4 ms·

I agree it's a bit big brotherish. For a while after we sold Viaweb I didn't have health insurance, because I figured I had enough in effect to be my own insur

by pg 17y ago

I agree it's a bit big brotherish. For a while after we sold Viaweb I didn't have health insurance, because I figured I had enough in effect to be my own insurer. I ended up getting health insurance eventually, because I found the system won't treat you without it; you can't simply offer to pay doctors with a credit card, the way you can with dentists. But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently, or we could end up with a string of Ruby Ridges.

Zak 17y ago
I found the system won't treat you without it Now there is something that could use some reform. I have a hard time picturing a good solution coming from a government though; something that looks like more like a union than an insurance company might be effective.
- protomyth 17y ago
  I really think they need to look at the input costs to health care and take a serious look at tort reform. For a look at how bad hysteria and court run amok can be look at the history of asbestos cases.
jerf 17y ago
It's going to be difficult for them not to enforce it, if something like this actually goes into effect. Getting those who think they can go without insurance to pay into the system is one of the major ways it is going to get paid for. (It is, objectively, a wealth transfer from young people to old people. I find myself wondering if youth support for the bill would drop somewhat if youth realized what was being done to them. I'm not "old" but I'm past the age where I feel I can go without now, so I guess I'm out of this "youth", but I still don't like it. I am young enough that I don't foresee a single penny of this ever being around when I'm actually old enough to need it, since there's just no way in hell either the current system or this new one if it passes will hold up until 2045.) One interesting scenario I saw (don't recall where, sorry) pointed out that the entire idea of forcing purchase of coverage like this is very Constitutionally dubious. (Where "dubious" means that I actually can't even come up with an argument I disagree with that the Federal government can do this based on the Constitution.) So it is possible this provision could be struck down, but leave the rest of the bill intact, committing to massive outlays with no way to pay for it.
- elblanco 17y ago
  >I find myself wondering if youth support for the bill would drop somewhat if youth realized what was being done to them. Probably not since: a) The youth are the least likely to have insurance. b) The least likely to be able to afford it (they usually have jobs that make less money). c) Since they meet both a & b, they'll likely be eligible for the credit/handout that they can use to buy the insurance (if that's still in the plan, hard to keep track of and I don't feel like reading through 80 different versions of a 2000 page bill). Thus it's more a transfer of wealth into the insurance companies. Even with a public option (which I believe in the last rev of the bill, states could opt out of), most people will probably just end up with private insurance. > So it is possible this provision could be struck down, but leave the rest of the bill intact, committing to massive outlays with no way to pay for it. This is probably where this will be in 3-4 years. Which will give lots of opportunity then for the opposition to be able to point out how expensive this all is. sigh Not a really helpful attitude towards engineering a solution, but the GOP hasn't been on top of this issue at all in the last 30 years while every other industrialized country on Earth has at least given it a good go.
  - jerf 17y ago
    It's not that hard for even a youth to get a job that gets you past the subsidy provisions... well, at least in a normal economy... but I hear what you're saying. Part of what I'm saying though is it is not just an instantaneous transfer; as "youth" move up into their 30s and 40s, they'll be transferring wealth up the chain, and in their 30s and 40s probably still not needing a lot of medical services on average. It's not just today, it's the next 30 years of your life that you'll be experiencing a high marginal tax rate. Which as we all know, under Democratic theories of economics, nobody ever considers the question of marginal tax rates when making decisions about their jobs, of course. "Not a really helpful attitude towards engineering a solution, but the GOP hasn't been on top of this issue at all in the last 30 years while every other industrialized country on Earth has at least given it a good go." Well, I've actually liked the GOP proposals that I've read. Yes, the ones that do in fact exist. (Claims that the GOP have offered no solutions are one of the most blatant lies of the entire process; it's simply objectively false. You may not like them but they exist. Another example of our media being either incredibly biased or totally unwilling to follow up on the statements of politicians.... reader's choice.) It's not particularly relevant because if they had to craft a bill that might actually pass in the real world it would get bogged down in all kinds of crap, but there's so much low hanging fruit in the system that the current bill still manages to fail to address in 2000 pages, such as tort reform.
davidw 17y ago
Leaving aside whether people like the government to do things for them or not (there are many internet libertarians here who obviously do not), is requiring you to purchase something really that different from just taxing you and purchasing it for you? For instance, I am not happy about having purchased a share of a war in Iraq or numerous other things the government spends my money on. Also, a point for consideration: you're pretty much required to own car insurance if you want to drive.
- Zak 17y ago
  If you want to drive, but this would require health insurance simply for being alive, the alternative to which most of us do not consider an acceptable option. It's also noteworthy that in most states, you can demonstrate an ability to pay for a certain amount of damage in lieu of car insurance.
  - swombat 17y ago
    If you don't consider being dead an acceptable option, then health insurance sounds just right for you! Seriously, this debate only makes sense in a context where you consider health insurance to be an "optional extra". It's not. Health insurance is as basic as roads and garbage collection, fire departments and a police force. Out of the whole developed world, it's only in America that something as fundamental as health insurance is considered an optional extra.
    - pmorici 17y ago
      There are people that compost and bring what little trash they have to the dump themselves. There are people that ride bikes instead of driving cars. There are people that are their own fire department. Why is it so had to imagine that health insurance might be optional foe some people.
      - swombat 17y ago
        Ok. Doctors don't have to get health insurance. The rest of us, who can't treat ourselves without external assistance (and also those amongst the doctor who expect that they might at some point get ill enough to require assistance from another human being), the rest of us need health insurance.
