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Health Care For Everyone!
While I'm for paying for health care for the small number of people in our population who are hopelessly indigent -- for example, the mentally ill chronically homeless -- I see a difference between those who absolutely can't help themselves and those who'd really rather not. Crid had a great point yesterday about the sillythink of people clamoring for health care via government:

The public seem to think insurance will create wealth that can somehow be used to care for people who are otherwise penniless (and unproductive).

Here's a better solution for those who suggest the rest of us should pay for the Graeme Frosts of the world (the child of the guy who doesn't understand that you stop being able to have a hobby instead of a job when you don't use a condom). Yes, it's free health care for the middle class that's free because all of you charity-tarians are paying for it. Connie Marshner on "The Free Clinic Movement" at TCSDaily:

Warren County, Virginia, at the confluence of the North and South Forks of the Shenandoah River has neither the rolling hills of horse country nor the fertile plains of the Shenandoah Valley.

Of its 36,000 citizens, an estimated 6,000 are uninsured. Typically, when they get sick, the uninsured go to the emergency room, which is about the most inefficient and costly way of delivering primary medical care.

But, thanks to the initiative of some local Christians, the uninsured of Warren County can instead go to the St. Luke Community Clinic for free medical care. In FY 2006, 2,633 uninsured people did just that.

St. Luke Clinic is one of an estimated two thousand Free Clinics around the country, fifty of them in Virginia. In 2006, the total budget of all the Free Clinics in Virginia was about $18 million, which they leveraged to a value in excess of $80 million.

If all of you who are clamoring for national health care can't start your free clinic right away, no matter. Just stand outside an emergency room, and wait for some guy or girl who chose to spend their money on a nice new plasma screen instead of on health insurance to find their way there, and give them a big wad of your hard-earned cash! Me? I'm taking my hard-earned cash to the bank, and maybe making a wee stop at Loehmann's.

Posted by aalkon at November 7, 2007 1:23 PM

Comments

While I'm for paying for health care for the small number of people in our population who are hopelessly indigent -- for example, the mentally ill chronically homeless -- I see a difference between those who absolutely can't help themselves and those who'd really rather not.

Yup. That having been said, these people are doing this without using a dime of my tax dollars, and are keeping people out of the ER system (which ends up saving the insured because hospitals have fewer harder-to-get-paid bills to compensate for). I hear a lot of talk about "Christian charity," but this is it in action.

I think I was won over by this:

No social worker is employed by or volunteers at St. Luke.

Yes, yes, I know there are some diligent, dedicated social workers out there. But I can see why a doctor might enjoy the chance to provide medical care without having to deal with either the social worker network or crushing malpractice suits.

Posted by: marion at November 7, 2007 5:30 AM

I'm thinking the emergency rooms should run a 24 hour clinic right next door.

Posted by: doombuggy at November 7, 2007 5:43 AM

Yup. That having been said, these people are doing this without using a dime of my tax dollars, and are keeping people out of the ER system

I prefer this method, of course. In the meantime, I'm okay with the other.

Posted by: Amy Alkon Author Profile Page at November 7, 2007 6:43 AM

What should be done with the parents of the Graeme Frosts in this world - those parents who make irresponsible choices about their family health care and then expect others to pick up the tab? Take their kids away? Fine them if they don't buy insurance for their families? (I'm being provocative, but there's a point here, really) Charity is fine and all, but it only goes so far. I'm fine with adults who make bad choices having to live with the consequences of their acts - that's life. I don't know about letting children suffer, though, even if their parents are total freaking morons. Or perhaps I'm wrong - perhaps it would be good if we had some more examples of misery to point to so that parents who aren't stepping up to the plate can see what could happen if they don't get their shit together.

Posted by: justin case at November 7, 2007 8:49 AM

crid's point certainly isn't a great point, but that appears to go unrecongnized by any in this blog.

Posted by: ha at November 7, 2007 10:13 AM

I'm a libertarian except when it comes to children. Graeme Frost's daddy should be dragged off to get a job digging ditches or whatever it takes to make up for the overactivity of his penis minus a condom, in light of his inability to feed his children on his hobby of choice. I seem to remember some Ivy League schooling in his past. Surely, he could suit up and toe the line in something white-collar and a little more profitable than woodworking.

Posted by: Amy Alkon at November 7, 2007 10:59 AM

Regarding Crid's point, those dregs of humanity in terrible straits are few, I'd imagine, compared to all of those who are more able-bodied but think it would be great if somebody else fronted their health care costs.

