Althouse: "Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."

February 8, 2011

"Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."

That's a sentence I've already quoted in the previous post, but focusing on it in isolation, I see it's a stunning example of something I've been observing more and more: Today's liberals sound like yesterday's right-wingers.

Read that sentence closely: "Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system." Doesn't Larry Tribe sound like your old man carping about welfare queens? There's no pity for people who are struggling to cover their basic expenses: Ah, don't be a bleeding heart — Larry/The Old Man scoffs — these people are choosing to sponge off the rest of us.

Tribe had to block out the possibility that people without health insurance aren't really making a choice. After paying for the things they think they need, they just don't have enough money left to cover a major expense that doesn't bring them a present good, only insurance against something that could go wrong.

Yeah, but that's why we need to force them to take responsibility, make them put insurance into their household budget along with the extra cupcakes and cars they're always blowing their money on — Larry/The Old Man snaps back at you.

Maybe now, you're thinking The Old Man was right! I'm not saying he wasn't. I'm just saying the liberals of today sound like The Old Man who used to enrage us with his heartlessness and his cynical observations about the lives of the people we thought of as vulnerable and unfortunate. That doesn't mean today's liberals are wrong. And I'll leave it to you to tease out the corresponding observation about the conservatives of today. Are they saying things that we Boomers, in our hippie days, used to scream back at The Old Man?

105 comments:

Henry said...: If Tribe really believes this, he should be against the bill.

First it allows people to opt out of insurance for a very small fine (much less than the cost of insurance for most individuals and households).

Second, it forces insurance companies to take people with preexisting conditions.

The rational thing to do is to pay the small fine and only buy coverage when you need it.

The system encourages freeloading.; 2/8/11, 8:50 AM
rhhardin said...: It forgets about self-insured people.

They'll pay if they need it, perhaps deciding that insurance isn't a useful economic deal because they'll cancel you if you're really sick, and you can cover the smaller cases yourself.

Ir deciding that health insurance trades on an unlikely fear: that you'll get really, really sick but won't die, which is the case you can't cover. In that unlikely case, you might decide, I'll take the die option.

Or you may not like doctors.; 2/8/11, 8:53 AM
Original Mike said...: @Henry: Liberals are about appearance, not whether a program actually works.; 2/8/11, 8:53 AM
Dark Eden said...: Obamacare is not designed to make sense its designed to kill insurance companies and force single payer down our throats, no more no less.; 2/8/11, 8:55 AM
Fen said...: If Tribe really believes this -

Remember Fen's Law: The Left doesn't really believe in the things they lecture the rest of us about

It will save you lots of time and energy.; 2/8/11, 8:57 AM
Mick said...: This comment has been removed by the author.; 2/8/11, 8:57 AM
Moose said...: I love it - great observation. God help us they're figuring out new ways to make this seem *practical* and *responsible*.

Freedom is wasteful.; 2/8/11, 8:57 AM
Anonymous said...: ""Individuals who don’t voluntarily end their life when they are too sick to cost-effectively treat have made a choice to take a free ride on the health care system.""

(Just looking ahead to future arguments.); 2/8/11, 8:57 AM
virgil xenophon said...: Good point Ann. But doesn't this line of reasoning also argue for forcing people to also buy the FAR MORE EXPENSIVE Disability Insurance also? And what about Life Ins--to take the burden off the state to provide for financially distressed widows (food-stamps, housing, et al) In fact this sort of thinking argues for making EVERY vendor a financial planner; for certifying RE Agents and car salesmen as financial planners. Is it not oft stated that the two biggest "investments" most people EVER make are their house and car? I can see it all now at the BMW dealership: "No, you see, with three kids and the need to fund college costs, you can only afford a Buick, best head on over there." Or the RE agent saying: "No, although you have the cash flow to buy this $950,000 home, what with your monthly medical, disability and life insurance payments,plus college costs, maybe we'd better look at something in the $400,000 range." Oh yeah--I've got a REAL MENTAL PICTURE of THAT!!

The feds want to march us all to financial virtue at bayonet point.; 2/8/11, 9:02 AM
DADvocate said...: Sounds to me that Tribe is not carping about welfare queens but people who can "afford" insurance, i.e. the middle class on up. Those who live in voluntary impovershment can't "afford" health insurance and will continue to take a free ride on the health care system like they always have.; 2/8/11, 9:04 AM
Hoosier Daddy said...: Read that sentence closely: "Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."

Again, how is it a free ride when we are consistently told how an illness or injury to someone uninsured leads to financial ruin? Either Tribe is lying or we already have a universal health care system in which someone else is picking up the tab.; 2/8/11, 9:09 AM
Anonymous said...: "We have freedom and responsibility. It's a very groovy time!" -- Austin "Enumerated" Powers, International Mandate of Mystery; 2/8/11, 9:12 AM
virgil xenophon said...: And btw, I'm not the first person to think of this. Some 35+ years ago the Life Insurance industry made a big push in Congress (beaten back) to force RE Agents to become
"Registered Investment Advisors" using JUST THIS LOGIC as I previously outlined in order to free-up more disposable income for the purchase of Life Insurance by forcing prospective home buyers to factor in life & Heatlh ins budget costs as part of the purchase.; 2/8/11, 9:14 AM
SteveR said...: The objective of "Health Care Reform" is to end up with a singlr payer system. When that end in mind all these logical gymnastics, intellectual goofiness and outright dishonesties make perfect sense.

