Insurance mandate: Should the healthy pay for irresponsibility?

[Care4all]

whether you are responsible or not responsible, you pay for the unhealthy, when you have group health insurance....

it is not the responsible that pays for the irresponsible....because many that are irresponsible and do take risks, never neeed the health care.... the sick and the accident prone medical services are paid for by the others in the group that are not sick or that did not get in an accident....

so, even the irresponsible end up paying for others that are sick or hurt...

 

[MikeHoncho]

Oh really?

i'm sorry i may have missed where it says the federal government has the power to make me purchase something.

I completely agree with you; I don't think you should have to purchase insurance. However, he was referring to the "entire health care debacle is unconstitutional", not simply the mandate. I'm assuming that the Democrats are attempting to "promote the general welfare" through their health care bill, though whether they actually are or not is debatable.

if one thing is deemed unconstitutional about it, then the entire bill would be unconstitutional.

 

[RationalAltruis]

whether you are responsible or not responsible, you pay for the unhealthy, when you have group health insurance....

it is not the responsible that pays for the irresponsible....because many that are irresponsible and do not take risks, never neeed the health care.... the sick and the accident prone medical services are paid for by the others in the group that are not sick or that did not get in an accident....

But there's significant overlap between the irresponsible and the "sick and the accident prone":

Untreated alcohol problems waste an estimated $184.6 billion dollars per year in health care, business and criminal justice costs, and cause more than 100,000 deaths.
Harwood, H. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods, and Data. Report prepared by The Lewin Group for the National Institute on Alcohol Abuse and Alcoholism, 2000.

Of course there is overlap. I'm saying that, in general, the mandate will force the more responsible / more healthy / more poor (can't afford insurance) to pay for insurance they don't need, which will benefit the less responsible, on average. They aren't all irresponsible; nothing of the sort. Nor are all of the healthy people responsible; however, I'm talking about averages.

if one thing is deemed unconstitutional about it, then the entire bill would be unconstitutional.

Of course. So if the mandate is determined unconstitutional then the bill will be struck down. I'm not disagreeing with that, but that wasn't the argument I was making; I was making an ethical argument (there are better solutions than the mandate) not a legal argument.

 

[The Rabbi]

whether you are responsible or not responsible, you pay for the unhealthy, when you have group health insurance....

it is not the responsible that pays for the irresponsible....because many that are irresponsible and do not take risks, never neeed the health care.... the sick and the accident prone medical services are paid for by the others in the group that are not sick or that did not get in an accident....

so, even the irresponsible end up paying for others that are sick or hurt...

Actually what you pay for is for someone else to take the risk of the medical bills. Which is fine because it is a voluntary arrangement.
What the Dums have proposed is not a voluntary arrangement. And that's what sucks about it.

 

[JScott]

Many Democrats are arguing that an insurance mandate is necessary so that everyone will be forced to get health insurance. This is for the sake of cost sharing; nowadays, for instance, many consumers are looking to tighten their belts and find savings everywhere they can. One bet many poor healthy people have made is to not get health insurance because they won't need it enough to justify the cost. Insurance companies lose many of their healthy subscribers, so they lose profit; as a result, those who are too sick remain on the plan, but for the company to offset its losses, it has to increase premiums. This is probably what caused the recent 39% premium increase Anthem imposed in California (statehealthfacts.org/profileind.jsp?ind=346&cat=6&rgn=6). A mandate will prevent the possibility of this happening in the future; people will have to get insurance even if it would not be economically rational, and insurance companies get more profit.

I have two main disagreements with this:

• Healthy people should not have to pay for sick people directly because sickness is often caused by poor lifestyle behaviors. If some people make poor decisions about their health, others (the healthy who would be forced to get insurance for cost-sharing) should not be forced to pay for it. Call me heartless, but I think if you eat so much that you're 300 pounds and need coronary bypass surgery or something, you should be the one to pay for it. It's basic personal responsibility.
• The government has no imperative to force citizens to buy something simply so that an industry can make more profit. Without the mandate, the people in need will disproportionately desire health insurance more - but that's how it is for every single other good and service the market provides. It's not unfair to the companies, they're voluntarily providing a service (hopefully) and others are voluntarily choosing to purchase that service or not.

