> I am confident Safeway's per capita
> health-care costs will decline for
> at least another five years as our
> work force becomes healthier.

And I am confident that by 2015, every newly-enrolled schoolchild in California will be given their own pony.

———

Good shot, wasn't it? No? There's just not enough sarcasm in the world to deal with fuckers who crunch numbers with such stupidity....

——Offtopic

(Speaking of grade schools, does anyone remember this sound, heard from a kid too eager to be called upon in class?):
OOOO-ooo-ooo-oooooooo... Amy, Have we got a blog post for you!

The other key is to NEVER provide service for free. There always must be a co-payment.

A lot of folks who would go to the emergency room for minor conditions find they can wait until they see their own doctor - once they are forced to pay part of the ER bill.

As for the co-pay effect, we've seen it in action here. Until three or four years ago the elderly payed nothing here. The result was that they used clinics like social clubs, the one I worked at included. We'd tell them to come twice a week for traction, but no matter how often we told them, they were there all 5 1/2 days we were open. A $5 co-pay swiftly brought an end to that.

I totally agree with the concept. There are already some incentives such as this built into the system. For example, I could not get long-term disability insurance without a physical due to my weight. The co-pay is another powerful tool. We see it in the simplest things - like seminars. Make it free and people will register but not show up. Make it even $5, and they will show because they have invested in it.

>>A lot of folks who would go to the emergency room for minor conditions find they can wait until they see their own doctor - once they are forced to pay part of the ER bill.

Ben-David,
I thought the conventional view was that people who use ER unwisely often have no insurance and no general doctor to visit, and use it out of desperation AND get socked with a bill?

Also - possibly this is just weird - but I've twice been instructed to take my kids to ER when trying to fix an appointment to deal with sudden onset symptoms. On the vague grounds a scan "might" be necessary - this via a doctor's receptionist who had talked to the duty MD. I refused (on the grounds this was likely total overkill & would involve a hideous wait), wrangled a clinic appointment and got things properly sorted.

Maybe you know better the reasons most people waste ER resources (no snark whatsoever)?

"Women who have no intention of becoming pregnant should also be able to opt out of maternity care. Currently, on my Kaiser plan, there's no way to say no way to maternity costs, which are sizable."

You are right. You should be able to opt out of that coverage.

However, when women who have checked that "no coverage" box do become pregnant, for whatever reason, the insurance companies know that they will have to provide coverage. Politicos and women groups will scream and yell if they do not.

That is just how it is when you are a heavily regulated industry, or really any industry with $ that the government and/or "activists" can readily locate.

The managers of insurance companies know that their policies will be rewritten via political pressure after the fact by regulators and "consumer groups", so they might as well go ahead and collect premium for the risk, rather than fool themselves that they will not be forced to pay that amount anyway.

I agree, with you, though--you should be able to opt out. But it is not really your insurance company's fault that you cannot. The insurance companies are simply pushing onto you the decision pushed on to them.

Humana had/has? the Vitality Rewards program. They gave you rewards points for regular exercise, participating in races, family fun runs, and such. Points for getting your cholesterol checked, regular check ups, smoking cessation programs, weight loss programs, keeping your weight within normal range, etc. You could redeem the points for different fitness related items. If you achieved a certain point level, you would get credit towards your deductible the following year. Companies loved the idea of it because it was going to be cheaper than all the sick time and lost productivity. However, most of the participants were already into fitness, and the effort didn't net as many new recruits as they'd hoped.

I don't see much reference to it these days. I don't know if it's still offered. Looks like Richard Branson has something similar going over at Virgin but much more generous in the redemption part.

> I am confident Safeway's per capita
> health-care costs will decline for
> at least another five years as our
> work force becomes healthier.

Mr. Burd apparently wrote this article before reading the Congressional health care "reform" plans, which explicitly prohibit "discriminating against" people based on how healthy they are.

Yesterday President Obama said "Do something soon to change the path of American health care or we'll all pay a severe price." (That quote is the article's paraphrase.) That's technically correct: if he and Congress get their way we will all pay a severe price.

Brilliant. Making people responsible for their own choices in life. What's sad is this is considered revolutionary. I am not fat, have never smoked, and barely drink. I use my seatbelt and exercise and eat right. Why do I have to pay the same as a chain-smoking fat-ass?

