२२ एप्रिल, २०१४
"I’d rather pay down my credit cards than take on another bill for something I don’t know that I’m going to need."
Says one lady, quoted in a NYT article about people who have chosen not to buy health insurance. These seem to be mostly people who just can't budget the cost, but some of it is about malfunctioning websites and some is ideological opposition to Obamacare.
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Yeah, but it is not up to her. Shut up and buy the insurance because if you get really sick you can buy the insurance then. Or something.....
budget the costs of something that may be needed. yes, it is difficult to budget this kind of cost--especially a cost which is mostly inflated. a single payer would be more fair and less intrusive. and i am a republican.
so, if we (as a society) know we're going to nearly catastrophic health care costs at some point in our lives (sickness, injury, end of life care) why don't we have Roth/529-esque accounts where we can save up for this major expense? I bet a perpetual FSA would be well received (and take some the Ponzi scheme feeling away from Medicaid-Medicare because you'd know how much $$$ you actually have for medical care).
What is our obligation to the foolish and irresponsible? How do we separate them from the truly unfortunate? Should the country dismantle the positive aspects (there are many) of employer based and other private insurance to accommodate these groups? These questions never really got a good debate. The debate has been overwhelmed by quackery, dishonesty, foolishness and complacency. We are still in the early stages of a longer process.
>> a single payer would be more fair and less intrusive
I think we have a winner in our "Assertion of the Year" contest!
Lady...believe me...you're going to need--and use--the insurance coverage. If not now, eventually. Guaranteed.
"eight million people bought private coverage through the federal and state marketplaces during the initial six-month enrollment period, exceeding the Obama administration’s target."
Sure. And you like your own plan and doctor you CAN keep it.
This is the thing to watch over the next few years--if the consumers determine the cost of the insurance per month is too high to justify (and the risks of needing that insurance are remote enough) we'll see more drop off the exchanges. You can't really expect people to pay for something they determine isn't a good deal for them.
And if a lot of them do drop off the exchanges, and premiums start to go up, I'd expect to see the government coming up with far tougher enforcement measures--perhaps garnishing wages or taking assets. It'd be the only way to force people to buy what looks like a bad deal for them.
"Lady...believe me...you're going to need--and use--the insurance coverage. If not now, eventually. Guaranteed."
1. A lot of these people are in their 50s and maybe think they can get to Medicare soon enough.
2. People can do what they did before, pay the small bills, and if something big happens, get the treatment and default on the bills.
3. It's not guaranteed, many people are healthy enough until the day they get hit by a truck or a massive heart attack. But these are the people we want in the insurance pool, paying in and not taking much out.
No wonder the NYT held this quote for last.
“If work picks back up and I jump right back up there,” she said, “then I’m stuck.”
This is poverty lock, Obama style.
Unknown said...
"a single payer would be more fair and less intrusive. and i am a republican."
Republican leadership would be wise to get with this. Repeal Obamacare. Replace with single payer.
"Republican leadership would be wise to get with this. Repeal Obamacare. Replace with single payer."
Oh! The ordeal we've gone through to get to this realization. We've come so far, and the whole time we've been wearing the ruby slippers.
Leave it to the Times to extrapolate from a single female to millions of Americans.
>>Oh! The ordeal we've gone through to get to this realization.
So, let me see if I follow... The same government that completely botched a partial takeover of health care should, therefore, take over all of it?
1. A lot of these people are in their 50s and maybe think they can get to Medicare soon enough.
2. People can do what they did before, pay the small bills, and if something big happens, get the treatment and default on the bills.
3. It's not guaranteed, many people are healthy enough until the day they get hit by a truck or a massive heart attack. But these are the people we want in the insurance pool, paying in and not taking much out.
There is a path to qualifying for Medicare before you are 65 years old. It is likely that many people are currently on this path BY DESIGN. That is my guess that I believe is the factor of current government policy and the incentives in the labor market.
If you have lived in the US for 5 years in a row and are a citizen or a resident alien AND you have been on Social Security Disability Insurance for at least 24 months, you qualify for Medicare.
