If I am young and healthy, I won't buy health insurance.

[johnmarc]

If I'm healthy and don't foresee any need for medical care in the future, I'm probably not going waste my money on an insurance policy.

Winepusher ended our conversation before I could really get to the heart of the matter (from my perspective anyway) and that is, "What does the end game look like?

Let's assume a 'Winepusher world' whereby public subsidies and government control were set aside in favor of a capitalistic (marketplace) insurance industry which (one would assume) would not require insurance coverage but certainly there to offer policies to those who might choose that direction.

Let's assume also that a large part of the population simply opted out of coverage during the young and healthy part of their lives---and it makes sense---why contribute from a limited income, funds that are clearly needed to pay the everyday bills and for which no benefit directly is derived anyway? Let's put that bill off until we need it.

What is the end game in this scenario? What does it look like a few years down the road?

Individual 'A' dies in his/her sleep at 82 years old having never contracted any illness nor suffered any accident except for that which 'over the counter' could provide. (unlikely)

Individual 'B' develops a host of ailments most of which need expensive treatments and simply pays the bill as he/she goes from his/her own pocket. (unlikely)

Individual 'C' decides that at about fifty years old, he/she should be thinking about an insurance policy and discovers that he/she is in a different 'risk' bracket than he/she would have been at twenty-five and the premiums are simply out of reach for his/her moderate income. (likely)

Individual 'D' develops a 'condition' at about thirty-five years old that qualifies as a 'pre-condition' and the private marketplace will not issue a policy to him/her. (likely)

Individual 'E' dies at age 35 in an automobile accident and has incurred little medical expense up to that point. (not a majority position certainly)

Individual 'F' is a member of a local church which is holding a bake sale for his/her expensive treatments. (bake sales won't fully cover expensive treatments)

Is there anyone out there who could work this thing backwards and give me a workable scenario for millions of individuals who for need or want would delay insurance costs until (it's too late) or what exactly? Is there a magical time in which these individuals would begin to contribute?

Question for debate:

If I'm healthy and don't foresee any need for medical care in the future, I'm probably not going waste my money on an insurance policy.

What is the end game? I am claiming that there is no suitable end game. Your claim????

By, "not wast[ing] my money on an insurance policy" one sets up eventual outcomes that (collectively speaking) either devastate the individual in the form of bankrupting costs or some other outside group or groups bear the cost of treatments. If we all chose to participate in medical insurance at age fifty (and not before) Some of us would be bankrupt and the others couldn't afford the premiums. The whole thing fails because the cost of medical care has to be spread out over our lifetimes to be cost effective when we need it.

[nayrbsnilloc]

[Replying to johnmarc]

Your scenario oversimplifies the situation and implies the necessity of insurance companies.

"spread out over our lifetimes to be cost effective when we need it" doesn't make sense either. It's not like the money you would pay an insurance company vanishes if you don't spend it on insurance. The same money could be saved specifically for healthcare purposes, or invested to possibly produce even more money. regardless, the concept of the time-value of money means (paraphrased) money I have now is worth more than money I will have later, so in a vacuum, paying for a middleman to hold onto my money set aside for healthcare would be a waste. Don't forget that that is what an insurance company is: a middleman whose entire purpose is to profit off of the transaction between you and the healthcare industry. Any middleman makes the system less efficient, but in this case the system has adjusted so abnormally as to making avoiding the middleman infeasible for the average consumer (by the raised prices of medical services in preemptive anticipation of insurance companies throwing their weight and haggling prices down). The system is what needs fixing.

[johnmarc]

[Replying to johnmarc]

Your scenario oversimplifies the situation and implies the necessity of insurance companies.

"spread out over our lifetimes to be cost effective when we need it" doesn't make sense either. It's not like the money you would pay an insurance company vanishes if you don't spend it on insurance. The same money could be saved specifically for healthcare purposes, or invested to possibly produce even more money. regardless, the concept of the time-value of money means (paraphrased) money I have now is worth more than money I will have later, so in a vacuum, paying for a middleman to hold onto my money set aside for healthcare would be a waste. Don't forget that that is what an insurance company is: a middleman whose entire purpose is to profit off of the transaction between you and the healthcare industry. Any middleman makes the system less efficient, but in this case the system has adjusted so abnormally as to making avoiding the middleman infeasible for the average consumer (by the raised prices of medical services in preemptive anticipation of insurance companies throwing their weight and haggling prices down). The system is what needs fixing.