However, when women who have checked that "no coverage" box do become pregnant, for whatever reason, the insurance companies know that they will have to provide coverage. Politicos and women groups will scream and yell if they do not.

Exactly. I could see this working more effectively if a woman got her tubes tied. There's no guarantee, but the odds are good that she won't suddenly find herself pregnant. It would also be nice if they'd cover abortion for premenopausal women who opted out of maternity coverage.

I don't understand why insurance companies aren't falling all over themselves to provide as much birth control as possible. I'm paying $60 a month for the pill, which I'll gladly pay, because it's cheaper than having a baby, but someone without that extra money might just take their chances. It's stupid, but it's reality.

They gave you rewards points for regular exercise, participating in races,

For the latter, is the reward a knee replacement?

Not all rewards are equally smart.

This makes so much sense. I'm self-employed, don't smoke, not overweight, in good health, yet I'm forced to change insurance companies every few years because they raise my rates, even though I rarely use my major medical insurance, rarely even meet a deductible. What starts as a reasonable rate just gets pushed up for no reason, probably because I'm expected to bear the cost of others who are unhealthy.

It should be like credit cards. Insurance companies should be pursuing me with low offers, and attempts to keep me as a customer, because I've shown that I'm responsible with my health.

Amy, it would be nice if men could opt out of maternity coverage too...

Exactly. I could see this working more effectively if a woman got her tubes tied.

Okay, or has an IUD, but birth control isn't foolproof. Still, there's no way I'm having a child.

How about that you just say you aren't going to use maternity services -- and have them not be covered if there is a pregnancy?

How about that you just say you aren't going to use maternity services -- and have them not be covered if there is a pregnancy?

I think Spartee's point is valid. The first time an insurance company refuses to cover someone's accidental (or "accidental") pregnancy, there will be a media shit storm. If I were insuring someone, the only way I'd feel comfortable letting them opt out is if they'd been sterilized.

The eager beaver human resources department at my husband's work (a major cancer & genetics research & teaching lab) would like nothing more than to force employees to attend lunchtime seminars on stress reduction, cholesterol, healthy eating and all the rest. Plus get employees to sign up for related classes.

So far, this is getting nowhere.

The only people with time for the lunchtime seminars are HR employees, meekly buckling under their department head's bossy memos!
And the scientists bridle at the "company town" threat of having HR monitoring their health as if they were peons of the insurance company.

I have to quibble with that "70% of health problems are preventable" statistic. Especially after reading Taubes and learning that conventional wisdom on "healthy" eating is all bass-ackwards. Now I'll trot out the anectdotes:

--I have very healthy habits (non-smoker, not overweight, get regular exercise and checkups). In the last three years I've had a)thyroid cancer and b) hip replacement.

--My father who had probably the healthiest lifestyle I know (non-smoker, never overweight, very active with horses and ranch maintenance), was diagnosed in January with ALS (and passed away recently, before the disease had progressed to the point that he was suffering terribly, which was a comfort.)

--My FIL (who was never overweight and had quit smoking 35 years before his death, and exercised every day) had recurring heart disease thoughtout his middle years and died of melanoma.

It's comforting to believe that our destinies/ health are mostly under our control, but the truth is they aren't as much as we'd like to think they are.

The point of an insurance pool is to have as many people of all types contribute, to spread out the risk and need, isn't it? that's the sunshine behind the idea of a universal plan, and the way any plan makes any money.

Younger Bear (my 20-year-old) was able to buy into his community college plan in spite of not being a full-time student. it cost $190 for half a year, and it's a semi-comprehensive plan. Yay!

Restricting access to people like my kids is absurd since they are the picture of excellent health, will always pay into the pool and will probably never need it.

The real way to make people wake up and smell the coffee is to prevent doctors and hospitals from directly billing insurance companies. If people had to handle all their bills themselves and thrash it out with they insurance companies to cover the stuff they're supposed to, I think there's be more awareness across the nation of the amount of bullshit that goes in in this cycle of misery.

Saying you want to opt out of this or that coverage might be troublesome in the long run— Sure, you'll be with other healthy folks and have less overhead, but just watch them throw you out if you're foolish enough to get hit by a car and live.

It reminds me of the "Then they came for the Catholics, but I wasn't Catholic, so I didn't speak up" thing.

