Full Version: Individual Mandate on Health Care
The legislature in Massachusetts is currently in joint committee, working on the details of a pioneering change in health care. Spearheaded by current Republican Governor (and presidential aspirant) Mitt Romney, the legislation would make Massachusetts the first state to ensure 100% health care coverage for its citizens.
A link to a summary of Romney's proposed version of the bill (I can't find the two version in committee) can be found here.
Here are a few bullet points to get a feel for the plan from USA Today:
At the center of the controversy is the paradigm changing idea that health care for an individual is not only a right, but a responsibility. If you do not own insurance and your company does not provide for it, you are required by law to buy into a medicaid plan or some type of state subsidized program.
I'd like to narrow this conversation a bit and focus it on Massachusetts approach and not let it descend into a generic universal health care debate. Please bear this in mind in when answering the questions. Thanks
Questions for Debate:
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
3) Under what circumstances do you think the Massachusetts experiment might struggle in other states?
A link to a summary of Romney's proposed version of the bill (I can't find the two version in committee) can be found here.
Here are a few bullet points to get a feel for the plan from USA Today:
QUOTE
The three-pronged approach would:
Boost efforts to get 106,000 eligible residents who have not signed up for Medicaid to do so.
Create a program called Commonwealth Care through which people of moderate income and small businesses could buy insurance from private insurers at a special rate. It would not be subsidized by the state. About 204,000 are eligible.
Policies would be offered covering primary care, hospital care, mental health services and prescription drugs, with annual deductibles of $250 to $1,000. Romney's plan estimates monthly premiums of less than $200 for an individual, well below current premiums in his state of more than $350 a month for small group coverage.
Establish a second program called Safety Net Care for residents with incomes up to 300% of the federal poverty level, which is $28,700 for a single person. Policies would have no annual deductible and would be subsidized by the state, with policyholders paying 1.3% to 5.8% of their income, or $2.30 to $32.31 a week, for an individual plan. About 150,000 people would be eligible.
Once the programs were in place, individual who did not get insurance from their jobs or buy it through one of the programs could lose their personal tax exemption of $3,300 — worth about $175 for an average taxpayer — face withholding of their income tax refund, or if they get medical care, their wages could be garnished for payment.
Boost efforts to get 106,000 eligible residents who have not signed up for Medicaid to do so.
Create a program called Commonwealth Care through which people of moderate income and small businesses could buy insurance from private insurers at a special rate. It would not be subsidized by the state. About 204,000 are eligible.
Policies would be offered covering primary care, hospital care, mental health services and prescription drugs, with annual deductibles of $250 to $1,000. Romney's plan estimates monthly premiums of less than $200 for an individual, well below current premiums in his state of more than $350 a month for small group coverage.
Establish a second program called Safety Net Care for residents with incomes up to 300% of the federal poverty level, which is $28,700 for a single person. Policies would have no annual deductible and would be subsidized by the state, with policyholders paying 1.3% to 5.8% of their income, or $2.30 to $32.31 a week, for an individual plan. About 150,000 people would be eligible.
Once the programs were in place, individual who did not get insurance from their jobs or buy it through one of the programs could lose their personal tax exemption of $3,300 — worth about $175 for an average taxpayer — face withholding of their income tax refund, or if they get medical care, their wages could be garnished for payment.
At the center of the controversy is the paradigm changing idea that health care for an individual is not only a right, but a responsibility. If you do not own insurance and your company does not provide for it, you are required by law to buy into a medicaid plan or some type of state subsidized program.
I'd like to narrow this conversation a bit and focus it on Massachusetts approach and not let it descend into a generic universal health care debate. Please bear this in mind in when answering the questions. Thanks
Questions for Debate:
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
3) Under what circumstances do you think the Massachusetts experiment might struggle in other states?
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
I think this plan, and others like it, misunderstand one basic idea behind insurance. That idea is that insurance is shared risk, where there are winners (those that pay less in and get more out) and losers (those that pay more in than they get in return).
Plans such as this basically force those that currently feel they would be losers to become losers under penalty of law (in this case, loss of the personal income exemption). This is the nanny state in action: you NEED this and you WILL pay for it.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
I suppose that the plan feels that it is doing this by indexing the out of pocket cost to the income of the recipient.
3) Under what circumstances do you think the Massachusetts experiment might struggle in other states?
I think it will struggle. People who used to do without insurance will now overindulge to get their money's worth. It's what I would do if there was no co-pay and no deductible (which is what the Safety Net Care seems to be) and it took money out of my check.
As I said, insurance only works if there are losers. By forcing people into it, you make people realize they are losers and then the losers take advantage of things they normally would not. This drives up costs for everyone because the system has no balance.
Of course, if this doesn't happen and there are people who are perfectly willing to pay money for something they don't want or use, then it will work out fine. I wouldn't bet on that of course.
I think this plan, and others like it, misunderstand one basic idea behind insurance. That idea is that insurance is shared risk, where there are winners (those that pay less in and get more out) and losers (those that pay more in than they get in return).
Plans such as this basically force those that currently feel they would be losers to become losers under penalty of law (in this case, loss of the personal income exemption). This is the nanny state in action: you NEED this and you WILL pay for it.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
I suppose that the plan feels that it is doing this by indexing the out of pocket cost to the income of the recipient.
3) Under what circumstances do you think the Massachusetts experiment might struggle in other states?
I think it will struggle. People who used to do without insurance will now overindulge to get their money's worth. It's what I would do if there was no co-pay and no deductible (which is what the Safety Net Care seems to be) and it took money out of my check.