radu_floricica 17y ago
I live in a country with universal health care (Romania). Being forced to pay insurance is annoying, in theory. What happens in practice is if you don't pay it and need insured medical care you have to pay for the last 6 years, with penalty (about double, in the worst case). That would be the "fine". Not being employed I was able to delay paying for about a year, without penalty and being insured in the meantime. What you get for it is the knowledge that you'll never have to budget for medical expenses. I did have to pay occasionally, like when I wanted a better yearly checkup, but it's never been an amount I couldn't just take out of my pocket. Anyways, I always felt that if there's something worth paying for it's a healthy society. At least as much as all the other givens: police, military or emergency services.
- jlees 17y ago
  There's also the option of the way the UK does it. You pay insurance. It's even called that - National Insurance. There is no alternative. Not having a National Insurance number is like not having a SSN. If you are in specific situations (student, low income, self-employed below a certain threshold etc) you become exempt from stamp, but it's still insurance. It's so well-entrenched and forgettable (comes out along with tax and student loan repayments - but I shouldn't stir that hornets' nest!) that hardly anyone realises what it is, or its origins as, quite descriptively, a nationalised form of healthcare and unemployment insurance.
  - radu_floricica 17y ago
    It's the same thing here. I was describing this from a freelancer's point of view, who has to actually take out the money, but if you're in the system in any way (employed, unemployed, student) you don't even know you pay it.
- ckinnan 17y ago
  Romania's society isn't especially healthy (life expectancy is lower than the U.S.). Neither is its economy, with a per capita GDP of less than $12,000 a year. Don't buy the myths of government-run health care. It increases corruption and political control of our lives, the new taxes hurt entrepreneurs, and it will reduce overall health care innovation. The US system needs reform but the bill passed last night does nothing to address the drivers of higher costs. Instead it forces more people and resources into the current system.
Calamitous 17y ago
I found the system won't treat you without it I find this assertion strange... my wife and I lived for several years on a cash-only basis with little trouble. Granted, there were no catastrophic expenses, but we never had any trouble paying cash for ordinary doctor's visits and the occasional minor emergency.
deleted 17y ago
[deleted]
Create 17y ago
the reason behind this is simple. A basic task of the state (a framework for society) is to insure[sic] that its people can live (even at the eventual price of others' lives, albeit in other states). This is why the state would (normally :) not kill you, and to the contrary, has to do everything to keep you alive (think euthanasia controversy, obesity, tobacco and alcohol price in healthcare). Therefore, when you fall ill, in most normal[!] societies, people would have to help you -- even before validating your PIN code, or even if you are not holder of a visa or mastercard (are there any other credit cards left?). Like the neighboring lady looking after the kids you were alluding to once. And this inevitably has monetary costs to the society: this is why the compulsory health insurance. The downside is, that it is wide open to abuse by those who only wish to profit themselves from society. Many countries in Europe introduced universal healthcare after the World Wars, because they learned the hard way, that health and lives and peace are the most important in [to] the world (and ie. not getting rich from online pr0n trade). A great wealth has been amassed, and it has become too tempting to chip off bits and pieces (as always with any huge value) hoping it will go unnoticed. This has happened in most countries (.de, .uk) along with the pension funds (think Enron: the millions who lost their pension savings). Currently there are little safeguards against these white collar crimes (no coincidence either, the politicians don't really make laws against their own interests).
jules 17y ago
What happens now if you don't have insurance and you need medical treatment? For example what happens if you're in a car accident, do they first ask you whether you have insurance? What do they do if you don't have health insurance & don't have enough money to pay for the treatment? 1) You die? 2) They take you to the hospital and treat you If it's (2), who pays for you? If the answer is the taxpayers then that's a reason for making not having insurance illegal. It's the same reason why car insurance isn't optional.
- davetufts 17y ago
  But a 2.5% penalty for someone who makes $150,000 is a great deal for emergency care. Obviously family and kids change the decision-making process, but if I were single and making $150k, I'd rather pay a $3750 penalty and get free emergency room care (as anyone can today) than pay an insurance company $600/month. In the end, passing a law that create more demand for private insurance services has little chance of driving the price down.
  - jules 17y ago
    I don't know. We have this kind of health care bill in the Netherlands and I'm paying ~70 euros per month (not sure exactly). Edit: that also includes liability insurance etc.
- jamesbritt 17y ago
  "It's the same reason why car insurance isn't optional." You can choose not to drive.
DanielBMarkham 17y ago
...But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently... I'm still trying to wrap my head around that sentence. Are you saying it's bad for government to take away all those freedoms? Or are you saying that it's a little bad for government to come strip you of your property, but hopefully they won't do it too much? It sounds like you are equivocating. Either it's more bad than good or not. Right? And -- assuming you reply -- if it's just a little bad, where is the line where you know the government is overstepping where it should go? If your party does a little bad this year, and the other guy's party does a little bad next year, after 100 years we're not going to be in such a good spot, are we? (Made even worse by having nobody to actually blame for our predicament) But hopefully nobody will enforce all those laws too much? (scratches head)
tptacek 17y ago
Wait wait wait wait wait wait. You had 7-8 figures in your brokerage account, and that was when you decided you didn't need health insurance?
- pg 17y ago
  Sure. Insurance is just a way of pooling risk. If you have enough money you don't need it. If you're an average risk, you save both the insurance company's profit and the tax you'd have to pay on the money you'd have to make to pay them.
  - tptacek 17y ago
    A normal person has maybe ~$70k to lose if they get seriously ill or injured without insurance. You have millions to lose. I'm not making a moral judgement. It just seems crazy that you'd risk losing so much money just to avoid an expense that had to have been a rounding error to you at the time.
adammichaelc 17y ago
Luckily it likely won't get to that: http://news.google.com/nwshp?hl=en&tab=wn http://news.google.com/nwshp?hl=en&tab=wn

