Via Big Mac

"On average, people without health insurance consume only about half as much health care as everyone else."

And why is that?

I suggest it is partly because of the idea that once an account is established, it is to be used for every small thing.

At the same time, I question the assertion, because it seems not to jibe with other stories about how emergency rooms are jammed with indigent and illegal people.

Should the government be in the business? Of course not. First - if you are not paying, you are not the customer, you are the product. Then, what sane individual would want the people exempting Congress from laws they foist on us, the executors of the invasion of Iraq, the owners of the IRS and BATFE and TSA to make us their business?

Thedala Magee, Health Care Professional?

That taste in your mouth is bile.

Joe could take out a loan.

It's more than mandated health insurance that's unfair. It's mandated health care that's unfair, as doctors and hospitals continue to treat people who can't afford healthcare and who have no health insurance.
I say kick those people to the curb.

At the same time, I question the assertion, because it seems not to jibe with other stories about how emergency rooms are jammed with indigent and illegal people.

Depends on what they are there for. A broken wrist for an uninsured person costs less than my low iron blood test results, which led me doctor to order up a colonoscopy and endoscopy (because anemia can be linked to colon cancer, natch). After the two procedures and an office visit, the specialist concluded that I should take iron pills.

And since end of life care is where the money is disproportionally spent then I suspect someone like Christopher Hitchens, who spent his last month or two in the care of the best cancer center in the world, costs more than an uninsured person dying of a similar condition.

The very term "mandated health insurance" is Orwellian. That sounds good right, everyone has to have it so everyone is paying in? When in reality it's the reverse - insurers can't reject you.

Language really is a pernicious thing.

Taxes as a solution? Agree with this? Disagree?

You know, it's very hard to say. It seems to suck in Canada, and to a lesser extent the UK, where if you opt for private treatment you lose all access to public money - even that amount you've already paid for through taxes. Australia's system is a bit of a hybrid - we pay a straight 1.5% of income (via personal taxes, not employer) to fund Medicare which is then open to all comers, irrespective of income. If you want private health insurance on top of that, Medicare reimburses your insurer for the level of coverage they would have been willing to provide and they cover the rest (pending co-pays etc).

Of course, you get all the rationing of care problems inherent in such a system - feel like waiting 9 months for an MRI? We're not as bad as Canada but that's not unusual for a public patient. A lot people don't understand that to a doctor under such a system, priority means something different. "Oh, you're in unbelievable pain? But your condition won't get worse while you wait so that's not a priority". They're not allowed to take into account that you can't work for instance, the priority system is skewed in favour of those who will get worse without treatment.

There's no doubt the US has the highest quality care in the world. To do that costs money though. I can't see a good way around it other than to either reduce the quality, or cough up. I doubt a taxation based system can ever achieve that level of care. Right now, it seems to me that the premium, well-insured patients in the US subsidize the uninsured, with the caveat that they get better treatment. But quite possibly the uninsured patient is getting better treatment than they would have otherwise, because all those machines are sitting idle sometimes...

Not everyone who is uninsured is uninsured because they were doing fun things with their money. There is something though to what you're saying about insurance being tied up with work.

I had insurance as a kid through my father's job. It continued until I was in college and then when I found my own job. When I married I had insurance through my husband's job. Most jobs offered insurance as part of compensation.

I'm divorced now and had insurance through my job but when I got hurt at work and then diagnosed with two diseases that left me disabled, I was unable to afford the COBRA payments and now considered to have a pre-existing condition.

When I was 19, I didn't buy my own insurance independently from my job because it wasn't necessary. I paid into it through my employment and then through my husband's employment. I always paid into it. Now I don't have it, but its not because I was doing things I considered to be more fun with my money.

I don't think there should be a tax penalty for not buying insurance, but I DO think you should be able to deduct your premiums.

Joe should be on the hook for his own medical costs.

But Amy, if you get sick enough or injured enough that you can no longer pay your premiums, Kaiser would drop you like a hot potato. They wouldn't say, oh, Amy Alkon paid for 20 years, so we are going to take care of her for the rest of her life. Nearly everybody I know had to pay out of pocket for something or other because they thought they were covered and the HMO weaseled out of their obligation.

Here's the flip side of paying for health insurance--a healthy person is paying for people who don't take care of themselves. And that's lots and lots of people. Why should I, someone who takes scrupulous care of her health, pay for people who eat copious amounts of processed food? People who aren't compliant with their diabetes care instructions? Mothers who want their Dr to write a prescription for Nix instead of going to Walgreens and paying for it themselves? Mothers who want the Dr to give their child an antibiotic for every little sneeze and refuse to believe that it will hurt the child in the long run?

