5 ms·

That's one of the reasons why subsidising and regulating private health insurance is not a good approach. If the government worked the way it was supposed to (r

by Weltan 13y ago

That's one of the reasons why subsidising and regulating private health insurance is not a good approach. If the government worked the way it was supposed to (rationally), then they would have voted for a public insurance option. They went half-way, and everyone will now pay the price.

yummyfajitas 13y ago
300bps is complaining about the fact that as a person with a low actuarial cost, he is being forced to subsidize others with a high actuarial cost. I too share this complaint - I wake up and hit the gym from 8-9:30 every day - as a reward for taking care of myself, I'm obligated to subsidize diabetes treatment for people who wake up and eat donuts. How would a public insurance option change this?
- jjoonathan 13y ago
  You've got it backwards: fat people and smokers cost less to cover because their bodies tend to fail more quickly and the most costly health care centers around slightly prolonging the lives of healthy people. Economically speaking, you should be penalized for your healthy habits. Of course, that doesn't fit in to the "we care about your health" line that insurers like to toss around, so they often just lie about what makes them money and use fat/smoker fines as a selling point aimed at healthy people. You've been had. http://www.outsidethebeltway.com/fat_people_smokers_have_lower_medical_bills/ http://www.outsidethebeltway.com/fat_people_smokers_have_low...
  - yummyfajitas 13y ago
    You are conflating the overall cost with the per-year cost. Per-year, fatties and smokers cost more. Since insurance premiums are also paid on a per-year basis, per-year is the relevant point of comparison. Of course, in a single payer system which only receives payments from people while they work, it would in fact be beneficial to induce people to die earlier.
    - rdl 13y ago
      Insurance premiums are insignificant for lifelong unhealthy people who heavily use healthcare. A $500/mo/person premium (which is about the maximum you could get per individual in the new system) is $240k total for 40 years. There's no compounding since the price of healthcare goes up faster than regulated premiums, and because expenses per-year exceed the premiums. $6k covers not a lot of care in a year, and the whole lifetime number is blown away by one serious event.
    - jjoonathan 13y ago
      > You are conflating the overall cost with the per-year cost. Performing the division to approximate yearly costs from the source I linked does not support your point. Obese people may have had the highest costs, but not the highest average yearly costs. In a single payer health system, the "insurance provider" sees ROI from peoples' productivity, meaning the single payer system has incentive to keep people healthy even if it costs more. OTOH, private insurance wants to dump you as quickly as legally possible the moment your costs exceed your premiums weather you are healthy or not.
      - yummyfajitas 13y ago
        I stand corrected. I misinterpreted this sentence: "The researchers found that from age 20 to 56, obese people racked up the most expensive health costs." I should indeed have done the math. You are correct that for long term health insurance contracts (i.e., contracts which are guaranteed to cover people past the age of 56 at a fixed cost), fatties and smokers should pay less. In a single payer health system, the "insurance provider" sees ROI from peoples' productivity, meaning the single payer system has incentive to keep people healthy even if it costs more. This makes no sense. According to your link, the healthy people cost more due to medical costs incurred during their unproductive years. There is no incentive for a single payer system to keep people alive in their unproductive years.
- Weltan 13y ago
  The real solution is single-payer, a public option may have eased transition into single-payer sometime in the future, whereas a sudden transition into single-payer would have shocked the economy and been nigh impossible (it wasn't even suggested). In my country we have single-payer. Despite this, I take care of myself, perhaps not as well as you do, but I'm close. I don't expect some sort of reward for taking proper care of myself, nor do I expect others to take the same kind of care because people are often careless. Health care is a right, whether you smoke, go to the gym, eat donuts or eat broccoli.
- mjn 13y ago
  > people who wake up and eat donuts Unlucky people, in addition. Some people I know currently excluded by the preexisting condition issue: a person with MS, and a person with a congenital heart condition. They can get coverage only via employer group plans and cannot work for themselves, i.e. they are mandated to work for either a government or a corporation. That's a bizarre intrusion on personal liberty, much more severe than some taxes, and the fact that it's somehow a "natural" one doesn't make an ethical difference. See F.A. Hayek for a more extensive argument on a mechanism to cover "risks common to all" as a prerequisite for an individualist society, because the alternative is forcing people into nonconsensual collectivist arrangements (like having to work for a company to get a group health plan, or having to stay affiliated with the Mormon church or family clan to receive safety nets via such groups). But hey, continue to rationalize your greed by despising everyone less fortunate than yourself as your lesser. People with MS should've gone to the gym more; poor people should've worked harder; you are John Galt.