by pg 17y ago

Zak 17y ago

I found the system won't treat you without it Now there is something that could use some reform. I have a hard time picturing a good solution coming from a government though; something that looks like more like a union than an insurance company might be effective.

protomyth 17y ago
I really think they need to look at the input costs to health care and take a serious look at tort reform. For a look at how bad hysteria and court run amok can be look at the history of asbestos cases.

jerf 17y ago

It's going to be difficult for them not to enforce it, if something like this actually goes into effect. Getting those who think they can go without insurance to pay into the system is one of the major ways it is going to get paid for. (It is, objectively, a wealth transfer from young people to old people. I find myself wondering if youth support for the bill would drop somewhat if youth realized what was being done to them. I'm not "old" but I'm past the age where I feel I can go without now, so I guess I'm out of this "youth", but I still don't like it. I am young enough that I don't foresee a single penny of this ever being around when I'm actually old enough to need it, since there's just no way in hell either the current system or this new one if it passes will hold up until 2045.) One interesting scenario I saw (don't recall where, sorry) pointed out that the entire idea of forcing purchase of coverage like this is very Constitutionally dubious. (Where "dubious" means that I actually can't even come up with an argument I disagree with that the Federal government can do this based on the Constitution.) So it is possible this provision could be struck down, but leave the rest of the bill intact, committing to massive outlays with no way to pay for it.