All will please note here that otherwise reasonable people, taking advantage of health-care provisions, are bogging it down and causing undue charges on their more-careful friends.

Remember this if and when you advocate legalizing drugs. Some behaviors are expressed across any lines you might construct between social groups.

I work for a company that has outlawed smoking on its campus (and it's campus is at least a 1/4 square mile in size.) There are other companies that have not just outlawed smoking on campus, but have actually told employees they are not allowed to smoke, period. Anywhere.

And yet, smoking is a legal activity.

(I've never smoked. Well one time after sex, I smoked for a few minutes, but I learned my lesson and use a higher priced lubricant.)

I have a problem in which companies (or their insurance companies as proxies) start enforcing various behaviors on employees in the name of reducing health care costs.

How long until they go after the fatties?

And worse, in the 90s they may have gone after those with ulcers caused by stress of course. Except now we know ulcers are caused by a bacteria. (And I recently read that obesity may also be due to a bacteria or virus disease process.)

Which diseases are we going to blame the victim for, and which will be deemed okay? And what do we do when our medical knowledge changes, just apologize to those who we were previously blaming?

The real solution Amy, as you usually state, is that Safeway should not be buying ANYONE's insurance. Insurance should not be linked to employment.

Saying you want to opt out of this or that coverage might be troublesome in the long run— Sure, you'll be with other healthy folks and have less overhead, but just watch them throw you out if you're foolish enough to get hit by a car and live.

One cause of escalating health care costs is our society's unwillingness to let people actually opt out of treatment, to the point of imprisoning those who opt out their kids. Radwaste's comment about legalizing drugs is exactly right: giving people the freedom to make bad decisions, while promising to pay for the consequences of those bad decisions, ultimately leads to paying lots of money. So far society has addressed this problem by limiting freedom, which is unfortunate.

"I don't understand why insurance companies aren't falling all over themselves to provide as much birth control as possible."

Again, see my earlier point about politics, only this time from the right, not the left. I can almost hear the mega-church ministers decrying the immorality of it even now (even as they put their girlfriend on the pill =D).

People spend way too much time worrying about--and legislating against--the sexual and reproductive choices of other people. Health care run by the government will simply be yet another chance to fight that sublimated Freudian battle out in public once again.

sigh...

This is a stupid idea. I mean just look at this percentage:

"60% of cancers are preventable"

That sounds like a pull out of your ass statistic. If we actually knew how to prevent 60% of cancers we wouldnt have such a large industry dedicated to curing cancer. Riiiiiiiight. Please tell me the secret of preventing 60% of cancers.

I think HR needs to tell the diffrence between ideas that are good on paper and ideas that are actually applicable in the real world.

HR MEMO to it's workers:

"Please be the pinnacle of good health for benefit of the company"

How can you even begin to monitor who fits the correct bill of health and who doesnt?
How do you even measure this?
Most people that get sick dont get sick because they lead unhealthy lives. Most people that get sick is an outta the blue experience. Or maybe they are just seniors. Or maybe its a pre-existing condition they can do nothing about.

That's why there is insurance, because you dont know what the hell is gonna happen to your body.

Amy-- speaking of "is your poor healthcare your fault"-- if you're not already reading Nurse K's blog "Crass-Pollination," you really should check out this entry on how obese patients are causing able-bodied healthcare workers DISABLING INJURY! Really eye-opening, and quite the ethical dilemma. It truly is high time we did something more about the obesity epidemic than just tiptoe sensitively around the topic.

"I totally agree -- I just think it's utterly unlikely that Obama will do something sensible like delinking insurance and employment."

That does seem too far out to be a real possibility, but I wonder...since a lot of the juice to blow the logjam will come from employers, delinking may well be on the table.

This is among other things a fight between employers and the health insurance companies. That tends to get lost in the rhetoric about free enterprise this and free enterprise that. And that is where the fight will be decided - Lord knows Congress is already all spoken for and locked in an impasse.

> I have to quibble with that
> "70% of health problems are
> preventable" statistic.

Go, Dej!

> That sounds like a pull out of
> your ass statistic.

Go, Purp!

Also, people forget that in the end, we're all fuckin' dead. Jus' sayin'.

