a broken system ctd.


Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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69 Responses

  1. Avatar greginak says:

    One of the weaknesses of liberal arguments is that we like to point to successful examples of something like health care. This is weak because is assumes those successful examples either won’t fit here, which I think is rare, but because it would be difficult to implement. This is a hard nut to swallow for liberals like me, since it makes so much sense to look for functioning examples of something to guide change. I think Frum and your point is frightening and true. We just may not be able to create any positive change in this country. Why that is that way is good question with a complex answer in am sure. (cue post from somebody cheering for gridlock in the government)Report

  2. Avatar Jaybird says:

    One of the big criticisms of our current system, it seems to me, is that The Rich get treatments that The Poor do not and this presents as injustice.

    Why is it fair that Stephen Stills can afford treatment when (poor child’s name here) cannot? If we had a better system, both Stephen Stills and (poor child’s name) could be treated alike.


    It seems to me that if Stephen Stills were also denied treatment, we’ d not have this problem at all… but, in this case, it strikes me that we’d have a system where Stephen Stills and (poor child’s name) would both get denied treatment… but (connected person) would get it. Maybe Stephen Stills would be able to pull enough strings (Hey Michael Bennet! Mark Udall! “Colorado was a pretty bitchin’ song, huh?”) to get help… but we’d still have a system where these people would get treatment and those people would not. We’d only shuffle around who “these people” would be somewhat.Report

    • Avatar E.D. Kain says:

      This may be true up to a point, but it’s also missing something. For instance, when I was poor (okay, I’m still fairly poor…) but when I had to go on the government insurance briefly, I received top-notch treatment for my daughter. So it’s not that there isn’t available care out there for the poor. It’s that the system as it stands is simply not sustainable, not really very effective, not very adaptive to a changing global economy, and so forth.Report

      • Avatar Jaybird says:

        I’ve been thinking about this, E.D…. and my intuitions are that the system we have, to be changed effectively, will need to be entirely dismantled.

        Additionally, the subsequent change will have new and different costs than the costs we have now (maybe they’ll be better, maybe they’ll be worse, but they will be new and different) and thus will feel more painful than they would otherwise be. For a good, long while, we will have to deal with folks saying something to the effect of “we didn’t used to have these problems” whenever they encounter any problem at all, no matter how trivial.

        Additionally, any attempt to flatten the lopsided-to-the-right bellcurve will definitely result in “THIS COULD HAPPEN TO YOU!” stories that will terrify people who self-identify as being more to the right than they realistically are and, this is my intuition here, significantly slow the march to the right of new technologies (can’t prove this, but I suspect it).

        The other day I was discussing this topic with a co-worker who argued that he wouldn’t mind if medical advancement stopped if it meant that everyone could get a decent level of health care now. “Who cares about the weird machine that can do a brain scan that will benefit maybe one out of a hundred thousand people if that machine could pay for health care for 999,999 people?”

        And I find myself wondering if, in the 70’s, he’d have explained that we don’t need those fancy MRI machines when we have X-Ray machines that work perfectly well… why do we need machines that will help baseball pitchers more than anyone else?

        For my part, I want medical science to advance at twice the rate it is now. Three times. Ten times. The benefits of such will far, far outweigh the costs even though we don’t see it now… but MRIs are used for a lot more than just baseball pitchers anymore. That’s a good thing. I imagine that that brain scanning machine that’ll help only 1/100,000 people will soon help 1/50,000, and then 1/25,000… and then new applications will be made. And new ones after that. And so on.

        Given the following:

        We cannot usefully/effectively change what we have now with incremental steps

        Massive change will be exceptionally painful for a short while and be psychically (if not really) painful for a medium while after that

        Massive change has a shot at significantly slowing the rate of medical advancement

        I don’t see how the bill that will be voted on will result in a significant number of people being helped enough to offset the good chance that future people will be helped even more (that which is unseen, if you will).

        If you see what I mean.Report

    • Avatar greginak says:

      Mostly wrong. It is fine if any member of CSN and Y gets super wonderful treatment as long as generic poor person can get still get good enough care. This is simply not about class envy of the privileged getting special treatment. Let the rich get robot bodies to replace their old ones if they want to pay for them. But lets have a system where everybody else can get a good system.Report

      • Avatar Jaybird says:

        If there is a bleeding edge treatment that Stephen Stills can get but (poor child) cannot, is this not, by definition, not a good system?

        If there is a treatment available, a specialist, a prescription, an operation, a *SOMETHING* that exists but only certain people can get it (not everybody), wouldn’t that, by definition, be a less-than-good system?Report

        • Avatar greginak says:

          No. There will always be things rich folk can buy. Fine. Nobody is trying to take that away. What we want is for everybody to have decent health care.