Posted by: Amy Alkon at November 7, 2007 11:01 AM

> isn't a great point, but
> that appears to go
> unrecongnized

Oh heck, be bold and express yourself clearly. Do you think [A] insurance creates value for the treatment of those who create no value for themselves or [B] even though it doesn't, those with resources should cheerfully and endlessly pay for those without?

I still want to hear from an an economist about the fundamental meaning of insurance. I think people here are confusing the risks for which we insure with the risks of insurance as an investment. They're not the same thing.


(Also, your fondness for lowercase is noted.)

Posted by: Crid at November 7, 2007 11:30 AM

Thank you. I am so damn tired of people who can't bother themselves to hit the shift key -- especially when expecting me to toss them advice for free.


Posted by: Amy Alkon at November 7, 2007 11:45 AM

First and most important; I am so damn tired of people who can't bother themselves to hit the shift key...

No kidding. This has become a huge pet peeve of mine. Not only do they refuse to hit shift, they also expect to be taken seriously. Me thinks not.

Now for the health care discussion.

I am not sure why Crid's comment was such a gem. I mean it's true, but it's equally true that insurance doesn't create wealth to care for those who aren't penniless and pay their premiums. If they're exceedingly lucky, insurance premiums are a break even proposition. Insurance alone, will never bring any real profit. This is why the insurance industry is allowed to consider outside investments part of the cost of doing business.

As for the free clinics, they have several limitations, depending on where you are. In urban areas, they are often at capacity and have to lower the their income requirements to ensure they have to the ability to serve anyone.

Case in point was my pneumonia. At the time, I was working in a program that provided vocational training to young adults. I was providing on the job training in construction and remodeling. I received food and board for myself, as well as seventy-five dollars a week. I still had to feed my son when I had him, which was half the time (back when I was a single dad for a while). At the end of my one year commitment I would then get my contractors license, six months of insurance and would get preferential treatment for municipal and county contracts.

After they figured all of my pay together, I was making too much to qualify for service, as it came together at two hundred twenty-five a week. So I waited and went to the ER, when I wasn't getting any better. Because I didn't make enough and the doctors want to get paid, I had to fill out some forms so that the indigent trust would cover the cost.

I also think that it's increasingly pointless to get a number of affordable insurance plans. Many of them do not cover a lot of problems. The HSA I am getting into, is actually fairly comprehensive, but only possible for me, because I can afford to put fifteen hundred on ice, which will go up over the years as I drive my premiums down. Unfortunately, for many folks this is not possible.

The other thing to consider about a multi-tiered system(such as the one I advocate), is that most people will be paying their own way through taxes. It's just that the monies they pay would be used more efficiently.

Posted by: DuWayne at November 7, 2007 1:14 PM

Strawmen anyone? I don't know where Crid gets his/her ideas, but they sure aren't anything like the ideas of the single-payer crowd, of which I am one. And in case Amy wants to think again, we taxpayers don't just pay for health coverage for the poor, we pay for it for the elderly and veterans as well. Ask a senior citizen if he/she wants to give up Medicare in favor of private insurance.

The reason that single-payer is a good idea is that it has been proven to work in dozens of countries. As I never tire of repeating, those countries have better health-care outcomes than we do and they spend less per capita to get them. That alone should tell you single-payer is necessary. But also, in survey after survey, Americans are far less satisfied with our healthcare system than are Canadians, British, French, etc. with theirs.

Where Crid gets the notion that we think insurance creates wealth, I'm sure I don't know.

Posted by: robert at November 7, 2007 1:34 PM

> fundamental meaning of insurance.

I'm not an economist, but I have read 5-10 economics popularizers and classics. I know, "economics popularizer" is an oxymoron, but I don't know how else to categorize a book like "Hidden Order." Also, I've read about 30 investment books, including Warren Buffett's biography.

Classic insurance boils down to one thing: people pooling their risks because those risks are larger than what the individuals want to assume on their own. That is the fundamental meaning.

In the real world insurance gets entangled with and distorted by all sorts of other things.

A few examples:
Insurance becomes an investment vehicle. Why? Because an insurance company that is responsible (or regulated to act responsibly) has to have assets on hand to cover claims. There is a time delay between when a premium is collected and when a claim is paid. This money hanging around is called the float. Here's where the distortion comes in. The rules for how the float can be invested and how it is taxed tend to be completely different from those governing an individual's investments. This is one of the keys to Buffett's success. He bought an insurance company and invested the float (extremely well).

There are all sorts of other tricky and frequently changing ways that insurance may be used as an investment vehicle and tax shelter, but to the best of my knowledge they mostly apply to the rich in the US.