I'm going to invite everyone on this blog to my home one day, mid-evening arrival. No food, no drinks, no sex, no music: Just a séance. We'll sacrifice a goat in the fireplace at midnight just as the moonlight streaks in from that one high window... Gathering as a circle in improbable, yoga-style postures, we will chant softly but insistently until dawn's first rays:

Insurance doesn't create value...
Insurance doesn't create value...
Insurance doesn't create value...
Insurance doesn't create value...

(beat)

Insurance doesn't create value...
Insurance doesn't....

Here's the fundemental problem: Insurance is designed to mitigate risks that are low probability, but high cost if they occur. Fire insurance is entirely sensible because most people will live their entire lives without ever having a significant fire in their homes.

Routine medical care is the exact opposite of this -- the cost is relatively low, but the probability of occurence is near 100%. Further, there are some insurable occurrences, such as obesity due to over-eating, and pregnancy, that are at least partially under the control of the insured. So medical insurance for these things really isn't insurance; it's a screwed-up form of a medical savings account. I say it's screwed up because there is only a very tenuous correlation between contributions and returns.

So medical insurance needs to get out of the area of routine care, and be limited to coverage for catastrophic and non-preventable (or at least non-predictable) occurrences. Routine care should be structured as a medical savings account that the individual can sign up for when young and carry with them.

The one hitch in all of this is what to do with individuals who have genetic conditions which can be tested for at birth or in the womb, which will lead to castrophic diseases. Under a totally free-market system, these individuals will not be able to find insurance; it goes back to that risk thing -- the probability that they will get the disease is 100%, and there is simply no way for the insurer to not lose money. The only thing I can think of is, going to the auto-insurance analogy, an assigned-risk pool that everyone who buys insurance has to pay a certain amount into.

And the scientists bridle at the "company town" threat of having HR monitoring their health as if they were peons of the insurance company.

I worked for a large computer manufacturer that during open enrollment offered 'incentives' to employees who would fill out a health questionnaire so that the insurance companies could find out what additional preventative measures these people could be taking and nag them to death about it. Interestingly enough, managers were e-mailed daily who had and who had not completed this 'voluntary' survey and would stomp around the cube farm brow beating employees into completing it.

I never could get a clear answer about who had access to this information, and the closest that I could figure, HR had to at least have some access to it, as the nagging e-mails were coming from an internal address. I have some rather significant health concerns and that isn't appropriate information for my employer to have easy access to around RIF time.

I also never saw any evidence that doing this reduced medical costs. This appears to just be a 'monkey spanker'. It makes them feel good, but doesn't produce anything but a sticky mess.

Again, see my earlier point about politics, only this time from the right, not the left. I can almost hear the mega-church ministers decrying the immorality of it even now

I can't think of any megachurches that oppose birth control across the board. I'm not familiar with all of them, of course. Can you provide a cite?

One in five megachurches are affiliated with the Southern Baptists, who don't oppose birth control. Most are nondenominational. Wikipedia provides fascinating information about them.

Catholics oppose birth control, of course, but they traditionally lean left.

"Also, people forget that in the end, we're all fuckin' dead. Jus' sayin'."

Yeah, and how about the statistic that 60% of all dollars spent on medical care is spent on people's last three months of life? In other words, on medical care that DOESN'T WORK.

Give these poor folks something for the pain, and then leave them alone to die in peace for chrissake.

Crid,

I am not sure I understand you, but your seance sounds really dull.

"Insurance doesn't create value..."

but disease destroys value to the individual, family, and even society.

So while insurance may not create value, does it preserve value far more than disease destroys value?

Could be.

Does health insurance create value? If you're the breadwinner and insurance enabled you to go to the doctor and get your bones mended and get you back to work, you may accurately believe that insurance created value.

"They gave you rewards points for regular exercise, participating in races,

For the latter, is the reward a knee replacement?

Not all rewards are equally smart"

What's with the running hate? (I've noticed it before.) Not every runner's knees are doomed to pain and injury. I'm sorry yours hurt when you ran, but there are many middle-aged runners whose knees are fine and for whom running is an excellent way to maintain good mental and physical health.

What's with the running hate? (I've noticed it before.)

Two words: Jim Fixx.

> your seance sounds really dull.

Dood, my séances aren't about petty amusements and distraction... My séances are about the TRUTH™!!!!!!!

