You don't go far enough. Why should there be health "insurance" at all? Why should my premiums subsidize sick people when I am healthy? People should just pay for health care on an as-needed basis. That way, they can bargain with the doctor to get the cost down. You know, your kid is sick, you can call around and compare prices. And if you're too poor to afford it, then tough - God must not love you.

Otherwise, great post!

Q: "Why should there be health 'insurance' at all?"

A: Because people want peace of mind ñ- ie, knowing that illness wonít eat up their savings and ruin them financially. And because insurance companies want a profit. Theyíre betting that the costs of care won't exceed their revenue from premiums and returns on investment. Originally, insurance was designed for the costs of large and uncertain losses, not small and predictable ones. This is how employers can justify not buying coverage for dental care or psychotherapy. Weíre expected to save up for those services, since they're predictable.

Q: "Why should my premiums subsidize sick people when I am healthy?"

A: Because you might not always be the healthy one. Group health insurance is really based on a sense of social solidarity. Our approach to insuring against health risks has roots in a movement among manual laborers in Germany and Austria, who voluntarily made regular payments into "sickness funds" to cover the costs of medical care. At the turn of the 20th century, immigrants brought this system with them to the U.S. and formed mutual aid associations at work to provide similar benefits.

Thank you, Lena.

Or wait... maybe that post from Mithras was in jest. Good one!

Why don't we introduce compulsory euthanasia for anyone with major congenital defects and/or the onset of a disease likely to incur debilitating financial costs on the rest of society? Spare those 50-something professionals the fear of heart attack by machine-gunning them down in their offices! Eliminate all smokers by age 45, before they contract emphysema and cancer and weigh us all down with the monetary burden of their filthy habit! Kill all 75-year-olds, thus slashing the costs of Medicaid and virtually eliminating old-age Alzheimer's, Parkinson's etc! Hell, they've lived long enough. Tell everyone who's 30 lbs overweight to get jogging or get a bullet in the cerebellum! And how about mandatory sterilisation for anyone too stupid to get into college? No more pesky children being rushed to the emergency room at public expense because their parents are too lame-brained and/or too poor to exercise proper preventive care!

With the money we save, we can introduce compulsory cosmetic surgery for the ugly, so we don't have to look at their sorry-ass faces every
time we walk down the street. And that's just the beginning of the new vistas that open up. Don't like Muslims, or Jews? Tell 'em to lose their religion in a hurry or pay the consequences!

Hey, it worked for the Nazis.

How much my insurance costs for me alone if I pay for it myself, for JUST myself: around $200 a month.
How much my insurance costs for me alone if my employer pays: $2.

I'm pretty sick of how in America you usually only have insurance if you're employed for 40 hours a week, but given how much it costs, it isn't always feasible for everyone to shell out for their own. Ugh.

I'm looking for a good plan that covers abdominal liposuction. Any suggestions?

love,
Lena and her JWA (Jiggly White Ass)

As for the euthanasia afficionado, I think people SHOULD pay the costs of self-induced illnesses -- perhaps through higher premiums -- and yes, yet again, I am completely in agreement with Lena -- health insurance is necessary and prudent to have in case of catastrophic illness or accident. If I fall and break my brain, I have Kaiser Permanente I pay $186 a month for, so my parents don't feel compelled to sell their house and go live in a shed to pay the docs to put Humpty Goddessdumpty back together again. Why, indeed, shouldn't we all pay our own health insurance costs? We pay anyway, when employers pay -- it's just not apportioned fairly, because single people are paying the costs of the breeders with five underparented brats and nonsmokers, the costs of the smokers.

"I think people SHOULD pay the costs of self-induced illnesses."

You make it sound like the causes (note the plural) of illness are always 1) obvious and 2) either hereditary OR self-induced. It's just not that clear-cut, my lovely red-haired one. If only science were that advanced!

"Single people are paying the costs of the breeders with five underparented brats and nonsmokers, the costs of the smokers."

Oh, but we're not paying as much as they are. One of the reasons why I'm happy to be single and childless is that my insurance premiums are nice and low. I can choose the cadillac plan at work. (The primary reason why I don't have a pet is the exposure to incredibly high veterinary costs. I just have to satisfy myself with the company of humans.) And before you scale to ever-higher moral heights over smokers, remember that not only do they pay higher health and life insurance premiums than non-smokers, they are also, through "sin" taxes, funding breast cancer screening programs and health insurance for low-income underparented brats in all 50 states (the S-CHIP program). So you can relax, Amy. They're being punished.

Alkon, I wanna know how you got on that Kaiser plan. You're freelance/self-employed too, right? Seriously.

Modestproposal, I'm liking your ideas, especially since I would benefit from the "compulsory cosmetic surgery." When I'm asked for my picture online, I simply say, "In compliance with the indecency statutes of the 1996 of the Federal Telecommunications Act, the image of my obscenely ugly face is no longer permitted to be sent online."

Reminds me of a joke I read on a message board. It seems there was this bus travelling down the Interstate, which by strange coincidence, was carrying only ugly people.