I believe that many people that were working in a job solely for the medical benefits are paying close attention to different incentives to have their job terminated or eliminated. I think these are likely the "2nd income" in the household. These prospects will allow people that live in markets with a closing factory or a large single employer to move to SSDI. They will remain there for 24 months with very little looking for a job until they can get on Medicare.
I still remain pessimistic about the economy with the current incentives to not look for work with a population that is rapidly getting older. CBO doesn't have any metrics to account for this.
I have been uninsured since I became a self-employed sub-contractor, except for Medicare, Part A, which no one can escape. Partly because I thought all medical insurance were pre-paid medical care plans like those offered by employers, which I did not want any part of. I now understand that regular disaster insurance plans indeed have been available, so I was wrong about that. However, so far I am still out ahead, since the only medical expenses I have had were for routine dental care.
As far as Obamacare goes, there is no way I am going to help pay for Sandra Fluke's birth control pills, I do not need pregnancy coverage, and I am not going to apply for any government subsidies to participate in any such programs.
The ruby slippers were covered in red sequins, not rubies.
If rubies are the allure of single payer, sequins are too often the reality.
"and i am a republican"
Oh, lord. The fake, astro-turf seminar concern trolls are starting already.
Ann Allthouse said, "People can do what they did before, pay the small bills, and if something big happens, get the treatment and default on the bills."
Except this is harder than it appears (and probably harder than it should be). Because without insurance even bills that should be small are large.
Without insurance one gets charged insanely high prices for everything (look at your insurance resolution bill sometime- where you see $214. charged for lab work, negotiated down to $17. by your insurance company). Prescription drug prices are significantly higher also; so are the "standard" fees charged for just about any medical service- sometimes insanely (>10x) higher.
Before Obamacare, one could deal with this by buying a low-cost, catastrophic-care-only policy. Changes are you'd never make a claim against it (yes, that's why it's cheap) but you'd get negotiated prices for medical stuff
Now such insurance can't be sold, and with Obamacare mandates and cross-subsidies premiums may be much, much higher.
Brando at 8:07 mentions an essential aspect of health insurance. It is paid monthly. Much has been made of how many of the now 8MM have made their first payment. Just as important is how many make the second, third and so on.
It requires real discipline to maintain your coverage. People get behind on their rent. People get behind on their bills. People will get behind on their health insurance.
And then what? This will be just like utilities that have to work with nonpayers before they turn off the water, gas, or electricity. After a slew of hard luck anecdotes, will we have a new set of regulations requiring insurance companies to maintain coverage in spite of nonpayment? I bet we will. These will be followed by a new round of premium increases to cover the deadbeats.
"If not now, eventually. Guaranteed"
-- Luckily, under the new system, she doesn't need to buy until she needs it.
Incentives: People follow them.
Brando at 8:07 mentions an essential aspect of health insurance. It is paid monthly. Much has been made of how many of the now 8MM have made their first payment. Just as important is how many make the second, third and so on.
If you don't make the first payment, you don't have the option to make a second payment. Your coverage is cancelled.
To my knowledge, Georgia released these numbers of paid versus unpaid premiums. I don't know if any other states have done this. The Feds are extremely coy about releasing this data when the President could just snap his fingers to get an actual answer. I don't think he wants the truth. If the truth would help him, he'd be all over it rubbing it in Republican faces to bolster Democratic prospects in November. Maybe he's holding this trump card to play later. It's all about political strategy for the White House. Just ask Sharyl Atkisson.
"What is our obligation to the foolish and irresponsible?"
Mandatory insurance does present a moral dilemma. When some couldn't get insurance coverage at any price it made sense to mandate that all be provided some medical care, regardless of ability to pay.
But with mandatory insurance, what does one do with those who could have bought the insurance yet refused to do so? In a cold, hard libertarian universe those without insurance would receive only the medical services providers were willing to provide (for free, or for cash or some other valuable consideration). But we don't have a libertarian republic, and I doubt we're willing to go that far.
My guess is: nothing at all will change, and providers will still be required to provide service to all regardless of ability to pay (even if that inability exists due to refusal to buy insurance). Medical organizatins will just figure this as a cost of doing business, and price accordingly.
Medical organizations are, after all, already figuring that the 20% co-pay in many Obamacare policies is, for some socioeconomic groups, essentially uncollectible. (Which, I suppose, makes you a sucker if you do pay it. Except that they'll go after you if if it's enough money and they detect that you really could pay.)