> but disease destroys value to
> the individual, family, and
> even society.

Value's value. Don't be in such a rush to be all touchy-feely that you miss the point of the word.

> does it preserve value far
> more than disease
> destroys value?

If it didn't, we wouldn't bother. (Brian doesn't bother anyway, but he's out of his mind.)

When I was a little boy there was a talk show on TV hosted by a man named Johnny Carson. Last night, I was thinking about the ol' Carson place up in Malibu... It's the one with the triangular atria. Note also the tennis court across the street... That was his, too. Visitor Letterman once described it as an 'Olympic-caliber venue'.

The widow got about 40meg for it. He didn't take it with him. The value had nothing, nothing to do with the fluffy loveliness of his humanity.

> you may accurately believe
> that insurance created value.

Nope, it just protected your ability to create wealth.

"Insurance doesn't create value... "

Kidding, right?

If not, you cannot see the economic value in people laying off risk on another party which, though pooling, is better suited to bear the risk? Seriously?

> you cannot see the economic value
> in people laying off risk on
> another party which, though
> pooling, is better suited to
> bear the risk?

You are confused.

All the things that people want done to defend their health will cost something. Wealth will be exhausted. Insurance doesn't create that wealth, it just takes it from one place and puts it in another.

"Better suited" is a fascinating, fascinating choice of words on your part. As it happens, Amy is much better suited to vacuum my carpet than I am. Jerry is much better suited to wash and detail my car. Sam is better suited to mow the lawn, and you, Spartee are just ideally suited to pay for my health care. See how that works?

I really don't understand why people can't get this. I think it's the quintessence of capitalism, and of human fucking decency besides!

It is not the case that there's a limited amount of wealth in the world, and it is not the case that in some natural, given state, that wealth is distributed in correspondence to needs, but the rich people happen to have gotten more than their fair share.

Needs are essentially infinite... (especially when the wealth to satisfy them comes from someone else's labor.)

But here's the miracle part, the part that makes life worth living! Ready? Here it is: We can create wealth!... It too is infinite! We can do things that other people will pay for. We can increase our happiness –individually and globally– by paying attention to each other's needs, bringing value into the universe.

Insurance moves existing wealth around. It doesn't create it.

Chanting begins at midnight, people....

Doctors buy into insurance because they need to get paid.

People buy into insurance because they think that's the only way they can pay for treatment.

'Taint so.

Mad about car companies? Your doctor has as many butts to carry as GM does.

Pirate Jo: "Yeah, and how about the statistic that 60% of all dollars spent on medical care is spent on people's last three months of life? In other words, on medical care that DOESN'T WORK."

I get your point, PJ, but I have a nagging feeling that this is a misleading statistic... I don't know if it includes emergency treatment, where the outcome is often in question up until the last minute. Emergency treatment is very expensive, and I'm afraid that people who die after emergency treatment slants the statistic. I'll try to dig up some numbers.

Crid: "It is not the case that there's a limited amount of wealth in the world, and it is not the case that in some natural, given state, that wealth is distributed in correspondence to needs, but the rich people happen to have gotten more than their fair share."

Crid, if I may... it is true that, at any given moment, the amount of wealth in the world is finite. However, there seems to be a widespread belief these days that wealth is a zero-sum game, and the only way someone can have more is for it to be taken away from someone else. People who believe this sort of thing point at Africa and claim that its very existence proves the inherent evil of Western capitalism. But it's ludicrous -- if wealth is a constant, where did it come from to begin with? Was the Earth created with a finite amount of wealth that has remained constant through history? If so, then centuries ago, when the world's population was a lot lower, why wasn't everyone filthy rich? Or, for that matter, why haven't we all gotten poorer as population has increased?

Don't anyone ever fall into the leftist trap of believing that wealth is a zero-sum game. Wealth can be created; it happens every day. If you build a house, the completed house is worth more (usually) than the sum of the cost of the materials that went into it. And, wealth can be destroyed. If the house burns down, wealth is certainly destroyed. This is where insurance comes in. Insurance doesn't create wealth, but it does *preserve* wealth by mitigating certain types of risk. If you suffer a catastrophic loss, the purpose of the insurance is to put you back (as much as possible) in the situation you were in prior to suffering the loss, so that you can become productive again a lot sooner.