One monster sized distortion that we have in the US is the one that is brought up often here: the tying of medical insurance to employment. And again it's there because of tax differences between a company and an individual paying for medical insurance.

The other monster size category of distortions is direct government involvement in providing or subsidizing insurance. Think Medicare, Medicaid, etc. These things tend to be as close to a pyramid scheme combined with a protection racket and welfare as they are to classic insurance, so they're hard to analyze as insurance, but people still think of them that way.

All of the distortions listed above incent (or force) people to spend more on insurance and less on directly assumed risk than they otherwise would.

This post is getting long, so the fascinating topic of warranties will have to wait till another time.

Posted by: Shawn at November 7, 2007 2:01 PM

Crid's comment makes sense to me b/c with health insurance, unlike auto or home insurance, you actively expect, hope, and TRY to get much, much more out than you put in.

Most people are satisfied to pay more in car and home ins. premiums b/c they'd rather not have to suffer an auto accident or their home burning down in order to "get their money's worth" out of their insurance.

It reminds me of a guy I know who was bemoaning the cost of COBRA premiums when he left a corporate gig - upwards of $1,000/month for a family of 4 - and saying how utterly screwed he'd have been if he'd had to pay COBRA during the 18 month span during which his kid had 6 laser surgeries for birthmark removal on her legs, each of which cost about $10,000.

So basically he believed he'd be screwed if he had to pay $18,000 in premiums to get $60,000 worth of non-essential cosmetic surgery!

Posted by: BerthaMinerva at November 7, 2007 2:43 PM

"The reason that single-payer is a good idea is that it has been proven to work in dozens of countries. As I never tire of repeating"

As I never tire of repeating: evidence?

Posted by: Shawn at November 7, 2007 2:54 PM

**I still want to hear from an an economist...**

I'm sure the profession is superflattered you've asked.

**...the fundamental meaning of insurance.**

Shawn said it pretty well. From a purely bookkeeping end, insurance doesn't matter to an economist: if a storm causes $1 million in damage, it doesn't matter if one person takes the hit, or if a million people lose $1, it is still a million dollar hit to the economy.

The psychological aspects can be profound, since now we can engage in riskier behavior, at a lower cost to any one particular individual. So now we can build closer to the water, or closer to the forest, now that our flood and fire insurance has spread the risk among more people, i.e. we have externalized some of the cost. So, in a way, insurance can create value, by allowing riskier behavior, such as building a skyscraper, which increases property value, and the value of work done per unit of land. It can also increase costs: driving faster, and wrecking more expensive cars; undertaking riskier pregnancies; taking less lucrative jobs (Graeme Frost).

It looks like health insurance is more of a cost than building insurance, because health insurance allows for more personal health risks, like driving faster, doing meth, and rock climbing, that don't have the upside of increasing GDP in a meaningful way. But, there are quality of life increases, since the buzz from rock climbing, or doing meth, has some value to people.

**I think people here are confusing the risks for which we insure with the risks of insurance as an investment.**

I'm not sure what you mean by "insurance as an investment".

Insurance can be looked at as an investment in social stability.

Some people think, "if I've paid $1000 in health insurance, I darn well better get $1000 in services, plus some vigorish, for my investment"

Posted by: doombuggy at November 8, 2007 2:44 AM

ha, they're helplessly clueless on this board. On another of this rants against the poor having health care in any way funded by any of her money, someone pointed out that if not for the working poor, Amy wouldn't have paper to wipe herself with let alone the computer to rail against the poor with and she replied that she works for those things. The point that without the working poor working to make those things she wouldn't be able to buy them and hence maybe it's in her best interest to help the working poor have a minimally decent life went completely over her head. She (and all her regular let-me-hoard-my-money cheerleaders here) seem to think that Mr. Frost is your typical uninsured. He's not. It's those poor doofuses who can't afford $250 a month for insurance because they're the working poor making toilet paper and computers.

Posted by: Not A Cheerleader at November 8, 2007 9:24 AM

Uh huh. And how much of your hard-earned money to you regularly give to the poor so that they can have better health care?

Posted by: Flynne at November 8, 2007 9:39 AM

> I'm sure the profession is
> superflattered you've asked.

Why are you a dick?

> insurance doesn't matter
> to an economist

Fella, let's ask one. Insurance is its own business --and a distinct career-- for a reason. Can you, without Googling, define the 10/10 test and unincorporated reciprocal inter-insurance exchange? I'd bet that anyone who could is used to explaining the basics of insurance to cocktail party gatherings such as ours.