          Everything does not have to be exactly equal to make something a good system.
          College education in this country is good even though there are certainly vast differences between Harvard/Stanford and Whatsamatta U.Report

    • Avatar EngineerScotty says:

      In the context of the current proposal, this argument seems a strawman. Nobody has suggested that the rich be systematically denied treatment unless the poor can receive it on equal terms–such a “feature” is simply not present in the proposal on the table.Report

      • Avatar Jaybird says:

        I’m wondering if the ability of some to get treatments not available to everyone will not be shown as evidence of injustice.

        Is this not the case?Report

        • Avatar greginak says:

          If it makes you content then part of it is relational. But it is far more then just that. There are some basic standards for care and quality of care. More then just rich guy got so I want it. but at this point I don’t think there is anything I can say to convince you of that.

          What is so hard to understand about wanting everybody to have access to a basic level of health care? I’m missing the point you are harping on.Report

          • Avatar Jaybird says:

            “What is so hard to understand about wanting everybody to have access to a basic level of health care?”

            We all want everybody to have access to a basic level of health care.

            The issue is not whether there are a shortage of people who want everybody to have access to a basic level of health care.

            The issue is whether the government system will be to health care what PATRIOT is to keeping you and your spouse and your children safe from harm. I’m one of those folks who believes that the problem is not one that will be fixed by a bill written by lobbyists, unread by supporters, congressmen, and senators alike, and then signed by a President who hasn’t read it either.

            Even if everyone is pointing out how very much they want everybody to have access to a basic level of health care.

            I don’t want people to die in a plane crash.

            I don’t see how people thought that yelling for the government to keep them safe would result in anything *BUT* PATRIOT.

            I get the feeling that the health care you’re going to end up with will be just as high quality as the protection from people who want to kill you turned out to be.Report

            • Avatar Dan Miller says:

              This seems like an argument that’s impossible to refute. Is there any way to allay this fear, short of living in a magical fairy world free of lobbyists? It seems that you’re basically giving up hope on improving the system in any way.Report

              • Avatar Jaybird says:

                I don’t know. Do you think that providing a basic level of health care is less complicated than keeping you and your spouse and your children safe from Muslim Terrorists?Report

              • Avatar greginak says:

                It seems pretty simple to make a shopping cart that doesn’t have one freaking wobbly wheel. But for some reason that still happens. But I will still fly in plane even though they are much more complicated then a shopping cart.Report

              • Avatar Jaybird says:

                Shopping carts are not (yet) made by the government. I suspect that I would go out of my way to avoid shopping at grocery stores that had government shopping carts.Report

              • Avatar Dan Miller says:

                Bridges are also more complicated than shopping carts. Should we assume you’ve never crossed a river?Report

              • Avatar Jaybird says:

                I’d trust the Army Corp of Engineers to build a bridge that worked, absolutely.

                If we’re talking about The Big Dig, however, I think that it’d be fair to discuss whether what was delivered was anything close to what was promised and whether not doing it at all would have been better than what eventually happened.

                We could also discuss whether there are significant differences between providing a basic level of health care to every individual in America and outsourcing engineers to do what the army corps of engineers would do if we had enough of them.Report

  3. Avatar Andy L says:

    I just read the post and . . . I don’t know what to say, except, maybe thank you. You are definitely talking some sense. I have been increasingly frustrated over the last several days and weeks as I’ve tried to talk sensibly and rationally about health reform, but I can’t seem to find anyone to reciprocate among my friends. This was just what I needed. Thanks.Report

    • Avatar E.D. Kain says:

      Thanks, Andy. Good to hear that.Report

    • Avatar St.John McCloskey says:

      I have to say that your first paragraph is neither rational nor sensible, but overall I’m glad you’re adding to the discussion. I think it’s ridiculous to say they will be culling our elderly or infirmed. And I think that the discussion over crowding is silly as well. Think about it. You would rather have the people not be there, because it might lead to lower care for you. if you follow that logic to the extreme, the entire health care system in the united states should revolve around you.
      You’re saying you’d prefer that the people who are crowding up your hospital would go piss off and die in a corner somewhere. essentially.
      I can’t quite agree with that.Report

      • Avatar E.D. Kain says:

        John, buddy, you gotta get on the sarcasm bandwagon. After that maybe you can start reading the post for what it is. And…well, I’m just not sure where you came up with this:

        You would rather have the people not be there, because it might lead to lower care for you. if you follow that logic to the extreme, the entire health care system in the united states should revolve around you.
        You’re saying you’d prefer that the people who are crowding up your hospital would go piss off and die in a corner somewhere. essentially.