In a tragic mishap, the bus collided with a semi and all the passengers were killed. Standing at the pearly gates, St. Peter, aggrieved by their tragic and untimely deaths, promised them each one wish before they entered paradise.

The first person said, "All my life I have been unattractive. My wish is that I may be beautiful."

"Done," replied St. Peter, and the first person joyfully entered paradise, newly adorned with a countenance an angel might have envied.

Then St. Peter addressed the second person, "And what is your wish, my daughter?"

The second passenger said, "I also have been considered ugly all my life. My wish is also to be made beautiful."

"Done," replied St. Peter, and she, too, was newly adorned with a beautiful face and body.

At the very end of the line, a slight snickering was heard.

One by one, St. Peter asked each person what their wish was before entering paradise, and each wished for the same thing: to be made beautiful. The laughter from the man at the end of the line grew louder and louder.

Finally, as the person ahead of him entered paradise with a beautiful new face, the last man stepped up before St. Peter.

"And what is your wish, my son?" asked St. Peter.

Still amused, the man replied, "Make 'em all ugly again."

Patrick, I'm sure you're a total babe. Your babeness is just oozing out from between your words.

Here's a joke you'll like:

A man goes to his doctor for a routine check-up. After extensive testing, he comes back for his results two weeks later.

The doctor gives him the bad news. "I'm sorry to have to tell you this, but it looks like you only have 6 months to live."

The man is outraged and says, "That's ridiculous! I want a second opinion."

The doctor obliges: "Okay. You're ugly too."

We do pay the costs of breeders and their five underparented children because they get before-tax health benefits. Also, that's especially true of anybody who works at a big company, where the company pie is apportioned so breeders and their kids get a much bigger portion (at exceptionally discounted rates). That discount is paid for somewhere...right? Maybe the single dude would get a bigger raise if mommy and her brood's health care costs weren't being paid for by the employer.

Why should people pay a higher premium because they're not sick, but I am? I suffer from a chronic illness that requires several medications, and frequent doctor visits. I work for the company I do because it has excellent health coverage. But, without health insurance, I would not be able to afford my medications. Without the medications, I would be unable to work, and therefore would qualify for disability. And then, you would be paying more. You wouldn't be paying a slightly higher premium. You would be paying for all of my doctor visits, all of my medications, and all of my living expenses. So, yes, you pay slightly more for insurance because I'm on your plan. But you pay less taxes because you're not supporting me, and the millions of Americans who have chronic illnesses but work so they can have insurance. Who do I blame? Do I blame my parents for passing on this genetic disorder? Do I blame the pharmaceutical companies for charging too much for the medications? Do I blame the doctors for having high office visit costs? So, before you get all upset because you have to pay for those of us who are using the insurance more than you, remember that it could be much worse. You could have to pay to house, clothe, and feed me, in addition to all my medical expenses. It seems that you're actually getting the better end of the deal. And one day, if and when you suffer a medical crisis, you will thank your lucky stars that there are those out there who are paying slightly higher premiums to support your high medical costs.

Yes, Sarah, I as one person who runs six miles about every other day, and is very healthy, pay part of your health care cost in my insurance. But health insurance is a kind of Vegas-like system -- a bet on the part of health care concerns that they won't go bankrupt if they charge Amy about $200 to pick up the cost of some of Sarah's care. I could have a different plan, where I don't have others' care built into mine, but I don't. Where I object, is for those working for a big company who have to pay the cost (as single people) for somebody else's six-person family. WRONG! Also, if I'm using after-tax dollars for my health care, so should everybody else. The world is increasingly self-employed, and it's unfair (just as marriage privileging and the tax breaks that go with that are unfair) to discriminate against me financially because I'm self-employed.

Yes, I work for a large Fortune 500 company. And I see your point about the single person paying for the family of 6. I use pre-tax dollars to pay for my premiums. However, seeing as how little I make, it doesn't bump me down a tax bracket and my paycheck is exactly the same as if I was using my after-tax dollars to pay for it. I guess the benefit I get out of it is that the IRS thinks I make $80 a month less than I do and therefore I would qualify for a slightly larger refund. I could argue that, needing insurance as I do, I was actually forced to work for a company that I would not have otherwise picked, and am doing work that I would not otherwise be doing. Yes I can go back to school, and am doing so, though I have to limit my class load so that I can work my 40 hours a week to qualify for my insurance. Our entire healthcare system needs to be overhauled, starting with the way insurance is set up.

Okay, time for some realities.

The reason health care costs are so high in this country has nothing to do with six-member families skimming off healthy single people like Amy (who, one day, will get sick and die, just like the rest of us). The reason is because the system is hijacked by private insurance companies and pharmaceutical companies who have successfully bought off Congress to ensure they can continue to charge exorbitant rates to everyone -- public health authorities, employers and individuals trying to meet the costs of their various insurance plans.

In every other major industrialised country in the world there is a government-sponsored health care system which ensures that 1) there are no health insurance companies to claim a slice of the cake, thus bringing costs down dramatically and 2) drugs, medical equipment etc are much more reasonably priced because their cost is either directly controlled by the government or else subject to negotiations in which the supplier companies do not have a licence to extort the consumer as they do in this country. Also those countries have far lower rates of infant mortality and a near-absence of easily preventable and/or eradicable diseases like tuberculosis, whose existence here is little short of a scandal.