As I said, insurance only works if there are losers. By forcing people into it, you make people realize they are losers and then the losers take advantage of things they normally would not. This drives up costs for everyone because the system has no balance.
Of course, if this doesn't happen and there are people who are perfectly willing to pay money for something they don't want or use, then it will work out fine. I wouldn't bet on that of course.
Do you support the concept of making health care insurance an individual responsibility?
No. I tend to take the Hippocratic approach to these things - "First, do no harm." So many of the problems in our health care system have been the result of government efforts to "solve" the problem previously. So before coming up with yet another radical solution that will in all likelihood result in even more unforeseen problems, we need to take stock of the things that have already been contributing to the existing problem.
Many of those things have taken place at the federal level, but not all. First of all Massachusetts has a number of rules requiring insurance companies to cover certain procedures and therapies. These should all be scrapped. What insurance companies do and do not cover should be a matter only between them and their customers. If a person wants a plan that covers psychological care, and the company's willing to offer it, then fine. If he doesn't want to have to pay for that, the state shouldn't require it. For my part, I'd be happy with a plan that has a low premium and high annual deductible (say, $7,000) for things that I truly need to preserve my physical health. Others might be willing to pay for a plan that covers more, but if the state requires that plans cover more, then it shouldn't act surprised when people are unable to afford insurance.
Also, hospitals need greater latitude in refusing care for people who a. won't be paying for it, and b. are crying wolf. I know from having worked in hospitals that there are certain classes of "frequent fliers" who are in and out of the hospital constantly, and are either hypochondriacs, or attention-seekers, or drug seekers. Others might have actual physical ailments, but are clearly doing nothing to help themselves - not following doctors' orders, or not getting off the bottle, or whatever. This puts a huge unnecessary drain on hospitals which drives up the cost of care for those who legitimately need it.
And finally, we need tort reform, big time. I generally do not support attempts to put artificial caps on malpractice suits, but it's the system itself that's in bad need of fixing. Its biggest ailment is a jury-selection practice known as peremptory challenges. What this means is that lawyers in a given case can preeemptively dismiss jurors without even having to give a reason. And of course the ones they're going to dismiss are the intelligent ones. They want jurors to whom they can appeal emotionally. We also need to do more to ensure that those who are called to serve, actually do. Currently, the ones who get out of jury duty tend to be those who have talents to offer, because they wind up being the ones with busy schedules (and not to mention the know-how to get out of jury duty). What we're left with, again, are people with little time on their hands, and who often are, shall we say, open to suggestion.
No. I tend to take the Hippocratic approach to these things - "First, do no harm." So many of the problems in our health care system have been the result of government efforts to "solve" the problem previously. So before coming up with yet another radical solution that will in all likelihood result in even more unforeseen problems, we need to take stock of the things that have already been contributing to the existing problem.
Many of those things have taken place at the federal level, but not all. First of all Massachusetts has a number of rules requiring insurance companies to cover certain procedures and therapies. These should all be scrapped. What insurance companies do and do not cover should be a matter only between them and their customers. If a person wants a plan that covers psychological care, and the company's willing to offer it, then fine. If he doesn't want to have to pay for that, the state shouldn't require it. For my part, I'd be happy with a plan that has a low premium and high annual deductible (say, $7,000) for things that I truly need to preserve my physical health. Others might be willing to pay for a plan that covers more, but if the state requires that plans cover more, then it shouldn't act surprised when people are unable to afford insurance.
Also, hospitals need greater latitude in refusing care for people who a. won't be paying for it, and b. are crying wolf. I know from having worked in hospitals that there are certain classes of "frequent fliers" who are in and out of the hospital constantly, and are either hypochondriacs, or attention-seekers, or drug seekers. Others might have actual physical ailments, but are clearly doing nothing to help themselves - not following doctors' orders, or not getting off the bottle, or whatever. This puts a huge unnecessary drain on hospitals which drives up the cost of care for those who legitimately need it.
And finally, we need tort reform, big time. I generally do not support attempts to put artificial caps on malpractice suits, but it's the system itself that's in bad need of fixing. Its biggest ailment is a jury-selection practice known as peremptory challenges. What this means is that lawyers in a given case can preeemptively dismiss jurors without even having to give a reason. And of course the ones they're going to dismiss are the intelligent ones. They want jurors to whom they can appeal emotionally. We also need to do more to ensure that those who are called to serve, actually do. Currently, the ones who get out of jury duty tend to be those who have talents to offer, because they wind up being the ones with busy schedules (and not to mention the know-how to get out of jury duty). What we're left with, again, are people with little time on their hands, and who often are, shall we say, open to suggestion.
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
What is meant by "making health care insurance in individual responsibility". Health care already is an individual responsibility. Most employers offer insurance with benefits, but usually the employee's have to opt-in and pay premiums. Even federal programs like Medicare usually have to be signed up for. Since in the United States every individual already has or does not have insurance at their choice, it's already a case of individual responsibility and your question is a moot point. Is this question asking if governments should criminalize not having health insurance? Please clarify.
You cannot jump from the statement that insurance is shared risk to the implication that this fact creates "winners" and "losers". The benefits from insurance are not solely to be measured by the benefits paid. I have always had medical insurance and am fairly confident that's its cumulative cost over the years has exceeded the value of the benefits I've received. However, I continue to purchase it and do not regret my past decisions. Obviously, there is some other value I obtain from the insurance. One of these benefits is most easily described as piece-of-mind. I know if something awful were to happy to me, or my family, insurance would help defray this unexpected cost. Knowing this safety net is there, even if I never cash in, has value to me, for which I am willing to pay. The point is, you cannot use a pure cost-in cost-out analysis to say that X percent of people are "losers" in the insurance system. In fact, I argue that given that insurance is voluntary (see above) everyone who has insurance considers themselves a winner. Most people want to share risk and the more that share, the cheaper insurance is for everyone else. (Someone let me know if they're not okay with me saying this without proof.)