Insurance is great for mitigating risks that are low probability but catastrophic if they occur. However, insurance is very inefficient for frequent, trivial losses. Unfortunately, that describes a lot of medical care... a few hundred here, a few hundred there, year in and year out. I really think that that, and *not* the costs of catastrophic care, is what accounts for the constant steep rise in the cost of medical insurance.

"70% of all health-care costs are the direct result of behavior."

This approach makes a lot of sense which is why I'm sure Amy is touting it.

However, I bet I could hear Amy's whine from 3,000 miles away if Safeway was including sexual behavior. Specifically, the proportionally higher costs and early death rates for promiscuous Gay Men.

Amy wants to opt out of paying for Maternity coverage because she doesn't intend to get pregnant and I want to opt out of paying for AIDS coverage.

Yes, I know. Straight people get AIDS too ... blah, blah, blah. But It's mainly Gay Men. And it's expensive to treat.

"How do you identify who the "promiscuous gay men" are, follow men who seem like they might be gay around with a video camera?"

This isn't any more invasive than mandatory testing for many drugs, legal or not.

This is another reason to get and keep government out of health care: just as with other laws, activists can cause your Congresscritter to write regulations and laws which reach into every aspect of your life.

"If it saves only one life...!"

Your kids die riding bicycles and dirt bikes, you kill yourself hiking, driving and flying your own plane, and if you carry a gun, you must want to kill someone. "All of these things should therefore be prohibited," says Chicken Little, "for your own good". Cue the Consumer Product Safety Commission.

Because there is no boundary between behavior and illness.

"How do you identify who the "promiscuous gay men" are, "

Your question would lead someone to believe that if that were possible, you'd be in favor of adding that to the list of behaviors used to determine healthcare costs.

Be honest Amy. You're not.

Amy, do you honestly think that an all-encompassing government health-care system coupled with a nanny-state mentality won't propose just such a thing?

Seriously. Right now, we have cops pulling over every car on the road at checkpoints to see if the occupants are wearing seat belts. For their own good.

Imagine, if you will, that this is taken to its absurd maximum - the government sending agents into your home to ensure proper condom use, random spot-checks of your refrigerator, checkpoints outside the supermarket.

Giving this kind of power to government WILL ultimately lead to what sean proposes, however flippantly.

Which means that sluts of all gender and attraction had better be against it if they wish to continue their slutty ways.

"Insurance is great for mitigating risks that are low probability but catastrophic if they occur. However, insurance is very inefficient for frequent, trivial losses. Unfortunately, that describes a lot of medical care... a few hundred here, a few hundred there, year in and year out. I really think that that, and *not* the costs of catastrophic care, is what accounts for the constant steep rise in the cost of medical insurance."

No one expects their auto insurance policy to cover gas, oil changes, or even expensive repairs. It's intended for things like when a storm blows through and drops a tree on top of it. Or homeowners insurance - you don't use that to pay for cleaning your home, or replacing carpet and furniture, or painting. It's intended for things like floods and fires.

There is absolutely no reason why medical insurance can't work the same way. But people would squawk if they had to start negotiating directly with their doctors for the cost of care, even though that would bring costs down. What, me? Pay fifty bucks for my doctor visit? (Yet I don't think twice about putting fifty bucks' worth of gas in the car.) All those people with insurance through their employers are part of the problem, too - especially when they go running to the doctor every time they have a cold. Not to mention, when I look around at all the obese people waddling around, I shudder to imagine what kinds of problems they must have with their joints, their backs, and blood pressure. All totally preventable.

When did "health care" become something a doctor gives you, and not something you provide for yourself?

"Sean, it's not something that can be identified."

That's not what I asked.

I proposed that if it could, you would be against it.

Which based on your dodge of the question makes me believe I'm right.

Go ahead and prove me wrong.

Just let us all know that you would be in favor of adding Promiscuous Gay Men to the categories of behavior to consider when providing health insurance if it could be identified.

As long as we're opting out of stuff we don't need (Like— I don't need flood insurance because my house is on a hill) I want to opt out of paying tax for the national guard forces that train for urban combat. I'll never need that— I live in a rural area. I also don't need to pay state tax for the highway patrol since I conduct all my business over the internet— I don't use the interstates any more. I also don't want to pay local police drug enforcement training or implementation because I live in a neighborhood of mostly-older people who aren't druggies. I really will never need to those services, so I don't want to pay for them.