That we have to play Constitutional Trivial Pursuit is well worth the risk, its just part of leading the masses to accept that there's only one way out.; 2/8/11, 9:15 AM
virgil xenophon said...: PS: And guess who was a leader in such a push? Good old Northwestern Mutual "The Quiet Company" right in Anns backyard HQ'd in Millwaukee.; 2/8/11, 9:18 AM
Hoosier Daddy said...: The objective of "Health Care Reform" is to end up with a singlr payer system.

In all liklihood, yes. Realistically what will probably happen is many mid-size or regional health insurers will fail, simply because they will not be able to provide coverage on a cost effective basis. We will probably end up with 2-3 major health insurers who will become de facto quasi-private entities much like Fannie and Freddie (and in all liklihood, end up with the same results).; 2/8/11, 9:25 AM
oleh said...: This comment has been removed by the author.; 2/8/11, 9:31 AM
Original Mike said...: "We will probably end up with 2-3 major health insurers who will become de facto quasi-private entities much like Fannie and Freddie"

From now on, I'm calling you "Deputy Downer".; 2/8/11, 9:32 AM
Original Mike said...: "Somewhat modified I could see conservatives agreeing to a welfare style health support (pretty sure we have that already)."

I'm OK with that. What I'm not OK with is crapifing everybody's health care.; 2/8/11, 9:34 AM
oleh said...: There isn’t really a corresponding characterization of conservatives. Or anyway, there shouldn’t be. If there is then we already have bought too much into the socialist paradigm. A problem with tax-payer funding of health care is that the government can then argue that on behalf of the tax payer it must control your health. Larry Tribe is doing the analogous.

A conservative view would reject the above paradigm. "If you choose not to purchase insurance you will have to rely on your family, your savings, your future income and/or charity to pay for your health." Government should stay out of it.

I guess I could see conservatives agreeing to a welfare style health support (pretty sure we have that already).; 2/8/11, 9:35 AM
traditionalguy said...: Hippie Days are here again, the skies above are clear again, so let's sing a song of cheer again, Hippie Days are here again.; 2/8/11, 9:36 AM
Henry said...: Everyone loves a cartel.; 2/8/11, 9:37 AM
888 said...: Conservatives in general don't make the distinction between those who can and cannot afford health insurance, thinking it a consequence of moral flaws to have so little money. It's like the meme about half the country not paying income taxes, often shortened to not paying taxes, but no consideration that most of the tax relief they get comes from personal and child exemptions which everybody gets.; 2/8/11, 9:40 AM
I'm Full of Soup said...: Today, some people don't pay their bills or take responsibility for their actions or inactions. Sorry, Professor Tribe but your beloved Obamacare won't fix that.; 2/8/11, 9:45 AM
Original Mike said...: "It's like the meme about half the country not paying income taxes, often shortened to not paying taxes, but no consideration that most of the tax relief they get comes from personal and child exemptions which everybody gets."

I don't see why the method by which their tax goes to zero (negative, actually, in the case of "refundable" tax credits) is relevant.

And while we're on the topic, can anybody explain to me the reason for a "personal exemption". It has never made any sense to me.; 2/8/11, 9:47 AM
Scott M said...: thinking it a consequence of moral flaws to have so little money.

They don't have to be moral flaws. Most of the adults I've known that would qualify as "poor", some in the dirt category, are living the end result of a series of really bad decisions. Very few were that way because they were outright victims of violence, divorce, disability, etc.; 2/8/11, 9:47 AM
bagoh20 said...: Besides the constitutional and liberty issues which are enough, the government will just blow the job, like it always does. Every health care job will get unionized and they will simply suck at doing what they now do incredibly well. Go to a private hospital and then go to a county public one, and you will see the difference even now. I've used a lot of hospitals in the last decade fighting to survive, some quasi-public and some completely private. The more private the better care, and lower billing.

We had a water main break in front of our business in December. It ended up being fixed in a 3 hour operation over a month later (a lot of water wasted) During the month leading up to the repair, the unionized workers showed up about three times a week to look at it without ever touching a tool. Probably 60 man hours just looking at it and numerous phone calls from us to fix it. Then when they did repair it, it was a continous scene of 4 guys watching one or two guys with a shovel. 3 hours of work cost us at least about a hundred at crazy unionized wages. Don't fret - California has lots of money.

I can imagine the operating rooms of America some day and the taxpayer bills.; 2/8/11, 9:48 AM
Ann Althouse said...: "Sounds to me that Tribe is not carping about welfare queens but people who can "afford" insurance, i.e. the middle class on up. "

The Old Man thought the welfare queens didn't deserve welfare, so it's the same thing. There are people sponging who shouldn't be sponging. There's a cranky presumption that the rest of us are paying for a lot of no-good freeloaders.; 2/8/11, 9:52 AM
bagoh20 said...: Are poor people dying in the streets for lack of health care? Then what is this about?; 2/8/11, 9:56 AM
Skyler said...: This is the nature of socialism. By insisting on subsidizing a service or commodity, they then have moral authority to control the behavior related to that service or commodity.

This is the inherent evil of socialism.

Taking from one group to give to another is simple theft. The enslavement that results is the more horrible evil.; 2/8/11, 9:59 AM
bagoh20 said...: "There's a cranky presumption that the rest of us are paying for a lot of no-good freeloaders.

I think that's call a cranky fact.

If you know any freeloaders, which I do, then you realize that these are the majority of the recipients - people smart enough to game the system or just use it well. In other words, they work, but only at freeloading. It's a part time job, that pays very well for the level of effort, but produces nothing but cost for the rest of us.; 2/8/11, 10:00 AM
Hoosier Daddy said...: Most of the adults I've known that would qualify as "poor", some in the dirt category, are living the end result of a series of really bad decisions.

