5 ms·

i'd like the choice to not have any insurance

mikeash 10y ago
How will you ensure that paramedics won't take you to the hospital if you have a sudden event in the street?
d_e_solomon 10y ago
Just to be sure - if you show up at the hospital w/o means of payment - even if in coma - are you going to be treated? If yes, then you have insurance and you're free-riding on the system. If no, then you're more barbaric than Reagan.
nyxtom 10y ago
That's not a sustainable choice for our economy, it leads to too many people living like nothing could possibly go wrong until they need a doctor. The point of insurance is to distribute risk, not participating in that effectively negates the effectiveness of the industry.
- MR4D 10y ago
  That's not quite true. For instance, life insurance takes a varying times for it to kick in (varies depending on type and amount, as well as which state's laws apply.) It's quite possible that your health insurance could be limited at first, and grows to cover more things and higher dollar amounts. And before anyone says you can't do this, go look at your dental insurance. Odds are that your coverage increases each year so long as you have two checkups annually and don't let a lapse of insurance occur. Note that as the ACA is __currently__ written, the situation the OP states probably exists.
  - dlp211 10y ago
    And what happens when you're 18 and get cancer? Building up may work for dental because even in the most catastrophic case, the costs have a ceiling, but your overall health doesn't have these kinds of ceilings. Also, every dental plan I have ever had has lifetime maximums, something else that doesn't work with health insurance.
  - mikeash 10y ago
    I've never heard of anyone getting hit with a million-dollar bill for dental work, so I don't think that's quite the existence proof you want it to be.
- db48x 10y ago
  You're making the assumption that nobody could possibly pay for their health care out of pocket. That's just not true, even with health care as expensive as it is these days.
  - dlp211 10y ago
    With the exception of the most wealthy (ie, Bill Gates), I guarantee that there is a health issue that would bankrupt you. Also, if you are that wealthy, why wouldn't you insure your health? It would be a pittance compared to your overall wealth and just simply a prudent thing to do. I bet you that Bill Gates and Warren Buffet have health insurance.
- lend000 10y ago
  The whole idea of health insurance is backwards and inconsistent with a free market in my opinion (fraudulent). The problem is that the government has enshrined it as the gateway to healthcare. Insurance is a useful product for mitigating risk, so accident insurance could be a very constructive concept (protecting against accidental injuries, broken arms, falls, car crashes, etc.). However, health problems are not a risk; they are a guarantee with probability approaching one as you age. The whole point of insurance is that you mitigate risk by paying more than you take out on average, but that doesn't make sense for healthcare, where almost everyone ends up going over their limit near the end of their lives. If we didn't have all of these subsidies everywhere and inflated demand from Medicare/Medicaid/restrictive occupational licensing/FDA-granted monopolies/ACA, then perhaps we could pay everything out of pocket, which would make a lot more sense.
  - mikeash 10y ago
    The basic concept of health insurance works fine. Yes, your probability of dying approaches 1 as you age, but the costs you incur along the way can vary enormously. Somebody who's wonderfully healthy until they instantly die in bed of a heart attack will cost the insurer basically nothing, while somebody with a chronic condition can easily cost millions of dollars over decades. Costs can vary enormously depending on your luck, which is just the sort of thing insurance is good for. There are big problems with running the whole system using insurance, of course. It's fairly easy to predict future costs for a lot of people. Given free reign, insurers will charge completely unaffordable premiums to those people, effectively excluding them from the system. You see the same thing with other types of insurance: if you have a horrible driving record, or if your house is in an area that gets a devastating hurricane every ten years, your premiums will be huge. The difference is that those are optional activities, and if you can't afford the premiums then you can walk, bike, hitch a ride, buy a different house, etc. A sick person can't switch to a healthy body. That's why the ACA has the mandate. If you require everyone to pay in, then you can also require insurers to ignore certain predictors of future risk when determining premiums. Fundamentally, there are only two choices. One choice is to have lots of people dying of easily treated conditions because they can't afford the treatment, and the other choice is to have government step in and socialize the system to some extent. The system was already socialized before the ACA with the Emergency Medical Treatment and Labor Act, which requires hospital emergency rooms to treat all patients regardless of ability to pay. This was horribly inefficient, of course, but that's how it was. So: choose your poison. If you think the advantages of going full free market in health care outweigh having poor people die of easily treatable diseases, then that's a valid opinion, but you should acknowledge the negative consequences. If you want poor people to be able to obtain treatment, then you'll need to accept some interference, the only question is how you'd like to have it be structured. Edit: rather than "poor people," I really should say "people whom the hospital thinks are poor." If you get beaten up and mugged and left for dead, the ER won't know if you have money, and might decide not to take the risk. There are good reasons for even a selfish wealthy person to want some form of universal treatment.
- antisthenes 10y ago
  Actually that's not what makes it expensive. It leads to too many people making very poor health choices and becoming obese or engaging in palliative care to eek out 2 more miserable weeks of existence at enormous costs to healthcare providers. Young people, and especially young, healthy people are the ones subsidizing the elderly and the unhealthy, including most of those who are unhealthy by choice through poor decisions. > The point of insurance is to distribute risk Perverse incentives. Insurance needs to be structured in such a way as to incentivize people to take part in preventive care, which costs a fraction of treatment and palliative care.
toodlebunions 10y ago
You have that choice right now.
rrock 10y ago
I'd like for you, along with everyone else, to pay an increased income tax to cover health care for everyone (the way every other industrialized country does it). And before you reject that notion, try asking someone from one of those other industrialized countries if they'd like to swap their system for ours.