If the United States could somehow find in itself the will to introduce a government-backed health system, the 43 million people currently uninsured would have access to health care, prescription drug prices would plummet and Amy would pay a fraction of her current insurance costs without having to worry about kids stealing nickels out of her cookie jar. Also when she gets old and infirm and realises kids might have come in handy after all to help take care of her, she could have access to assisted living facilities, home nurse visits, etc etc etc.

So let's focus on the real issue here, all right, and not let the nexus of corporations, lobbyists and revolving-door politicians play their game of dividing us against ourselves and preventing us from understanding that they are the ones we should be taking aim at.

Amy, you've spent time in France, so you know all this is true. And don't give me any crap about the French letting thousands of old people die last summer. The French are a bunch of fuckers, okay, but that doesn't mean their health system, as a system, doesn't work far far better than the sorry excuse that exists here in the United States.

Andrew writes: If the United States could somehow find in itself the will to introduce a government-backed health system, the 43 million people currently uninsured would have access to health care, prescription drug prices would plummet and Amy would pay a fraction of her current insurance costs without having to worry about kids stealing nickels out of her cookie jar. Also when she gets old and infirm and realises kids might have come in handy after all to help take care of her, she could have access to assisted living facilities, home nurse visits, etc etc etc.<<

Sounds nice, but you're forgetting one thing. In order to PAY for a government-backed health care system, Amy would also be TAXED out the yin-yang. Or haven't you bothered to check the tax rates in countries with Government backed health care systems, like Germany?

Not only have I checked the tax rates, I've paid them. I've lived in France, England and Italy as well as here and find the tax rates more or less equivalent. The difference being: in Europe, you get a health care system for your money too!

Think it would be a little off-topic to get into the reasons for this, but try checking: US corporate tax rates (scandalously low), or the size of the US military budget (ludicrously, dangerously high, and they don't even give veterans proper health care!). Just for starters.

Face it: you are being ripped off, my friends.

I'm almost afraid to admit this, but I work for a health insurance administration company. One point that Amy makes is that insured employees are paying with pre-tax dollars. That's not always true. Not every employer offers a pre-tax (Section 125) plan to its employees.

Another point is that not every employer contributes toward dependent insurance costs. That's one way many employers have tried to save themselves money. And even for the employers that do contribute something towards the cost of dependent coverage, it is usually a smaller percentage than what they pay toward the employee's coverage.

I think, in general, most employees do not realize exactly what a benefit health insurance is. If your employer contributes 50% or more to the cost of your coverage, it can easily be the equivalent of another $1-3 dollars per hour over what you currently get paid.

You may not be aware that there is an existing system that the IRS lets employers set up called a cafeteria system. It allows the employer to offer a set amount of money to the employee to use in 'shopping' for benefits from a wide array of choices, and the employee can then select whatever plans he/she wants. If the employee wants more coverage than what the employer contributes, the employee has to pay for it. But any money unused is then credited to the employee. Unfortunately, they can be an absolute nightmare to administer, so usually you only find extremely large employers who offer them.

The government already regulates so many factors regarding health insurance that the carriers continue to hike their fees in order to pay for all of the compliance work. I regularly have to deal with the Department of Labor, the IRS, the California Department of Insurance, and the California Department of Managed Healthcare in my line of work. It would make you sick to try and follow all of the different (and sometimes conflicting) rules that each imposes. Plus, we as consumers continue to demand that more and more services be covered, so someone's going to pay the cost for those benefits, and the carriers don't plan on it being them!

Something will eventually give--I hope I've found another job by the time it does!

The way insurance is set up comes from World War II. Companies couldn't give raises due to salary freezes. So, what they did was offer free health insurance to their employees as a bonus. Over time, that system deteriorated to what we have today. While the idea of socialized healthcare is appealing, there are too mnay people who still fall through the cracks of national health plans. Some services and illnesses are put on the backburner by the government, while here in America, they aren't. We pay more for healthcare, but we also have more freedoms. Freedom to choose a doctor, freedom to choose which medication to take when there are a variety that will work, etc. I am one of the first ones to curse my insurance company when they screw something up, or deny me a treatment I think I need. But I also have many friends in Great Britain who say that National Health isn't all its cracked up to be. Waiting lists for procedures are years long. Neither system is perfect. It really is the lesser of two evils.

"Freedom to choose a doctor"
... if he/she is on the panel of "preferred providers."

"freedom to choose which medication to take"
... if it's on the formulary.

In France, the tax rates are equivalent!!? Which France would that be, the France on Earth II?

Sure Andrew, this is why we have citizens of other nations coming to the US and paying for diagnostics that would take months to schedule in their home nations. A sufficient delay that a little tumor can become several big ones.

Under socialist medical programs everybody is taken care but only at a generally mediocre level. We've allowed government programs to grossly distort the market for medical care here. Excellent care is available to those who can pay. With a truly free market that portion of the population would be much larger.

As far as socialist dental care goes, let's just say that the French are better known for their food and fashion than their smiles.