And then they'll rack up medical bills that they never intend to pay.
Obama's Healthcare Reform and the Supreme Court
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And then they'll rack up medical bills that they never intend to pay.
To be more accurate, they make a calculated risk without having a clue what the actual risks are in order to make an accurate calculation. Also, to suggest that they consciously think "I'll just go to the emergency room" probably overestimates the degree of planning.
Perhaps I was being naive. If given the choice, it seems a real no-brainer to have insurance. I think many would claim they can't afford it, it's not offered by the jobs, they have pre-existing conditions, etc.
But this really goes to the heart of the government's argument, doesn't it? These uninsured (by choice or by circumstances) are indeed healthcare consumers. Sooner or later, everyone needs medical care. And since we are not willing to take the step of locking them out (nor should we), subsidized insurance plans and a tax/fee/penalty/whatever for not buying it seems a perfectly reasonable solution to me.
Most people I know who don't have insurance would prefer to have some. However, some people are just ignorant of the whole thing and decide they have better things to spend money on. If anything, the health care bill has raised awareness of the need for insurance that didn't exist before.
The issue of being uninsurable because of pre-existing conditions has been a big part of the problem. Not only is it bad for the people who cannot get the treatment they need, but it ends up being a huge drain on the system because it eventually gets to the point where they need emergency and long-term treatment that could have been avoided. The company I work for has never had any restrictions against pre-existing conditions and we still manage to have the lowest administrative cost ratio in the business (as well as the healthiest reserves), so requiring other companies to do this can only save money in the long term, as well as improving the general health and quality of life of the people.
Actually, I'm in favor of that, as it does follow logically.
As for what should be happening with this, if people DO have insurance, they can get regular checkups--preventative care is a wonderful thing. My husband worked at a hospital's clinic (pharmacist) where the pediatricians' offices saw children once or twice a year. They acted as gatekeepers, maintaining good health and referencing more serious cases to the hospital itself. Yes, it cost money (and the pediatricians made a lot of money from Medi-Cal), but far more money was saved by this preemptive care.
I wonder...on the assumption that Obama is re-elected and Obamacare has positive results...how long will it take for Republicans to "reclaim" it as "Romneycare" and "well we proposed it in the 90s"?
For a great many people not carrying insurance is extremely sensible. The average per-capita American health-care cost is about $7,500. For young adults who don't take part in risky activities, their yearly health care needs cost $0, and unless they start a family they may go a decade or two in this low-risk pool. Many determine that they'll not need major medical care for a long time and willing offset their assets or their families assets against the risk that they are wrong.
Since they can pick up insurance later in life, not staying insured for this period saves them (at a 3% interest rate) $88,600 (10-year) to $207,000 (20-year). With that amount of money, the average person can cover their own health-care costs. They can also use it to buy a home or start a business, and those can be collateral on a health loan if the need arises. Once they are financially established, they have more than enough money to spend on health insurance without feeling a significant loss of disposable income, and this usually occurs as the get older and their risk aversion increases.
A great many people do this, and the vast majority of them come out way ahead financially. Others, much more risk averse, insure against everything. One of my housemate's young friends carries a special Medflight insurance policy that covers the costs of emergency helicopter transport in case he tumbles his car on the highway, arguing that you can never know what will happen. Some of more neurotic young smokers carry special lung cancer insurance policies, even though they're almost certain to drop it before they're thirty. One size does not fit all.
The problem with compelling these people to carry insurance is that it's their money to allocate. Since, as a group, they're not going to be incurring health care costs, what the rest of us are doing is raiding them for cash to cover our own health-care costs or subsidize our desire for lower premiums.
Since health care costs have been outstripping inflation by over 3% a year since about 1980, rising now to 16% of GNP, these insurance premiums put a huge dent in the income of young adults who are trying to get started. As a group, these are also the poorest adults among us. The people who use the most health care, the elderly, are the wealthiest among us (according to government statistics, their real-estate holdings rank them as far, far wealthier than average). So what we're doing is forcing the poorest but healthiest among us to subsidize the health-care costs of the richest and sickest among us.
