consistently fail to make the good choices. I’m not even talking making the absolute best choice 100% of the time. I’m talking consistently putting in the effort to improve their situation. Hell, I have friends who are like that and I don’t invite them into my home, feed them, and clothe them. Why? Because until I earn many times what I earn now, I don’t have excess to give away. And in the end, I could sell my house, raid my children’s college fund and give them the proceeds and they aren’t going to improve themselves. So please explain why we should permanently impair our individual family’s well being for people who just can’t be saved.
It’s not a matter of deciding who is deserving, it’s a matter of you wanting me to put my family’s well being below the well being of some stranger. Not only a stranger, but a stranger who puts themselves ahead of my family. Your position is utterly irrational.
October 12, 2009, 12:31 amGrover Gardner says:
Nothing whatsoever. But in a few years, if she’s pregnant and calls the insurance company about coverage, get back to us. Hint: If I were you, I would have encouraged her to spend the extra $50 a month. Even if she waits ten years to have a child, it would have been a steal.
October 12, 2009, 12:45 amDavid Nieporent says:
Nor, apparently, did the government, so I fail to see what this shows about anything.
Uh, no. “Libertarian theory” does not say that nothing bad will happen in the world if only it is adopted; unlike socialism, libertarianism is not utopian.
October 12, 2009, 12:57 amRicardo says:
Let me see if I got this straight: Government fails to pass or enforce regulations aimed at preventing or minimizing the risk of ‘X’. ‘X’ happens. Therefore, this shows the incompetence and poor judgment of government in failing to pass or enforce regulations aimed at preventing or minimizing ‘X’. Therefore, the proper conclusion is that government has no business trying to prevent or minimize ‘X’ since it is clearly too incompetent to do so.
October 12, 2009, 1:23 amGrover Gardner says:
I really don’t know what to tell you. I’m sorry you’re surrounded by losers. I wouldn’t suggest a second mortgage to help them out, when a few dollars in taxes could keep them out of your hair. ;-)
Among the many contractors I hire in my work, a few are very talented but disfunctional people. I assign them projects I feel sure they can handle. Sometimes they cost me a bit more money due to lapses in their productivity. But I try to get the best out of them. Occasionally they win awards and accolades for their work and my decisions are justified. Sometimes they fail and I don’t look so good, but generally it works out to my advantage.
Some people are just a drag and I’ve dropped them. That doesn’t mean I want them to die or their children to starve.
Mostly the people I know are productive and capable. Some are not. If they need occasional help from the government to compensate for their inadequacies, I can’t say I resent that. Maybe their spouses and kids will get by in spite of their personal flaws.
I recently moved from the suburbs of DC to flyover country in Southern Oregon, to take a job with a company in the one of the few industries that’s actually expanding in this economy. What I’ve seen has astonished me. In this conservative, don’t-tread-on-me area with no city sales tax, inadequate school funding, rampant drug abuse, soaring teenage pregnancies and high unemployment, what people have to go through to get by has opened my eyes. On my pleasant little suburban street, a third of the pre-school age kids are in Headstart. I can’t help them all. But if you were to raise my taxes by a hundred dollars a year, I wouldn’t holler.
The older brother of one of my employees has had five children by three different women. He’s thirty-six. In my crazy artsy-fartsy liberal socialist free-spending, straight-gay-bi-lesbian welfare-loving circle back east, no one would think of doing such a thing. Who’s going to pay for all those kids? He certainly can’t. He’s joining the army because his current wife needs a kidney operation. Is he a loser? A free-loader? I guess he is, in some way. He’s also a kid who grew up in a very narrow social environment. I say “kid” because, even though he’s thirty-six, even I, the crazy liberal left-wing artsy-fartsy socialist welfare-lover had more sense than to father five kids I couldn’t afford before I hit thirty-six.
On the other hand, through no effort of my own, I grew up in a well-to-do household, went to high school overseas, attended a fine college at no expense to mhyself and have seen more of the world than most people will ever get to see.
You know what I saw at the Medford DMV the other day? Two fat, unemployed chumps taking signatures to protest a tax hike in Oregon. You know what I said to them? “Please raise my f***ing taxes so you can get a job, your kids can go to better schools and I don’t have to pay $600 extra in child care this year because they cut the school days in our district and my wife wants to keep her job.” I mean, talk about losers! ;-) These idiots sitting on their rumps talking about a tax increase that wouldn’t even effect them, who had all day to sit around at the DMV propping up a sign, when the extra jobs generated might possibly mean they could spend less time sitting in front of the DMV protesting tax hikes, their kids would have better teachers, the state would continue to attract tourism, etc etc… Jeebus.