elblanco 17y ago
>I find myself wondering if youth support for the bill would drop somewhat if youth realized what was being done to them. Probably not since: a) The youth are the least likely to have insurance. b) The least likely to be able to afford it (they usually have jobs that make less money). c) Since they meet both a & b, they'll likely be eligible for the credit/handout that they can use to buy the insurance (if that's still in the plan, hard to keep track of and I don't feel like reading through 80 different versions of a 2000 page bill). Thus it's more a transfer of wealth into the insurance companies. Even with a public option (which I believe in the last rev of the bill, states could opt out of), most people will probably just end up with private insurance. > So it is possible this provision could be struck down, but leave the rest of the bill intact, committing to massive outlays with no way to pay for it. This is probably where this will be in 3-4 years. Which will give lots of opportunity then for the opposition to be able to point out how expensive this all is. sigh Not a really helpful attitude towards engineering a solution, but the GOP hasn't been on top of this issue at all in the last 30 years while every other industrialized country on Earth has at least given it a good go.
- jerf 17y ago
  It's not that hard for even a youth to get a job that gets you past the subsidy provisions... well, at least in a normal economy... but I hear what you're saying. Part of what I'm saying though is it is not just an instantaneous transfer; as "youth" move up into their 30s and 40s, they'll be transferring wealth up the chain, and in their 30s and 40s probably still not needing a lot of medical services on average. It's not just today, it's the next 30 years of your life that you'll be experiencing a high marginal tax rate. Which as we all know, under Democratic theories of economics, nobody ever considers the question of marginal tax rates when making decisions about their jobs, of course. "Not a really helpful attitude towards engineering a solution, but the GOP hasn't been on top of this issue at all in the last 30 years while every other industrialized country on Earth has at least given it a good go." Well, I've actually liked the GOP proposals that I've read. Yes, the ones that do in fact exist. (Claims that the GOP have offered no solutions are one of the most blatant lies of the entire process; it's simply objectively false. You may not like them but they exist. Another example of our media being either incredibly biased or totally unwilling to follow up on the statements of politicians.... reader's choice.) It's not particularly relevant because if they had to craft a bill that might actually pass in the real world it would get bogged down in all kinds of crap, but there's so much low hanging fruit in the system that the current bill still manages to fail to address in 2000 pages, such as tort reform.

davidw 17y ago

Leaving aside whether people like the government to do things for them or not (there are many internet libertarians here who obviously do not), is requiring you to purchase something really that different from just taxing you and purchasing it for you? For instance, I am not happy about having purchased a share of a war in Iraq or numerous other things the government spends my money on. Also, a point for consideration: you're pretty much required to own car insurance if you want to drive.

Zak 17y ago
If you want to drive, but this would require health insurance simply for being alive, the alternative to which most of us do not consider an acceptable option. It's also noteworthy that in most states, you can demonstrate an ability to pay for a certain amount of damage in lieu of car insurance.
- swombat 17y ago
  If you don't consider being dead an acceptable option, then health insurance sounds just right for you! Seriously, this debate only makes sense in a context where you consider health insurance to be an "optional extra". It's not. Health insurance is as basic as roads and garbage collection, fire departments and a police force. Out of the whole developed world, it's only in America that something as fundamental as health insurance is considered an optional extra.
  - pmorici 17y ago
    There are people that compost and bring what little trash they have to the dump themselves. There are people that ride bikes instead of driving cars. There are people that are their own fire department. Why is it so had to imagine that health insurance might be optional foe some people.
    - swombat 17y ago
      Ok. Doctors don't have to get health insurance. The rest of us, who can't treat ourselves without external assistance (and also those amongst the doctor who expect that they might at some point get ill enough to require assistance from another human being), the rest of us need health insurance.

radu_floricica 17y ago

I live in a country with universal health care (Romania). Being forced to pay insurance is annoying, in theory. What happens in practice is if you don't pay it and need insured medical care you have to pay for the last 6 years, with penalty (about double, in the worst case). That would be the "fine". Not being employed I was able to delay paying for about a year, without penalty and being insured in the meantime. What you get for it is the knowledge that you'll never have to budget for medical expenses. I did have to pay occasionally, like when I wanted a better yearly checkup, but it's never been an amount I couldn't just take out of my pocket. Anyways, I always felt that if there's something worth paying for it's a healthy society. At least as much as all the other givens: police, military or emergency services.

jlees 17y ago
There's also the option of the way the UK does it. You pay insurance. It's even called that - National Insurance. There is no alternative. Not having a National Insurance number is like not having a SSN. If you are in specific situations (student, low income, self-employed below a certain threshold etc) you become exempt from stamp, but it's still insurance. It's so well-entrenched and forgettable (comes out along with tax and student loan repayments - but I shouldn't stir that hornets' nest!) that hardly anyone realises what it is, or its origins as, quite descriptively, a nationalised form of healthcare and unemployment insurance.
- radu_floricica 17y ago
  It's the same thing here. I was describing this from a freelancer's point of view, who has to actually take out the money, but if you're in the system in any way (employed, unemployed, student) you don't even know you pay it.
ckinnan 17y ago
Romania's society isn't especially healthy (life expectancy is lower than the U.S.). Neither is its economy, with a per capita GDP of less than $12,000 a year. Don't buy the myths of government-run health care. It increases corruption and political control of our lives, the new taxes hurt entrepreneurs, and it will reduce overall health care innovation. The US system needs reform but the bill passed last night does nothing to address the drivers of higher costs. Instead it forces more people and resources into the current system.