Now the question becomes what of those people not in the system. Why are they not in it and why should they be? In other words, is government justified in making them buy insurance?
This statement lumps together three major classes of people who should not be because it confuses detailed analysis.
1. The first group are the uninsured, people for whom the value of medical care consumed is greater than the cost of insurance. Typically these are the unhealthy poor who don't have insurance because they work in jobs where it is not provided by employers and who cannot afford to buy it on the open market. This leads to an inefficient situation where these people do not buy insurance because they don't have the means to buy it. Getting these people into insurance, even if it had to be subsidized, would be cheaper than the alternative: where they can't get preventative care and end up in the emergency room any time something goes wrong. Besides being morally undesirable, this also increases cost for everyone else, since the ER costs of the uninsured are paid for by the insured. For this group, the best solution is one that finds a way to get them into the insurance market while maintaining incentives to end reliance on government entitlements and provide for themselves. The Mass. plan seems to do the first, but no data was given regarding how to wean people from the system.
2. The second group is small: those who could afford the cost of any conceivable malady. Think the (Donald) Trumps, (Bill) Gates, and (Richard) Bransons of the world. They have enough assets to be their own insurance and have no incentive to buy it. Basically the piece-of-mind has no value to them because their piles of cash provide plenty. For this group, forcing them to buy insurance may not be in their best interests, but from a policy standpoint, it may be simplest to require them to buy in with everyone else. (Meaning it gets around the issue of deciding how rich someone has to be before you give them an insurance waiver.) Car insurance is like this, even the rich are forced to buy it.
3. The third group are the risk takers. These people cannot absorb the cost of an unexpected malady but are banking on the odds that it won't happen. These people are a risk to society because when malady does strike, they are unable to pay and society has to pick up the burden (since hospitals cannot deny emergency service). These people should be compelled to buy into the insurance system because if they don't and for some reason need it, they will force society to absorb the cost of a risk they should have been hedging against with insurance.
Society has a right to protect itself from leeches. How to enforce this would be tough, but no more difficult than the same problem with car insurance.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
This is a difficult policy question to answer because "unduly burdensome" is impossible to define to everyone's satisfaction. One extreme answer is no: if people can't pay, then government paying for them is done at the expense of the other members of society and thus is unfair to them.
The other extreme is yes: otherwise, government has made all those unable to obtain insurance criminals.
The right answer is probably between these two extremes, a situation where most people get no help and some people are subsidized. The critical question is how to subsidize the poor without destroying the economic incentives promoting self-sufficiency. The answer to this question might be the most interesting of all. How can government provide or subsidize healthcare to people unable to afford it without creating a welfare state which destroys the motivation to get off the system?
What is meant by "making health care insurance in individual responsibility". Health care already is an individual responsibility. Most employers offer insurance with benefits, but usually the employee's have to opt-in and pay premiums. Even federal programs like Medicare usually have to be signed up for. Since in the United States every individual already has or does not have insurance at their choice, it's already a case of individual responsibility and your question is a moot point. Is this question asking if governments should criminalize not having health insurance? Please clarify.
QUOTE
I think this plan, and others like it, misunderstand one basic idea behind insurance. That idea is that insurance is shared risk, where there are winners (those that pay less in and get more out) and losers (those that pay more in than they get in return).
You cannot jump from the statement that insurance is shared risk to the implication that this fact creates "winners" and "losers". The benefits from insurance are not solely to be measured by the benefits paid. I have always had medical insurance and am fairly confident that's its cumulative cost over the years has exceeded the value of the benefits I've received. However, I continue to purchase it and do not regret my past decisions. Obviously, there is some other value I obtain from the insurance. One of these benefits is most easily described as piece-of-mind. I know if something awful were to happy to me, or my family, insurance would help defray this unexpected cost. Knowing this safety net is there, even if I never cash in, has value to me, for which I am willing to pay. The point is, you cannot use a pure cost-in cost-out analysis to say that X percent of people are "losers" in the insurance system. In fact, I argue that given that insurance is voluntary (see above) everyone who has insurance considers themselves a winner. Most people want to share risk and the more that share, the cheaper insurance is for everyone else. (Someone let me know if they're not okay with me saying this without proof.)
Now the question becomes what of those people not in the system. Why are they not in it and why should they be? In other words, is government justified in making them buy insurance?
QUOTE
Plans such as this basically force those that currently feel they would be losers to become losers under penalty of law.
This statement lumps together three major classes of people who should not be because it confuses detailed analysis.
1. The first group are the uninsured, people for whom the value of medical care consumed is greater than the cost of insurance. Typically these are the unhealthy poor who don't have insurance because they work in jobs where it is not provided by employers and who cannot afford to buy it on the open market. This leads to an inefficient situation where these people do not buy insurance because they don't have the means to buy it. Getting these people into insurance, even if it had to be subsidized, would be cheaper than the alternative: where they can't get preventative care and end up in the emergency room any time something goes wrong. Besides being morally undesirable, this also increases cost for everyone else, since the ER costs of the uninsured are paid for by the insured. For this group, the best solution is one that finds a way to get them into the insurance market while maintaining incentives to end reliance on government entitlements and provide for themselves. The Mass. plan seems to do the first, but no data was given regarding how to wean people from the system.