Liberals tend to hold true to the belief that everyone poor is due to cruel twists of Fate. Typically those truly in poverty can trace thier situation to: 1)teen pregnancy, 2)dropping out of school, 3)committing a felony or 4) all of the above.

Along the way there are some who were doing fine and will fall on hard times. Invariably those individuals will pick themselves back up again. But lack of education/training or a criminal record is the equivalent of starting at bat at 0 and 2.; 2/8/11, 10:00 AM
Original Mike said...: "Are poor people dying in the streets for lack of health care? Then what is this about?"

It's about running the world the way they think it should be run. It's about control by the elites.

Because they're so good at it.; 2/8/11, 10:00 AM
Michael K said...: One of the worst aspects of Obamacare is the cost shifting and subsidies. A mandate to buy a cheap catastrophic policy with a high deductible for the young who don't use all those other services would be more defensible on moral grounds but the present intent is to soak the healthy to pay for the sick.

The minimum policy is larded up with unnecessary provisions that are lobbyist contributions. I spent years on the California Medical Association's legislation commission. Every group that wanted their own little piece of the insurance market would go to the legislature, contribute to campaigns and say "We only want this little thing in the law."

After a while, the really needed coverage is so diluted with crap that doctors' payment goes way down and then there is nobody to care for the poor on Medicaid, for example. This will happen with Obamacare.; 2/8/11, 10:02 AM
Anonymous said...: Some of us bought real insurance — high-deductible catastrophic — and simply relied on our, you know, incomes to cover mere routine expenses of living, like medical checkups. Which is to say, we weren't free-riding at all; if a disaster struck, we were covered, and if it didn't, we were buying care with our own money.

Since ObamaCare outlaws that approach to covering your own health care, it's pretty clear that the law isn't about eliminating free riders. It's a blatant, explicit lie for Tribe to pretend it is.; 2/8/11, 10:03 AM
Hoosier Daddy said...: And while we're on the topic, can anybody explain to me the reason for a "personal exemption". It has never made any sense to me.

It was meant to be an amount that the state would not tax as it was considered necessary for minimum substinence. At least that is what I remember from a tax class I took in college.; 2/8/11, 10:03 AM
Original Mike said...: What Michael K said.; 2/8/11, 10:04 AM
Original Mike said...: What Stevenehrbar said.; 2/8/11, 10:05 AM
Hoosier Daddy said...: One of the worst aspects of Obamacare is the cost shifting and subsidies. A mandate to buy a cheap catastrophic policy with a high deductible for the young who don't use all those other services would be more defensible on moral grounds but the present intent is to soak the healthy to pay for the sick.

Essentially that is how insurance works though. The healthy will always be paying for the sick. That’s how your homeowner’s or car insurance works as well. Assume you have never made an auto or homeowner’s claim. Your premiums were paying (largely) into the company surplus to cover other people’s claims.

The minimum policy is larded up with unnecessary provisions that are lobbyist contributions.

Absolutely as individual state mandates are as varied as they are expensive. Again this goes back to why health care is so expensive is because the expectation is that a third party payer cover everything. This is simply untenable and is not how insurance is supposed to work. If the goal is to take insurance out of the picture altogether than fine and dandy. Problem is the State is now faced with the same predicament the insurer had. How much coverage can we reasonably provide to 300 million people and how much will it cost?; 2/8/11, 10:18 AM
Original Mike said...: "Essentially that is how insurance works though. The healthy will always be paying for the sick. That’s how your homeowner’s or car insurance works as well."

In the case of car insurance, home insurance, and catastrophic health insurance, it can work because not everybody will need it. What doesn't work is health "insurance" which pays for all the maintenance stuff.; 2/8/11, 10:26 AM
Pastafarian said...: "Doesn't Larry Tribe sound like your old man carping about welfare queens?"

Yes he does -- by design. A common tactic of the left is to use language to seem to co-opt the opponent's position and triangulate, but of course it's just an illusion.; 2/8/11, 10:28 AM
Zach said...: "Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."

Not me. When I do nothing, I'm taking a free ride on the national solar panel initiative.; 2/8/11, 10:33 AM
Hoosier Daddy said...: What doesn't work is health "insurance" which pays for all the maintenance stuff.

Correct which is a large part of why insurance is so expensive. Consider how much your car insurance would go up if you were to file a claim for every oil change, tire rotation, etc.

Michael K's example of buying Cat Care policies would in all liklihood have the effect of the health funding the coverage for the poor since most young people don't have chronic illnesses that require other than routine medical care.; 2/8/11, 10:43 AM
Dust Bunny Queen said...: Some of us bought real insurance — high-deductible catastrophic — and simply relied on our, you know, incomes to cover mere routine expenses of living, like medical checkups. Which is to say, we weren't free-riding at all; if a disaster struck, we were covered, and if it didn't, we were buying care with our own money.

Exactly!. This is what insurance is supposed to do. Cover a catastrophic disaster that you can't pay for or self insure for out of your own savings or cash flow.

Our auto insurance does not cover oil changes, flat tires, routine maintenance and only covers wrecks or disasters.

Why should the health INSURANCE that Obama is ramming down our throats cover every little bandaid incident.

Young healthy people only need a major medical/catastrophic coverage policy. Same thing for us older healthy people :-)

To force us to do otherwise is nothing more than robbing us of our money and our freedom to subsidize and transfer wealth to Obama and the Liberal's selected group of favored people.