> I'm not sure what you mean

People (well, Stu) are arguing that the risk in an insurance pool declines as the number of participants goes up. The landscape is befogged.

> But, there are

I hate your commas.

Posted by: Crid at November 8, 2007 11:26 AM

**Why are you a [Richard]**

I was trying to be complimentary. Economists are usually looked down upon as being out of touch with reality. That someone with your mojo would ask for their help, that put some pride in my heart.

**> insurance doesn't matter
> to an economist**

I was trying to point out a difference in a place where accounting and economics intersect.

**Can you, without Googling, define the 10/10 test and unincorporated reciprocal inter-insurance exchange? **

No.

**...are arguing that the risk in an insurance pool declines as the number of participants goes up.**

This depends purely on whether the newcomers to the insurance pool carry a higher or lower risk, relative to the original pool members. Newcomers to insurance tend to be young, so growing insurance pools tend to have lower risk. The young and healthy tend not to buy health insurance, so some think we need to rope them into buying insurance, thus lessening the load for the high maintenance members.

**I hate your commas.**

I always have a feeling I'm using too many, but I'm compelled.

Posted by: doombuggy at November 8, 2007 12:36 PM

Love your asterisks, though

> This depends purely on whether
> the newcomers to the insurance
> pool carry a higher or lower
> risk

I dunno. At least when I was a little boy (or had a little boy's understanding of such things), people entered into insurance pools with the understanding that we were surrendering our individual probabilities for the Bad Outcome. Insurance companies who want to pick and choose their customers --say by DNA analysis for likelihood of heritable disease-- were thought to be cheating. Insurers, who make a living out in the real world where things are cold and heartless, couldn't understand why they weren't allowed to use these new insights and logical tools. In recent decades it's become commonplace to charge smokers more for insurance, and nobody gets to cranked about it. But there's still a huge, boring argument underway out there.... And the insurance industry's Blog Commenter of My Dreams could probably just give us the highlights.

Posted by: Crid at November 8, 2007 1:01 PM

Economists are usually looked down upon as being out of touch with reality.

Not by me. And whether a particular economist should be, well, depends on the particular economist.

Anybody know any economists to invite to the party? I know Robert H. Frank in passing, but I sense that he's a bit busy to be blog commenting.

Posted by: Amy Alkon at November 8, 2007 1:18 PM

Not that it's an unworthy enterprise, mind you!

Posted by: Amy Alkon at November 8, 2007 1:18 PM

Re: Not a Cheerleader

There are always going to be people available to make toilet paper. If left alone by regulators, the pay will be just enough to get people to take the job. If the government would stop handing out free money, finding takers would be even easier. I only need so much toilet paper. I also need well-engineered cars, bridges that don't collapse and, well, medical care. I'm willing to pay much more for those than for toilet paper, because I've got toilet paper covered.

It seems to suck, trying to live on minimum wage. I sympathize. I'm just puzzled as to how so many people got the notion that you should be able to live a comfortable lifestyle on what you can make in the lower levels of the toilet paper business. Maybe if you're straining in the trenches of toilet paper production, you should think about moving up. In the meantime, kindly get your hand out of my wallet.

Posted by: Allison at November 8, 2007 9:00 PM

Allison wipes up!

Posted by: Amy Alkon at November 8, 2007 9:50 PM

Allison wipes up? Hardly. No one said comfortable -- they said decent. I guess you'd rather pay $10 a roll for toilet paper than have something in place for the working poor, of which I'm not one just come from blue labor people and still have friends and yes I do give to many charities that help over and beyond what taxes of mine, not in my book excessive because I realize the value of these people (something you lot don't seem to, replace them with the next turd of a human being who wasn't as lucky as you in life while you scream about illegals in America). In short, we and they belong to the same society, like it or not and also like it or not, you'll be picking that cost up in some form: whether it's health care, or increased crime rates (gee, I wonder why crime is so high with snots like the bunch of you acting like you're human and the less unfortunate aren't) or paying one hell of a lot for toilet paper because they finally had to raise pay and benefits to get anyone to agree to work for them.

Posted by: Not a cheerleader at November 9, 2007 6:08 AM

http://www.madehow.com/Volume-6/Toilet-Paper.html

Apparently, making TP is big business, and a rather complicated process; I rather doubt that the "poor" people involved in it are that "poor" at all, and it looks like the companies that make toilet paper are big enough to provide basic benefits for all their workers. Try again?

Posted by: Flynne at November 9, 2007 7:04 AM

Actually, i think the correct proceedure for women is down.

Posted by: Allison at November 9, 2007 8:31 AM

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