9 ms·

Health care is a fundamentally different kind of expense. Housing, food, clothing, basic necessities are pretty stable expenses in the short run. An income of

Health care is a fundamentally different kind of expense. Housing, food, clothing, basic necessities are pretty stable expenses in the short run. An income of a particular size could be judged to be more or less sufficient for the needs of that expense or not. Healthcare is a lottery. If you're 30 years old, your healthcare needs for the year might be $0 or $1,000,000. Trying to make basic income cover that doesn't make sense.

dragonwriter 10y ago
OTOH, BI could be expected to cover minor healthcare costs plus insurance for major costs.
- aetherson 10y ago
  Sure, but, like, changing the fundamental cost structure of our health care system seems like a pretty big add to the already absurdly big policy change of a basic income. (Which is not to say that I disagree with you, though I do think that there are actually three different cost categories of health care: 1. Routine/preventative/minor care. Probably best dealt with as out-of-pocket costs. 2. One-time catastrophes, like "I broke my arm" or "I got pneumonia." Probably best dealt with as insurance. 3. Long-term or lifelong large expenses, like "I have HIV" or "I have MS." Probably best dealt with as a government program. But then you'll have a lot of problems with the boundary cases.)
  - dragonwriter 10y ago
    > Sure, but, like, changing the fundamental cost structure of our health care system seems like a pretty big add to the already absurdly big policy change of a basic income. We already have a national individual mandate for health insurance with specific coverage rules which has made decisions about this; essentially, a mature BI would cover expected out-of-pocket costs plus insurance premiums in that system. (That's not to say further reform of that system isn't possible or desirable, with or without BI, just that, given the existing system, there seems to be a fairly natural way that healthcare within that system fits into BI.)
    - aetherson 10y ago
      Sorry, I misunderstood your previous comment to mean that you thought we should go to an India-like "out of pocket" system plus (optional) health insurance to handle catastrophic costs. Rereading, your intent is clear. (Not sure why I jumped to that conclusion, except that perhaps a basic income system appeals to the same economic minimalism that an out-of-pocket health cost system does.)
  - bryondowd 10y ago
    Just want to point out that making routine/preventative care an out-of-pocket cost is probably one of the worst things you can do. I expect there's a reason many companies emphasize and encourage their employees take advantage of 100% free preventive care under their insurance plans. You can save a ton of money later by catching and treating issues early, and even a small personal cost can encourage people to ignore warning signs and not seek aid until the problem has become severe and expensive.
    - aetherson 10y ago
      Yeah, this is deeply off-topic, but my reading of the evidence is that preventative or diagnostic care is typically not cost-effective or even outcome-enhancing, with a few specific exceptions like vaccinations.
      - bryondowd 10y ago
        Interesting. I'd love to see support for this view. Everything I've heard suggests the opposite. Especially if you consider worker productivity in addition to healthcare costs.
        aetherson 10y ago
        http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129 http://www.reuters.com/article/us-preventive-economics-idUSB... http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-eng.htm http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-... http://www.thehoopsnews.com/effectiveness-of-mammograms-vastly-overestimated-study-6622 http://www.thehoopsnews.com/effectiveness-of-mammograms-vast... It's a complex subject, and a few articles aren't the final word one way or the other. My opinion is based on various things I've read over the past couple of decades (most of which I can't summon up right now) and conversations with various medical professionals in my family and social circle, and my overall worldview (as anyone's must be).
        10y ago
  - wutbrodo 10y ago
    > 1. Routine/preventative/minor care. Probably best dealt with as out-of-pocket costs. This is a pretty terrible idea. Even programs in the current day that are trying to make consumers feel their healthcare costs (like HSAs and their required high-deductible PPO plans) often or always cover preventative care at 100%. Preventative care is precisely the kind of care that people are most likely to skip to save on some money, and at the system-level this just means much more costly healthcare. Regardless of how you structure your healthcare system, increasing the cost of the actual care itself is a horrible idea.