Socialism. Nothing less.; 2/8/11, 10:47 AM
Dust Bunny Queen said...: Correction: To force us to do otherwise is nothing more than robbing us of our money and our freedom IN ORDER to subsidize and transfer wealth to Obama and the Liberal's selected group of favored people.

Grrrr.

If the Government can force us to buy health insurance to subisidize health care for everyone, there is no limit to what they can force us to do or to buy.

Things that we may not need, not want or may never ever use.

Buy an extra new car to subsidize cars for the poor people who can't afford a new car.

Buy a college education whether you want one or not so that EVERYONE can go to college.

Meat Subsidy: Extra charge for meat at the grocery store check out stand. Meat that you don't use or even take home, just so we can subsidize for those who do. Sugar, Milk, Toilet Paper, Drugs, Health Insurance.....whatever.

The lobbists for every conceivable industry will be active and force their industry and products upon us by government fiat.

It could go on and on. Brave New World people.; 2/8/11, 11:01 AM
Paul Brinkley said...: To be fair, the Obamacare advocates ARE claiming to give you something in return for demanding your money. Namely, that health care plan.

Which, unfortunately, makes Obamacare advocates the moral equivalent of someone running up to your car in the street, washing it, and then demanding $10 in payment.; 2/8/11, 11:16 AM
Scott M said...: and then demanding $10 in payment.

...you forgot to add "at gunpoint"...; 2/8/11, 11:23 AM
traditionalguy said...: Fear not Professor. The Progressives so admire China that their final solution will become regulating couples to one child, or else they are screwing up Interstate Commerce.; 2/8/11, 11:25 AM
Larry J said...: Liberals tend to hold true to the belief that everyone poor is due to cruel twists of Fate. Typically those truly in poverty can trace thier situation to: 1)teen pregnancy, 2)dropping out of school, 3)committing a felony or 4) all of the above.

There was a study a few years ago that pointed out that there were three simple things any young person could do that would give them an 85% chance of never ending up in poverty.

1. Graduate from high school.
2. Don't have children until you're married.
3. Don't get married until you're at least 22 (and I suggest 25).

I'd also add to the list: stay off of drugs.

All of those things are under each individual's control.; 2/8/11, 11:30 AM
mrs whatsit said...: This quotation also assumes that people who don't have insurance won't pay the medical bills they do incur. That's a completely false assumption. There was a long period when I was self-employed and could afford health insurance for myself and my family only sporadically. (Yes, it was a choice: we chose to pay the mortgage and buy groceries rather than pay for health insurance.) We incurred plenty of health care costs during that period and paid every penny of every bill -- when necessary, in installments over a long period of time. We took no free ride on anybody -- and I'll bet most inadequately-9insured Americans do, or try to do, the same.

The assumption that every person who can't afford health insurance is, by definition, a deadbeat, is REALLY illiberal, and remarkably ignorant besides.; 2/8/11, 11:33 AM
former law student said...: I'm picturing Tribe as the cranky old mechanic: "You can pay me now or pay me later."

DBQ: the Kaiser HMO costs employers much less than traditional 80-20 fee-for-service health insurance. Why is it cheaper to provide free oil changes than to wait till the engine seizes?; 2/8/11, 11:34 AM
Robert Cook said...: "Obamacare is not designed to make sense its designed to kill insurance companies and force single payer down our throats, no more no less."

Sheer idiocy.

ObamaRomneycare is designed to guarantee the insurance companies more customers while giving merely the appearance of substantially resolving the shortfalls in our system of medical care delivery.; 2/8/11, 11:38 AM
Scott M said...: @RC

It's valid insomuch as the President himself said he wants single-payer, but that we can't get there all at once.; 2/8/11, 11:42 AM
Robert Cook said...: "Realistically what will probably happen is many mid-size or regional health insurers will fail, simply because they will not be able to provide coverage on a cost effective basis."

Not at all. The insurers who "must" offer coverage to everyone--you know they'll find ways to NOT--will offer plans that may be (barely) "affordable" but will offer limited coverage. What's not covered will be the responsibility of the "insured" to pay...as is true today of many policy-holding health insurance customers.

ObamaRomneycare is a gift to the health insurers and a bane to the defrauded customers who will still be bankrupted if they face grievous injury or illness.; 2/8/11, 11:46 AM
knox said...: Sounds to me that Tribe is not carping about welfare queens but people who can "afford" insurance, i.e. the middle class on up.

Probably true. The majority of liberal ire is directed at the bourgeois middle-class, after all. I mean the ire that's left over after that directed at Palin.; 2/8/11, 11:50 AM
Dust Bunny Queen said...: DBQ: the Kaiser HMO costs employers much less than traditional 80-20 fee-for-service health insurance. Why is it cheaper to provide free oil changes than to wait till the engine seizes?

You do realize that under Obamacare that the Kaiser HMO model will be outlawed and replaced by a mandatory full coverage low deductible policy? Kaiser's model, which only really works for people who live near a Kaiser facility (a minority of the country) will pass away.

Why should I or anyone else pay for your oil changes in your car or other routine maintenance that you should take care of for yourself?

If you are young and healthy or OLD and healthy why should you be forced to purchase coverage for every little thing that you do not need and forbidden to purchase the coverage for things that you DO need?

I'll tell you why. It is so that my money for services that I do not need will be given to subsidize (welfare) for those who are soaking up the medical costs.

It is nothing more than a scheme to rip off some people for the benefit of others.; 2/8/11, 11:54 AM
Robert Cook said...: "...the President himself said he wants single-payer, but that we can't get there all at once."

He may have said it years ago before he held office, but as President he refused to invite or to allow proponents of single-payer to speak or be present at the various meetings he held where he lied that he wanted to hear "ideas from all sides" on the best way to help craft a better health care model for our country.