Firstly, the healthy should not have to pay for those who make bad decisions and make themselves sick or require expensive surgery or drugs. Of course, there are many ailments which are not caused by negligence, but many are. For instance, eating at McDonalds every other day, or taking the elevator up to the 2nd floor, or using a motorized lawn mower you ride on, or not exercising, etc. Recent advances in technology and manufacturing have increased our ability to stay inactive or to buy cheap, unhealthy goods. You can see the effects of thsese things today:

Obesity:
upload.wikimedia.org/wikipedia/commons/c/c1/USObesityRate1960-2004.gif
2/3 of all Americans are overweight.
1/3 of all Americans are obese.

In 2018, the cost of obesity at a national level is projected to be $1,425 per person. Source: americashealthrankings.org/2009/spotlight/cost.aspx"

($1425 per person * ~300 million people = $427,500 million, or $427.5 billion)

Diabetes:

If nothing is done, the number of Americans with diabetes will nearly double in the next 25 years and spending on the disease will nearly triple, a new study shows. ... By 2034, as many as 44 million Americans will have diabetes, up from 23 million today, according to the new projections, published in the November issue of the American Diabetes Association journal Diabetes Care.

The cost of caring for diabetes patients is projected to rise from $113 billion to $336 annually, before adjusting for inflation.
Source: medicinenet.com/script/main/art.asp?articlekey=108138
Medical Journal Source:care.diabetesjournals.org/content/32/12/2225.full

Alcoholism:

• Percent of adults who were current regular drinkers (at least 12 drinks in the past year): 50
• Number of alcoholic liver disease deaths: 13,050
• Number of alcohol-induced deaths, excluding accidents and homicides: 22,073

Source: cdc.gov/nchs/fastats/alcohol.htm

The bottom line is that poor lifestyle choices are a significant cause of much of our extravagant health care spending. These poor choices should not be subsidized by unrelated third-parties (the healthy) - it creates a moral hazard. People are more likely to make bad decisions if they know others would pay for potential consequences.

Secondly, even if the lack of a mandate gives a company greater cost pressures, that's no reason to interfere with the market simply for the sake of providing the company more profit. We don't force corporations to operate at a loss; why should we force some consumers to operate at a loss (be forced to buy insurance)? This would simply be a giveaway to the insurance companies. They're already making billions of dollars in profits; why should the government interfere simply to give them more, hurting healthy citizens in the process?

Of course, there is one caveat applicable to both of these, which is that some sicknesses are not caused by risky behaviors. It would be quite difficult to fairly and consistently separate those responsible, and given that reducing costs is one of the main reasons for health reform, I don't see a solution, other than the following:

There is also the idea that, whether or not one is responsible for one's ailment, the state nevertheless has a duty to help out financially. While this may have philosophical merit, I don't think it's workable here, given that personal freedom is supposed to be one of the main principles of the country, and that cost control is absolutely necessary.

One last argument for the mandate is that some will buy health insurance only when they get sick, decreasing the insurance industry's profits if they decide to carry you. A possible counter is that the firms may be free to deny your insurance application, which would incentivise getting insurance before you need it, for the sake of cost-sharing among the healthy.

What do you think?

Should the healthy help pay for affordable health care? Yes.

 

[RationalAltruis]

Should the healthy help pay for affordable health care? Yes.

I agree completely. That's why I supported the public option, and why I support subsidies in lieu of the public option. But I'm pretty sure that with subsidies, the problem of a lack of access to affordable health care can be mostly solved. Not completely, but mostly. A mandate isn't necessary.