As someone who has navigated the health care system as a cancer patient, let me say that it is NOT a forgone conclusion that you will receive care while uninsured. I was insured (on COBRA) when diagnosed. Perfectly healthy, no medical bills before except dental, blah blah blah. But then bam! Thrust into the system. My high deductible was met almost instantly and then the coverage kicked in and was wonderful.
But there were some hiccups along the way - just red tape things when the new deductible came around and so on. And the stress of working through some VERY MINOR insurance snafus was almost overwhelming when dealing with concurrently with a major illness. I would not wish it on anyone. And I can tell you that the billing people at the specialists practices were EXTREMELY thorough in ensuring I was covered before extending services. In fact, one time when there was a mixup, they called me to cancel my scheduled chemo, until they could figure it out.
Yes the penalty is minor, but you are STILL uninsured and therefore totally vulnerable. And major health incidents are extremely difficult to self-insure for, unless you are extremely wealthy.
I am very conservative and no fan of Obamacare. However, to gamble with your own health, and your ability to access care if/when you need it - seems beyond foolish to me.
If that guy in the article thought the enrollment process was confusing, he would be way over his head trying to navigate the process of finding care if he should need it while uninsured.
"Meade said...
Unknown said...
"a single payer would be more fair and less intrusive. and i am a republican."
Republican leadership would be wise to get with this. Repeal Obamacare. Replace with single payer."
Why's that?
"Republican leadership would be wise to get with this. Repeal Obamacare. Replace with single payer."
Absolutely!
(I don't see Republicans doing this, barring a huge sea change in the make up of those in office. But it is what is needed, however it is done and by whomever can get it done.)
Hers is a rational decision.
When we were "allowed" to make our own choices, the rational economic choice might be to buy an inexpensive, bare bones, catastrophic only plan. Something that would cover you if you get hit by a bus or develop a life threatening illness that would require much medical attention. Healthy people, young people, those who live and work in safe ways don't need "Comprehensive" Coverage that forces us to cover things we don't need and for some of us will NEVER need. Maternity care, pediatric dentistry, drug and alcohol counseling.
Instead, in a rational world, people look at the chances, the odds, of an occurrence and place their bets accordingly.
When money is scarce, your job is shaky, and you see immediate threats like not being able buy food or pay your rent, other options take a back seat.
THIS is rational and people are well able to make these decisions for themselves.......and should be allowed to do so.
Who are the foolish and irresponsible? What makes them foolish and irresponsible?
The vast majority of healthcare is neither intrusive, bankrupting or unanticipated, thus not requiring insurance.
The issue with insurance companies not actually paying, and the pay-for-service prices being extortionate is not an insurance, or lack of it, issue. There is a regulation problem that the government is exacerbating by becoming an additional middle man.
Single payer does not and will not solve this. It requires an ever increasing intrusion from government and rationing of some kind.
It's not guaranteed, many people are healthy enough until the day they get hit by a truck or a massive heart attack. But these are the people we want in the insurance pool, paying in and not taking much out.
I'd say we want those people in the risk pool if and only if they want themselves in the risk pool. Otherwise we're just grabbing their money.
"...for something I don't know that I'm going to need."
Point to consider when designing future policy- People respond to incentives.
The shoes I bought with my credit cards were absolutely divine, and, unlike poor Sandra Fluke, I can afford to pay for my own condoms.
If you don't make the first payment, you don't have the option to make a second payment. Your coverage is cancelled.
Actually, if you qualify for a subsidy and enroll through an exchange, you get a 3 month "grace period" for paying your share (if any) of the monthly premium. So you could sign up, load up on doctors' appts. during this period, not pay, and after 3 months get booted. The insurance company is on the hook for whatever medical care you got in the 1st month, the doctors are on the hook for the 2nd-3rd months.
There's no fine or indeed any repercussion from such behavior. During the next year's enrollment period, if you're so inclined, you can sign up again and, again, not pay the 1st 3 months premiums while getting care during that period.
Logically speaking, health has nothing to do with health insurance. Health insurance has nothing to do with Obamacare.