- yequalsx 13y ago
  It wouldn't change that and this is a good thing. Part of being in a society is shared responsibilities. I subsidize the education of other peoples' children by paying taxes that fund k-12 education. I have no children of my own. But I'm not being cheated because a society that has universal, free k-12 education is better than one that doesn't. Similarly a society that has free, universal healthcare is better than one that doesn't. In the current system the U.S. spends around 40% more GDP per year on healthcare than any universal healthcare system and has much lower outcomes than many. The evidence is that it would be cheaper and better to have a single payer system. It's great that you workout and lead a healthy life. What are you doing to counter genetic defects you may possess? Perhaps you have a predisposition to cancer or some rare disease that is expensive to cover. The reward in a single payer system is that everyone gets covered regardless of genetic or life circumstances. Every person for themself makes us all(almost all!) poorer.
  - ahallock 13y ago
    I agree with the shared responsibilities, but you make it sound as if you are voluntarily subsidizing other peoples' children when in fact you are forced to. If you would contribute to the education and the health costs of others, why do you need to be forced to do it? And if people agree with you, they will do so without a gang of people coercing them to. So cut out the middleman. > Similarly a society that has free, universal healthcare is better than one that doesn't. That's a pretty broad, unsubstantiated statement. And how is it free? Nothing is free; that's just propaganda.
    - yequalsx 13y ago
      We all know that nothing, ultimately is free. However, the colloquial usage of the term means free means that the person receiving a free service means they don't fork over money specifically for that service. Free healthcare means, in essence, a person receiving it is not in danger of going bankrupt or of having significantly less money as a result of the care. I did not make it seem like I pay for k-12 education voluntarily. the opposite is true. It was an essential part of my point that it isn't done voluntarily. It should be forced because some greedy self-centered person will refuse to pay for it. It's called the free rider problem. Societies that don't have free, universal healthcare overwhelmingly have worse health outcomes, and are crappier places to live.
- logn 13y ago
  > How would a public insurance option change this? Because when the guy who eats donuts has some numbness in his foot due to Type 2 diabetes, he's going to go to a doctor for advice since he has insurance. The doctor could catch him early enough to prevent the most devastating parts of diabetes and saving you more money than had he woken up one day unable to walk and called 911 and received an amputation that the state picked up the tab for. This applies for everything. Poor people regularly never see doctors in their offices. They go to the ER when it's nearly too late and rack up huge bills in the most expensive facilities. We don't turn away patients with emergencies. The hospital will bill you and the state will cover you if you don't pay. Edit: Here's a public health idea: tax sugar (or crops such as corn turned into sugar). We tax cigarettes; it's only fair in my opinion. And the tax on cigarettes makes e-cigarettes very economical.
- a3n 13y ago
  Diabetics who wake up and eat donuts is an ignorant stereotype. There are many paths to diabetes, some of which involve donuts. As for subsidizing people, younger people are also subsidizing their older future selves, so it's not entirely win-lose.
insla 13y ago
Government-provided insurance is not necessarily better than properly regulated private insurance. Consider the current situation in California vs. Illinois. Under the federal HIPAA law, individuals coming off group plans must have an option available to purchase a new plan without the possibility of denial due to pre-existing conditions. It is up to each state, however, to decide exactly how this will be implemented. In Illinois, it is implemented as a state-provided insurance plan. In California, it is implemented through regulation of private insurance companies. I have a very costly pre-existing condition and I can tell you which one I'd rather be on: California. The reason is that the Illinois government is basically insolvent. Right now they are engaged in a political battle where even the state's lawmakers are threatened with not receiving a paycheck due to budgetary issues. This does not inspire my confidence that I want my health insurance provided by that organization (the state). However, in California, I have Blue Shield, and no worries about its imminent dysfunction due to budget problems and political games. The insurance I get is expensive compared to what is optimal, but at least it is there.