2. The second group is small: those who could afford the cost of any conceivable malady. Think the (Donald) Trumps, (Bill) Gates, and (Richard) Bransons of the world. They have enough assets to be their own insurance and have no incentive to buy it. Basically the piece-of-mind has no value to them because their piles of cash provide plenty. For this group, forcing them to buy insurance may not be in their best interests, but from a policy standpoint, it may be simplest to require them to buy in with everyone else. (Meaning it gets around the issue of deciding how rich someone has to be before you give them an insurance waiver.) Car insurance is like this, even the rich are forced to buy it.
3. The third group are the risk takers. These people cannot absorb the cost of an unexpected malady but are banking on the odds that it won't happen. These people are a risk to society because when malady does strike, they are unable to pay and society has to pick up the burden (since hospitals cannot deny emergency service). These people should be compelled to buy into the insurance system because if they don't and for some reason need it, they will force society to absorb the cost of a risk they should have been hedging against with insurance.
Society has a right to protect itself from leeches. How to enforce this would be tough, but no more difficult than the same problem with car insurance.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
This is a difficult policy question to answer because "unduly burdensome" is impossible to define to everyone's satisfaction. One extreme answer is no: if people can't pay, then government paying for them is done at the expense of the other members of society and thus is unfair to them.
The other extreme is yes: otherwise, government has made all those unable to obtain insurance criminals.
The right answer is probably between these two extremes, a situation where most people get no help and some people are subsidized. The critical question is how to subsidize the poor without destroying the economic incentives promoting self-sufficiency. The answer to this question might be the most interesting of all. How can government provide or subsidize healthcare to people unable to afford it without creating a welfare state which destroys the motivation to get off the system?
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
Yes, to a point. Unless you cannot afford such. I cannot agree with simply allowing people that work, or even not work receive no healthcare period, not in a nation as rich as ours.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
I find this one of the more serious problems facing homo sapiens. There is becoming to many of us, so I do not see any system in the long run that will be able to float such, free trade or government, does not matter. I think most the resources will collapse as our behavior continues to morph ecology in the way it is and resources or the ecology becomes to stressed overall. As far as it being a burden on other people, well, I doubt for any individual to truly be the only provider in his or her life, being I did not build the computer I use, or the internet, its cables or my car as other examples. So to say that society is not connected is a bit false, a company needs employees.
3) Under what circumstances do you think the Massachusetts experiment might struggle in other states?
I think it will all be subject to individual state economical issues, which of course will tie into other human based issues such as poverty.
Yes, to a point. Unless you cannot afford such. I cannot agree with simply allowing people that work, or even not work receive no healthcare period, not in a nation as rich as ours.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
I find this one of the more serious problems facing homo sapiens. There is becoming to many of us, so I do not see any system in the long run that will be able to float such, free trade or government, does not matter. I think most the resources will collapse as our behavior continues to morph ecology in the way it is and resources or the ecology becomes to stressed overall. As far as it being a burden on other people, well, I doubt for any individual to truly be the only provider in his or her life, being I did not build the computer I use, or the internet, its cables or my car as other examples. So to say that society is not connected is a bit false, a company needs employees.
3) Under what circumstances do you think the Massachusetts experiment might struggle in other states?
I think it will all be subject to individual state economical issues, which of course will tie into other human based issues such as poverty.
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
If you find someone unconscious on the sidewalk do you call for help or do you check for their health care card first? (a lot of us carry our health care card in our wallets for that reason) If you call for help first and don't ask yourself if you are going to make the person go bankrupt by doing that, or assume that if they don't have insurance or the money it will still somehow get paid for then you must believe that health care is not an individual responsibility because you would be willing to assume the responsibility for a stranger.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
There is a huge difference between health insurance and car insurance. I'm a college student and my neighbor offered to sell me her for 400$, it's not that nice of a car but I only want it for convince around town and I know how to get my self around if it breaks down so reliability is not that important to me. I could come up with the 400$'s relatively easily if I saved my money, but I told her I couldn't buy the car. Why? Because of car insurance, even though I might be able to save up 400$ to buy a car I don't know if I will have the 80$'s a month it costs to insure the car even if I don't drive it and spend no money on gas. As my dad is so fond of telling me I have feet, I have a bike, I can get anywhere I want on the bus, it just takes a little longer. I live in a state that mandates car insurance but I don't pay a cent for car insurance and I'm not breaking the law because I don't drive, and not driving is beneficial to society, it helps keep the air clean, and creates more space on the roads, and walking reduces obesity. There are no such alternatives with health insurance and the government doesn't have the right to force people to pay for the privilege of being alive. So yes I think that the state has an obligation to provide health care at a price that is not unduly burdensome, and that this is the benefit to the Mass system.
I think you could also have something like you have to have the deductible to your health insurance plan in a health savings account and if your health savings account had upwards of 5 mill you were exempt from any health care requirement, thus exempting the Bill Gates and Donald Trumps of the world.
If you find someone unconscious on the sidewalk do you call for help or do you check for their health care card first? (a lot of us carry our health care card in our wallets for that reason) If you call for help first and don't ask yourself if you are going to make the person go bankrupt by doing that, or assume that if they don't have insurance or the money it will still somehow get paid for then you must believe that health care is not an individual responsibility because you would be willing to assume the responsibility for a stranger.
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
QUOTE
Society has a right to protect itself from leeches. How to enforce this would be tough, but no more difficult than the same problem with car insurance.