Folks interested in health should forgo health insurance in general and Obamacare in particular.
Run the numbers. Those of you who can't pay for those of us who can.
We'll eventually go back to single payer in the US.
> It's not guaranteed, many people are healthy enough until the day they get hit by a truck or a massive heart attack. But these are the people we want in the insurance pool, paying in and not taking much out.
Those may be the people "we" want in the insurance pool, but they may not want to be in the insurance pool.
"To my knowledge, Georgia released these numbers of paid versus unpaid premiums."
You left out the punch line. Only 50% of Georgia's enrollees paid their first premium. Fifty. Percent.
"Instead, in a rational world, people look at the chances, the odds, of an occurrence and place their bets accordingly."
Some people do, some people don't. No evidence suggests that humanity, on the whole, behaves rationally, either now or historically.
I will take the advocates of single payer seriously when they are willing to accept single payer for themselves.
Health insurance isn't in the least bit like a whole life insurance policy. There is no cash value built up over the years. There is no rational reason to buy it in any given year if you don't percive a need for it in any given year. It's just wasting money to subsidize someone else's insurance coverage. It's not enough to get rid of ObamaCare, it's time to allow for interstate health insurance policies that allow the policy holder to purchase the coverage they want or need and exclude things they don't want covered like chiropractors, acupuncture and birth control among others.
Mr. Apropos: Your proposal for personal savings accounts for medical expenses is a good one, but won't happen. You own your peronal accounts. You own your 401k. Do you own the money to which you're entitled under Social Security? If you own the account and funds, they can't be used to pay for somoene else's care, so for the system as a whole you having your own account is not useful.
I'm not sure why folks here think single payer is a solution to the overall problem. Single payer is probably the best mechanism for hiding the cost, but unless you chnage many other things all you've done is shift who pays. Obamacare already does a lot of work hiding the true cost of things, but at the expense of large market distortions. Single payer would do the same but to a much greater degree (assuming you make the massive changes usually necessitated by single-payer) or if the only change was single-payer the expense would quickly be overwhelming.
"Some people do, some people don't. No evidence suggests that humanity, on the whole, behaves rationally, either now or historically"
I've always said that the defining characteristic of liberals is their inability to understand incentives. I may have to modify that; apparently they assume other people do not understand incentives. Same outcome, though.
Before they passed ACA, many said they were purposely ruining insurance so that we'd have to go single payer. And here we are.
You mean to tell me that people might rationally decide they don't need gold-plated insurance (or any at all)?
Or just a catastrophic coverage plan such as they now cannot get at any price, as I am led to believe?
I was assured that no such individuals existed, before the ACA passed; that the universal law of humanity was to deeply desire health insurance at almost any cost!
What changed, Sirs?
Original Mike,
If you believe all or most people behave logically according to the incentives available to them, you have not looked at the behavior of humanity taken in whole. We are animals who have achieved a degree of reason, but our deepest drives are emotional and irrational. More often than not, we apply a frosting of "reason" to excuse/explain/justify beliefs or acts that are manifestly irrational.
The best one can say is that many who may try to behave rationally according to perceived incentives is that they misperceive, misunderstand, or have been misinformed as to what the rewards or consequences of their choices will actually be.
I wish we could get good numbers on the record wrt the "young invincibles" - who when childless between the ages of 18 and 32 see a doctor a total, yes, a total of six times, and 5.75 of those visits are to renew their birth control prescription. I've been told that Walgreen's $9 per month would be $4 per month if we made birth-control prescriptions "no fault" - i.e. compensate for affects, not damages (given good faith) and would only be $2 a month if these pills could be treated as "pharmacist over-the-counter" - i.e. see a pharmacist who educates and advises a user when to see a physician.
The current plan is to make these invincibles pay $3-4K per year for what they don't need (where even the most responsible purchase a catastrophic care policy for 300-400$ a year that kicks in after a deductible of a dozen iPhones.)
No wonder the medical sector (was anyone not bought off?) love Obama-Care which makes a gift of 20% more revenues to spend on the old without requiring competing for it.
A pity the frog was so easily bought off by the scorpion. We will all suffer for this foolishness. Meaning the young are the energetic and innovative heart of the country. Taking $3000 a year out of their pockets means many won't attempt to start a business, invest in themselves, even just challenge us oldsters and our established ways.