I used to do medical paging, so I've dealt with these issues firsthand, plus listened to many old school Drs rant and rave about health insurance and how patients abuse it. You are paying for other people's irresponsibility *right now* Amy.

Probably also true, deathbysnoosnoo. Personally I regard cigarette taxes as my health plan. We're talking $20 a 25-pack here now. Anyone wants to deny me medical cover, I'll be giving them a bill for refunds to my nominated beneficiary. They justified it partly on the grounds that smokers posed an undue burden on the health system. I've paid in at least three times what I could ever possibly cost, even before we factor in the pension I won't be drawing into my 80s. Screw 'em.

Then I can go drink whiskey and smoke cigars wherever Chris Hitchens ended up.

Untie it from employment! If we shop for our own plans, and companies are competing for our business, it won't be any time at all before some lizard is telling us 15 minutes can save us 15 percent on our health care costs.

"But Amy, if you get sick enough or injured enough that you can no longer pay your premiums, Kaiser would drop you like a hot potato."

Maybe you should spread the word: health "insurance" isn't really insurance.

In regular insurance, you only have the possibility of a loss.

With health care, it's a certainty.

So, don't think of the "premiums" as having anywhere near the same definition, between regular insurance and anything to do with health care.

I've covered this at the link above, but why do you think you should pay for a service you don't get?

Untie it from employment! If we shop for our own plans, and companies are competing for our business, it won't be any time at all before some lizard is telling us 15 minutes can save us 15 percent on our health care costs.

Still better than Flo or that creepy "Midnight Cowboy" guy. Or that guy with the blue phone and the hand puppets.

I can't wait to hear what Allstate's stand on colon cancer is.

Why do insurance companies need multiple mascots? And why are all of them creepy?

Maybe you should spread the word: health "insurance" isn't really insurance.

A very good point Rad. Unfortunately one that escapes most people. In a sane world, it would be treated more like retirement funds - put away money during the good times which you can draw on later (with some sort of catastrophe safety net for those with bad luck). A health care savings account for instance.

But by treating it as insurance, you get *no* credit for prior contributions, it only matters whether you're paid up right now. You know, when you're sick, and can least afford the premiums. And having it tied to employment makes things even worse, because if you change jobs there is no mechanism to transfer the contributions you have previously made to your new employer's fund.

April is right, that's probably the single biggest mistake the US ever made on health care, and one which Obamacare completely failed to address. Until that's fixed, the model is broken and will stay that way.

I think medical expenses, not just insurance premiums, should be tax deductible. I include in this the purchase of over the counter medications and medical devices.

Maintaining health is essential to maintaining productivity, and treating small problems is an investment in preventing big problems.

It's perverse that a worker could spend all of his or her income on health care expenses, and then owe the government money on that income even though there's no cash left once (or even before) the medical expenses are paid.

I have had health insurance (general, dental & eye care) from my employers for better than 15 years. In that time I've hit them up for about $1000 total.

I have paid for my own eyeglasses, dentures or oral orthotics, and am now paying for my own medicines/devices/test strips on my own in all that time.

I view insurance as that -- it is for disaster coverage -- not the day to day crap.

If they came up with a true, long-term MSA system, I'd be all for it. I can put 7.5% tax free into an account in perpetuity that the insurance company is only responsible for anything above $5 or $10K that is in the account. Negotiate the premiums on my health and risks, and the amount in my account.

treating small problems is an investment in preventing big problems.

Never works. Too many false positives on preventative tests, too many people clogging up the system with minor ailments. A friend of mine cut his forehead recently (he had a band-aid on it when we went to the bar for dinner). It wasn't that bad - nasty cut, but it wasn't bleeding and he'd cleaned it out. He asked me "do you think I should go to the doctor in the morning and get stitches?"

I told him, for fuck's sake no, if the bleeding has stopped you don't need them. He went anyway. Doctor told him exactly what I had, in politer terms. It's healed fine, not even a scar.

Preventative care *increases* costs. That's the reason for co-pays.

No offense, but I'll take the Canadian system. Sure, the US might have a 'better' medical system, but after years of hearing stories about people being denied treatment by their insurance companies due to spurious claims of 'pre-existing conditions', I'll pass. (Like the story of the woman who was denied coverage of therapy after being raped, because she'd been raped before and it was now a 'pre-existing condition' and not covered.

An insurance company's job is to make money. The way to do that is to sign up people who will pay into it without needing to use it. In health insurance, that means signing up healthy people, then finding a way to dump them if they start needing treatments. Especially if it involves long-term care.

Is the Canadian system the best possible? No, of course not. But it's pretty damned good. And I don't have to worry about getting bankrupted by a trip to the hospital that gets refused by an profit seeking insurance company.