by Weltan 13y ago

yummyfajitas 13y ago

300bps is complaining about the fact that as a person with a low actuarial cost, he is being forced to subsidize others with a high actuarial cost. I too share this complaint - I wake up and hit the gym from 8-9:30 every day - as a reward for taking care of myself, I'm obligated to subsidize diabetes treatment for people who wake up and eat donuts. How would a public insurance option change this?

jjoonathan 13y ago
You've got it backwards: fat people and smokers cost less to cover because their bodies tend to fail more quickly and the most costly health care centers around slightly prolonging the lives of healthy people. Economically speaking, you should be penalized for your healthy habits. Of course, that doesn't fit in to the "we care about your health" line that insurers like to toss around, so they often just lie about what makes them money and use fat/smoker fines as a selling point aimed at healthy people. You've been had. http://www.outsidethebeltway.com/fat_people_smokers_have_lower_medical_bills/ http://www.outsidethebeltway.com/fat_people_smokers_have_low...
- yummyfajitas 13y ago
  You are conflating the overall cost with the per-year cost. Per-year, fatties and smokers cost more. Since insurance premiums are also paid on a per-year basis, per-year is the relevant point of comparison. Of course, in a single payer system which only receives payments from people while they work, it would in fact be beneficial to induce people to die earlier.
  - rdl 13y ago
    Insurance premiums are insignificant for lifelong unhealthy people who heavily use healthcare. A $500/mo/person premium (which is about the maximum you could get per individual in the new system) is $240k total for 40 years. There's no compounding since the price of healthcare goes up faster than regulated premiums, and because expenses per-year exceed the premiums. $6k covers not a lot of care in a year, and the whole lifetime number is blown away by one serious event.
  - jjoonathan 13y ago
    > You are conflating the overall cost with the per-year cost. Performing the division to approximate yearly costs from the source I linked does not support your point. Obese people may have had the highest costs, but not the highest average yearly costs. In a single payer health system, the "insurance provider" sees ROI from peoples' productivity, meaning the single payer system has incentive to keep people healthy even if it costs more. OTOH, private insurance wants to dump you as quickly as legally possible the moment your costs exceed your premiums weather you are healthy or not.
    - yummyfajitas 13y ago
      I stand corrected. I misinterpreted this sentence: "The researchers found that from age 20 to 56, obese people racked up the most expensive health costs." I should indeed have done the math. You are correct that for long term health insurance contracts (i.e., contracts which are guaranteed to cover people past the age of 56 at a fixed cost), fatties and smokers should pay less. In a single payer health system, the "insurance provider" sees ROI from peoples' productivity, meaning the single payer system has incentive to keep people healthy even if it costs more. This makes no sense. According to your link, the healthy people cost more due to medical costs incurred during their unproductive years. There is no incentive for a single payer system to keep people alive in their unproductive years.
Weltan 13y ago
The real solution is single-payer, a public option may have eased transition into single-payer sometime in the future, whereas a sudden transition into single-payer would have shocked the economy and been nigh impossible (it wasn't even suggested). In my country we have single-payer. Despite this, I take care of myself, perhaps not as well as you do, but I'm close. I don't expect some sort of reward for taking proper care of myself, nor do I expect others to take the same kind of care because people are often careless. Health care is a right, whether you smoke, go to the gym, eat donuts or eat broccoli.
mjn 13y ago
> people who wake up and eat donuts Unlucky people, in addition. Some people I know currently excluded by the preexisting condition issue: a person with MS, and a person with a congenital heart condition. They can get coverage only via employer group plans and cannot work for themselves, i.e. they are mandated to work for either a government or a corporation. That's a bizarre intrusion on personal liberty, much more severe than some taxes, and the fact that it's somehow a "natural" one doesn't make an ethical difference. See F.A. Hayek for a more extensive argument on a mechanism to cover "risks common to all" as a prerequisite for an individualist society, because the alternative is forcing people into nonconsensual collectivist arrangements (like having to work for a company to get a group health plan, or having to stay affiliated with the Mormon church or family clan to receive safety nets via such groups). But hey, continue to rationalize your greed by despising everyone less fortunate than yourself as your lesser. People with MS should've gone to the gym more; poor people should've worked harder; you are John Galt.