To some, it's like forcing young, thin, poor, health-conscious vegetarians to pay for all the extra food really obsese people eat, along with paying for all the diabetes and heart disease that goes along with it, just because fat people think thin people are scamming the grocery store by not spending enough on food.
But we're going to fix it anyway, by decreasing tax deductible health care expenses so people have to pay more, increasing the tax on business so they hire fewer people or pay them less, taxing medical device manufacturers so health care costs more, taxing hospitals more, taxing (no longer a fine) anyone who's not spending enough on insurance, and also taxing anyone who's spending too much on insurance. All of this extra tax money is needed to pay for 15,000 new IRS agents and a giant bureaucracy that admits it has no idea how to implement the system laid out in a bill that nobody read.
Since they can pick up insurance later in life, not staying insured for this period saves them (at a 3% interest rate) $88,600 (10-year) to $207,000 (20-year). With that amount of money, the average person can cover their own health-care costs. They can also use it to buy a home or start a business, and those can be collateral on a health loan if the need arises. Once they are financially established, they have more than enough money to spend on health insurance without feeling a significant loss of disposable income, and this usually occurs as the get older and their risk aversion increases.
A great many people do this, and the vast majority of them come out way ahead financially. Others, much more risk averse, insure against everything. One of my housemate's young friends carries a special Medflight insurance policy that covers the costs of emergency helicopter transport in case he tumbles his car on the highway, arguing that you can never know what will happen. Some of more neurotic young smokers carry special lung cancer insurance policies, even though they're almost certain to drop it before they're thirty. One size does not fit all.
The problem with compelling these people to carry insurance is that it's their money to allocate. Since, as a group, they're not going to be incurring health care costs, what the rest of us are doing is raiding them for cash to cover our own health-care costs or subsidize our desire for lower premiums.
Since health care costs have been outstripping inflation by over 3% a year since about 1980, rising now to 16% of GNP, these insurance premiums put a huge dent in the income of young adults who are trying to get started. As a group, these are also the poorest adults among us. The people who use the most health care, the elderly, are the wealthiest among us (according to government statistics, their real-estate holdings rank them as far, far wealthier than average). So what we're doing is forcing the poorest but healthiest among us to subsidize the health-care costs of the richest and sickest among us.
To some, it's like forcing young, thin, poor, health-conscious vegetarians to pay for all the extra food really obsese people eat, along with paying for all the diabetes and heart disease that goes along with it, just because fat people think thin people are scamming the grocery store by not spending enough on food.
But we're going to fix it anyway, by decreasing tax deductible health care expenses so people have to pay more, increasing the tax on business so they hire fewer people or pay them less, taxing medical device manufacturers so health care costs more, taxing hospitals more, taxing (no longer a fine) anyone who's not spending enough on insurance, and also taxing anyone who's spending too much on insurance. All of this extra tax money is needed to pay for 15,000 new IRS agents and a giant bureaucracy that admits it has no idea how to implement the system laid out in a bill that nobody read.
Bullshit.
The first car accident where they sustain an injury, the first time they eat contaminated lettuce, any of that kind of thing makes it NOT SENSIBLE FOR ANYONE to not have insurance.
Lots of people can get very rich by playing off your fears of unlikely misfortune.
If I offered to pay your health costs if you eat lettuce contaminated with E. Coli, for a premium of just $10 a year, would you sign on with me?
My business model is simple. On average, over the past 15 years, 25 people a year were sickened by lettuce contaminated by E. coli. My payout per incident is probably going to be about $2,000, so if I insure 300 million Americans I'm taking in $3 billion dollars while I'm only paying out $50,000 a year in claims. Since E. coli contamination is random, I don't even have to screen my customers using any statistical modeling for their individual risk. I'll basically be scamming the American public for $3 billion a year because they're scared of lettuce.
There are many things that it doesn't make a lot of sense to carry insurance against because your risk is low. Do you carry insurance against being kidnapped and held for ransom by Columbian FARC rebels? That could well happen, and then your out-of-pocket ransom, plus lost wages, would leave you destitute. They might even lose hope that they'll get paid and just shoot you. Do you want to die in jungle?What about insurance against attacks by the Chechen mafia, going bankrupt after winning the lottery? How about insuring against lost wages due to a 20-year prison term caused by a DNA mixup in a forensic lab?