I may have said when I was younger that I wanted to be a cowboy, but that doesn't mean that cowboying has held any appeal for me in the last 40+ years. (Actually, I probably never really wanted to be a cowboy.)

Moreover, why can't we "get there all at once?" Sounds to me like mealy-mouthing excuses. All it takes is the will to do it and the courage of those in Washington to defy the health insurance industry lobbyists and their millions of dollars.

Oh---that's why we "can't get there all at once"--or ever, probably.; 2/8/11, 11:55 AM
Scott M said...: Ever consider the possibility, RC, that he's both smarter than you are and better knows how to go about accomplishing it? Any possibility of that at all?; 2/8/11, 11:59 AM
Original Mike said...: "Why is it cheaper to provide free oil changes than to wait till the engine seizes?"

The false "preventive care saves money" meme.; 2/8/11, 12:03 PM
Original Mike said...: "Moreover, why can't we "get there all at once?" Sounds to me like mealy-mouthing excuses. All it takes is the will to do it and the courage of those in Washington to defy the health insurance industry lobbyists and their millions of dollars."

Ever consider the possibility, RC, that the opposition believes that this model is exactly the wrong way to provide affordable health insurance?; 2/8/11, 12:06 PM
coketown said...: So, putting our thinking caps on, can we start compiling a list of all the things Congress is allowed to do given the extraordinarily broad scope of the Commerce Clause that the left is embracing? Could Congress now outlaw abortion under the pretense of economic activity since aborting or keeping a baby unquestionably has economic consequences? Would slaying that sacred cow cause the left to reevaluate their position on the commerce clause?; 2/8/11, 12:07 PM
Scott M said...: The false "preventive care saves money" meme.

I was listening to Make It Plain on Sirius Left yesterday afternoon and remarked to my wife that we've gotten to a place in this society where the bare-boned words, "personal responsibility" have been co-opted and contorted into hate speech and prejudiced code words. The host of this show, his guests, and a great deal of his callers chafe at the very mention of the term.

If we can't call a spade a spade, to use an ill-advised analogy, what the hell are we left with? If taking care of the most minimal aspects of good health cannot be the ownership of the individual, where does that leave us?; 2/8/11, 12:09 PM
Revenant said...: Complaining about welfare queens made some sense because -- pretty much by definition -- everyone on welfare was getting more in benefits than they had paid for.

In contrast, pretty much everybody who purchases insurance receives less in benefits than they paid for. That's how insurance *works*.; 2/8/11, 12:13 PM
Paul Brinkley said...: Preventative care DOES save money.

Well, sometimes; depends on the care. An oil change every 9000 miles will definitely incur less maintenance cost on your car than an oil change every time the engine seizes up. An oil change every 3000 miles, however, might not have an appreciable effect over the 9000-mile schedule. Some people will tell you it does. Many of those people work for Jiffy Lube.

That means it's impossible to tell which preventative care is worth your money without more information, sometimes more than you have time to gather. So you have to trust an authority. Which authority? Who gets to pick? I'd like to have that choice, but apparently it has to be in the hands of someone with an incentive to make me spend more money on preventative care.; 2/8/11, 12:13 PM
Methadras said...: Is healthcare a right or is it optional. If I injure myself in a grievous manner, then in this country, wouldn't I expect that my tax dollars that I already pay into would be used to not let me die and once stabilized I'm on my own at that point?

I"m self-insured by the way and I'm covered for everything, so why should I be forced to give up my coverage for federally mandated coverage.; 2/8/11, 12:13 PM
Revenant said...: Could Congress now outlaw abortion under the pretense of economic activity since aborting or keeping a baby unquestionably has economic consequences?

Don't be silly. Abortion is the one and only thing actually protected by the living Constitution.; 2/8/11, 12:14 PM
Original Mike said...: "Preventative care DOES save money."

The analogy in inapt. The human body is not a car.

Preventive care is good for you. But it does not, averaged over the population, save money. It costs money.; 2/8/11, 12:18 PM
Paul Brinkley said...: Revenant: ...pretty much everybody who purchases insurance receives less in benefits than they paid for. That's how insurance *works*.

We can't ignore the other side of the coin, though. A consumer of insurance has to be able to choose between buying that insurance and enjoying a near guarantee of not going bankrupt from a rare misfortune, or not buying that insurance and enjoying a somewhat higher standard of living, in return for the risk of that bankruptcy. And that's assuming they haven't figured out an alternative way of managing risk.

Otherwise, insurance itself has no incentive to charge more and more for the same coverage. Consumers have to be permitted to opt out, albeit with a natural risk; insurers have to be permitted to price whatever keeps them getting business and attracting good employees, albeit while providing the risk management they say they will. *That's* how insurance works.; 2/8/11, 12:19 PM
Paul Brinkley said...: Eruh?? How can preventative cost you more money than not having it at all, and also be good for you?

I'm talking TCO here. An oil change costs you more money than not changing your oil at all, too - until you factor in the cost of fixing/replacing the engine.; 2/8/11, 12:23 PM
Original Mike said...: @Paul - Again, the body is not a car. Change your oil and that engine has a strong probability of running "forever". However, most of the diseases that afflict us can not be fixed. Seeing the doctor once a year does not prevent them, nor in many cases, does detecting them early lead to a cure. Sucks, but that's life.; 2/8/11, 12:29 PM
Robert Cook said...: "If you are young and healthy or OLD and healthy why should you be forced to purchase coverage for every little thing that you do not need and forbidden to purchase the coverage for things that you DO need?"