        You’ve either seriously misread the post, or you didn’t read it at all.Report

        • Avatar St.John McCloskey says:

          no no mate, As I said, I appreciate most of what you’ve said, particularly what you’d like to see in a plan.

          And I know it’s sarcasm, but it’s still pushing around the idea that a lot of people take literally.

          But I was saying that the whole fear of long lines is nonsense. If there are long lines that means that whoever is new to those lines was not there before, which means that they fell through the cracks. People who have never been insured before will begin to pour out of the woodworks towards hospitals when they need care. It might lower the quality of care, but would you have it any other way?
          If these lines didnt exist (barring a massive boost in efficiency of our hospitals), as they dont now, that means that people aren’t able to get the health care they need.
          do you get what I’m saying?
          I’m just trying to refute the argument that long lines due to more people is a bad thing. I think long lines are bad, but that they should be avoided through more efficient health care (like you’re saying about cutting the bureaucracy) rather than having fewer patients.Report

          • Avatar E.D. Kain says:

            Not necessarily. Longer lines could indicate lots of things. It could indicate worse people at the desk or more paperwork to fill out or fewer doctors in the back – lots of things, not just “more people in line.” If half the rides at Disney Land break down, the remaining rides will have longer lines.Report

            • Avatar St.John McCloskey says:

              That’s a very good point!

              but in this situation, we’re talking about implementing a plan to give more people coverage. That will, in all likelihood lead to longer lines, and people are resisting *that* in particular.

              I could be wrong, maybe the lines we forsee wouldnt exist, or maybe they would be caused by a red tape bottleneck, but many just don’t want too many more people to have coverage because it would detract from the quality of thier own.
              People wouldnt say so in as many words, but that’s what it boils down to, right?Report

  4. Avatar steve says:

    We will not see agreement on any health reform because it will harm Republicans in the short run. The successful passage of a bill will be seen as a plus for Dems. Republicans will oppose any plan, even Wyden-Bennett, which is not that bad a plan after all.

    I must say that the academician in me would like to see the public option pass. It would be a good test of many prevailing economic theories.


  5. Avatar mike farmer says:

    “But he’s right about one thing – a conservative victory that is little more than a defeat of reform in general is no victory at all. ”

    I don’t really know of any politician who is against reform in general, so this is one of Frum’s empty tactics. I think most Republicans will vote for a plan that has a few of the things they want (and this is likely to be what will happen – a bi-partisan compromise). I think most career Republican politicians want control of healthcare just like the Democrat career politicians want control — This is like a huge success in growth and diversity would be to an ambitious corporation. With control of healthcare they have much more power. The Republicans simply need to find a way to appear a part of it, so they can enjoy part of the power advantage of healthcare control. Republicans need to be seen as players with influence, because if the power bases this will create go totally in favor of the Democrats, it will be difficult for Republicans to ever be a majority again. The hoop-la now is mostly a show — both parties want healthcare control. What they have to work out is whther they are going to share the power. The Democrats risk taking full responsibility for failure if they don’t offer the Republicans something, yet they don’t want the Republicans to appear too influential, because when the public becomes dependent on government healthcare, the Democrats want the public to think of them as the creators and the saviors. Republicans want a piece of it, but they have to convince their followers it’s a bipartisan effort that they had a hand in.

    As I wrote on my blog, the Democrats may be contemplating a gamble and power-play. They may ram through legislation and take the risk that the damage is not too great to overcome and that a large part of the public becomes dependent on “free” healthcare and likes it. This way, if the gamble pays off, they will be seen as the heroes of healthcare, the ones with the courage to what was right against oppostion, and they can portray the Republicans as the bad guys who could only say no and try to protect their evil capitalist backers. Being a gambling man, this is the way I’d go — if I was also a lowlife politican who didn’t give a shit about the country but loved power.Report

    • Avatar zic says:

      That’s the most contrived logic for Republican obstructionism I’ve read yet. Olympia Snowe wants reform. I see no indications any other “career” Republican is so inclined; they’re putting politics before national interest, and condoning the spread of propaganda. Borrowing a notion from the early years of the Bush Admin., I’d say they’re being unpatriotic.Report

    • Avatar AC says:

      No one is calling for “free” healthcare. Please remove the straw man from your argument.

      Without anything constructive to add to the debate, the Republicans have chosen to be contrarian, and in effect defend a status-quo that is perverse, unhealthy, and on track to bankrupt individuals and institutions alike.