  - stordoff 10y ago
    > Routine/preventative/minor care. Probably best dealt with as out-of-pocket costs. This seems like a terrible idea. If someone, for example, notices a new mole, they are much less likely to get it checked out if it is an out-of-pocket expense. Obviously, most of the time it'll be fine, but it could also be skin cancer that was easily treatable but has now metastasised and will be hugely expensive to treat.
- dpc59 10y ago
  Insurance companies are just a leech on the economy who collect rent. This would turn healthcare into an even more negative sum game.
  - dragonwriter 10y ago
    > This would turn healthcare into an even more negative sum game. How, specifically, would it do so compared to the actual system that exists now in the US?
    - deleted 10y ago
      [deleted]
    - mjevans 10y ago
      The system that exists now in the US is broken and already exactly what is described. Those with money pay too much for insurance because those without insurance are only covered at the last stages, when it becomes inhumane (by anyone's definition) to deny them care (which is also the most drastic and expensive level of care for a problem) which is then 'written off' and padded in to the 'prices' asked for other services. A LOT of medical costs are actually sunk fixed op-ex. Big expensive machines that cost deferentially little to use or not (but always coast a lot to have the option of using), drugs and other supplies that have shelf lifes, etc. Labwork presently requires a lot of humans, but much of it could also be converted to automation and human review, lowering the per unit cost; if there were incentive to make such technology. It's also a major bit of administrative overhead to have to haggle with different insurance companies, hound patients for billing, and in general worry IF someone will pay and how much.
      - trbvm2 10y ago
        Sorry to basically just negate your post but I do believe that you missed answering the last question in explaining details. The poster asked, how would the provision of basic income further turn healthcare supply in the US to a negative sum game as compared to private insurance supplemented with corporate and government benefits? Your response does a fair job of detailing some of the current issues with the US healthcare system but does not mention how basic income would make these issues worse. Would you kindly link the two for those of us who are not making the connection?
bryondowd 10y ago
Healthcare for an individual is a lottery. For a population, it generally isn't. In other words, the total expense to provide healthcare for everybody is a pretty stable expense, which is why it makes more sense to handle at the national level, with the individuals who 'lose' the health lottery being subsidized by those who do not. The common complaint I've seen against this (aside from general complaints against redistribution) is that it forces the general populace to pay for the poor health choices of smokers and other such bad habits. I think this is a relatively minor issue, but if necessary, penalty taxes/fees can alleviate the concerns of people legitimately bothered by this.
- duaneb 10y ago
  > I think this is a relatively minor issue, but if necessary, penalty taxes/fees can alleviate the concerns of people legitimately bothered by this. It is not minor at all. Depending on how you look at it, smoking either costs the health care industry billions (in treatment of the living) or saves them billions (on premature death). Compound this by: diet, exercise, stress, and socialization problems and you see that the lottery has a lot of knobs and buttons, most of which will only be effective if people get effective health care their entire life.
  - rtkwe 10y ago
    That would be an interesting analysis: savings of premature deaths from smoking vs long terms costs of people that smoke and don't die and costs of treating those early deaths before they die. Intuition says the costs probably outweigh the benefits there. Even so it feels pretty macabre (and species threatening at the extreme [1]) to consider someone dying before they need medical care a savings. [1] Considering killing someone before they're born saves the cost of them and any children they would statistically have. So if we wiped out everyone we'd save all the money ever spent on healthcare.