Why should I be forced to pay one cent toward the mass murder and torture and international terror that is inflicted internationally by our War Department? Why should I be forced to pay for the billions in losses that result from criminal fraud by banks, savings-and-loans, and Wall Street, the perpetrators of said crimes being mostly still in place and enjoying their ill-gotten riches?

More comparably, why should I help pay for public education if I have no children in school? Why should I help pay for our highway system if I don't have a car and don't drive? Why should I pay for anything in the budget that I personally don't support or use?

Because there are others in our society who do support them and use them and need them. Because at various times I might use them or need them. Because even if I have no children in school, educated young people are necessary for our future progress and prosperity and our present stability. Because the highways allow others to transport things to me that I could not otherwise obtain. Because as much as I might be unaware how many things I don't think I need or want may actually be of benefit to me, they are.

There's one thing sure about healthy young people or healthy old people...a predominant majority of them are going to one day get sick or be injured. (The minority who won't be are those who will be killed or drop dead suddenly without having been sick.) Spreading the cost of care among all insures that medical care is available to all when needed, and that no individual or family need fear (or actually be) bankrupted in the event of unexpected (but largely inevitable) injury or illness.

I'm for universal health care for selfish reasons...for me. I'm employed and have a very good group insurance plan provided by my employer, but I'm at an age where I am not guaranteed to find employment if I leave or lose my present job. If I tried to buy insurance coverage for myself--even assuming I could afford it, which, if unemployed, would be questionable--no insurer would sell me coverage. Although I am healthy and fit, I have had a few past episodes of illness that, even taken separately, would be considered "pre-existing conditions" and which make me (from the point of view of for-profit insurers) "uninsurable."

Yes, I'm for universal coverage because it's right and humane, but I'm also for it for me.; 2/8/11, 12:32 PM
Original Mike said...: I'm a selfish person too, RC. If I thought this plan would actually provide good health care, I'd probably be for it, Constitutional questions aside. But it will provide crappy health care for everybody. There's a better way.; 2/8/11, 12:42 PM
Hoosier Daddy said...: DBQ: the Kaiser HMO costs employers much less than traditional 80-20 fee-for-service health insurance. Why is it cheaper to provide free oil changes than to wait till the engine seizes?

Managed care is always cheaper, mainly due to the fact that you are 1) confined to a cadre of doctors under that HMO and 2) the HMO manages your care, in other words, you can’t just decide you’re going to see whatever specialist you want, when you want. PPOs cost more because they offer a wider range of choice in terms of providers and the ability to contact specialists.

Your oil change analogy is an apt one provided of course you go on the assumption that most people will actually engage in preventative medicine. Considering that many of the chronic ailments people face today are highly preventable through diet, proper nutrition and proper exercise, activities that are by and large ignored by a large percentage of people, its folly to think people will take the time to visit the doc unless they actually feel a need to do so.; 2/8/11, 12:42 PM
Duncan said...: I think there's a difference between collecting a welfare payment and risking a future welfare payment.

Among the 10% uninsured, plenty of people negotiate costs in advance and pay cash or make payments.

And like college costs, absent government intervention, medical costs would be much closer to other normal costs of living as they were prior to 1965.; 2/8/11, 12:46 PM
former law student said...: You do realize that under Obamacare that the Kaiser HMO model will be outlawed and replaced by a mandatory full coverage low deductible policy?

No, and it's not just me: Kaiser Permanente doesn't realize it either. But they are closing four plans to those who did not enroll before March, 2010.; 2/8/11, 12:51 PM
Revenant said...: Eruh?? How can preventative cost you more money than not having it at all, and also be good for you?

Because being unhealthy is free.

If you make regular use of preventative care you will spend a lot of money, directly (through your own payments) and indirectly (through insurance, government benefits, etc). You will also be healthier, which is good for you.

If you do not, you will be less healthy. You MAY develop some critical condition that could have been prevented with the above care, but probably not. You will, on average, spend less money on health care.; 2/8/11, 12:51 PM
Hoosier Daddy said...: Why should I be forced to pay one cent toward the mass murder and torture and international terror that is inflicted internationally by our War Department?

I would think that you could stop any voluntrary contributions to Al Qadea and its affiliates anytime you choose.

Yes, I'm for universal coverage because it's right and humane, but I'm also for it for me.

I would also be for universal coverage if it could be provided at a fair and cost effective manner. Unfortunately when society feels that everything should be covered at a cost to someone else, then unfortunately such a program will be short lived.; 2/8/11, 12:51 PM
former law student said...: Perhaps for people who live off the grid like dbq Congress will make an exception so they can continue to exchange chickens for medical care.

But I constantly read about the shortage of physicians in rural areas, and the immense burden of maintaining tax-supported hospitals out in the boondocks. So maybe dbq will have to snowshoe near a Kaiser facility if she wants care at all.; 2/8/11, 12:57 PM
Scott M said...: FLS - I worked long and hard to both make my HSA workable. This abomination is the enemy of all that work. I did everything I could to both make myself as little other people's problem as possible and make things as affordable for me that I can. All for what?; 2/8/11, 12:59 PM
Scott M said...: er...workable AND affordable...should have been the sentence. d'oh; 2/8/11, 1:00 PM
Hoosier Daddy said...: I'm talking TCO here. An oil change costs you more money than not changing your oil at all, too - until you factor in the cost of fixing/replacing the engine.

Are you basing this on the assumption that most individuals will actually take the time to sit in the doctor's office to receive preventative care if the Federal government covers the cost?