      Explain to me how citizens being priced out of the most basic medical care, and/or bilked of their hard-earned wages for “insurance” that doesn’t live up to it’s name when the other shoe invariably drops, is a good thing for “the country.”

      I get your objections to reform, but you must defend the status-quo, instead of simply knocking down efforts to improve the lives of our fellow citizens. What about the current system do you actually like?Report

      • Avatar AC says:

        … And the Dem’s gambling that doing something beneficial AND politically popular sounds an awful lot better than the Republicans betting that the current system will somehow magically market-correct into something good for the country.Report

  6. Avatar Bob Cheeks says:

    BO’s not doing ‘health care reform’ he’s shoving socialized medicine down the American public’s throat. I’ve never been as proud of the Am. citizenry as I am when I hear them go after the commie-dem congressmen who don’t have a clue what’s in the ‘plan,’ whatever ‘plan’ it is.
    The next few months will determine if the USA will become an eastern European country or not, but the fight’s not about ‘health care’ it’s about freedom.Report

    • Avatar zic says:

      Do you have a clue?

      Like all those people saying, “No government program” and “Don’t touch my Medicare” in the same breath?

      Too funny. Laughing so hard I’m crying.

      Much of this isn’t discussion isn’t “socialized” medicine (like Medicare); it’s about a fair playing field for those of us without employer-provided insurance.Report

      • Avatar Pat in Ohio says:

        Please don’t call Medicare socialized medicine. It is a government payment system for health care provided by the private sector (doctors, hospitals, pharmacies).

        Enough with the “socialist” – you wouldn’t know one if he bit you in the rear.Report

    • Avatar AC says:

      Explain what you like about our current system of health care. I’m particularly curious where you see elements of “freedom” in it, and how that freedom is enhanced.Report

    • Avatar Truthynesslover says:

      How about the freedom to leave or take a job because you know you will be covered either way.

      Thats REAL freedom brainiac.Report

  7. Avatar Technology says:

    It sounds like people are picking certain parts of the proposed health plan and understanding them to mean whatever suits them.Report

  8. Avatar John Zimmer says:

    The heart of this countries Medical Insurance crisis resides in the problem of illegal immigration. All these discussions about Medical Reform are just a symptom of the problem….there are estimates that there are 12 to 20 million illegal immigrants; few of whom pay taxes and clog our hospital emergency rooms as their primary healthcare provider…that the rest of us pay for through higher taxes and healthcare premiums. Why isn’t our President or Congress addressing illegal immigration first???Report

  9. Avatar Michael Harnois says:

    It’s always gratifying when a conservative gets a clue about what life is like for those who are harmed by their philosophical bent, rather than being helped by it. I just wish it led to a more generalized realization of the evil that their worldview does in the world.Report

  10. Avatar Sully Fick says:

    First off, nice to see your pro/con thoughts about health care in one place. I certainly don’t agree with all of it, but I have a good understanding of what you think. Kudos for the clearly defined position.

    However, this part is confusing:

    I don’t have much faith in government, but I also don’t have much faith that society will act voluntarily for the public good enough to provide meaningful safety nets. I believe that for capitalism to work, safety nets need to work, and never is this more true than in an increasingly globalized economy where industries themselves rise and fall in the space of a generation.

    If government can’t be relied on to provide meaningful safety nets (for capitalism to work), and society can’t be relied on to provide meaningful safety nets, then where do these “meaningful safety nets” come from?

    They certainly don’t come from compromise, unless we’re talking about compromises that include how we spend ALL government dollars.


    As of 2009, the United States government is spending about $1 trillion annually on defense-related purposes.

    The 2005 U.S. military budget is almost as much as the rest of the world’s defense spending combined and is over eight times larger than the military budget of China. The United States and its close allies are responsible for about two-thirds of the world’s military spending (of which, in turn, the U.S. is responsible for the majority). In 2007, US military spending was above 1/4 of combined industrial and agricultural production in the USA.

    And, to compare to your Denmark example (~18.9 billion DKK):

    The Danish military economy is the fifth largest single economy in the Danish Government (the 2006 Finance law), significantly less than that of the Ministry of Social Affairs (~110 billion DKK), Ministry of Employment (~67 billion DKK), Ministry of the Interior and Health (~66 billion DKK) and Ministry of Education (~30 billion DKK) and only slightly larger than that of the Ministry of Science, Technology and Innovation (~14 billion DKK).

    So, Denmark spends ~30 billion on Education and only ~20 billion on Defense. The US spends ~1,000 billion on Defense and only ~150 billion on Education.