Nothing here to disagree with really except that it expresses an ideal and not a practical reality. The ideal will never be met so we are faced with the reality of (at least for this OP) the insurance industry. Within this context, are there any large scale 'end game' solutions to the scenario that Winepusher has advanced?

[nayrbsnilloc]

[Replying to post 3 by johnmarc]

I fail to see why attempting to change the system is an impractical reality.


But. Redirected towards the OP. It still comes back to the fact that insurance companies are businesses and profit off of people. On a large-scale using effective probabilities and measurements, they calculate the amount to charge people that will earn them a profit, thus charging MORE than the actual value of the health care services rendered. Very rarely does somebody actually pay less through their insurance in the long-run. So how exactly is it less costly/a better option to pay for insurance when it will inevitably cost more?
On small-scales, yes, some people would suffer and not be able to afford all of their desired health care. But as a whole, a larger group of people would likely be save money by not purchasing insurance.

[bluethread]

[Replying to post 3 by johnmarc]

I fail to see why attempting to change the system is an impractical reality.


But. Redirected towards the OP. It still comes back to the fact that insurance companies are businesses and profit off of people. On a large-scale using effective probabilities and measurements, they calculate the amount to charge people that will earn them a profit, thus charging MORE than the actual value of the health care services rendered. Very rarely does somebody actually pay less through their insurance in the long-run. So how exactly is it less costly/a better option to pay for insurance when it will inevitably cost more?
On small-scales, yes, some people would suffer and not be able to afford all of their desired health care. But as a whole, a larger group of people would likely be save money by not purchasing insurance.

The root problem is that, as you eluded to, but did not state, insurance companies do not provide the services that they insure. What they do is spread risk. The two assumptions that are often ignored in these discussions are the degree and type of risk, as well as the amount of services required should something bad occur.

For example:

A. If one chooses to carry one's health risk, then one deals with one's health needs as they occur to the extent that one can afford them. If something bad occurs, the individual suffers, physically and/or financially, and/or dies. If nothing bad happens, the individual uses ones resources on other things. The reality is that eventually something bad will occur and the individual will suffer, physically and/or financially, and die.

B. If one does not wish to account for that risk and focus on other things for a time, one can pay an insurance company to pay for a given amount and quality of health care for a given term. If something bad happens, the insurance company bared the cost to the extent and term negotiated. If the effects of the bad thing exceed the costs and/or term negotiated, the individual suffers, physically and/or financially, and/or dies. If nothing bad happens, the individual uses ones remaining resources on other things and the insurance company pockets the premiums. The reality is that eventually the effects of bad things will occur in excess of the agreed upon costs and term, and the individual will suffer, physically and/or financially, and die.

C. If one does not wish to account for that risk and focus on other things beyond a given term, should something bad happen, one could possibly get a continued coverage rider on ones policy. If something bad happens, the insurance company bared the cost to the extent negotiated, for the duration of the treatments. If nothing bad happens, the individual uses ones remaining resources on other things and the insurance company pockets higher premiums. The reality is that eventually the effects of bad things will occur in excess of the agreed upon costs and/or some other bad thing will occur, and the individual will suffer, physically and/or financially, and die.

D. If one does not wish to account for that risk and focus on other things in perpetuity, one could possibly get an automatic renewal rider on ones policy. If something bad happens, the insurance company bared the cost to the extent negotiated in perpetuity. If nothing bad happens, the individual uses ones remaining resources on other things and the insurance company pockets extremely high premiums. The reality is that eventually the effects of bad things will occur in excess of the agreed upon costs and the individual will suffer, physically and/or financially, and die.