There is a huge difference between health insurance and car insurance. I'm a college student and my neighbor offered to sell me her for 400$, it's not that nice of a car but I only want it for convince around town and I know how to get my self around if it breaks down so reliability is not that important to me. I could come up with the 400$'s relatively easily if I saved my money, but I told her I couldn't buy the car. Why? Because of car insurance, even though I might be able to save up 400$ to buy a car I don't know if I will have the 80$'s a month it costs to insure the car even if I don't drive it and spend no money on gas. As my dad is so fond of telling me I have feet, I have a bike, I can get anywhere I want on the bus, it just takes a little longer. I live in a state that mandates car insurance but I don't pay a cent for car insurance and I'm not breaking the law because I don't drive, and not driving is beneficial to society, it helps keep the air clean, and creates more space on the roads, and walking reduces obesity. There are no such alternatives with health insurance and the government doesn't have the right to force people to pay for the privilege of being alive. So yes I think that the state has an obligation to provide health care at a price that is not unduly burdensome, and that this is the benefit to the Mass system.
I think you could also have something like you have to have the deductible to your health insurance plan in a health savings account and if your health savings account had upwards of 5 mill you were exempt from any health care requirement, thus exempting the Bill Gates and Donald Trumps of the world.
QUOTE
There is becoming to many of us, so I do not see any system in the long run that will be able to float such, free trade or government, does not matter. I think most the resources will collapse as our behavior continues to morph ecology in the way it is and resources or the ecology becomes to stressed overall. As far as it being a burden on other people, well, I doubt for any individual to truly be the only provider in his or her life, being I did not build the computer I use, or the internet, its cables or my car as other examples. So to say that society is not connected is a bit false, a company needs employees.
What are you talking about? What does any of this drivel, which I can only describe as an incoherent sustainable development argument, have to do with health insurance? The statements above show no linkage between population growth and the sustainability of the healthcare system. Who said anything about members of society not being connected, and what does that have to do with anything?
Regarding the post by lesforpeace1984: This was a long argument so let me summarize quickly to make sure I understand and don't mis-state your point. Your fundamental argument seemed to be that the main difference between car insurance and health insurance is that you can forego buying the former by choosing not to drive, but cannot forego the latter without choosing not to live. Assuming that's an accuracy summary, I would agree. But the next step in your logic doesn't hold.
QUOTE
There are no such alternatives with health insurance and the government doesn't have the right to force people to pay for the privilege of being alive. So yes I think that the state has an obligation to provide health care at a price that is not unduly burdensome, and that this is the benefit to the Mass system.
Despite the fact that everyone is alive, why does that not give society (through the government) the right to obligate people to buy insurance? People have an obligation to provides for themselves, which includes healthcare. If as a society we have adopted a policy of providing life-saving medical care to people regardless of their ability to pay, we have a corresponding obligation to make people buy insurance. Otherwise, we create a system where people can renig on their half of the bargin and obtain medical services that are "free" to them and paid for by the rest of society. That is less fair than the alternative you espouse, which enables people to use a service they don't pay for to the detriment of the rest of society.
To resurrect the car analogy, the healthcare situation would be an uninsured driver, who after getting in an accident asks the government to pay for car damages and any other liability. Ludicrous on the road and just as non-sensical in the hospital.
QUOTE
So yes I think that the state has an obligation to provide health care at a price that is not unduly burdensome, and that this is the benefit to the Mass system.
Again I question what are the criteria for unduly burdensome? Different levels of coverage costs different amounts. In a functioning market the cost of insurance will be dictated by supply and demand. Who are you to say it's cost are unduly? The cost reflects the value of the service. If it is expensive, perhaps that's because it's a reflection of how much modern medical care costs. (We could start another thread about why healthcare is not a properly functioning market and what could be done to drive down prices, but I'm not allowed to start posts yet.)
Again, I say, how to you prevent people from becoming addicted to the Mass. system and staying on state provided medical care (which is being paid for by the other residents of the state) their entire lives? What are the incentives to get off the program?
QUOTE(Adam @ Dec 10 2005, 03:24 PM)
What are you talking about? What does any of this drivel, which I can only describe as an incoherent sustainable development argument, have to do with health insurance? 
Let's not belittle anyone. Debate in a civil fashion, please. If you feel a member has gone off topic, report it. Thanks.TOPICS:
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
2) If the government makes carrying health insurance a legal requirement, does it own some responsibility to provide assistance to those in which the costs of doing so would be unduly burdensome?
3) Under what circumstances do you think the Massachusetts experiment might struggle in other states?
1) Do you support the concept of making health care insurance an individual responsibility? Why or why not?
I don't like to make assumptions, so someone tell me if I'm wrong on this one. We all agree that their is an inherent value to human life, that it is wrong both to kill or let someone die when we could prevent it. Correct?
What I say next is the same summary you just made. That it is perfectly acceptable to take a persons car or their right to drive if they refuse to pay for car insurance because driving not a fundamental human right. The comparable alternative to taking someone's car with health insurance is to incarcerate or kill people, and if you agree with my statement above this is unacceptable as well as unconstitutional, and at least the later of the two alternatives is also a violation of the Geneva Conventions. I do not believe any sane person believes it is acceptable for the state to actively kill or seek out for incarceration people who do not have health insurance. More over when it is perfectly acceptable for police to pull your car over and demand licence, registration and proof of insurance when it is unacceptable for police to demand proof of insurance from a person on the sidewalk. That is just the enforcement side. If you recall this was in response to a comment saying that it would be no more difficult to enforce having health insurance than it is to enforce that people have car insurance.