    There are reasons why Denmark is more successful than the U.S. They have different priorities in how they spend their money.Report

    • Avatar E.D. Kain says:

      If government can’t be relied on to provide meaningful safety nets (for capitalism to work), and society can’t be relied on to provide meaningful safety nets, then where do these “meaningful safety nets” come from?

      You misread me. I’m not saying that government can’t provide meaningful safety nets. I’m saying it’s difficult and that there are alternative implementations of those safety nets than the ones commonly proposed by welfare liberals.Report

      • Avatar Sully Fick says:

        Thanks for the clarification.

        IMO, this country is being slowly destroyed by those pro-business “alternatives” (i.e. less regulation on business, less tax on business, bailouts for giant corporations, etc.) that have been much more successful in the past few decades than the alternatives championed by “welfare liberals”.

        It was the “welfare liberals” who championed child labor laws, that stopped corporations from working poor children in horrendous conditions. That stopped bias (racial, religious, gender, etc.) from being standard practice in business. Things like Sarbannes-Oxley, the FDIC, the SEC, the FHA, Social Security, etc, etc.

        I’d prefer to err on the side that isn’t just looking for a way to increase profit. Not that I think there are many (any?) politicians who aren’t in the pockets of Big Business.Report

  11. Avatar ElectronJohn says:

    So can anyone explain to me why I have to pay for the health insurance of anyone other than my family and me? If someone chooses not to spend their money on health insurance but say on a big new TV or new car or cigarettes or alcohol instead why do I have to pay for their insurance? Shoes are nice to have as well. If they do not have nice shoes do I have to pay for new shoes for them as well?Report

    • Avatar Sully Fick says:

      So can anyone explain to me why I have to pay for the health insurance of anyone other than my family and me?

      You don’t HAVE to pay for the health insurance of anyone (not even you and your dependents).

      Or, are you talking about Medicaid/Medicare? In that case, you must pay into it because a law was passed in ’65.

      Or, are you talking about not wanting to obey that law? In that case, I can’t help answer your questions.

      You do realize, of course, that you already “pay” for those without health insurance, since those without health insurance go to the emergency room when they are sick and that cost is prorated onto the cost of your coverage.

      Or, was your comment just hyperbole?Report

      • Avatar ElectronJohn says:

        I do realize that I already pay for the present benefits that others get. But why should I have to pay for others to have more health care benefits then they are already getting for free (i.e. government health insurance)? Health insurance is nice but it is not a right, just like a lot of things are nice but not rights (like new shoes).Report

        • Avatar Sully Fick says:

          There is too much to explain about this, but I’ll try to summarize.

          Emergency room care is among the HIGHEST COST care. Regular doctor/preventative care is among the LOWEST COST care (based on the same services provided).

          If everyone received regular preventative care, the overall costs to the system would be LOWER (per capita) than they would be by keeping with the status quo (emergency room care).

          Basically, you would pay less if everyone received basic health care.

          And, you do realize that you already pay for “government health insurance”? Medicare is one form of it. VA is another form of it.Report

          • Avatar ElectronJohn says:

            That is an interesting theory that costs would go down if everyone had basic care but when one thinks of the numbers, 40million or so people that would be using the health insurance for check up and other routine procedures not done in the ER, it really starts to add up. Right now they hit the ER for broken bones, ruptured appendixes, etc. much of which can not be prevented by regular care. So I doubt that the numbers add up to support your theory, although I agree that some ER visits would be reduced.
            And yes of course I know about Medicare and VA care. What I am talking about is the new preposed ObamaCare that would cover everyone.Report

            • Avatar DaleA says:

              You pay for the health care of others because diseases are infectious; they spread from person to person. Classic examples are cholera, typhus, bubonic plague and tuberculosis. There is no way your life improves if people with TB are not able to receive treatment; their every breath spreads a deadly disease. Interestingly, conditions as varied as cancer, heart disease and obesity are now being found to be either infections or have infections in their development. This argument seems to mean that everyone should treat their own sewerage. Do you think having a neighbor who saves money by using a pit latrine in his yard does not effect you? Basic science, ie Pasteur, explains why we must all pitch in to treat everybody which reduces the risk we face.Report

    • Avatar Ottovbvs says:

      Get a book or perhaps google an explanation of how the insurance model works! Judging by the acuity of your shoe commentary I’m not sure it will do much good but you never know.Report

      • Avatar ElectronJohn says:

        In other words, philosophically speaking you can not explain why I should be responsible for providing health insurance to someone (other than my immediate family) who is not responsible enough to provide it for himself. So you imply that I do not understand the issue, and possibly am unable to ever grasp it either, rather than address my valid point.Report

        • Avatar Sully Fick says:

          who is not responsible enough to provide it for himself

          Is it really this simple to you? That some people just aren’t “responsible” enough?