> Sean, it's not something that
> can be identified.

Neither is a woman's sincere disinterest in having kids. (I've been surprised about this a number of times, including within a marriage.) What if a woman isn't interested in having kids but gets pregnant anyway ('Happens all the time!', we are told on this blog), or what if a non-promiscuous gay guy gets AIDS?

(Turns out Spartee's already covered this.)

There's nothing bad that can happen to you from misbehavior that can't happen to you anyway. I readily believed Seipp when she said she'd never puffed a cigarette.

Insurance is indeed something that can be readily abused. (Hi, Brian!) But it's also possible to push too hard to make consequences line up behind responsibilities. Doing that is the world counter-libertarian busybodies.

Whoops, doing that is the work of counter-libertarian busybodies.

"I also don't want to pay local police drug enforcement training or implementation because I live in a neighborhood of mostly-older people who aren't druggies."

Your post seems a little tongue-in-cheek, Deirdre, but I am a firm believer in drugs being an issue for local law enforcement. I don't want meth labs in my neighborhood, and will gladly pay a portion of my property taxes to keep them out. But I don't care about people smoking pot, and am not willing to spend a cent (at the federal OR local level) to keep people from doing it. You want to spend a fortune keeping it out of your own neighborhood, be my guest. Although, as your example illustrates, people who hate marijuana won't have to spend a bunch of money keeping it out of their own neighborhoods, because nobody who lives there smokes pot anyway.

I could be wrong about this, but I thought most interstate highway maintenance was funded through gas taxes. I don't have a problem with that, because it does seem to be a more or less effective way of shifting the cost to the users. Maybe not perfect, but people who buy lots of gas, like trucking companies, end up putting the most wear and tear on the roads and also end up paying for them. The merchandise they move from place to place has to be priced to cover the trucking cost, however, so every time you buy a gallon of milk (unless it came from the cow living at the farm next door) you are paying a few cents to have it shipped. Makes sense to me.

Pirate Jo: "Yeah, and how about the statistic that 60% of all dollars spent on medical care is spent on people's last three months of life? In other words, on medical care that DOESN'T WORK."

I get your point, PJ, but I have a nagging feeling that this is a misleading statistic...

Me too. I've actually heard the claim that it is not true, but I haven't verified it for myself.

This doesn't mean that it's perfectly OK to spend lots of money on one's final years of medical care; just that if we were to do it less, we wouldn't save as much as we might think if we believed the 60% number.

Your post seems a little tongue-in-cheek, Deirdre, but I am a firm believer in drugs being an issue for local law enforcement.

Never heard of West Virginia, huh? Local law enforcement looked the other way, because drug income was putting gas in the police car.

-----

The American public does not want to hear about responsibility except to claim it when it comes to doing what they please.

When you're overweight and out of shape, you're easier for a thug to mug, more likely to get a variety of cancers and diabetes and more likely to be seriously injured in a car crash or fall. Yet people will ignore that to do what they want. They want to smoke, and throw butts on the ground. They want to drink, and then drive. They want a cell phone to babble unnecessary noises to someone while they drive. They want to buy a four-wheeler or motorcycle and blame someone, anyone, else for their crash.

They buy coffee and then claim it is someone else's fault when they spill it on themselves.

And then, you hear, "Legalize drugs. It's my body, and I'm responsible."

Yes, yes, the old "If people are responsible and good, they don't need a government. If people are irresponsible and bad, you don't dare have one."

Yeah, it was tongue-in-cheek. The whole point of having a national insurance pool is to spread out the risk the same way we fund local and state police and the army.

The idea is to make EVERYONE PAY INTO THE POOL. The healthy ones subsidize the sickest ones. Fucking duh— that's the way insurance works.
The object overall is to disengage the availability of heath coverage from employment. State sovereignty and other goddamned roadblocks are held dear by some but are a smokescreen. The current object of the insurers is to make as much money as is possible, and their chief method of doing this is denying accessibility and denying claims.

La la la. Broken record, Stats rule, you're a fatty or a smoker, fuck you.
Whatever. And insurance only goes so far, anyway.
It is morally reprehensible and an outrage that a man or woman should fear losing their home because they got into a car wreck made the mistake of living.