Calamitous 17y ago

I found the system won't treat you without it I find this assertion strange... my wife and I lived for several years on a cash-only basis with little trouble. Granted, there were no catastrophic expenses, but we never had any trouble paying cash for ordinary doctor's visits and the occasional minor emergency.

deleted 17y ago

[deleted]

Create 17y ago

the reason behind this is simple. A basic task of the state (a framework for society) is to insure[sic] that its people can live (even at the eventual price of others' lives, albeit in other states). This is why the state would (normally :) not kill you, and to the contrary, has to do everything to keep you alive (think euthanasia controversy, obesity, tobacco and alcohol price in healthcare). Therefore, when you fall ill, in most normal[!] societies, people would have to help you -- even before validating your PIN code, or even if you are not holder of a visa or mastercard (are there any other credit cards left?). Like the neighboring lady looking after the kids you were alluding to once. And this inevitably has monetary costs to the society: this is why the compulsory health insurance. The downside is, that it is wide open to abuse by those who only wish to profit themselves from society. Many countries in Europe introduced universal healthcare after the World Wars, because they learned the hard way, that health and lives and peace are the most important in [to] the world (and ie. not getting rich from online pr0n trade). A great wealth has been amassed, and it has become too tempting to chip off bits and pieces (as always with any huge value) hoping it will go unnoticed. This has happened in most countries (.de, .uk) along with the pension funds (think Enron: the millions who lost their pension savings). Currently there are little safeguards against these white collar crimes (no coincidence either, the politicians don't really make laws against their own interests).

jules 17y ago

What happens now if you don't have insurance and you need medical treatment? For example what happens if you're in a car accident, do they first ask you whether you have insurance? What do they do if you don't have health insurance & don't have enough money to pay for the treatment? 1) You die? 2) They take you to the hospital and treat you If it's (2), who pays for you? If the answer is the taxpayers then that's a reason for making not having insurance illegal. It's the same reason why car insurance isn't optional.

davetufts 17y ago
But a 2.5% penalty for someone who makes $150,000 is a great deal for emergency care. Obviously family and kids change the decision-making process, but if I were single and making $150k, I'd rather pay a $3750 penalty and get free emergency room care (as anyone can today) than pay an insurance company $600/month. In the end, passing a law that create more demand for private insurance services has little chance of driving the price down.
- jules 17y ago
  I don't know. We have this kind of health care bill in the Netherlands and I'm paying ~70 euros per month (not sure exactly). Edit: that also includes liability insurance etc.
jamesbritt 17y ago
"It's the same reason why car insurance isn't optional." You can choose not to drive.

DanielBMarkham 17y ago

...But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently... I'm still trying to wrap my head around that sentence. Are you saying it's bad for government to take away all those freedoms? Or are you saying that it's a little bad for government to come strip you of your property, but hopefully they won't do it too much? It sounds like you are equivocating. Either it's more bad than good or not. Right? And -- assuming you reply -- if it's just a little bad, where is the line where you know the government is overstepping where it should go? If your party does a little bad this year, and the other guy's party does a little bad next year, after 100 years we're not going to be in such a good spot, are we? (Made even worse by having nobody to actually blame for our predicament) But hopefully nobody will enforce all those laws too much? (scratches head)

tptacek 17y ago

Wait wait wait wait wait wait. You had 7-8 figures in your brokerage account, and that was when you decided you didn't need health insurance?

pg 17y ago
Sure. Insurance is just a way of pooling risk. If you have enough money you don't need it. If you're an average risk, you save both the insurance company's profit and the tax you'd have to pay on the money you'd have to make to pay them.
- tptacek 17y ago
  A normal person has maybe ~$70k to lose if they get seriously ill or injured without insurance. You have millions to lose. I'm not making a moral judgement. It just seems crazy that you'd risk losing so much money just to avoid an expense that had to have been a rounding error to you at the time.

adammichaelc 17y ago

Luckily it likely won't get to that: http://news.google.com/nwshp?hl=en&tab=wn http://news.google.com/nwshp?hl=en&tab=wn