5 ms·

That's my favourite argument for nationalized health care (insurance)! _Everyone_ pays the insurance and so the risks can be accounted for actuarially without l

by kspaans 11y ago

That's my favourite argument for nationalized health care (insurance)! _Everyone_ pays the insurance and so the risks can be accounted for actuarially without leaving anyone behind.

yummyfajitas 11y ago
The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? One way to mitigate this would be with Singapore-style high deductible insurance - subsidies only kick in after you've spent 10-20% of your income on medicine. See also "too big to fail", federally subsidized flood insurance, student loan guarantees, etc, all of which have the same problem.
- elipsey 11y ago
  >> gay sex I heard promiscuous straight people can catch AIDS too! No way that's really true though, right?
  - yummyfajitas 11y ago
    They can. It's just far less likely. http://www.cdc.gov/hiv/basics/statistics.html http://www.cdc.gov/hiv/basics/statistics.html Simple division (63% of HIV infections / 2% of population) / (25% of HIV infections / 98% of population) suggests gay sex is about 120x as risky as straight sex.
    - kspaans 11y ago
      I think you mean unprotected anal sex, not "gay" sex.
- gambiting 11y ago
  >>The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? Does it not work the exact same way with private insurance? If you require treatment, you increase premiums for everyone, not just yourself. Anyway, I'm personally super happy with national insurance because I simply don't have to think about it. I know that if I need an operation, I will get one. I know that if I have an accident, and they need to send a helicopter to get me, I won't even see the bill for that. If I need to stay in hospital for the next year of my life, I won't see the bill. If I lose my job and become homeless I'm still going to be covered. I don't need to worry which hospital to go to, or which doctor/dentist can see me - they all can, there's no receipt produced, it's simply not a worry I have. Right now I pay about ~$100USD a month for the national health insurance, and it's an amount I am extremely happy to pay. Why would I care that other people are having accidents or smoking?
  - maxerickson 11y ago
    If you are talking about insurance in the pure actuarial sense, the company can choose to charge higher rates or not carry people that engage in excessive risks. Of course insurance is not purely actuarial anymore, if it ever was.
  - yummyfajitas 11y ago
    If private insurance can account for your risky behavior (as the article is describing, then no. Private insurance doesn't have this problem. And again, high deductibles mitigate it, since your risky behavior can cause you to lose 20% of your income, but still protect you from tail risk. Why would I care that other people are having accidents or smoking? Because you are paying for the consequences of their actions. A quick google search suggests more than 20% of the (far more than $100/month) Americans pay is caused by gluttony alone: http://www.healthycommunitieshealthyfuture.org/learn-the-facts/economic-costs-of-obesity/ http://www.healthycommunitieshealthyfuture.org/learn-the-fac... That's about 1/3 of what we spent on our overpriced military. And that ignores the costs inflicted by overweight but not obese people as well as various other unhealthy behaviors. In a country where medical professionals have no other options and therefore take low salaries, this may be less of an issue. But in the US medicine is very expensive, so it costs us a lot.
- littletimmy 11y ago
  Considering that insurance companies cannot exclude by law, aren't you paying for those things even if you go for private insurance over public insurance?
  - yummyfajitas 11y ago
    The issue is not exclusion, it's actuarial pricing. If companies can't exclude, but can charge people their expected cost, insurance works just fine and fitness vegetable girl doesn't subsidize hypochondriac unprotected gay junkie glutton. The latter person just pays a lot more. https://en.wikipedia.org/wiki/Central_limit_theorem#Lyapunov_CLT https://en.wikipedia.org/wiki/Central_limit_theorem#Lyapunov...
    - thatcat 11y ago
      The first problem then is how the insurance company determines that you're a junkie glutton because the sources of information from which they conceivably have access(search engine results, super market discount card, and other aggregated data sources), do not correlate 1 to 1 with behaviour. In addition to this, there is no mechanism of appeal in which one could contest their appraisal. Then there is also the issue that the working poor buy shittier food because it's cheaper and more convenient, so their business logic creates a paradox where the assumption that all behaviour’s can be modified and accounted for economically really stops making sense. Trying to hold poor people accountable for their poverty by increase their costs of living can't possibly work and a major health crisis currently is diabetes which is directly related to the cheapest and most sugar filled things eaten disproportionally by mostly poor peole (in the US anyway, thanks to cheap corn). This is true in other ways as well, for example commute time is related to housing cost, stress is related to driving time, stress is related to poor health. Increased commute time can lead to less sleep, less sleep leads to poor health. there are probably infinitely more... Live in a trailer? You're being exposed constantly to toxins being emitted by the fibre board that everything in your house is made from; by "insurance" logic people that live in trailers make bad health decisions and should be charged more so that the cost of living in trailers is the same as the cost of living some where non toxic. So then should we subsidize housing instead? or let that person become homeless. tldr; being poor = 'bad health behaviour' and so poor people will be disproportionately punished for their existing poverty with additional poverty.
- beejiu 11y ago
  In the UK for example, when you buy cigarettes you pay 77% tax. The total tax receipts for this tax are about £9bn per year, whereas the NHS spends only £2.7bn. (Figures from http://news.bbc.co.uk/1/hi/health/7654153.stm http://news.bbc.co.uk/1/hi/health/7654153.stm, 2008.) Therefore, you could argue that the costs of this behaviour are fully funded. The point is, there are other ways to deter dangerous acts than via insurance premiums.