Secondly, the state does not require people ensure their cars, the state requires that people pay insurance to pay for the damage they could do to someone else's car. No one else is injured by your not getting health care, society is concerned about people not having health care because the vast majority of people agree with what my assumption that not only actively killing people is immoral, but that allowing people to die or suffer when it could be prevented it is immoral.
If you crash your car you run a large risk of killing other people as well as yourself and if you do this you will be forcing either the government or the person whose car you crashed into to would have to pay the damages. Car insurance is required not because society see the right of people to drive a moral imperative and does not want you to lose that right my crashing your car, but because society (either the government or other individuals) does not want to pay for the possible damage that your driving could cause someone else, and society wants to ensure that such possible damages will be paid for by you, not society at large. If you don't have the money to pay for car insurance society does help you, we have a public transit system that is available to everyone and is priced in a way so that money is not a large barrier to access. (I can go on about public transit forever, so please, I know this analogy is incomplete, if you would like to discuss it further please PM before you put it on the forum so we don't get completely off topic; I probably can answer many of the challenges to this analogy, but not without getting far deeper into the intricacies of public transit policies.)
Society wants people to buy health care not because people not having health care is a potential liability to others as driving is, if you die and no one does anything to stop it this is not a liability to society. The problem is that the vast majority of people agree with my assumption above and believes that it is morally unacceptable to let a person die when it can be prevented and that is why we are concerned that people lack health care in the first place. Society believes health care is their responsibility because refusing to take responsibility for health care has morally unacceptable consequences, therefor society is responsible for health care not individuals.
What are the incentives to get off the program?
The incentives to get off the program is the job of the private sector to create if they want those peoples business. This question is based on multiple faulty or at least questionable assumptions. The assumption that "getting off the program" is necessarily good is faulty for one, is it in your mind somehow more moral to give power &/or resources to a corporation driven by money than to a democratically elected government? The advantage to capitalistic systems is their efficacy, our capitalistic health care system is not efficient so what then makes it inherently better? Second you are assuming that health care is a functioning market, and I find this highly unlikely considering the rapid rise in prices. When and if you set up a post about this issue I'd love to explain in greater detail - elasticity for health care is near 0, and this alone makes it a non-functional market. Perhaps active competition for the public sector is what it will take to create a closer to functional health care market.
I don't like to make assumptions, so someone tell me if I'm wrong on this one. We all agree that their is an inherent value to human life, that it is wrong both to kill or let someone die when we could prevent it. Correct?
QUOTE
Your fundamental argument seemed to be that the main difference between car insurance and health insurance is that you can forego buying the former by choosing not to drive, but cannot forego the latter without choosing not to live. Assuming that's an accuracy summary, I would agree. But the next step in your logic doesn't hold. "There are no such alternatives with health insurance and the government doesn't have the right to force people to pay for the privilege of being alive. So yes I think that the state has an obligation to provide health care at a price that is not unduly burdensome, and that this is the benefit to the Mass system."
What I say next is the same summary you just made. That it is perfectly acceptable to take a persons car or their right to drive if they refuse to pay for car insurance because driving not a fundamental human right. The comparable alternative to taking someone's car with health insurance is to incarcerate or kill people, and if you agree with my statement above this is unacceptable as well as unconstitutional, and at least the later of the two alternatives is also a violation of the Geneva Conventions. I do not believe any sane person believes it is acceptable for the state to actively kill or seek out for incarceration people who do not have health insurance. More over when it is perfectly acceptable for police to pull your car over and demand licence, registration and proof of insurance when it is unacceptable for police to demand proof of insurance from a person on the sidewalk. That is just the enforcement side. If you recall this was in response to a comment saying that it would be no more difficult to enforce having health insurance than it is to enforce that people have car insurance.
Secondly, the state does not require people ensure their cars, the state requires that people pay insurance to pay for the damage they could do to someone else's car. No one else is injured by your not getting health care, society is concerned about people not having health care because the vast majority of people agree with what my assumption that not only actively killing people is immoral, but that allowing people to die or suffer when it could be prevented it is immoral.
QUOTE
To resurrect the car analogy, the healthcare situation would be an uninsured driver, who after getting in an accident asks the government to pay for car damages and any other liability.
If you crash your car you run a large risk of killing other people as well as yourself and if you do this you will be forcing either the government or the person whose car you crashed into to would have to pay the damages. Car insurance is required not because society see the right of people to drive a moral imperative and does not want you to lose that right my crashing your car, but because society (either the government or other individuals) does not want to pay for the possible damage that your driving could cause someone else, and society wants to ensure that such possible damages will be paid for by you, not society at large. If you don't have the money to pay for car insurance society does help you, we have a public transit system that is available to everyone and is priced in a way so that money is not a large barrier to access. (I can go on about public transit forever, so please, I know this analogy is incomplete, if you would like to discuss it further please PM before you put it on the forum so we don't get completely off topic; I probably can answer many of the challenges to this analogy, but not without getting far deeper into the intricacies of public transit policies.)
Society wants people to buy health care not because people not having health care is a potential liability to others as driving is, if you die and no one does anything to stop it this is not a liability to society. The problem is that the vast majority of people agree with my assumption above and believes that it is morally unacceptable to let a person die when it can be prevented and that is why we are concerned that people lack health care in the first place. Society believes health care is their responsibility because refusing to take responsibility for health care has morally unacceptable consequences, therefor society is responsible for health care not individuals.
What are the incentives to get off the program?