So I’m sorry you’re surroundede by losers. I am too, but I preferto see the potential, not the minimal financial loss to myself.
October 12, 2009, 1:31 amLargo says:
– Bartleby, get to work!
– I prefer not to.
October 12, 2009, 1:45 amDoc Merlin says:
This argument can and has been used to justify many types of usurpations of rights. Its actually the standard argument that happens when someone wants to restrict behavior.
October 12, 2009, 3:43 amBeth says:
Larry, your wife should be getting gynecological care even in her 60s. Just because the policy includes pregnancy and in-vitro doesn’t mean that the whole policy is bad for you. You may be paying for in-vitro that you won’t use, but I’m paying for mammograms that I won’t use but your wife might. That’s why insurances have pools. If everyone in the pool were likely to need every procedure, the insurance company would go broke.
October 12, 2009, 3:52 amRicardo says:
The Texas law requiring pregnancy coverage on all health insurance policies is an interesting case. I think conservatives would do well not to protest too loudly. Think in terms of economics: if you don’t have insurance, pregnancy-related expenses can easily top $20,000. An abortion in many cases can cost less than $2,000. Do the math…
October 12, 2009, 5:08 amDavid Schwartz says:
Someone who is self-employed may offer themselves and their family health insurance, paid for by their business, just as someone employed by someone else can by offered health insurance tax free. Do not misunderstand the requirement that the insurance plan be “established in the name of the business” — if you are self-employed, your own name is also the name of your business and they are the same legal entity. See IRS publication 535.
This is a straight business expense, not a personal deduction. You can also deduct any other medical expenses (including health insurance premiums that don’t qualify as a business expense) if you itemize and have enough of them.
October 12, 2009, 8:00 am“You Can Keep Your Insurance If You Like It” « 36 Chambers – The Legendary Journeys: Execution to the max! says:
[...] insurance, as opposed to health insurance which covers pretty much every contingency. Now, that’s no longer allowed. Possibly related posts: (automatically generated)What I Don’t Like About The US Health Care [...]
October 12, 2009, 10:18 amAndrew J. Lazarus says:
I don’t agree here at all. Libertarianism is always claiming for its Deity, The Market, powers that would make a televangelist blush. The Market, just in our little sub-thread, will cause houses to be built to fire-resistant standards. Except, it didn’t. Indeed, just as Communists have ‘false consciousness’ to wave away the failure of their predictions, Libertarians always have an excuse why the Holy Market did not do what they predicted, or, more accurately, what seems like the obviously desirable outcome. I would prefer not to threadjack, but a discussion of Libertarian opposition to the 1964 Civil Rights Act with particular attention to how the Blessed Market would end economic discrimination against ‘Negroes’ is a fine example.
October 12, 2009, 11:26 amNot liking this says:
From the article: “We insist that everybody who drives a car has insurance, and cars are a lot less expensive than people,”
There’s the difference though; when is the fine imposed. No one is forced to pay for car insurance…only those who chose to drive. There are probably plenty of people in the city who use public transportation (or walk) to get to/from where they need to go. You only get a fine if you DRIVE without insurance; therefore, you have the opportunity to legally not have that expense.
If the state is going to mandate medical insurance coverage, you should only be fined if you use medical services without insurance, or fail to pay your medical bills.
I spend less than $250 per year on medical coverage because I take steps to stay healthy and use alternative medical options (i.e. midwife instead of OBGYN). I pay my medical expenses out of pocket, and I’m not wealthy. As an adult, all my medical expenses (including all three of my children) cost me less than paying an insurance premium and deductable would have cost.
Why force people to buy something they won’t use? It’s one thing to force drivers to buy insurance they won’t use, at least they’re taking the risk of driving…but people like me who want to live life naturally and die when it’s my time…why should I have to pay for medical insurance?
October 12, 2009, 11:27 amShelbyC says:
Yeah, and your Deity is the Government. Whoop-ti Do. I’m sure you get up every morning, kneel down and pray to the Government to send them manna from heaven.
See? Anybody can do it!
October 12, 2009, 11:31 amShelbyC says:
And up until 1964, the Blessed Market was pretty much the only thing they had going for them. Lord knows the Blessed Government wasn’t doing much for them, interfering with the market every step of the way. But despite all the de jure discrimination, places like Rosewood and Tulsa had thriving economic communities, at least untill mobs of white people marched in and burnt them to the ground, with the support or tolerance of all the governments. Governments are fickle, markets aren’t.