    - srum 10y ago
      The high taxes for cigarettes (and similarly alcohol) should also be taken into account when considering net gains/losses. According to this [1] in the uk at least the taxes more than cover it for tobacco [1]https://fullfact.org/economy/does-smoking-cost-much-it-makes-treasury/ https://fullfact.org/economy/does-smoking-cost-much-it-makes...
danudey 10y ago
Except that, on the whole, an individual in the US who 'loses' that lottery is going to cost themselves/their insurance significantly more than an identical individual in another country with the exact same condition, due to multiple levels of negotiation, backroom dealing, 'in-network', overcharges, etc. That 30 year old individual with the $1m healthcare bill for the year in a for-profit system might well have only cost a public system (e.g. in Canada) $200k for the same standard of care, but with less additional financial stress impacting their ability to recover from their illness, and with no bills, phone calls, rejections, negotiations, and arguments after the fact. It's just another example of how a uniform, public system works better.
- danjayh 10y ago
  Disagree. I had a valve replaced, and researched extensively what my experience was like vs. that in other countries. I received an unquestionably higher standard of care. I had my choice of valve, doctor, hospital, I had nearly zero wait (a few weeks from diagnosis to surgery, and only because I asked for the time -- in my circumstance there was a double digit chance of death, and I needed to ... process), and the nursing care that I received after surgery in the ICU was literally one-on-one - there was a nurse assigned to me. I had a bed that massaged and hammered the goop out of my lungs, I had tasty food (when I could eat again), and I had some say in when I would be discharged. The only thing that wasn't absolutely first-class was that I had a shared room with two beds post-ICU, but even that's becoming uncommon in the US. After reading on the experiences of people from European countries and Canada in the 'OMG I had a valve replaced' forum (yes, there's a site just for that -- valvereplacement.org), the level of care that I received was significantly better than what is typical of public health systems. Oh, and last week I needed to see the doc for a sore throat, and I was in the same day. Queues are a regular thing in public systems.
  - e_proxus 10y ago
    I think there are a lot of data points missing in this anecdote. What do you pay for health insurance? How many people in the lower levels of society could afford to pay what you pay for healthcare? Do you have an employer that provides you with healthcare benefits? I agree that healthcare in many countries could be greatly improved, but at least in many of those systems you could just walk into an hospital to start the process.
JohnTHaller 10y ago
It's a lottery at most ages. Age 39 health care costs: $0. Age 40 health care costs: $45,000. Due to a single incident of slipping and falling on an icy sidewalk. I carry insurance because (1) you never know when something big might happen and (2) I have to just in case the Republicans ever get their wish to "repeal Obamacare" and suddenly my kidney donation to my dad becomes a pre-existing condition again.
- george_soros 10y ago
  Isn't obama care a so called disaster ?
- webXL 10y ago
  #1 is a legit reason for insurance. I'm having a hard time with #2 though. You elected to have a condition that others might have to eventually pay for. Now this was an extension of your dad's condition, so really his insurance company (pool) should pay for your condition's expenses, but with the help of Obamacare, all insurance companies are going to share in these expenses and raise their rates, and they can raise the rates more than their actual costs, because with all the new regulations, how many plans can you really choose from? So we now see healthcare providers laughing all the way to the bank, and a new form of guaranteed income for the insurance workforce. #1 and #2 shouldn't be in the same system. That's what needs to be repealed.
  - JohnTHaller 10y ago