E. If one does not wish to account for that risk and focus on other things in perpetuity regardless of cost, one could possibly go to Lloyds of London or some other extreme risk insurer. If something bad happens, the insurance company bared all health costs. If nothing bad happens, the individual uses ones remaining resources on other things and the insurance company pockets a fortune. The reality is that eventually the effects of bad things will occur in excess of existing technology and the individual will suffer, physically and/or financially, and die.

There is also the issue of premium structure, ie flat fee, monthly, yearly, etc. and the effect of a failure to pay said premiums. However, they follow the same pattern.

Those who call for socialized medicine like to argue against any acknowledgement of the above stated scenarios by saying, "So, you are just going to let them die?!!" The bottom line is that, for everyone, the effects of bad things will occur and the individual will suffer, physically and/or financially, and die, regardless of which insurance policy one has. This is not the fault of the "evil" insurance companies, the "evil" healthcare providers, the "evil" government, or any other "evil" institution one wishes to blame. They are simply the facts of life and death. The only question is, what is the best way to distribute limited resources over and large population that have increasingly high expectations.

[nayrbsnilloc]

[Replying to post 5 by bluethread]

maybe I'm misunderstanding your post, but it seems to me that you're arguing the ultimate ineffectiveness of insurance companies because of the inevitability of death?
This seems to be a bit of a misnomer, as insurance companies aren't intended to prevent death...

[Goat]

Let's look at another case (which, actually is true).

You are young, healthy, and as a pedestrian, get run over by a mack truck that
was stopped, and started when you were crossing the street. You almost got out of the way, but the truck ran over your leg. You need a bunch of surgeries, and skin grafs. That total hospital bill is 100,000 dollars.

Or, you are young and healthy, and get shot by a stray bullet in a drive by shooting.

Things happen, and sometimes, hopital bills can ruin someone for life... even if they ARE alive.

[johnmarc]

[Replying to post 5 by bluethread]

I think that you are just smarter than I am. I had to read your post several times. I think that as far as the OP is concerned there is just your option 'A' and you have described it as an unsatisfactory option. (correct me if that is wrong)

The point remains. If one chooses option 'A' as winepusher has done, what is the eventual end game. You have described one---die in bankruptcy. I don't see any positive endgames to this scenario---have I missed one?

Two more things:

I have been a classroom teacher all of my working career. We teachers here in Washington state have had (until recently) excellent health insurance. It has become costly enough and with enough out of pocket expenses to be a major grumbling point for virtually all teachers. It is presently hard to see private insurance carriers as anything except vultures.

I am presently on Medicare and the coverage and care have been excellent. I suppose that I have paid some form of taxation all of my life for the present opportunity to have better coverage for less cost during the most expensive part of my life. We liberals like the notion of 'Medicare for all" for a reason.

A year or more ago, Goat described a hospital stay in his home country of Australia. He had been paying a little each month in taxation throughout his working life for medical insurance and now was recovering from some procedure or another, but not from any financial ruin. His stay was without cost, because the cost was upfront a little at a time until he needed it. A very practical and useful system which we cannot implement here at home because of political falsehoods.

None of this is, however, directly connected to the OP which states again:

Are there any positive endgames for the game that Winepusher is suggesting?

[johnmarc]

Let's look at another case (which, actually is true).

You are young, healthy, and as a pedestrian, get run over by a mack truck that
was stopped, and started when you were crossing the street. You almost got out of the way, but the truck ran over your leg. You need a bunch of surgeries, and skin grafs. That total hospital bill is 100,000 dollars.

Or, you are young and healthy, and get shot by a stray bullet in a drive by shooting.

Things happen, and sometimes, hopital bills can ruin someone for life... even if they ARE alive.

Notice that your name came up in the previous reply. I hope that I represented you accurately---if not, make the needed corrections.

I am going to assume that you believe (like me) that winepusher's example here is not well thought out (no surprise here) and the endgame might be sooner than we have represented in my OP.

[otseng]

If one chooses option 'A' as winepusher has done,\

Moderator Comment

Please avoid speaking for others. WinePusher has not even posted in this thread, so he cannot have chosen one of those options.

Please review the Rules.


______________

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