October 12, 2009, 11:42 amOren says:
But the whole point is to prevent prospective risk. This is like saying we will fine people for inadequate fire prevention only after their building burns down.
People that use medical services without insurance and then skip the bill are already broke. It does not good to levy a fine on top of their already-unpaid bills. Blood from a turnip.
October 12, 2009, 12:11 pmChrisTS says:
notlikingthis:
Unfortunately, we cannot assume that your wishes will be met so as not to impose costs on the rest of us. If you have a heart attack on the street, you will be taken by ambulance to a hospital. Even if they have a DNR from you, costs have been incurred. If your condition does not trigger the DNR, very high costs, indeed, will be incurred.
It is also worth noting that many people without insurance or under-insured do not, in fact, want to die when it is their ‘time,’ not if that time can be delayed. They will go to the hospital; they will receive care; and ‘someone’ will pay.
October 12, 2009, 12:32 pmAndrew J. Lazarus says:
When the Federal Government decided to get rid of Jim Crow, it was able to do so. The Market doesn’t decide in this way and its Invisible Hand didn’t seem to dent Jim Crow much.
October 12, 2009, 2:29 pmOren says:
(1) Did you carefully consider your promise not to have costly medical attention under any circumstances? Let’s suppose an uninsured driver with no assets crushes your legs, do you want to die instead of living out the rest of your life in a wheelchair.
(2) If that really happens and you are on the pavement begging to be saved, should I hold you to your previous promise?
If the answer to both of those questions is a genuine ‘yes’, then I suppose I would be willing to have a formal opt-out system from the emergency medical system — a sort of super-duper-DNR.
October 12, 2009, 2:47 pmegd says:
Actually it usually is the regulator (read the government) who, instead of “ensuring . . . vigorous competition” actually sets up the barriers to entry. Environmental regulations, employment laws, and zoning are all dead weight that are add no value and only serve to keep current businesses (usually grandfathered in) free from competition.
Start up money is the only barrier to entry that should exist in a free capitalist society. If I can produce electricity at $0.05/kW*hr, and the mega-electric company produces it at $0.10/kW*hr, then I should have no problem finding investors to provide me with start up costs.
October 12, 2009, 3:20 pmXenocles says:
Oren, as far as I can tell your argument has been thus:
-
Society has chosen to provide free emergency treatment to all, but it’s not fair that society has to pay for emergency treatment to those who can’t pay. All those people who take the free treatment we offered are freeloaders.
-
What you seem to be failing to consider is that under a mandate system there will still be freeloaders; they will just be the people who get money to buy coverage instead of the people who don’t pay at the ER. There is also the neglected option of ending free emergency care. Of course, as you say, the electorate seems loath to do that – but if that’s the case they need to shut up about this notion of freeloading because they refuse to stop offering the rides.
October 12, 2009, 3:29 pmDavid Schwartz says:
Nobody is saying that the best solution is the one that eliminates as much freeloading as possible. They’re saying that medical coverage for people who opt not to get medical insurance, fully knowing and expecting that they will get urgent care should they need it and not be able to afford it, cause certain very specific problems. These problems include increasing the cost of medical insurance and therefore increasing the number of uninsured.
It’s not a general moral argument against freeloading that they’re raising. And they’re not saying there’s anything morally wrong with doing this, just that you should be forced to internalize the externality you create thereby.
October 12, 2009, 3:58 pmegd says:
Well if that’s the proposition, I can’t say I disagree. So long as the taxpayers are required to subsidize ER visits, we should at least make everyone pay for the privilege of getting treatment at the ER.
There’s really only two points to disagree on in the health care debate: (1) whether taxpayers should subsidize ER visits in the first place, and (2) whether taxpayers should pay for coverage beyond the ER.
Regarding the first, I’m sure most libertarians (and some conservatives) would say no, while most progressives and statists (and some conservatives) would say yes. And as Oren pointed out, it’s political suicide to suggest repealing EMTALA, effectively making the issue moot.
Regarding the second, obviously requiring health insurance for ER visits will decrease government spending. Therefore, even libertarians should support such a move. But if we increase coverage beyond the ER, then we need to determine the cost (extra outlays) versus benefit (people paying).
I think that is that last point where there is contention between Democrats & Republicans.