What about insurance against up to $10 million dollar lawsuits, such as by a pet-owner whose cat gets knocked up by your cat, or getting sued for libel by Tom Cruise? All of these things could happen to you, so it would be insane not to carry all of my custom policies.
I can think of lots of ways to take your money, but what I can't do is force you to sign up for one of my bizarre insurance schemes. I have to get the government to make you do that.
If I offered to pay your health costs if you eat lettuce contaminated with E. Coli, for a premium of just $10 a year, would you sign on with me?
My business model is simple. On average, over the past 15 years, 25 people a year were sickened by lettuce contaminated by E. coli. My payout per incident is probably going to be about $2,000, so if I insure 300 million Americans I'm taking in $3 billion dollars while I'm only paying out $50,000 a year in claims. Since E. coli contamination is random, I don't even have to screen my customers using any statistical modeling for their individual risk. I'll basically be scamming the American public for $3 billion a year because they're scared of lettuce.
There are many things that it doesn't make a lot of sense to carry insurance against because your risk is low. Do you carry insurance against being kidnapped and held for ransom by Columbian FARC rebels? That could well happen, and then your out-of-pocket ransom, plus lost wages, would leave you destitute. They might even lose hope that they'll get paid and just shoot you. Do you want to die in jungle?What about insurance against attacks by the Chechen mafia, going bankrupt after winning the lottery? How about insuring against lost wages due to a 20-year prison term caused by a DNA mixup in a forensic lab?
What about insurance against up to $10 million dollar lawsuits, such as by a pet-owner whose cat gets knocked up by your cat, or getting sued for libel by Tom Cruise? All of these things could happen to you, so it would be insane not to carry all of my custom policies.
I can think of lots of ways to take your money, but what I can't do is force you to sign up for one of my bizarre insurance schemes. I have to get the government to make you do that.
That has nothing to do with ACTUAL health insurance, which covers MOST medical related things. People don't get insurance to cover ONE thing, so your comparison is a deliberately manufactured fantasy.
If you want fantasy, claim that the mandate is a fine and not a tax.
You can get some pretty odd health insurance, at least until Obamacare places strict limits on the types of health insurance that can be offered. You can get special cancer insurance policies, pregnancy policies, study abroad policies, so why not an E. coli policy?
You can get accident health coverage for $25 a month, which will probably cover 90% of what might befall a young adult, outside of drug overdoses or sleeping with Charlie Sheen. That comes to $300 a year, and at least $50 of that is overhead and profit. So actual health-care usage among this group probably amounts to about $250 a year, including getting hit by buses or trampled at rock concerts.
But we're not going to let them get off nearly that cheap. No, we're going to sock it to them, because it would take a hundred of the young working poor spending their most productive years huddled under a matress in a bomb shelter to provide enough insurance revenue to cover a rich, fat, alcoholic elderly chain-smoker running up $25,000 a year in emphysema, diabetes, and dialysis treatments.
For many groups or situations, health insurance is like playing the lottery. The argument that you must buy health insurance if you have any sense is like the argument that you must play the lottery because you might win.
Mathematically, the two are related because you're spending money for a small chance of winning, or spending money to avoid a small chance of losing. Whether you play or not involves personal psychology (your comfortable risk levels), your behavior patterns, estimated costs, payouts, and odds, and ability to absorb financial losses.
As one small example, Jennifer Lawrence has never seen a doctor since the day she was born and can afford to buy her own hospital wing. Does she really need to play this game? Obviously, she doesn't, but there are a lot of people who would like Jennifer to pay for their insurance. That's pretty much how this idea was peddled, but the better off are only going to be paying a small fraction of the costs of the new program. The trick, as in British health care, was how to get the poor people to pay for something via a tax that they had been getting for free.
You can get some pretty odd health insurance, at least until Obamacare places strict limits on the types of health insurance that can be offered. You can get special cancer insurance policies, pregnancy policies, study abroad policies, so why not an E. coli policy?