 

[The Rabbi]

Should the healthy help pay for affordable health care? Yes.

Do you mean they should, like a moral responsibility? Or do you mean should like we're going to make it mandatory?
If the latter then why??

 

[JScott]

Should the healthy help pay for affordable health care? Yes.

Do you mean they should, like a moral responsibility? Or do you mean should like we're going to make it mandatory?
If the latter then why??

If everyone pays then the price goes down. Its the best way and its the only way.

 

[RationalAltruis]

Should the healthy help pay for affordable health care? Yes.

Do you mean they should, like a moral responsibility? Or do you mean should like we're going to make it mandatory?
If the latter then why??

If everyone pays then the price goes down. Its the best way and its the only way.

But there are multiple ways to have "everyone pay". One way is through the mandate, though insurance companies also get more profit that way. Another way is the public option, though that seems impossible as well. A last way is using hundreds of billions of dollars on subsidies (paid for through taxes) so that everyone (or, most) can have access; that seems to solve the problem without a mandate.

 

[The Rabbi]

Should the healthy help pay for affordable health care? Yes.

Do you mean they should, like a moral responsibility? Or do you mean should like we're going to make it mandatory?
If the latter then why??

If everyone pays then the price goes down. Its the best way and its the only way.

How do you figure that??
There is a cost to deliver the service, whatever it is. If I pay full price for my service, and you for yours and someone else for theirs, how is the price going to go down? If I pay for mine and you for yours and the two of us chip in for someone else's how is the price lower on what we've bought?
It isn't.

 

[rightwinger]

whether you are responsible or not responsible, you pay for the unhealthy, when you have group health insurance....

it is not the responsible that pays for the irresponsible....because many that are irresponsible and do not take risks, never neeed the health care.... the sick and the accident prone medical services are paid for by the others in the group that are not sick or that did not get in an accident....

so, even the irresponsible end up paying for others that are sick or hurt...

The Health Insurance Pool is generally comprised of two groups

1. The large percentage who pay premiums and rarely use them

2. A smaller percentage that get much more in health benefits than they pay in.


I would prefer to be in the first group

 

[RationalAltruis]

How do you figure that??
There is a cost to deliver the service, whatever it is. If I pay full price for my service, and you for yours and someone else for theirs, how is the price going to go down? If I pay for mine and you for yours and the two of us chip in for someone else's how is the price lower on what we've bought?
It isn't.

If the guy you're quoting is referring to the mandate, the train of thought is that the healthy people without insurance currently, if forced to buy insurance, would bring some revenue to the system, while introducing only a tiny amount of risk, so they're justified in bringing down premiums for everyone. If more healthy people are in the system, there's less average risk in the system, so there's less average cost to the system, per person.

So it's cheaper that way, per person. I don't think that means it's a good idea, though, as you can see by this thread.

 

[The Rabbi]

How do you figure that??
There is a cost to deliver the service, whatever it is. If I pay full price for my service, and you for yours and someone else for theirs, how is the price going to go down? If I pay for mine and you for yours and the two of us chip in for someone else's how is the price lower on what we've bought?
It isn't.

If the guy you're quoting is referring to the mandate, the train of thought is that the healthy people without insurance currently, if forced to buy insurance, would bring some revenue to the system, while introducing only a tiny amount of risk, so they're justified in bringing down premiums for everyone. If more healthy people are in the system, there's less average risk in the system, so there's less average cost to the system, per person.

So it's cheaper that way, per person. I don't think that means it's a good idea, though, as you can see by this thread.

But at the same time people who can't afford the premiums will get them subsidized by the government via taxation, which comes from the same people who likely already have insurance.
And demand is not static. Studies are that when people get insurance they tend to use much more medical services. This obviously drives costs up.

It's an idiotic idea and based on many unfounded assumptions. Chief among those is that people without insurance are driving up the cost of healthcare.