by kspaans 11y ago

That's my favourite argument for nationalized health care (insurance)! _Everyone_ pays the insurance and so the risks can be accounted for actuarially without leaving anyone behind.

yummyfajitas 11y ago

The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? One way to mitigate this would be with Singapore-style high deductible insurance - subsidies only kick in after you've spent 10-20% of your income on medicine. See also "too big to fail", federally subsidized flood insurance, student loan guarantees, etc, all of which have the same problem.

elipsey 11y ago
>> gay sex I heard promiscuous straight people can catch AIDS too! No way that's really true though, right?
- yummyfajitas 11y ago
  They can. It's just far less likely. http://www.cdc.gov/hiv/basics/statistics.html http://www.cdc.gov/hiv/basics/statistics.html Simple division (63% of HIV infections / 2% of population) / (25% of HIV infections / 98% of population) suggests gay sex is about 120x as risky as straight sex.
  - kspaans 11y ago
    I think you mean unprotected anal sex, not "gay" sex.
gambiting 11y ago
>>The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? Does it not work the exact same way with private insurance? If you require treatment, you increase premiums for everyone, not just yourself. Anyway, I'm personally super happy with national insurance because I simply don't have to think about it. I know that if I need an operation, I will get one. I know that if I have an accident, and they need to send a helicopter to get me, I won't even see the bill for that. If I need to stay in hospital for the next year of my life, I won't see the bill. If I lose my job and become homeless I'm still going to be covered. I don't need to worry which hospital to go to, or which doctor/dentist can see me - they all can, there's no receipt produced, it's simply not a worry I have. Right now I pay about ~$100USD a month for the national health insurance, and it's an amount I am extremely happy to pay. Why would I care that other people are having accidents or smoking?
- maxerickson 11y ago
  If you are talking about insurance in the pure actuarial sense, the company can choose to charge higher rates or not carry people that engage in excessive risks. Of course insurance is not purely actuarial anymore, if it ever was.
- yummyfajitas 11y ago
  If private insurance can account for your risky behavior (as the article is describing, then no. Private insurance doesn't have this problem. And again, high deductibles mitigate it, since your risky behavior can cause you to lose 20% of your income, but still protect you from tail risk. Why would I care that other people are having accidents or smoking? Because you are paying for the consequences of their actions. A quick google search suggests more than 20% of the (far more than $100/month) Americans pay is caused by gluttony alone: http://www.healthycommunitieshealthyfuture.org/learn-the-facts/economic-costs-of-obesity/ http://www.healthycommunitieshealthyfuture.org/learn-the-fac... That's about 1/3 of what we spent on our overpriced military. And that ignores the costs inflicted by overweight but not obese people as well as various other unhealthy behaviors. In a country where medical professionals have no other options and therefore take low salaries, this may be less of an issue. But in the US medicine is very expensive, so it costs us a lot.
littletimmy 11y ago
Considering that insurance companies cannot exclude by law, aren't you paying for those things even if you go for private insurance over public insurance?
- yummyfajitas 11y ago
  The issue is not exclusion, it's actuarial pricing. If companies can't exclude, but can charge people their expected cost, insurance works just fine and fitness vegetable girl doesn't subsidize hypochondriac unprotected gay junkie glutton. The latter person just pays a lot more. https://en.wikipedia.org/wiki/Central_limit_theorem#Lyapunov_CLT https://en.wikipedia.org/wiki/Central_limit_theorem#Lyapunov...
  - thatcat 11y ago
    The first problem then is how the insurance company determines that you're a junkie glutton because the sources of information from which they conceivably have access(search engine results, super market discount card, and other aggregated data sources), do not correlate 1 to 1 with behaviour. In addition to this, there is no mechanism of appeal in which one could contest their appraisal. Then there is also the issue that the working poor buy shittier food because it's cheaper and more convenient, so their business logic creates a paradox where the assumption that all behaviour’s can be modified and accounted for economically really stops making sense. Trying to hold poor people accountable for their poverty by increase their costs of living can't possibly work and a major health crisis currently is diabetes which is directly related to the cheapest and most sugar filled things eaten disproportionally by mostly poor peole (in the US anyway, thanks to cheap corn). This is true in other ways as well, for example commute time is related to housing cost, stress is related to driving time, stress is related to poor health. Increased commute time can lead to less sleep, less sleep leads to poor health. there are probably infinitely more... Live in a trailer? You're being exposed constantly to toxins being emitted by the fibre board that everything in your house is made from; by "insurance" logic people that live in trailers make bad health decisions and should be charged more so that the cost of living in trailers is the same as the cost of living some where non toxic. So then should we subsidize housing instead? or let that person become homeless. tldr; being poor = 'bad health behaviour' and so poor people will be disproportionately punished for their existing poverty with additional poverty.
beejiu 11y ago
In the UK for example, when you buy cigarettes you pay 77% tax. The total tax receipts for this tax are about £9bn per year, whereas the NHS spends only £2.7bn. (Figures from http://news.bbc.co.uk/1/hi/health/7654153.stm http://news.bbc.co.uk/1/hi/health/7654153.stm, 2008.) Therefore, you could argue that the costs of this behaviour are fully funded. The point is, there are other ways to deter dangerous acts than via insurance premiums.