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]

what defines a "workable endgame" to you? ive seen you use that phrase multiple times and how other people's version dont match up to it. but what is it exactly?

another question though that cuts to the heart of the issue: does everyone really have the right to receive healthcare?

i posit that everyone should have the right to have access to it, but still need to be able to pay for it in full. (not a single-payer tax system but through the free market)

[JohnPaul]

[Replying to johnmarc]

what defines a "workable endgame" to you? ive seen you use that phrase multiple times and how other people's version dont match up to it. but what is it exactly?

another question though that cuts to the heart of the issue: does everyone really have the right to receive healthcare?

i posit that everyone should have the right to have access to it, but still need to be able to pay for it in full. (not a single-payer tax system but through the free market)

I also favor a free market, but I don't carry that to counter-productive extremes. The ideal of a free market is meaningless if its benefits are available only to a select few. Do we really want to return to a feudal society of peasants and Robber Barons?

Does anyone have the right to at least an elementary education, the right to police and fire protection, or the right to use public streets and roads? These things benefit not only the individual, but the society as a whole, and are essential to a modern society.

If a collective solution is the only one that works, then don't throw out the baby with the bath water.

[bluethread]

Goat's case is anecdotal. There are plenty of government funding horror stories also, as there are a variety of good and bad stories in the free market. Public policy should be based on principles not on anecdotes.

It might be 'anecdotal', but it HAPPENED. It is a actual case. It is truth. As an actual a case, it shows a principle.. of what happens when someone in insured, verses what happens when someone is NOT insured.[/quote]

My point is that, though the costs are high, the likelihood is low. Therefore, a low cost catastrophic plan would be sufficient for those risks. That kind of plan is now illegal. To address the cases you mentioned. The trucking company is liable for the accident and the shooter is responsible for the shooting. If one wished to legislate that liability, the legislation should be directed at trucking companies and perps. If I, as a pedestrian wish to accept the risk of those two events happening, that is up to me and society in general should not be obligated cover the costs related to that decision. Why am I as a disinterested third party liable to bear those costs?

[DanieltheDragon]

[Replying to post 23 by bluethread]

I would agree bluethread but we must consider that we exist in a closed system. In other words, cost of each individual will and does eventually effect every other individual in the system. It is simply a matter of choosing how to pay for said cost.

For example lets say I stand firmly that I should not cover other peoples medical expenses by paying into an insurance plan and I have enough money to cover my own medical liabilities whatever they may be.

Joe Nobody has no insurance gets into a car accident with someone else who has no insurance they are both taken to the hospital and cannot afford to pay for the costs and declare bankruptcy.

The hospital is out the money and spreads that cost by increasing the price of its services.

You incur a medical condition and have to pay the increased price of services. So whether you pay for insurance or not you still pay the cost of others. Now I despise insurance as it is an inefficient middle man. When in seattle I really enjoyed the benefits of a health co-op like group health. My insurance cost $175 per month and everything was covered doctor visits were $10 and prescriptions cost $10 dollars all medical records were available online and I could easily transfer out of network.

I would have no problem with a federal health co-op on these conditions it is self-supporting i.e. no taxes feed the system you pay into it to receive benefits. And no mandated health care as everybody should have the choice on how they want to pay for their health-care.

[bluethread]

[Replying to post 23 by bluethread]

I would agree bluethread but we must consider that we exist in a closed system. In other words, cost of each individual will and does eventually effect every other individual in the system. It is simply a matter of choosing how to pay for said cost.

For example lets say I stand firmly that I should not cover other peoples medical expenses by paying into an insurance plan and I have enough money to cover my own medical liabilities whatever they may be.

Joe Nobody has no insurance gets into a car accident with someone else who has no insurance they are both taken to the hospital and cannot afford to pay for the costs and declare bankruptcy.

The hospital is out the money and spreads that cost by increasing the price of its services.

You incur a medical condition and have to pay the increased price of services. So whether you pay for insurance or not you still pay the cost of others. Now I despise insurance as it is an inefficient middle man. When in seattle I really enjoyed the benefits of a health co-op like group health. My insurance cost $175 per month and everything was covered doctor visits were $10 and prescriptions cost $10 dollars all medical records were available online and I could easily transfer out of network.

I would have no problem with a federal health co-op on these conditions it is self-supporting i.e. no taxes feed the system you pay into it to receive benefits. And no mandated health care as everybody should have the choice on how they want to pay for their health-care.

That is because we permit bankruptcy and require certain services regardless of ability to pay. The same happens with all kinds of services under bankruptcy. When someone declares bankruptcy that cost either reduces the profitability or cost of that service. We don't require home furnishings insurance, even though that industry is commonly hurt by bankruptcy. Government mandates also increase the cost for those who actually pay. The question is how much the government should mandate. People tend to ignore that question and just focus on how it is going to be paid for, if that. There are a lot of risks in life. Should there be mandates and required insurance for all of them?

[DanieltheDragon]

[Replying to post 25 by bluethread]

I would say there should be a mandate on any hospital that receives public money to provide care. Regardless of bankruptcy or not some people simply cannot pay those bills and probably never would be capable of paying the bills so I don't see how that enters the equation. Joe nobody making $18,000 a year gets a $30,000 bill. He would have to be homeless and stop eating for 2 years to cover the bill.