yequalsx 13y ago
It wouldn't change that and this is a good thing. Part of being in a society is shared responsibilities. I subsidize the education of other peoples' children by paying taxes that fund k-12 education. I have no children of my own. But I'm not being cheated because a society that has universal, free k-12 education is better than one that doesn't. Similarly a society that has free, universal healthcare is better than one that doesn't. In the current system the U.S. spends around 40% more GDP per year on healthcare than any universal healthcare system and has much lower outcomes than many. The evidence is that it would be cheaper and better to have a single payer system. It's great that you workout and lead a healthy life. What are you doing to counter genetic defects you may possess? Perhaps you have a predisposition to cancer or some rare disease that is expensive to cover. The reward in a single payer system is that everyone gets covered regardless of genetic or life circumstances. Every person for themself makes us all(almost all!) poorer.
- ahallock 13y ago
  I agree with the shared responsibilities, but you make it sound as if you are voluntarily subsidizing other peoples' children when in fact you are forced to. If you would contribute to the education and the health costs of others, why do you need to be forced to do it? And if people agree with you, they will do so without a gang of people coercing them to. So cut out the middleman. > Similarly a society that has free, universal healthcare is better than one that doesn't. That's a pretty broad, unsubstantiated statement. And how is it free? Nothing is free; that's just propaganda.
  - yequalsx 13y ago
    We all know that nothing, ultimately is free. However, the colloquial usage of the term means free means that the person receiving a free service means they don't fork over money specifically for that service. Free healthcare means, in essence, a person receiving it is not in danger of going bankrupt or of having significantly less money as a result of the care. I did not make it seem like I pay for k-12 education voluntarily. the opposite is true. It was an essential part of my point that it isn't done voluntarily. It should be forced because some greedy self-centered person will refuse to pay for it. It's called the free rider problem. Societies that don't have free, universal healthcare overwhelmingly have worse health outcomes, and are crappier places to live.
logn 13y ago
> How would a public insurance option change this? Because when the guy who eats donuts has some numbness in his foot due to Type 2 diabetes, he's going to go to a doctor for advice since he has insurance. The doctor could catch him early enough to prevent the most devastating parts of diabetes and saving you more money than had he woken up one day unable to walk and called 911 and received an amputation that the state picked up the tab for. This applies for everything. Poor people regularly never see doctors in their offices. They go to the ER when it's nearly too late and rack up huge bills in the most expensive facilities. We don't turn away patients with emergencies. The hospital will bill you and the state will cover you if you don't pay. Edit: Here's a public health idea: tax sugar (or crops such as corn turned into sugar). We tax cigarettes; it's only fair in my opinion. And the tax on cigarettes makes e-cigarettes very economical.
a3n 13y ago
Diabetics who wake up and eat donuts is an ignorant stereotype. There are many paths to diabetes, some of which involve donuts. As for subsidizing people, younger people are also subsidizing their older future selves, so it's not entirely win-lose.

insla 13y ago

Government-provided insurance is not necessarily better than properly regulated private insurance. Consider the current situation in California vs. Illinois. Under the federal HIPAA law, individuals coming off group plans must have an option available to purchase a new plan without the possibility of denial due to pre-existing conditions. It is up to each state, however, to decide exactly how this will be implemented. In Illinois, it is implemented as a state-provided insurance plan. In California, it is implemented through regulation of private insurance companies. I have a very costly pre-existing condition and I can tell you which one I'd rather be on: California. The reason is that the Illinois government is basically insolvent. Right now they are engaged in a political battle where even the state's lawmakers are threatened with not receiving a paycheck due to budgetary issues. This does not inspire my confidence that I want my health insurance provided by that organization (the state). However, in California, I have Blue Shield, and no worries about its imminent dysfunction due to budget problems and political games. The insurance I get is expensive compared to what is optimal, but at least it is there.