Original Mike said...
"the defining characteristic of liberals is their inability to understand incentives. I may have to modify that; apparently they assume other people do not understand incentives."
Liberals understand incentives very well, their own incentives: to entrench themselves in power and riches, no matter what.
They wanted a single payer Fed controlled system. They didn't get it, so they passed the thousands pages monstrosity with incentives to their favored insurance companies, and exemptions for South Dakota (or was it North?) and believed they could tweak the monster to their agenda. They forced states to expand Mediaid, an unfunded mandate; they imposed penalties which were to be raised so high that would dwarf the unaffordable premiums. But the Supremes threw them a monkey wrench: states do not have to expand their Mediaid, the penalty is a tax that cannot be raised without Congress.
Here we are. Enjoy the show while it lasts.
"The best one can say is that many who may try to behave rationally according to perceived incentives is that they misperceive, misunderstand, or have been misinformed as to what the rewards or consequences of their choices will actually be."
Thus the need for our betters to make our personal decisions for us. Right?
"Before they passed ACA, many said they were purposely ruining insurance so that we'd have to go single payer. And here we are."
Who says we're there?
Who says ACA "ruined insurance?" It was already an extortion racket that (too often) ill- or under-served it's paying customers.
@ Original Mike:
"Thus the need for our betters to make our personal decisions for us. Right?"
Wrong. Our "betters" (sic) are no less, and possibly more irrational than the rest of us--given their distance from humbling and prosaic daily concerns and challenges such as worrying about maintaining food and home and health. We have to try to make our own decisions as best with can with the best information at hand, but we should never assume that we--or humanity at large--are not acting wholly or partially from irrational drives that we believe to be "reason," or that, even if we and many others do make clear, rational choices, that many others are not.
"The best one can say is that many who may try to behave rationally according to perceived incentives is that they misperceive, misunderstand, or have been misinformed as to what the rewards or consequences of their choices will actually be."
So if you make the wrong choices.....you die. Thereby enriching the remaining gene pool for those who rationally chose correctly.
:-)
"Liberals understand incentives very well, their own incentives: to entrench themselves in power and riches, no matter what."
Heh. You don't think "conservatives" (or whatever "not-liberals" are calling themselves) want exactly the same thing? Don't kid yourself.
You say "wrong", Robert, but you clearly believe so when it comes to health insurance.
Can you believe people are actually making their own decisions? What is the world coming to?
Obamacare, like all mandatory taxes, will require reconciliation. It would have been better if it addressed progressive costs. It would have been better if it addressed progressive corruption. But there is no evidence that either was a goal, other than through redistribution in order to placate people.
"When money is scarce, your job is shaky, and you see immediate threats like not being able buy food or pay your rent, other options take a back seat."
Ah yes, but the rational for healthcare for all is that we are our brothers keeper (Whatever the hell that's supposed to mean).
How far of a step is it from providing health insurance to providing the more rational things, like food and shelter?
This is the progression of "progress". There isn't a point at which you are done controlling the lives of others. If we can justify health care for all, mandated, then we can also mandate food and housing and clothes, right?
And after that comes a job (unless you can't work because, well, mental illness like laziness has set in). Where does it end?
It doesn't.
"Ah yes, but the rational for healthcare for all is that we are our brothers keeper (Whatever the hell that's supposed to mean)."
That is one rationale; one might also champion "healthcare for all" for purely selfish reasons, to insure that oneself or one's loved ones are guaranteed access to healthcare if struck down by injury or illness while lacking the means otherwise to pay for care.
As for what being one's brother's keeper might mean, well, you can read Jesus' thoughts on the matter, but I wonder if you really are so puzzled as you present.
It simply means that, as social creatures, we live in groups of friends and families, and our survival depends on our interdependence with one another. We thrive when we have the support of our fellows, and do not when we do not. A society whose members care about helping their fellows seems obviously a more desirable--and more healthy--society than one in which all against all is the prevailing ethos. When we tut tut about the neighbors who failed to call for help as Kitty Genovese was murdered in slow motion in front of them we are expressing our horror at a society that does not believe we are our brother's keepers. If we would assist Kitty Genovese rather than leave her to be murdered, why do we not assist those who are without when it is possible to help them? How do we know we will not one day ourselves become among those needing such help?