A healthy diet and exercise are low cost to free and are key to staying health yet obesity is an epidemic in this country.; 2/8/11, 1:10 PM
Original Mike said...: Ya'll have too much faith in the power of preventive medicine.; 2/8/11, 1:23 PM
jdkchem said...: The lobbists for every conceivable industry will be active and force their industry and products upon us by government fiat.

And the left will still call it capitalism.; 2/8/11, 1:26 PM
Hoosier Daddy said...: Not at all. The insurers who "must" offer coverage to everyone--you know they'll find ways to NOT--will offer plans that may be (barely) "affordable" but will offer limited coverage.

Robert, you obviously do not understand how insurance regulation, health insurance in particular works. All states have mandated coverage requirements therefore unless there are Federal exemptions within Obamacare, those mandates will have to be included. Barely affordable might mean that someone will have to forego their Direct TV or Iphone subscription. The truly needy will be, as usual, picked up by the taxpayer.
What's not covered will be the responsibility of the "insured" to pay...as is true today of many policy-holding health insurance customers.

Including that Federal insurance program known as Medicare which provides universal coverage to 43 million elderly (and disabled) Americans. Not everything can or should be covered in part or in full.; 2/8/11, 1:31 PM
Revenant said...: The insurers who "must" offer coverage to everyone--you know they'll find ways to NOT--will offer plans that may be (barely) "affordable" but will offer limited coverage.

If it was as simple as that nobody would care about the mandate or mandatory coverage of pre-existing conditions. I could start my own insurance company. RevCare -- for just $1 a month, you get health insurance with a $1 trillion deductible and a $0.01 lifetime cap on payouts.

This kills two birds with one stone, since (a) I can offer it to everyone regardless of pre-existing conditions, and (b) anyone looking to avoid the fine for being without health insurance can purchase it.; 2/8/11, 2:18 PM
Dust Bunny Queen said...: More comparably, why should I help pay for public education if I have no children in school? Why should I help pay for our highway system if I don't have a car and don't drive? Why should I pay for anything in the budget that I personally don't support or use?

@Cook. Why indeed?

Well, firstly all of those things are part of the taxes that we all pay....or rather that about 50% of us pay.

The difference is that taxes are to support various public works types of products. THIS plan, Obamacare, is forcing us to PURCHASE an item from a private company. Not taxes....purchase.

This is the difference.

We can bitch about what the government does with our tax money and try to get them to do other things that we don't object to (good luck with that).

Forcing us to buy a product (of any kind) that we don't need or want for the sole benefit of some one else is a step too far and a slippery slope.; 2/8/11, 2:49 PM
Revenant said...: Why should I pay for anything in the budget that I personally don't support or use?

We'll make a libertarian out of you yet, Cook. :); 2/8/11, 3:07 PM
former law student said...: I worked long and hard to both make my HSA workable. This abomination is the enemy of all that work.

Far too few people wanted to go to such lengths in five years HSAs never did take off. HSAs were an evolutionary dead end, like Betamax or the HD-DVD.; 2/8/11, 3:21 PM
Scott M said...: Far too few people wanted to go to such lengths in five years HSAs never did take off.

WTF does this mean? They don't need to "take off", they only have to work for the parties included. Which they do, extremely well. I'm paying less now for health care, even after three ER visits last year, than I ever have.; 2/8/11, 3:24 PM
Paul Brinkley said...: Revenant and Original Mike: We seem to be in vehement agreement.

First off, a car probably won't run virtually "forever" given regular oil (and fuel, of course). Entropy will have its way as surely as with the human body. But I agree that a lot of diseases aren't curable, or even preventable - I just wouldn't then call any health care addressing those diseases as "preventative care". Depending on the specific case, it'd be anything from palliative to pain relief to simply unnecessary. Moreover, even care that is widely accepted as preventative isn't universally accepted as such, and has many exceptions. And what I don't like about universal care is that it pretends no one knows these things, and slathers some small group's notion of preventative over the entire country.

As for unhealthy being free - not exactly. Unhealthy means you're not able to produce as much value from the same amount of work, and you can't work as much; similarly, you end up with less free time (partly taken by sitting around being sick, partly taken by being dead), and you get less enjoyment out of that time.

The upside of that is that if it was because you didn't take care of yourself - didn't eat nutritious food, didn't exercise enough, didn't take safety precautions, or didn't plan financially for an accident - it's your fault, which places the incentive to take such preventative measures squarely on the party with the most interest in performing them. Not only that, but it places it on the party that is most likely to know what its local exceptions are.

It always boggles my mind a bit to encounter people who think it should be any other way. The American health care system seems to want to be some dysfunctional co-dependent relationship, of people who want to control everything, and succeeding in the case of other people who want to be told what to spend their money on.; 2/8/11, 3:30 PM
Paul Brinkley said...: Hoosier Daddy: "A healthy diet and exercise are low cost to free and are key to staying health yet obesity is an epidemic in this country."

I characterize that as two things at work.

One, a lot of people don't completely understand the link between diet, exercise, and long term health. That's an education problem, and I think we can agree Obamacare won't cover that. (It might make the need for it more visible, but so would a lot of much cheaper measures.)

Two, a lot of people think that healthy diet and exercise aren't worth the time and money; they'd rather be obese. Which is to say, they'd rather spend their time doing whatever else they deem necessary or enjoyable. They've made their bed, and are willing to lie in it. I say, let them, and not with some admonishing finger as if to say "I hope you teach your children better than this", but instead, a genuine "I wish you best of luck with your cost/benefit analysis". To make a big deal about paying for their late-life care ought to be insulting to their intelligence, so don't. Just let them be.; 2/8/11, 3:45 PM
Revenant said...: Far too few people wanted to go to such lengths in five years HSAs never did take off.