I completely agree that people who willfully put themselves at risk should pay more. Likewise I think that people who make an effort to keep themselves wicked healthy should get a break.

Gene Burns, my favorite Libertarian and talk-show God, always says when you want to make something cease, you tax it, and when you want something to grow, you subsidize it. So sure— why not make it fiscal good sense to stay healthy?

I don't believe in opting out of coverage possibilities, though, otherwise the whole point of a large pool is ruined.

People like my kids should be paying in all the time, So why on earth do insurance companies make it so hard to gain entry to a plan?
Even my idiotic union AFTRA has a separate arm that supervises its health and pension funds. Their chief job is to keep members OUT of the plan. What the fuck, people.

> The idea is to make EVERYONE PAY
> INTO THE POOL.

If it's compulsory, it ain't insurance, it's taxation. Maybe it's just and decent, but it ain't insurance.

> The healthy ones subsidize the
> sickest ones. Fucking duh–
> that's the way insurance works.

Naw... It's about sharing risks.

So then let it be a tax. Amy wants compulsory insurance, too— and don't you, in the end? We all end up paying for people who don't plan ahead.

Naw... It's about sharing risks.

Yep— I said as much.

The whole point of having a national insurance pool is to spread out the risk the same way we fund local and state police and the army.

I guess that settles it.

Amy is in favor of charging more only for non-politically correct behavior.

She can climb down off her high horse now.

> The whole point of having a
> national insurance pool is to
> spread out the risk the same
> way we fund local and state
> police and the army.

If Commies invade, I'm fucked... But medical threats don't work that way. I smoked for 11 years, at this hour have no cancer (at this hour).

Forcing everyone to pay for every risk faced by every person at every moment is going to be a tough sell for you... It's just not what we're about.

I wish your kid had insurance, truly.

"I wish your kid had insurance, truly."

Crid, thank you. Really, truly.
He does— thru his college. It's not expensive, either. He just needs to stay in school forever.

My older boy has insurance thru his employer.
My husband is old enough to have gotten Medicare and I have a CIGNA plan thru AFTRA.

We're all set for now.

Some of my best pals are not tho'. They live in NH, have their own business and pay over $12000 per year for non-comprehensive insurance.
This money is ON TOP of the "health savings account" of $6500 they are required to maintain.

How many people do you know who have $18000 to throw around for the hell of it? They may as well burn a thousand every month, or at least play Megabucks. I'll bet their odds of getting the right bang for their buck are better with the lottery than it is with for-profit take-your-money-and-give-you-nothing "insurance" companies.

I'll bet their odds of getting the right bang for their buck are better with the lottery than it is with for-profit take-your-money-and-give-you-nothing "insurance" companies.

What's shocking is that you believe for even one second that the government is going to make the situation BETTER.

They're the ones who created the problem in the first place!

The problems of today cannot be solved by the same people who created them.

"I completely agree that people who willfully put themselves at risk should pay more."

And that's what a "medical VISA card" would do. You pay - but you pay on your schedule. You pay the doctor, not a skyscraperful of form pushers. And the doctor can relax because he gets paid, just as the insurance company did, but with fewer forms and costs.

There are plenty of people who cost us all but who we cannot track

I am an example. If you were to do lab work on me right now (Typical stuff, CBC, lipids, thyroid, liver, kidneys, etc) I look great. I am a relatively young non-smoker, non-drinker. However, I am a FUCKING MESS healthwise. Much of it is managed with my absolute diligence and control, but much of it is treated palatively with fist fulls of pills each day. New doctors are often shocked at the medications I am taking. I'm sure I've cost insurance companies millions.

What did I do to land myself in this position? I was born. All of my illnesses run in my very large family, I just managed to get each and every one of them. So, unless we start doing some level of enforced eugenics (which I am not advocating) or severe rationing, we will never be able to eliminate the high cost of medical care. Eliminating insurance will only work if we all make the change together. Otherwise people without are just left unable to get care.

As it is now the only people who pay full price for medical care are those who don't have insurance. Not only do they have to pay 100% of the cost, but most insurance companies negotiate discounts with doctors (that is what 'in network really means'). So where I might pay 30% of $100 to see a doctor, the person without insurance often must pay 100% of $200 for the same visit.

-Julie