You can get accident health coverage for $25 a month, which will probably cover 90% of what might befall a young adult, outside of drug overdoses or sleeping with Charlie Sheen. That comes to $300 a year, and at least $50 of that is overhead and profit. So actual health-care usage among this group probably amounts to about $250 a year, including getting hit by buses or trampled at rock concerts.
But we're not going to let them get off nearly that cheap. No, we're going to sock it to them, because it would take a hundred of the young working poor spending their most productive years huddled under a matress in a bomb shelter to provide enough insurance revenue to cover a rich, fat, alcoholic elderly chain-smoker running up $25,000 a year in emphysema, diabetes, and dialysis treatments.
For many groups or situations, health insurance is like playing the lottery. The argument that you must buy health insurance if you have any sense is like the argument that you must play the lottery because you might win.
Mathematically, the two are related because you're spending money for a small chance of winning, or spending money to avoid a small chance of losing. Whether you play or not involves personal psychology (your comfortable risk levels), your behavior patterns, estimated costs, payouts, and odds, and ability to absorb financial losses.
As one small example, Jennifer Lawrence has never seen a doctor since the day she was born and can afford to buy her own hospital wing. Does she really need to play this game? Obviously, she doesn't, but there are a lot of people who would like Jennifer to pay for their insurance. That's pretty much how this idea was peddled, but the better off are only going to be paying a small fraction of the costs of the new program. The trick, as in British health care, was how to get the poor people to pay for something via a tax that they had been getting for free.
But for most young people (20-40), is needing thousands of dollars a year of it likely? Why do Americans seem to need two to three times as much health care as Japanese or Europeans? Why do we already outspend them even in the public sector (Medicaid, Medicare, etc), and why should we insist on spending hundreds of billions more on health-care when we already spend vastly more (by almost a factor of two) than anybody else? Or given that, wouldn't emulating European socialist health care models mean that we'd cut our health-care payments in half, so everyone gets half as much care?
It's a very, very complex subject, and all we've done is write up some feel-good bureaucratic BS that wasn't even read by the people who wrote it. There are secondary and tertiary effects that we won't see for perhaps 10 or 20 years down the road, such as the inevitable screaming about health-care taxes, politicians proudly reining those in by cutting health care salaries (as has happened all over Europe, because after all, a garbage man is as much a public serveant as a doctor, equality, fraternity, etc), smart people avoiding the medical profession, rulings that medical interns shouldn't have to work more than anyone else (as opposed to the 100+ hour workweeks for US interns), and on and on.
Part of the irony of the whole thing is that the uninsured poor aren't going to benefit from Obamacare because they have to be above the poverty level to receive the insurance breaks and other goodies. Those below the poverty level were going to be thrown into an expanded Medicaid program, which none of the state want or can afford, but they were to be forced into providing such benefits under the duress of withholding all Medicaid payments to the states. The Supreme Court just ruled such strong arm tactics unconstitutional, and governors are lining up to refuse the program because it will force them to cut funding for police, fire, and schools.
So under Obamacare, the poor are still screwed, the middle class gets hit with hundreds of billions of new taxes that ramp up in January of 2013 (how convenient was that!) and nothing is done to get at the root of the problems of health costs.
My grandfather who worked in insurance almost all his life used to say, that insurance is valuable even if you never claim any damages, because it gives peace of mind.
The problem isn't the average person, it's the exception. Even for young people who take a calculated risk, there are those who gamble and lose. And the cost borne by this is done by society. Regardless of the merits, the rhetoric of this argument is never sympathetic because it isn't "people who can't afford insurance" it's "people who decided insurance wasn't the best use of their money." Hell, one of the people who filed a lawsuit challenging this health care law ended up needing health care and had to file for bankruptcy (and passed the cost of the health care onto everyone else). She took a calculated risk and failed and a large number of other people do as well.
Less input doesn't automatically imply less output. These nasty "socialist" (social democratic is the precise word) healthcare systems in Europe are more efficient than the one of the US.
About your gamble logic, if uninsured people are covered by everybody via the public part of the health care system anyway if they have an accident the natural think to do is to force everybody to buy insurance. If the public bails you out when you lose you gotta forbid this gamble, simple as that.