    The rules around "pre-existing conditions" are completely asinine. Under the old rules that Republicans would like to go back to, I'm covered as long as I don't have any period that I didn't have insurance since donating the kidney. However, if I temporarily lose health insurance and then get health insurance again, that kidney donation 16 years ago magically becomes a pre-existing condition again for a period of multiple years. Even though nothing at all happened in that short period I went without health insurance. The kicker is, health insurance companies will use any pre-existing condition to get out of paying for just about everything. So, for example, if I wound up getting poly-cystic kidney disease, my insurance company would use the fact that I donated a kidney as a pre-existing condition to get out of paying for it. Even though it's completely unrelated and can't cause PKD. It's an out in their mind and they're going to take it. Health insurance and medical care in the US is absurdly corrupt. That's why I wasn't allowed to leave the hospital without buying a walking boot from their provider. And their provider billed my insurance company $700. And the insurance company paid them $400. And then the provider billed me $100 and threatened to send me to collections if I didn't pay them. All for a walking boot that didn't fit, that I didn't use, and that I could have purchased from Amazon.com for $53 with free shipping.
maerF0x0 10y ago
Healthcare can be universally provided via BI w/o having single payer government universal healthcare. Individuals can choose (not) to buy health insurance with their BI payments. Thus getting coverage or not as they see fit. Its a bit of a gamble because it turns everyone into an actuarial (do i feel lucky this year? should i buy insurance? Am I higher or lower risk than the cost of insurance?) .. But, it also allows market forces to drive down the cost of insurance and healthcare provision.
- hypersoar 10y ago
  The problem with that is that it requires not treating people who are uninsured and unable to pay for care. "Sorry you got hit by a drunk driver, but we think that the risk is too great that you and the guy who hit you won't ever pay the $100,000 it would cost to fix you." That's pretty unpalatable.
  - eru 10y ago
    Also people with pre-existing expensive conditions would need to pay a lot more. Either, because insurance companies charge them more. Or, if insurance companies are not allowed to charge them a special price, healthy people will be reluctant to pay for (now) overpriced (for them) insurance. One clever technical way out is to have your parents buy insurance for you before you are even conceived. This way, because neither the buyer nor the seller of insurance knows what's coming, it's not a market for lemons. (And if the parents genes make this kind of insurance too expensive, because it's expected that you inherit some defects, perhaps they should rethink their decision to procreate with each other. (Just like couples with sickle-cell-anemia on both sides are already advised.)) But of course, people will not be that farsighted, and we don't want to penalize people for their parents making stupid decisions, like not to buy insurance, more than necessary. So in actual life, a basic version of an NHS like system plus optional extra insurance you can buy seems like the most sensible policy.
  - maerF0x0 10y ago
    I see what you're saying, but how can one get a market forces involved so that the price of care isnt super high and that users have some choice. I have lived in a country with universal healthcare. Its not that cheap, my portion of taxes that went to healthcare was about the same as the highest cost Kaiser plan. But Kaiser (thus far) is leaps and bounds better than the care received. Where I am from you make an appointment with a doctor, and they will almost certainly be 30-60 minutes late for it. Then when you do get in the room with them, they will give you 15 minutes max because thats all the government pays for. Similarly every person I know who needed something done is on a waiting list. For months and a small number for years. People complain about the cost of US healthcare, but if you can pay for it then it does seem excellent.
trbvm2 10y ago
It looks like we went in to a fairly deep reply chain but never got back up to here. Presenting, perhaps, a different take: basic income can cover insurance which does account for the 0-1mil total distribution via actuarial science.
danjayh 10y ago
Even the world's crappiest healthcare plan protects against the worst case. I know - I had a major health event at age 29, and I had absolutely garbage insurance. $350,000 in hospital bills later, with approximately only $7k out of pocket, I was all fixed up (as well as current medical tech allows, at least) and my heart was a click-click-clicking away. Insurance with deductibles in that range for a single (and ~double that for a family) is really relatively cheap.
- mrgoldenbrown 10y ago
  only 7k out of pocket implies your insurance was not as garbage as you thought.