 

[JScott]

How do you figure that??
There is a cost to deliver the service, whatever it is. If I pay full price for my service, and you for yours and someone else for theirs, how is the price going to go down? If I pay for mine and you for yours and the two of us chip in for someone else's how is the price lower on what we've bought?
It isn't.

If the guy you're quoting is referring to the mandate, the train of thought is that the healthy people without insurance currently, if forced to buy insurance, would bring some revenue to the system, while introducing only a tiny amount of risk, so they're justified in bringing down premiums for everyone. If more healthy people are in the system, there's less average risk in the system, so there's less average cost to the system, per person.

So it's cheaper that way, per person. I don't think that means it's a good idea, though, as you can see by this thread.

But at the same time people who can't afford the premiums will get them subsidized by the government via taxation, which comes from the same people who likely already have insurance.
And demand is not static. Studies are that when people get insurance they tend to use much more medical services. This obviously drives costs up.

It's an idiotic idea and based on many unfounded assumptions. Chief among those is that people without insurance are driving up the cost of healthcare.

There is a growing group of people in this country who work and still cant afford insurance.

So, whats your idea?

 

[boedicca]

If everyone pays then the price goes down. Its the best way and its the only way.

Only if the supply of doctors, nurses, medical equipment, etc. increases along with supply.

As that is not the case when government takes over health care. Providers and technology becomes scarcer over time, until long wait times "ration" care so that those who are often in most need of it die while waiting.

 

[Care4all]

If everyone pays then the price goes down. Its the best way and its the only way.

Only if the supply of doctors, nurses, medical equipment, etc. increases along with supply.

As that is not the case when government takes over health care. Providers and technology becomes scarcer over time, until long wait times "ration" care so that those who are often in most need of it die while waiting.

the bill had funding to increase medical schools and more grants for doctors....and i believe more money for hospitals as well, if memory serves me!

AND i agree, unless doctors, nurses, technicians, med schools, hospitals increase, we will have a huge problem....

but supply will increase Bod, if the demand increases....it could take a blip or 2 to get us there with supply, but it will happen....

 

[The T]

Should the healthy help pay for affordable health care? Yes.

Do you mean they should, like a moral responsibility? Or do you mean should like we're going to make it mandatory?
If the latter then why??

If everyone pays then the price goes down. Its the best way and its the only way.

How the Hell does that work? Government MANDATES to compell people to purchase *ANYTHING* are inheriently frought with problems, and UnConstitutional in the Venue of Healthcare.

Healthcare has NOT been proven by LAW to be an established right of any sort, under any circumstances. It's an affront to Liberty of the people.

Good luck with this...you'll need it (And you're outnumbered besides).

 

[RationalAltruis]

This is the graphic I was trying to post earlier. Health costs are extremely concentrated.

 

[boedicca]

but supply will increase Bod, if the demand increases....it could take a blip or 2 to get us there with supply, but it will happen....

That's not what existing doctors claim. Many who are in practice now say they will retire or go into other careers.

If the government steps in to say "a medical degree is a right" in order to pump up supply, I doubt any of us will be happy with the quality of such doctors.

 

[The T]

If everyone pays then the price goes down. Its the best way and its the only way.

Only if the supply of doctors, nurses, medical equipment, etc. increases along with supply.

As that is not the case when government takes over health care. Providers and technology becomes scarcer over time, until long wait times "ration" care so that those who are often in most need of it die while waiting.

the bill had funding to increase medical schools and more grants for doctors....and i believe more money for hospitals as well, if memory serves me!

AND i agree, unless doctors, nurses, technicians, med schools, hospitals increase, we will have a huge problem....

but supply will increase Bod, if the demand increases....it could take a blip or 2 to get us there with supply, but it will happen....

And what is that BILL exactly? It portends that the Government will pay for job skills, as long as those participating sign their lives away, and become slaves to the Government in that field with such a mandate.

And that is what will happen in this case.

It's wrong.