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.

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.

egd: Regarding the second, obviously requiring health insurance for ER visits will decrease government spending.

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.

Andrew J. Lazarus: 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.

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.

“Hey! My lunch is gone!”
“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!”

Oren, as far as I can tell your argument has been thus:

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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.

Again, people don’t “take” emergency treatment. Visits to the ER are generally unintentional and often unconscious.

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.

On the other hand, some money will be recovered from those that can afford but refuse to buy insurance.

There is also the neglected option of ending free emergency care.

In a country dedicated to the ‘culture of life’?

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.

Fortunately for us, the electorate does not take commands from you.

Still, what will we do with him?

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.

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.

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.

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.

ShelbyC: Conspirator Dave B. has a good book on the subject BTW.

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?

Andrew J. Lazarus: The Market doesn’t decide in this way and its Invisible Hand didn’t seem to dent Jim Crow much.

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.

Xenocles: 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.

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.

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.

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.

-
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.

Tatil: 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.

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.

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?

(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.

ShelbyC: I’m sure you get up every morning, kneel down and pray to the Government to send them manna from heaven.

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.

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?

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.

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.

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.

Andrew J. Lazarus: 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.

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.

Andrew J. Lazarus: I don’t agree here at all. Libertarianism is always claiming for its Deity, The Market, powers that would make a televangelist blush.

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!

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?

David Nieporent: unlike socialism, libertarianism is not utopian.

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.

GaryC:
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.

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.

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.

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.

Allan: 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.

– I prefer not to.

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.

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.

David Nieporent: Nor, apparently, did the government, so I fail to see what this shows about anything.

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.

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.

Nor, apparently, did the government, so I fail to see what this shows about anything.

When libertarian theory gets marked-to-market, it usually comes up short.

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.

What was wrong with that?

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.

Grover Gardner: 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’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.