October 12, 2009, 4:33 pmShelbyC says:
It dented it enought that the various level of government needed to impose Jim Crow to smack the invisible hand away as it was attempting to transfer resouces to blacks. Such as: emmigrant agent laws, prevailing wage laws, support of discriminatory union memberships, discriminatory zoning, discriminatory trade regulations, closing all the black medical schools and when all else failed, toleration of private violence against economically successful black communites. Conspirator Dave B. has a good book on the subject BTW.
October 12, 2009, 5:41 pmAndrew J. Lazarus says:
Non-conspirator Ian Ayres has some good articles on the inadequacy of the Libertarian analysis: segregation existed in areas beyond that required by law. No law that I know of, for example, prohibited department stores from letting blacks (but not whites) from trying on merchandise. Why don’t we leave this for another thread?
October 12, 2009, 6:33 pmChrisTS says:
Oren:
If that really happens and you are on the pavement begging to be saved, should I hold you to your previous promise?
Suppose he does answer both questions in the affirmative (at the appropriate times). Still, what will we do with him? Passersby should not have to see/hear him, and, eventually, he will die. Who is going to clean up that mess?
The trouble is that unless one goes out to live in the wilderness, other people will have to pick up at least some of the pieces.
October 12, 2009, 7:40 pmGrover Gardner says:
We’ll call it DNT, or Do Not Treat. Or better yet, Do Not Touch. Unfortunately, people like this will be holding up traffic for hours while the med techs patently wait for them to exsanguinate. Or they’ll create a disgusting stain on the lawn of the ER that will have to be re-sodded at some point. Seems like we’re STILL gonna have to pay for them, one way or another.
October 12, 2009, 7:48 pmOren says:
Again, people don’t “take” emergency treatment. Visits to the ER are generally unintentional and often unconscious.
On the other hand, some money will be recovered from those that can afford but refuse to buy insurance.
In a country dedicated to the ‘culture of life’?
Fortunately for us, the electorate does not take commands from you.
Take him to a hospice, shoot him up with heroin and call the relatives and tell them to make arrangements to pick up the body or he’s cremated at the county morgue.
With less snark, what I mean is that if a rational adult wants to forgo all medical care (obviously we can move him out the way of traffic), he ought to have that right. Well, I’m not convinced either way, but it seems reasonable enough.
It would certainly be heartwrenching to see someone bleed to death from an easily-stitched wounds while begging to be saved. Most of the medical establishment probably couldn’t handle it. Nevertheless, at least in the abstract, the argument seems plausible.
October 12, 2009, 10:10 pmXenocles says:
The point is that if the electorate chooses to offer this free treatment they lose the ability to rationally claim that they’re being unjustly injured by people taking it. Arguably a major motive behind the freebies was to ensure that people would get treatment regardless of ability to pay. Now you’re saying how awful it is that people aren’t paying for ER treatment. Well, the public has made its policy bed and now they can sleep in it.
“Hey! My lunch is gone!”
October 12, 2009, 10:54 pm“You mean the bag labelled ‘Free lunch if you want it?’”
“Yeah! I didn’t think they’d take it! We need better security around here!”
punditius says:
I don’t think that anyone much disagrees with the need for regulation of health care, and in fact, we have that regulation, both for providers and insurers.
So your observations are true, and even validly support not only regulation, but some government intervention in the medical economy to the extent that it is dealing with such things as emergencies and epidemics.
But they don’t support your position that the rest of us should have to pay for your health care. There is a big difference between government power being used to deal with situations that threaten our collective safety, and government power being used to reallocate wealth in order to address personal misfortunes or misjudgments.
October 13, 2009, 12:45 ampunditius says:
NOTHING decreases government spending. The best we can do is try to stop more spending.
In fact, government spending not only inexorably increases, it drives up the costs for everyone involved with securing the particular good. I’m paying several times the amount, in constant dollars, to send my kids to a state university compared to what my father paid to send me. Why? Because government subsidies have driven up the price of college.
What will happen if government requires everyone to have insurance for ER treatment is that the definition of ER treatment will be expanded by Congress as the years go by. Then they will mandate that the hospitals absorb the cost of the increased treatments, which will result in higher costs for the non-ER treatments.
October 13, 2009, 1:00 amOren says:
Because some people that can pay for that treatment, especially if they insure themselves so as to pay only the a priori expected value of treatment.
October 13, 2009, 11:25 amLargo says:
For those of you discussing DNR/DNT, I point you to my earlier comment in this thread. It’s a bit long, so you might all have skipped it. It addresses some of the issues that were subsequently raised.
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