dragonwriter 10y ago

OTOH, BI could be expected to cover minor healthcare costs plus insurance for major costs.

aetherson 10y ago
Sure, but, like, changing the fundamental cost structure of our health care system seems like a pretty big add to the already absurdly big policy change of a basic income. (Which is not to say that I disagree with you, though I do think that there are actually three different cost categories of health care: 1. Routine/preventative/minor care. Probably best dealt with as out-of-pocket costs. 2. One-time catastrophes, like "I broke my arm" or "I got pneumonia." Probably best dealt with as insurance. 3. Long-term or lifelong large expenses, like "I have HIV" or "I have MS." Probably best dealt with as a government program. But then you'll have a lot of problems with the boundary cases.)
- dragonwriter 10y ago
  > Sure, but, like, changing the fundamental cost structure of our health care system seems like a pretty big add to the already absurdly big policy change of a basic income. We already have a national individual mandate for health insurance with specific coverage rules which has made decisions about this; essentially, a mature BI would cover expected out-of-pocket costs plus insurance premiums in that system. (That's not to say further reform of that system isn't possible or desirable, with or without BI, just that, given the existing system, there seems to be a fairly natural way that healthcare within that system fits into BI.)
  - aetherson 10y ago
    Sorry, I misunderstood your previous comment to mean that you thought we should go to an India-like "out of pocket" system plus (optional) health insurance to handle catastrophic costs. Rereading, your intent is clear. (Not sure why I jumped to that conclusion, except that perhaps a basic income system appeals to the same economic minimalism that an out-of-pocket health cost system does.)
- bryondowd 10y ago
  Just want to point out that making routine/preventative care an out-of-pocket cost is probably one of the worst things you can do. I expect there's a reason many companies emphasize and encourage their employees take advantage of 100% free preventive care under their insurance plans. You can save a ton of money later by catching and treating issues early, and even a small personal cost can encourage people to ignore warning signs and not seek aid until the problem has become severe and expensive.
  - aetherson 10y ago
    Yeah, this is deeply off-topic, but my reading of the evidence is that preventative or diagnostic care is typically not cost-effective or even outcome-enhancing, with a few specific exceptions like vaccinations.
    - bryondowd 10y ago
      Interesting. I'd love to see support for this view. Everything I've heard suggests the opposite. Especially if you consider worker productivity in addition to healthcare costs.
      - aetherson 10y ago
        http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129 http://www.reuters.com/article/us-preventive-economics-idUSB... http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-eng.htm http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-... http://www.thehoopsnews.com/effectiveness-of-mammograms-vastly-overestimated-study-6622 http://www.thehoopsnews.com/effectiveness-of-mammograms-vast... It's a complex subject, and a few articles aren't the final word one way or the other. My opinion is based on various things I've read over the past couple of decades (most of which I can't summon up right now) and conversations with various medical professionals in my family and social circle, and my overall worldview (as anyone's must be).
        10y ago
- wutbrodo 10y ago
  > 1. Routine/preventative/minor care. Probably best dealt with as out-of-pocket costs. This is a pretty terrible idea. Even programs in the current day that are trying to make consumers feel their healthcare costs (like HSAs and their required high-deductible PPO plans) often or always cover preventative care at 100%. Preventative care is precisely the kind of care that people are most likely to skip to save on some money, and at the system-level this just means much more costly healthcare. Regardless of how you structure your healthcare system, increasing the cost of the actual care itself is a horrible idea.
- stordoff 10y ago
  > Routine/preventative/minor care. Probably best dealt with as out-of-pocket costs. This seems like a terrible idea. If someone, for example, notices a new mole, they are much less likely to get it checked out if it is an out-of-pocket expense. Obviously, most of the time it'll be fine, but it could also be skin cancer that was easily treatable but has now metastasised and will be hugely expensive to treat.
dpc59 10y ago
Insurance companies are just a leech on the economy who collect rent. This would turn healthcare into an even more negative sum game.
- dragonwriter 10y ago
  > This would turn healthcare into an even more negative sum game. How, specifically, would it do so compared to the actual system that exists now in the US?
  - deleted 10y ago
    [deleted]
  - mjevans 10y ago
    The system that exists now in the US is broken and already exactly what is described. Those with money pay too much for insurance because those without insurance are only covered at the last stages, when it becomes inhumane (by anyone's definition) to deny them care (which is also the most drastic and expensive level of care for a problem) which is then 'written off' and padded in to the 'prices' asked for other services. A LOT of medical costs are actually sunk fixed op-ex. Big expensive machines that cost deferentially little to use or not (but always coast a lot to have the option of using), drugs and other supplies that have shelf lifes, etc. Labwork presently requires a lot of humans, but much of it could also be converted to automation and human review, lowering the per unit cost; if there were incentive to make such technology. It's also a major bit of administrative overhead to have to haggle with different insurance companies, hound patients for billing, and in general worry IF someone will pay and how much.
    - trbvm2 10y ago
      Sorry to basically just negate your post but I do believe that you missed answering the last question in explaining details. The poster asked, how would the provision of basic income further turn healthcare supply in the US to a negative sum game as compared to private insurance supplemented with corporate and government benefits? Your response does a fair job of detailing some of the current issues with the US healthcare system but does not mention how basic income would make these issues worse. Would you kindly link the two for those of us who are not making the connection?

bryondowd 10y ago

Healthcare for an individual is a lottery. For a population, it generally isn't. In other words, the total expense to provide healthcare for everybody is a pretty stable expense, which is why it makes more sense to handle at the national level, with the individuals who 'lose' the health lottery being subsidized by those who do not. The common complaint I've seen against this (aside from general complaints against redistribution) is that it forces the general populace to pay for the poor health choices of smokers and other such bad habits. I think this is a relatively minor issue, but if necessary, penalty taxes/fees can alleviate the concerns of people legitimately bothered by this.