If we live without concern for the well-being of our fellow creatures, what are we? Are we really alive, or are we just reflex machines, as Philip K. Dick put it, operating as automatons oblivious to others?
eric:
Social insurance can be considered from two perspectives: moral and natural. The moral perspective rests on recognition of intrinsic value. The natural perspective rests on the desire to avoid an extensive bloodletting (e.g. French Revolution). The former is a principle of American conservatism (i.e. Christian morality). The latter is a fear which motivates wealthy individuals, especially in high density population centers, to subsidize and placate the masses. The limit of this policy should be set where it sponsors moral and natural corruption. Ideally, it would be managed at local levels (i.e. proximity engenders accountability), beginning with the natural family.
The Democrats are fundamentally corrupt, and have only reached a self-evident conclusion by virtue of necessity. Their support for denigrating individual dignity and devaluing human life undermine any claims to moral fitness. The Republicans are exceptionally corrupt, and only occasionally reach a self-evident conclusion, often on religious (i.e. moral) lines. It is the rare occasion when either Party will discuss the issues on merit.
"Ah yes, but the rational for healthcare for all is that we are our brothers keeper (Whatever the hell that's supposed to mean)."
If the thing actually achieved this goal, I could easily overlook my libertarian leanings, but it will do exactly the opposite. This law will seriously degrade the quality of care for everyone in the country, and that I can not overlook.
Don't think for a minute, Robert, that all opposition to ObamaCare stems from selfishness.
eric,
I for one appreciated your 2:45 post. Just sayin'
"Don't think for a minute, Robert, that all opposition to ObamaCare stems from selfishness."
Original Mike, don't think for a minute that I supported Obamneycare; I opposed it.
I support single payer...Medicare for all...tax-funded healthcare...whatever you want to call it. While Obamneycare may prove to be beneficial for some--or not, as only time will tell--it is primarily a gift to the private health insurance industry, and further entrenches them in our health services delivery system. We need to remove the profit motive from the delivery of health care and make it a public utility that we can all utilize without having to worry about the possibly ruinous financial impact on us...like the interstate highway system, bridges, reservoirs, public schools, clean tap water, the fire department, libraries, and so on.
Robert Cook said...
"Don't think for a minute, Robert, that all opposition to ObamaCare stems from selfishness."
I support single payer...Medicare for all...tax-funded healthcare... We need to remove the profit motive from the delivery of health care and make it a public utility that we can all utilize without having to worry about the possibly ruinous financial impact on us...like the interstate highway system, bridges, reservoirs, public schools, clean tap water, the fire department, libraries, and so on.
4/23/14, 8:05 AM
What makes you think that utilities are not run for profit? They just have massive controls over their profit because they are a monopoly in an area. You want healthcare more "fair" then get the government out of it. Stop with the minimum requirements. Stop with the restrictions on cross state sales.
What makes you think the government would run "our" healthcare any better than they run the post office, the VA, Medicare, Medicaid, the IRA, the NSA, or any of the other things that they currently run?
All single-payer will do is increase the divide between the "upper crust" and everyone else. Imagine a politicized healthcare system like the IRS where your place in line and your service of care are managed in part by how you vote and to whom you contribute money. Unless you are powerful, of course. In that case you will have access to all the healthcare you want or need. Everyone else will be judged on all those factors above as well as how much is it going to cost "us" to treat you verses your value to "us". If you are too old, screw you. If you have a too expensive condition, screw you. They may not say that out loud. They would just restrict access until most with those conditions just die from neglect. Waiting lines for you and me until the problem just goes away.
No thank you. I prefer even the junk we have today to that.
"We need to remove the profit motive from the delivery of health care ..."
You remove the profit motive from the delivery of health care and you remove any chance of reigning in medical costs. You remove the profit motive from the delivery of health care and you stop the advancement of disease treatment dead in its tracks (and before you claim that government agencies such as NIH will carry the load, I'll tell you that I was an NIH-funded PI for decades. NIH is a piece of the puzzle, but it is incapable of delivering basic research to the bedside, where it actually helps people).
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