I use one.

They're not widely used because most peoples' out-of-pocket medical expenses are trivial. Mine aren't, since I use a high-deductible plan.; 2/8/11, 3:55 PM
Revenant said...: As for unhealthy being free - not exactly. Unhealthy means you're not able to produce as much value from the same amount of work, and you can't work as much; similarly, you end up with less free time (partly taken by sitting around being sick, partly taken by being dead), and you get less enjoyment out of that time.

We are speaking in terms of actual monetary costs. The actual monetary cost of poor health is nil.

If you want to bring in non-monetary costs like "free time" and "enjoyment" then you need to address ObamaCare's non-monetary costs, e.g. depriving people of freedom and choice.; 2/8/11, 3:59 PM
Paul Brinkley said...: Revenant: If you want to bring in non-monetary costs like "free time" and "enjoyment" then you need to address ObamaCare's non-monetary costs, e.g. depriving people of freedom and choice.

I thought that was clearly implied by what I wrote. Need I be explicit? I'm agin' it.; 2/8/11, 4:03 PM
Shanna said...: It's like the meme about half the country not paying income taxes, often shortened to not paying taxes, but no consideration that most of the tax relief they get comes from personal and child exemptions which everybody gets.

You know there are actually quite a few subsidies and tax credits that “everybody” doesn’t get. They phase out based on income. My brother made a profit on his income tax one year of like 3000 dollars above what he paid because he hit the sweet spot for all that stuff one year. That’s certainly never happened to me, no matter how little I made.; 2/8/11, 4:13 PM
888 said...: Shanna,

You're right. A lot of subsidies get passed off as tax breaks and refunds. (If you work for major retailers, you will see this advertised by the time clock.)
I suspect that the middle class with incomes between 60k and 200(?)k can suffer a real lowering in living standard due to the income tax, while the rest of the population will not.; 2/8/11, 7:24 PM
RC3 said...: Fans of the “individual mandate” are citing the 1792 Militia Act that ordered citizens enrolled in the military to provide themselves with weapons. This was an obligation of our collective military defense, since we can only field an army… collectively. Congress did not order anyone to buy a weapon to defend himself, as an individual, against his individual risks from murderers and thieves in the night. Maybe it should have tried.

Channeling Tribe: “Individuals who don’t purchase guns they can afford have made a choice to take a free ride on the police system. They know that if they need emergency-police protection, to stop a murderer, that they can’t pay for, the public will pick up that tab.”

And if you have a religious objection to violence? Brandish weapon, aim wide.; 2/8/11, 9:18 PM
Don M said...: I figure if the government can create health care from nothing, I have an obligation to sponge off them. If they are merely committing theft under color of authority, I have an obligation to resist their theft, and not be a receiver of stolen goods; 2/8/11, 10:51 PM
dave in boca said...: Tribe is a dishonest plagiarist, from what I've been told by people who follow the law much more than I do. He is also a totally devoted worshipper of the double standard. Without it, Larry Tribe would have no standards at all.; 2/8/11, 11:47 PM
Revenant said...: most of the tax relief they get comes from personal and child exemptions which everybody gets.

Who cares?

What matters is the amount you pay in taxes -- the amount of your money that the government gets. If I pay $10,000 and you pay nothing, who cares that we both got the same "tax relief"? The end result is still that I'm paying taxes and you're freeloading.; 2/9/11, 12:32 AM
888 said...: Revenant,

The income tax is not the only tax. Having a low income is not the same as freeloading.; 2/9/11, 11:26 AM
Ed Darrell said...: Read that sentence closely: "Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system." Doesn't Larry Tribe sound like your old man carping about welfare queens? There's no pity for people who are struggling to cover their basic expenses: Ah, don't be a bleeding heart — Larry/The Old Man scoffs — these people are choosing to sponge off the rest of us.

So we put in more enforcers. Then in the Clinton administration we completely changed the system to end welfare queens, and welfare princesses, and welfare entrepreneurs, and most of welfare.

Nobody ever defended the welfare queens. Yeah, the liberals sound a bit like the old conservatives. Liberals listened, the system was changed.

Time for conservatives to stop acting like welfare queens, or the queens' guard.; 2/9/11, 2:00 PM
Gene said...: I would like to see some enterprising reporter investigate people who say they can't afford health insurance and determine if they have a big screen TV, cable service or a smart phone. Get ride of all three and there's your insurance premium right there.

Of course some people would argue their 42 inch flat screen is actually a "right," not a luxury.; 2/9/11, 9:57 PM
Theresa Klein said...: There are lots of other reasons why someone might not buy health insurance.

For example, because health insurance prices are so high that it doesn't make financial sense to buy it rather than self-insure.

This is especially true if you ban risk-based pricing. If you do so, the lower-risk people are necessarily going to be overcharged, making health insurance a bad deal.; 2/10/11, 12:13 AM
888 said...: gene,
With those monthly bills you can get a cheap plan, but one-off purchases such as televisions, smart phones and computers don't really account to much. Other purchases that people hurt themselves with are unnecessary car expenses, expensive clothes and jewelry (weaves, tattoos), vacations, college loans (esp. for drop outs, humanities w/o (with?) teaching certificates, big name schools), divorce and palimony. Drugs and alcohol of course; that gets expensive, but may be discounted as means of tolerating employers and existence. Another big expense is one's choice of neighborhood: sometimes one's rent or mortgage is simply more than one can afford.; 2/10/11, 11:27 PM