duaneb 10y ago
> I think this is a relatively minor issue, but if necessary, penalty taxes/fees can alleviate the concerns of people legitimately bothered by this. It is not minor at all. Depending on how you look at it, smoking either costs the health care industry billions (in treatment of the living) or saves them billions (on premature death). Compound this by: diet, exercise, stress, and socialization problems and you see that the lottery has a lot of knobs and buttons, most of which will only be effective if people get effective health care their entire life.
- rtkwe 10y ago
  That would be an interesting analysis: savings of premature deaths from smoking vs long terms costs of people that smoke and don't die and costs of treating those early deaths before they die. Intuition says the costs probably outweigh the benefits there. Even so it feels pretty macabre (and species threatening at the extreme [1]) to consider someone dying before they need medical care a savings. [1] Considering killing someone before they're born saves the cost of them and any children they would statistically have. So if we wiped out everyone we'd save all the money ever spent on healthcare.
  - srum 10y ago
    The high taxes for cigarettes (and similarly alcohol) should also be taken into account when considering net gains/losses. According to this [1] in the uk at least the taxes more than cover it for tobacco [1]https://fullfact.org/economy/does-smoking-cost-much-it-makes-treasury/ https://fullfact.org/economy/does-smoking-cost-much-it-makes...

danudey 10y ago

Except that, on the whole, an individual in the US who 'loses' that lottery is going to cost themselves/their insurance significantly more than an identical individual in another country with the exact same condition, due to multiple levels of negotiation, backroom dealing, 'in-network', overcharges, etc. That 30 year old individual with the $1m healthcare bill for the year in a for-profit system might well have only cost a public system (e.g. in Canada) $200k for the same standard of care, but with less additional financial stress impacting their ability to recover from their illness, and with no bills, phone calls, rejections, negotiations, and arguments after the fact. It's just another example of how a uniform, public system works better.

danjayh 10y ago
Disagree. I had a valve replaced, and researched extensively what my experience was like vs. that in other countries. I received an unquestionably higher standard of care. I had my choice of valve, doctor, hospital, I had nearly zero wait (a few weeks from diagnosis to surgery, and only because I asked for the time -- in my circumstance there was a double digit chance of death, and I needed to ... process), and the nursing care that I received after surgery in the ICU was literally one-on-one - there was a nurse assigned to me. I had a bed that massaged and hammered the goop out of my lungs, I had tasty food (when I could eat again), and I had some say in when I would be discharged. The only thing that wasn't absolutely first-class was that I had a shared room with two beds post-ICU, but even that's becoming uncommon in the US. After reading on the experiences of people from European countries and Canada in the 'OMG I had a valve replaced' forum (yes, there's a site just for that -- valvereplacement.org), the level of care that I received was significantly better than what is typical of public health systems. Oh, and last week I needed to see the doc for a sore throat, and I was in the same day. Queues are a regular thing in public systems.
- e_proxus 10y ago
  I think there are a lot of data points missing in this anecdote. What do you pay for health insurance? How many people in the lower levels of society could afford to pay what you pay for healthcare? Do you have an employer that provides you with healthcare benefits? I agree that healthcare in many countries could be greatly improved, but at least in many of those systems you could just walk into an hospital to start the process.

JohnTHaller 10y ago

It's a lottery at most ages. Age 39 health care costs: $0. Age 40 health care costs: $45,000. Due to a single incident of slipping and falling on an icy sidewalk. I carry insurance because (1) you never know when something big might happen and (2) I have to just in case the Republicans ever get their wish to "repeal Obamacare" and suddenly my kidney donation to my dad becomes a pre-existing condition again.