Aside from that mandate there should be no requirement to purchase insurance. I am just saying there should be a public option to get into a low cost(profit free) insurance or co-op. If the fear is it puts private insurance out of business fine we can put an income cap on say if you make more than $60,000 you cant buy into it.

[bluethread]

[Replying to post 25 by bluethread]

I would say there should be a mandate on any hospital that receives public money to provide care. Regardless of bankruptcy or not some people simply cannot pay those bills and probably never would be capable of paying the bills so I don't see how that enters the equation. Joe nobody making $18,000 a year gets a $30,000 bill. He would have to be homeless and stop eating for 2 years to cover the bill.

Aside from that mandate there should be no requirement to purchase insurance. I am just saying there should be a public option to get into a low cost(profit free) insurance or co-op. If the fear is it puts private insurance out of business fine we can put an income cap on say if you make more than $60,000 you cant buy into it.

I see no problem with the co-op option. In fact, there are such options in the insurance industry already. If you are talking about so called "nonprofit" government health insurance, I question the "nonprofit" premise. Nonprofits are often just shell games that find ways of distributing what would be a profit among certain employee groups. Also, government programs are rarely no-cost transfers. They take on a life of their own, often increasing costs beyond what would be the case with a "for-profit" entity. Also, government programs are often exempted from prosecution for common unfair trade practices, resulting in "off the books" costs and institutional bailouts that cover up incompetence and inefficiencies.

[DanieltheDragon]

[Replying to post 27 by bluethread]


I agree to a certain extent

save for the peace corps red cross salvation army. these are effective non-profit/charitable organizations that use their money for the causes they promote.

that being said if the terms are rigidly defined and capped pay, saving enough flexibility to adjust with an ever changing environment it should be fine. It really is all in the terms I wouldn't just agree to any old bill. But I think a co-op/public insurance would be far more cost efficient than Obamacare. I say scrap obamacare entirely offer a public co-op/insurance define it properly you can operate it using a nearly bare-bones staff if most of it is distributed online.

no-mandate for insurance
and only mandate required care for entities receiving public money.

[dianaiad]

I'm torn.

As a rabid right wing conservative, I have always had a problem with socialized medicine, and still do. For reasons I"ll go into in a bit, I ALSO have a huge problem with Obamacare. Indeed, Obamacare is going to hurt me, personally, badly, because of the changes in insurance that are happening/will happen.

On the other hand, because of reasons I'll go into in a bit, I have very personal reasons for wanting to reform the US health care system.

Now, I have a very, very expensive problem. So far this year I have cost my insurance company (Kaiser Permanente, which is an HMO about as close to 'socialized medicine' as one can get, for those IN it) nearly half a million bucks, adding up hospital stays and prescriptions.

.....and it ain't gonna get better. I just got a FedEx delivery yesterday; a bottle of Revlimid. They sent it Fed Ex insured because three weeks worth of pills cost Kaiser considerably over $9000. For 21 pills. I'm going to be taking those pills for, according to my doc, the rest of my life, or three years, whichever expires first.

Just those pills will total a bit over $350,000 by the time I'm done with 'em. Of course, if we add in another bone marrow transplant (likely) and a hospital stay or two (also likely) the total cost of my problem is going to cost considerably over a million bucks.

Here's the problem: right now, if I didn't have any insurance at all,Celgene (the company that makes Revlimid) would be giving me the pills for free; they have a program for that. The City of Hope, if I didn't have insurance, would have contributed the cost of hospital care for free. In sum, I would be paying a bit more than I am now to get that very expensive care, but not much more---because the private sector has programs to help/cover the cost of what I need.

So far, so good, right?

Not exactly. You see, the ACA has this committee: IPAB, which will consist of 15 people--non practicing physicians and others, who are authorized to cut Medicare across the board and to recommend specific cost saving costs. The AMA vehemently opposes it, because it takes the decision making away from the doctor doing the treating, and will, evidently, focus on exactly the sort of thing that people like me will need: novel drugs and treatments for rare conditions.

I have to admit, the government would save a LOT of money by cutting me off. I suppose I should be altruistic and say 'go ahead,' but, damn it, it was the government (by way of Lockheed) that GAVE me this, and soldiers who were exposed to stuff like Agent Orange are particularly at risk for it. So are the workers who cleaned up the Twin Towers.

I do not like the government solution to health care. It's a mess. We can see just how big a mess it is just by looking around. HOW many people have lost their perfectly good health insurance policies? HOW many people have had to buy new policies for premiums that are impossible to meet?

Does something need to be done? I think so...but not this.

[bluethread]

[Replying to post 27 by bluethread]


I agree to a certain extent

save for the peace corps red cross salvation army. these are effective non-profit/charitable organizations that use their money for the causes they promote.

that being said if the terms are rigidly defined and capped pay, saving enough flexibility to adjust with an ever changing environment it should be fine. It really is all in the terms I wouldn't just agree to any old bill. But I think a co-op/public insurance would be far more cost efficient than Obamacare. I say scrap obamacare entirely offer a public co-op/insurance define it properly you can operate it using a nearly bare-bones staff if most of it is distributed online.

no-mandate for insurance
and only mandate required care for entities receiving public money.

So, you expect people to be efficient and innovative working with rigidly defined and capped pay? Also, how does on craft enough flexibility to adjust with an ever changing environment in such an environment? How would one anticipate and adjust for changes in the environment?