The incentives to get off the program is the job of the private sector to create if they want those peoples business. This question is based on multiple faulty or at least questionable assumptions. The assumption that "getting off the program" is necessarily good is faulty for one, is it in your mind somehow more moral to give power &/or resources to a corporation driven by money than to a democratically elected government? The advantage to capitalistic systems is their efficacy, our capitalistic health care system is not efficient so what then makes it inherently better? Second you are assuming that health care is a functioning market, and I find this highly unlikely considering the rapid rise in prices. When and if you set up a post about this issue I'd love to explain in greater detail - elasticity for health care is near 0, and this alone makes it a non-functional market. Perhaps active competition for the public sector is what it will take to create a closer to functional health care market.
Sorry it took so long for me to reply: finals week.
Re Jaime's post: I don't remember who's post I was responding to but I apologize. Feel free to repost if you want to explain your position again. I couldn't understand what you were trying to say the first time.
From lesforpeace1984:
I agree that life has inherent value. It is wrong to kill someone without cause. I don't necessarily agree it is always wrong to prevent someone from dying if it can be prevented.
1) I am in favor of capital punishment (but let's not discuss that in this thread)
2) I belive killing enemy soliders in a war is justified
3) I believe it is justifiable to kill to defend your life or the life of your family
4) There may be cases where saving one person's life requires the sacrifice of many more lives. If those sacrificing their lives have not consented then it isn't moral to save the first life.
So to the extent your following arguments rely on agreement on this point we may disagree at a fundamental level.
Several things to refute.
1) I have not argued for taking away people's health insurance. I've argued for making having it mandatory, and for helping those who can't afford it to buy it.
2) Not having health insurance isn't the same as being dead, or America would have about 35 million less citizens than it does
3) Killing people isn't unconstitutional or else Tookie would still be alive
4) Killing people isn't unacceptable in all cases (see above), although I'd agree that the killing you're referring to would be immoral
5) I'm not sure what the Geneva convention has to do with anything. It doesn't apply to how America treats it citizens, it applies to prisoners of war.
I feel you are twisting my words. I never advocated killing people without health insurance!! That's terrible. I don't think incarceration is the right answer either. For people who have the means the government could garnish their wages and use it to pay for insurance. For those without the means they would be part of those who received subsidized insurance.
I was thinking more like when you went to the doctor or the hospital and when you took a new job (just like you have to show proof of citizenship or green card).
Not true, Washington does and other states probably do as well.
Not true. The uninsured drive up the cost of healthcare for everyone else (see my earlier posts). The uninsured typically don't receive good preventative care because they have to pay out-of-pocket. Thus prolems go un-noticed until they require emergency care which is more expensive and paid for by tax dollars; if they don't have the money to pay for themselves.
This is a red herring argument. No one, especially not me, has advocated killing people. On the contrary, I'm trying to find a way for everyone to have health coverage, which should save lives, not end them. I'm looking to get people coverage so they can have a doctor help them deal with problems before they become an emergency.
Perhaps you've never lived in a state with lots of illegal immigrants (like Cali), but this is a real problem and a real issue in this state. The emergency rooms have a disproportionately large number of people in them who aren't here legally and don't have insurance.
Regarding mass transit: I agree this is a topic for another thread. Feel free to start one as I think we're in disagreement there as well.
The private sector will create policies that people can buy. The problem is the people on the program are too poor to afford the coverage. It's not the private sector's responsibility to offer them insurance at a loss. As for faulty assumptions, here is my defense:
No it's not. People on the program are getting something they're not paying for, at the expense of everyone else. That's prima facie unfair to those not on the program and thus desirable to stop. Forced "charity" isn't charity at all, it's theft. I'm not saying helping the less fortunate isn't a good thing. It's just when it's being done with tax money, the people receiving the aid have an obligation to try and become self-sufficient. I'm not sure how to help the poor with government money and encourage this behavior.
I'm afraid I don't understand your argument. I'm not "giving" anything to a corporation. I'm trading them my money for the amortization of my health risks and the associated costs. And yes, this type of willing trade is more moral than having it taken by the government, democratic or not. This is because it's my money and in the private sector I choose how to spend it. I don't get to choose how much I pay in taxes or what those taxes go for. It is decided by the majority and they have decided to appropriate more than I would willingly give and spend it on things I do not approve of.
Our health care system is only quasi-capitalistic. A consumer-based health care market, which is ultimately what I propose, would be more capitalistic, and it would be more efficient than the status quo.
No I'm not, as I said above. But you're right that I'm assuming a consumer-based system would be a functioning market. But this can't happen unless people are directly and clearly accountable for the medical cost they consume. As a quick example, take lasik eye surgery, which in a consumer-based system has expanded rapidly and become steadily cheaper since it was invented.
Please explain. Most health care costs are electable. Especially preventative medicine. Even when not, if we had a consumer-based healthcare system people could choose what doctor to go to. The only case where this is not true would be life-saving emergency care, but that is a small fraction of total health care costs. Again, my examples regarding lasik surgery prove health care can function as a normal market as long as government stops preventing it from functioning properly.
Or perhaps the public sector could get out of the way. It's sad that the invisible hand is smarter than all of congress.
Re Jaime's post: I don't remember who's post I was responding to but I apologize. Feel free to repost if you want to explain your position again. I couldn't understand what you were trying to say the first time.
From lesforpeace1984:
QUOTE
We all agree that their is an inherent value to human life, that it is wrong both to kill or let someone die when we could prevent it. Correct?
I agree that life has inherent value. It is wrong to kill someone without cause. I don't necessarily agree it is always wrong to prevent someone from dying if it can be prevented.