How will you ensure that paramedics won't take you to the hospital if you have a sudden event in the street?

Just to be sure - if you show up at the hospital w/o means of payment - even if in coma - are you going to be treated? If yes, then you have insurance and you're free-riding on the system. If no, then you're more barbaric than Reagan.

nyxtom 10y ago

That's not a sustainable choice for our economy, it leads to too many people living like nothing could possibly go wrong until they need a doctor. The point of insurance is to distribute risk, not participating in that effectively negates the effectiveness of the industry.

MR4D 10y ago
That's not quite true. For instance, life insurance takes a varying times for it to kick in (varies depending on type and amount, as well as which state's laws apply.) It's quite possible that your health insurance could be limited at first, and grows to cover more things and higher dollar amounts. And before anyone says you can't do this, go look at your dental insurance. Odds are that your coverage increases each year so long as you have two checkups annually and don't let a lapse of insurance occur. Note that as the ACA is __currently__ written, the situation the OP states probably exists.
- dlp211 10y ago
  And what happens when you're 18 and get cancer? Building up may work for dental because even in the most catastrophic case, the costs have a ceiling, but your overall health doesn't have these kinds of ceilings. Also, every dental plan I have ever had has lifetime maximums, something else that doesn't work with health insurance.
- mikeash 10y ago
  I've never heard of anyone getting hit with a million-dollar bill for dental work, so I don't think that's quite the existence proof you want it to be.
db48x 10y ago
You're making the assumption that nobody could possibly pay for their health care out of pocket. That's just not true, even with health care as expensive as it is these days.
- dlp211 10y ago
  With the exception of the most wealthy (ie, Bill Gates), I guarantee that there is a health issue that would bankrupt you. Also, if you are that wealthy, why wouldn't you insure your health? It would be a pittance compared to your overall wealth and just simply a prudent thing to do. I bet you that Bill Gates and Warren Buffet have health insurance.
lend000 10y ago
The whole idea of health insurance is backwards and inconsistent with a free market in my opinion (fraudulent). The problem is that the government has enshrined it as the gateway to healthcare. Insurance is a useful product for mitigating risk, so accident insurance could be a very constructive concept (protecting against accidental injuries, broken arms, falls, car crashes, etc.). However, health problems are not a risk; they are a guarantee with probability approaching one as you age. The whole point of insurance is that you mitigate risk by paying more than you take out on average, but that doesn't make sense for healthcare, where almost everyone ends up going over their limit near the end of their lives. If we didn't have all of these subsidies everywhere and inflated demand from Medicare/Medicaid/restrictive occupational licensing/FDA-granted monopolies/ACA, then perhaps we could pay everything out of pocket, which would make a lot more sense.
- mikeash 10y ago
  The basic concept of health insurance works fine. Yes, your probability of dying approaches 1 as you age, but the costs you incur along the way can vary enormously. Somebody who's wonderfully healthy until they instantly die in bed of a heart attack will cost the insurer basically nothing, while somebody with a chronic condition can easily cost millions of dollars over decades. Costs can vary enormously depending on your luck, which is just the sort of thing insurance is good for. There are big problems with running the whole system using insurance, of course. It's fairly easy to predict future costs for a lot of people. Given free reign, insurers will charge completely unaffordable premiums to those people, effectively excluding them from the system. You see the same thing with other types of insurance: if you have a horrible driving record, or if your house is in an area that gets a devastating hurricane every ten years, your premiums will be huge. The difference is that those are optional activities, and if you can't afford the premiums then you can walk, bike, hitch a ride, buy a different house, etc. A sick person can't switch to a healthy body. That's why the ACA has the mandate. If you require everyone to pay in, then you can also require insurers to ignore certain predictors of future risk when determining premiums. Fundamentally, there are only two choices. One choice is to have lots of people dying of easily treated conditions because they can't afford the treatment, and the other choice is to have government step in and socialize the system to some extent. The system was already socialized before the ACA with the Emergency Medical Treatment and Labor Act, which requires hospital emergency rooms to treat all patients regardless of ability to pay. This was horribly inefficient, of course, but that's how it was. So: choose your poison. If you think the advantages of going full free market in health care outweigh having poor people die of easily treatable diseases, then that's a valid opinion, but you should acknowledge the negative consequences. If you want poor people to be able to obtain treatment, then you'll need to accept some interference, the only question is how you'd like to have it be structured. Edit: rather than "poor people," I really should say "people whom the hospital thinks are poor." If you get beaten up and mugged and left for dead, the ER won't know if you have money, and might decide not to take the risk. There are good reasons for even a selfish wealthy person to want some form of universal treatment.
antisthenes 10y ago
Actually that's not what makes it expensive. It leads to too many people making very poor health choices and becoming obese or engaging in palliative care to eek out 2 more miserable weeks of existence at enormous costs to healthcare providers. Young people, and especially young, healthy people are the ones subsidizing the elderly and the unhealthy, including most of those who are unhealthy by choice through poor decisions. > The point of insurance is to distribute risk Perverse incentives. Insurance needs to be structured in such a way as to incentivize people to take part in preventive care, which costs a fraction of treatment and palliative care.

toodlebunions 10y ago

You have that choice right now.

rrock 10y ago

I'd like for you, along with everyone else, to pay an increased income tax to cover health care for everyone (the way every other industrialized country does it). And before you reject that notion, try asking someone from one of those other industrialized countries if they'd like to swap their system for ours.