          What a myopic view of the world you have, ElectronJohn.

          Some men worship rank, some worship heroes, some worship power, some worship God, and over these ideals they dispute and cannot unite – but they all worship money.
          – Mark Twain


        • Avatar Francis says:

          Philosophically speaking, the reason you provide health care (the care itself, not insurance) to others who can’t afford it is that you, apparently, choose to remain a citizen of the US, and the voters of this great nation have enacted laws that (a) mandate the provision of emergency care irrespective of ability to pay and (b) cover the elderly and very poor.

          Don’t like the laws? Elect people who will change them. Believe the laws are unconstitutional? That’s your privilege, but many people disagree including large majorities on the US Sup Ct. on multiple occasions.

          Now, the reason to tax you to provide health insurance (as opposed to the care itself) is that the current system is, bluntly, insane. Every single other industrial country provides comparable care for a fraction of the cost. So Congress is debating proposals whereby the government will subsidize the provision of insurance to the poor with the hope that by bringing these people into the private market they will receive better care at lower costs.

          (Note that you are in some respects already being taxed for the provision of health care insurance by employers to their employees, because those employers obtain tax advantages you don’t get.)Report

          • Avatar ElectronJohn says:

            Yes I understand that we have laws covering the existing care and benefits. What we are all talking about, i think, is the new proposed ObamaCare that is not law yet.

            Could it be that our health insurance costs, in the USA, are higher than other industrial countries because of our life style (diet, obesity, lack of exercise, cigarettes, etc.) and not just our health care system? And also that our drug companies and medical product companies are spending lots of money developing new drugs and products which we are paying for. And lets not forget lawsuits, medical malpractice insurance and lack of tort reform.

            But still my basic point is that it is not my responsibility take care of anyone but me and mine. Nor is it the Governments responsibility to provide health insurance.Report

            • Avatar Ron Amundson says:

              Self Preservation if you cant?
              What if you exhaust the limits of your coverage. Short of the very wealthy, very few can afford a policy much above a $1 million dollar lifetime limit. What if your employer’s self funded pool goes bankrupt, and their stop loss is cancelled, and private coverage comparable to your prior plan is not available at any cost?

              Self preservation from a public health point of view
              If a flu goes viral, and only 50% of the population can afford vacination, the resistance of the population as a whole is compromised. That can affect you, no matter how responsible you are. Granted, this is a lame argument, as no doubt govt would step in, but I think it applies in other areas.

              From a moral point of view.
              In a Wisconsin study, the un-insureds yearly value of life (QALY) was determined to be $5,500. Contrast this with NICE in the UK, which uses a figure of $49,000. And some private plans in the US ranking in the hundreds of thousands of dollars, albeit unaffordable for other than key employees of large firms. Granted, different folks have way different value sets. A $5,500 figure may be fine for many folks morality.Report

        • Avatar Pat in Ohio says:

          You have a ridiculous assumption that he who is without health insurance is “not responsible enough” to pay for it.

          First, if you don’t have a job with a large employer, you will not have health insurance from your employer. (By the way, if YOU have insurance through your employer, why are you taking “responsibility” for having health insurance? You’re not paying for it, most likely.) In the last few years, even employment-based health insurance is thinning out. My 28 year old nephew got a good job a few years ago; they offered him only individual health insurance, even though he is married. His wife now works also and can get insurance through work. But if they have a child, they will have to buy insurance for the kid, and deal with 3 DIFFERENT providers for 3 people, not to mention 3 deductibles.

          Additionally, if you have to buy insurance on the open market (self-employed, employed without health insurance), and you have a pre-existing condition, you cannot get coverage for that condition (and likely many other “associated” conditions that the insurance company will tell you about after you become sick). Not only is ANY insurance horribly expensive, but you are faced with a dilemma – should I pay through the nose for insurance that won’t cover me most of the time, or should I just sock away the premiums and hope that I don’t get some megamillion dollar disease like cancer? (Honestly, I probably would be better off taking my $470 a month premium and buying lottery tickets; I’d probably make enough on the scratch-off tickets to create some cushion if I get sick with anything other than the BIG C.)

          Finally, I just have to tell you how much I appreciate you and your ilk who are always saying “why should I pay for the other guy?” It’s nice to know that you birthed yourself, taught yourself English, provided your own food from day 1 and paid for your public school education starting at age 5. I don’t often fly. If you do, why am I paying for your airport? I don’t get into trouble with the cops; if you get a speeding ticket, why am I paying for your cops, your court, your courthouse, etc.?