1) I am in favor of capital punishment (but let's not discuss that in this thread)
2) I belive killing enemy soliders in a war is justified
3) I believe it is justifiable to kill to defend your life or the life of your family
4) There may be cases where saving one person's life requires the sacrifice of many more lives. If those sacrificing their lives have not consented then it isn't moral to save the first life.
So to the extent your following arguments rely on agreement on this point we may disagree at a fundamental level.
QUOTE
The comparable alternative to taking someone's car with health insurance is to incarcerate or kill people, and if you agree with my statement above this is unacceptable as well as unconstitutional, and at least the later of the two alternatives is also a violation of the Geneva Conventions.
Several things to refute.
1) I have not argued for taking away people's health insurance. I've argued for making having it mandatory, and for helping those who can't afford it to buy it.
2) Not having health insurance isn't the same as being dead, or America would have about 35 million less citizens than it does
3) Killing people isn't unconstitutional or else Tookie would still be alive
4) Killing people isn't unacceptable in all cases (see above), although I'd agree that the killing you're referring to would be immoral
5) I'm not sure what the Geneva convention has to do with anything. It doesn't apply to how America treats it citizens, it applies to prisoners of war.
QUOTE
I do not believe any sane person believes it is acceptable for the state to actively kill or seek out for incarceration people who do not have health insurance.
I feel you are twisting my words. I never advocated killing people without health insurance!! That's terrible. I don't think incarceration is the right answer either. For people who have the means the government could garnish their wages and use it to pay for insurance. For those without the means they would be part of those who received subsidized insurance.
QUOTE
it is unacceptable for police to demand proof of insurance from a person on the sidewalk
I was thinking more like when you went to the doctor or the hospital and when you took a new job (just like you have to show proof of citizenship or green card).
QUOTE
Secondly, the state does not require people ensure their cars, the state requires that people pay insurance to pay for the damage they could do to someone else's car.
Not true, Washington does and other states probably do as well.
QUOTE
No one else is injured by your not getting health care, society is concerned about people not having health care
Not true. The uninsured drive up the cost of healthcare for everyone else (see my earlier posts). The uninsured typically don't receive good preventative care because they have to pay out-of-pocket. Thus prolems go un-noticed until they require emergency care which is more expensive and paid for by tax dollars; if they don't have the money to pay for themselves.
QUOTE
... because the vast majority of people agree with what my assumption that not only actively killing people is immoral, but that allowing people to die or suffer when it could be prevented it is immoral.
This is a red herring argument. No one, especially not me, has advocated killing people. On the contrary, I'm trying to find a way for everyone to have health coverage, which should save lives, not end them. I'm looking to get people coverage so they can have a doctor help them deal with problems before they become an emergency.
Perhaps you've never lived in a state with lots of illegal immigrants (like Cali), but this is a real problem and a real issue in this state. The emergency rooms have a disproportionately large number of people in them who aren't here legally and don't have insurance.
Regarding mass transit: I agree this is a topic for another thread. Feel free to start one as I think we're in disagreement there as well.
QUOTE
The incentives to get off the program is the job of the private sector to create if they want those peoples business.
The private sector will create policies that people can buy. The problem is the people on the program are too poor to afford the coverage. It's not the private sector's responsibility to offer them insurance at a loss. As for faulty assumptions, here is my defense:
QUOTE
The assumption that "getting off the program" assumption that "getting off the program" is necessarily good is faulty for one
No it's not. People on the program are getting something they're not paying for, at the expense of everyone else. That's prima facie unfair to those not on the program and thus desirable to stop. Forced "charity" isn't charity at all, it's theft. I'm not saying helping the less fortunate isn't a good thing. It's just when it's being done with tax money, the people receiving the aid have an obligation to try and become self-sufficient. I'm not sure how to help the poor with government money and encourage this behavior.
QUOTE
... is it in your mind somehow more moral to give power &/or resources to a corporation driven by money than to a democratically elected government?
I'm afraid I don't understand your argument. I'm not "giving" anything to a corporation. I'm trading them my money for the amortization of my health risks and the associated costs. And yes, this type of willing trade is more moral than having it taken by the government, democratic or not. This is because it's my money and in the private sector I choose how to spend it. I don't get to choose how much I pay in taxes or what those taxes go for. It is decided by the majority and they have decided to appropriate more than I would willingly give and spend it on things I do not approve of.
QUOTE
The advantage to capitalistic systems is their efficacy, our capitalistic health care system is not efficient so what then makes it inherently better?
Our health care system is only quasi-capitalistic. A consumer-based health care market, which is ultimately what I propose, would be more capitalistic, and it would be more efficient than the status quo.
QUOTE
Second you are assuming that health care is a functioning market
No I'm not, as I said above. But you're right that I'm assuming a consumer-based system would be a functioning market. But this can't happen unless people are directly and clearly accountable for the medical cost they consume. As a quick example, take lasik eye surgery, which in a consumer-based system has expanded rapidly and become steadily cheaper since it was invented.
QUOTE
elasticity for health care is near 0, and this alone makes it a non-functional market.
Please explain. Most health care costs are electable. Especially preventative medicine. Even when not, if we had a consumer-based healthcare system people could choose what doctor to go to. The only case where this is not true would be life-saving emergency care, but that is a small fraction of total health care costs. Again, my examples regarding lasik surgery prove health care can function as a normal market as long as government stops preventing it from functioning properly.
QUOTE
Perhaps active competition for the public sector is what it will take to create a closer to functional health care market.
Or perhaps the public sector could get out of the way. It's sad that the invisible hand is smarter than all of congress.
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