george_soros 10y ago
Isn't obama care a so called disaster ?
webXL 10y ago
#1 is a legit reason for insurance. I'm having a hard time with #2 though. You elected to have a condition that others might have to eventually pay for. Now this was an extension of your dad's condition, so really his insurance company (pool) should pay for your condition's expenses, but with the help of Obamacare, all insurance companies are going to share in these expenses and raise their rates, and they can raise the rates more than their actual costs, because with all the new regulations, how many plans can you really choose from? So we now see healthcare providers laughing all the way to the bank, and a new form of guaranteed income for the insurance workforce. #1 and #2 shouldn't be in the same system. That's what needs to be repealed.
- JohnTHaller 10y ago
  The rules around "pre-existing conditions" are completely asinine. Under the old rules that Republicans would like to go back to, I'm covered as long as I don't have any period that I didn't have insurance since donating the kidney. However, if I temporarily lose health insurance and then get health insurance again, that kidney donation 16 years ago magically becomes a pre-existing condition again for a period of multiple years. Even though nothing at all happened in that short period I went without health insurance. The kicker is, health insurance companies will use any pre-existing condition to get out of paying for just about everything. So, for example, if I wound up getting poly-cystic kidney disease, my insurance company would use the fact that I donated a kidney as a pre-existing condition to get out of paying for it. Even though it's completely unrelated and can't cause PKD. It's an out in their mind and they're going to take it. Health insurance and medical care in the US is absurdly corrupt. That's why I wasn't allowed to leave the hospital without buying a walking boot from their provider. And their provider billed my insurance company $700. And the insurance company paid them $400. And then the provider billed me $100 and threatened to send me to collections if I didn't pay them. All for a walking boot that didn't fit, that I didn't use, and that I could have purchased from Amazon.com for $53 with free shipping.

maerF0x0 10y ago

Healthcare can be universally provided via BI w/o having single payer government universal healthcare. Individuals can choose (not) to buy health insurance with their BI payments. Thus getting coverage or not as they see fit. Its a bit of a gamble because it turns everyone into an actuarial (do i feel lucky this year? should i buy insurance? Am I higher or lower risk than the cost of insurance?) .. But, it also allows market forces to drive down the cost of insurance and healthcare provision.

hypersoar 10y ago
The problem with that is that it requires not treating people who are uninsured and unable to pay for care. "Sorry you got hit by a drunk driver, but we think that the risk is too great that you and the guy who hit you won't ever pay the $100,000 it would cost to fix you." That's pretty unpalatable.
- eru 10y ago
  Also people with pre-existing expensive conditions would need to pay a lot more. Either, because insurance companies charge them more. Or, if insurance companies are not allowed to charge them a special price, healthy people will be reluctant to pay for (now) overpriced (for them) insurance. One clever technical way out is to have your parents buy insurance for you before you are even conceived. This way, because neither the buyer nor the seller of insurance knows what's coming, it's not a market for lemons. (And if the parents genes make this kind of insurance too expensive, because it's expected that you inherit some defects, perhaps they should rethink their decision to procreate with each other. (Just like couples with sickle-cell-anemia on both sides are already advised.)) But of course, people will not be that farsighted, and we don't want to penalize people for their parents making stupid decisions, like not to buy insurance, more than necessary. So in actual life, a basic version of an NHS like system plus optional extra insurance you can buy seems like the most sensible policy.
- maerF0x0 10y ago
  I see what you're saying, but how can one get a market forces involved so that the price of care isnt super high and that users have some choice. I have lived in a country with universal healthcare. Its not that cheap, my portion of taxes that went to healthcare was about the same as the highest cost Kaiser plan. But Kaiser (thus far) is leaps and bounds better than the care received. Where I am from you make an appointment with a doctor, and they will almost certainly be 30-60 minutes late for it. Then when you do get in the room with them, they will give you 15 minutes max because thats all the government pays for. Similarly every person I know who needed something done is on a waiting list. For months and a small number for years. People complain about the cost of US healthcare, but if you can pay for it then it does seem excellent.

trbvm2 10y ago

It looks like we went in to a fairly deep reply chain but never got back up to here. Presenting, perhaps, a different take: basic income can cover insurance which does account for the 0-1mil total distribution via actuarial science.

danjayh 10y ago

Even the world's crappiest healthcare plan protects against the worst case. I know - I had a major health event at age 29, and I had absolutely garbage insurance. $350,000 in hospital bills later, with approximately only $7k out of pocket, I was all fixed up (as well as current medical tech allows, at least) and my heart was a click-click-clicking away. Insurance with deductibles in that range for a single (and ~double that for a family) is really relatively cheap.

mrgoldenbrown 10y ago
only 7k out of pocket implies your insurance was not as garbage as you thought.