          It’s called civilization, big boy. If you don’t like it, I’m sure you’ll love Somalia.

          Get down on your knees and thank your Almighty that you live in a country where the work that you do is rewarded with a reasonable amount of pay, such that you actually have money to pay in taxes and still feed your family. Thank God that you live in a country where the government cares about the poor (excuse me while I tear up on that one), so that the poor are not blasting through your livingroom door with Uzis in order to get some money to feed their families.

          Really. Forget what I just said. It’s all about you. Really. All about you. My bad.Report

          • Avatar Jack says:

            There is a difference between ridiculous assumptions and different life experiences/points of view. I grew up on the east coast and now live in the Pacific NW. They may as well be 2 different countries.

            East coast tends to be more civically and socially aware. That doesn’t mean people agree, just that by dint of living so close to one another, there isn’t room – physically or metaphorically – to ignore what your neighbors are doing or to realize what they do impacts you directly. How they act on that does vary.

            Out in the Pac NW, we largely have enough room to be left alone if that’s what we so desire. People across the political spectrum prefer to be left to their own devices as much as possible. We tend to disagree on what govt should be involved in rather than the extent of involvement.

            So given that, reasonable people can disagree about where to draw up the social safety net. I agree that responsibility is not the biggest factor in who has health ins, but it is a factor for reasons no one has brought up yet.

            Anyone 25, single and male, could easily make the responsible, selfish-as-in-free-markets decision not to buy health insurance, especially if it goes toward other investments in themselves. While they are completely rational in that action, society as a whole suffers because risks become greater to everyone, including the 25 year.

            Why? For everyone else, costs go up because the ins pool is riskier if those least at risk opt out. For the 25 year old, he is betting a great deal that he won’t spend more on health care than he spends on health insurance.

            I’m typically conservative, but I think that healthcare is one of the few issues that have to be all or nothing – everyone is covered or it doesn’t work efficiently (in the sense that it creates imbalances and arbitrage issues). This is also an area that, like it or not, requires rationing. I’d prefer those decisions NOT be made by a bean-counter (as is currently the case).Report

  12. Avatar chiefeng says:

    Well laid out argument Kain. It’s tough to find non-hysterical (either side) discussion on this topic.

    Tell me what you think of opening Medicare to all as the public option part of reform with the gigantic caveat of doing away with all the other health insurance programs the feds and states run.

    Seems to me the most fiscally responsible way in that the vehicle to deliver health insurance satisfactorily to a large segment of the population, it would eliminate the need not only for more government but could cut out huge segmented government, it has an already established and accepted by the providers billing system in place. We could do away with Medicaid and all the state programs for children by instituting a sliding scale for premium payments which I believe Medicaid and those state programs already use, we could do away with the VA by simply giving vets Medicare for free which would also likely make the care level at the very least easier for vets to access since they wouldn’t be forced to transport themselves to VA facilities unless they wanted to.

    Cutting those programs out would leave us with a pile of money to put toward shoring up Medicare (which will have to be done anyway) not to mention a new flow of premium payment monies coming in.

    I just can’t see creating a whole new giant bureaucracy when we have a perfectly good mechanism already in place that needs to stabilize it’s financial footing. Why not do both, provide affordable care to all and rejigger Medicare’s finances, at the same time?

    Medicare works in that it provides it’s consumers with first rate health care access at reasonable prices. Why not use it to build a public option that would compliment, not replace, the private for profit insurance industry?Report

    • Avatar Sully Fick says:

      Why not use it to build a public option that would compliment, not replace, the private for profit insurance industry?

      Because that would make sense.

      Congress…the smallest minds and the selfishest souls and the cowardliest hearts that God makes.
      – Mark Twain


  13. Avatar ElectronJohn says:

    “(By the way, if YOU have insurance through your employer, why are you taking “responsibility” for having health insurance? You’re not paying for it, most likely.)”
    Actually I started my own company years ago and pay for my health insurance as well as my employees plus dental because it is good business. They are good employees, make me money and I want them to stay with me (plus I like them but don’t tell them that).

    I also appreciate my country and joined the USMC when I was 20 as my way of helping to pay some of the debt I feel I owe the USA and ended up fighting in the Gulf War. I understand that civilization requires that its government provide some basic services (i.e. military protection, police, schools, even emergency medical) but personal responsibility has to kick in somewhere along the way. Health insurance is not a basic service nor is it a right. Why are we asking our government to take care of us in more and more ways? If you enjoy being totally dependent on your government for all your needs then maybe your are not the man you think you are. Remember they are spending our money to take care of us, more and more of it. That only makes sense if you think they are fundamentally smarter than you are. I do not happen to believe that.Report

  14. Avatar chiefeng says:

    Electron John may I ask what your personal experience has been with the health CARE industry? Had any operations? Children get sick?

    Since you run the company then you can address a question I have. If one or more of your employees gets sick can the company you contract through raise your overall rates or just cancel those that are sickly? Are you presented with any options if the company is thinking about canceling your contract or is that contract only amendable at certain time intervals?Report

  15. Avatar ElectronJohn says:

    Chiefeng, I have not had much experience with the HCI personally except for when my kids get sick and they have always received excellent treatment and fast service (come in right away or later that day type of thing). My wife uses her HC insurance a lot more than me and she has had good experiences as well. But I understand not everyone is happy with their HC insurance service or doctors.
    I called my HMO provider (Blue Cross Blue Shield) to double check you other questions since those situations have not happened to me yet. If they can be believed they tell me that coverage can not be canceled unless I stop paying and rates do not go up if an employee gets sick. Yearly the rates go up a bit based on over all costs but not based on the costs of my employees use of their HC services. So no increase if someone get big time sick and no cancellation for that reason either. I have a small business and live in MA if that makes any difference.Report

    • Avatar ElectronJohn says:

      Also cost is $380 a month for individuals and $998 for families. So $12 for a family of 4 is only $3k per person, not bad.Report

  16. Avatar chiefeng says:

    Thanks John.

    I’m not sure I understand this *So $12 for a family of 4 is only $3k per person, not bad.^ if you could explain.

    Also it’s very interesting that you operate in MA as their statewide plan is one that many are looking at for a model for national revamp. Can you give us a bit of a rundown on how the Romney plan affected you as a business owner? Was the process of insuring easier before or after? Does you HR person manage/help employees manage their benefits or do you contract that? Have the costs of insuring gone up or down under the state plan? Any other pluses or problems for small business before/after the state program?

    The reason I ask is it’s my understanding MA has an individual mandate which I have always opposed just on principle. At this juncture though practical experience, while anecdotal, is what all of us need to hear about so we can better judge the various proposals. Since most of us have not experienced what your state has done, we’re all trying to evaluate in the abstract which is fairly worthless.

    Also, have your business or personal taxes been affected by the state plan?

    Thanks for letting me pick your brain.Report

  17. Avatar ElectronJohn says:

    I meant to say $12K a year for a family of 4 (also for a family of 2 or 10 for that matter) which comes to $3K a year for each person in that family of 4, $4k per year for a family of 3, etc.

    I did not have any employees when Romney was the Gov. Just picked up two employees in the last year when a competitor went out of business and I bought up their client list, equipment, and hired two of there people. So I can not compare the Romney plan to the new plan. My company is not mandated to get HCI for my employees because we have less than 10 or 20 employees (or whatever the number is).

    Sales tax just went up in MA from 5 percent to 6.25 percent but we sell a service so we are exempt from that. I do not think personnel income tax or corporate taxes have gone up.Report

  18. Avatar Jack says:

    Q. for ElectronJohn…

    I’m also a small business owner, and one of the reasons I prefer to work with other independent contractors rather than hiring up is that I can’t compete for employees with larger companies on the basis of benefits. MS and Amazon are big software companies out here, and I can’t match there benefits. I would LOVE to be able to not compete against MS in particular. However, they spread their risk across 80,000, keeping their rates low.

    I’d much rather say “We pay x dollars. Where you spend it is up to you”. But I also know that individuals (and individual families) can’t touch health insurance for the amount a company can. So I feel squeezed – have to offer it, but it isn’t as good as larger employers can offer.

    My wife’s boss told me that her company (also small) had their insurance premiums go up 75% the first year they hired a female – because she was of child-bearing age, and they ins co expected to pay out on her.

    Anything they can do to get health insurance off the books of employers is a good thing.Report

    • Avatar ElectronJohn says:

      Hi Jack,
      I did not see any question in your last post, but I got HCI for my employees through PayChex, they also do my payroll, and since they have at least 80,000 clients I think they are able to get comparable rates as MS. I think there are other small business groups as well that allow you to group together and get better rates.

      Seems like a few laws that allow individuals to purchase HCI at big business rates and protects them from being cut off if they get sick is all we need. Setting up a huge government run HC system is over kill, crazy costly and likely less efficient than what we have now.Report