Health Insurance and Personal Responsibility
Blitzer talks about “society” letting someone die, but whom does he mean? Each individual is part of society, so isn’t the real question, “What are YOU going to do about it?” Treating “society” as some super-entity above and beyond the individuals who compose it causes two problems. First, it gives individuals an excuse to do nothing by their own initiative; second, it encourages many to ignore the actual victims of politicians’ forced wealth transfer schemes.
“Society” has no right to violate the rights of minorities or of individuals. Doctors, hospitals, and individuals who wish to help pay for others’ care remain free to do so, but they should not be forced by federal politicians to do so.
The deeper problem, the real reason a healthy 30 year old grows tempted to forgo health insurance, is that politicians have made the costs of health care and insurance ludicrously expensive.
Through destructive tax policies, the federal government linked health insurance to employment and encouraged the use of “insurance” for routine, every-day costs rather than for true emergencies. As a consequence, consumers have almost no incentive to seek economical care, and a considerable portion of each health dollar goes to insurance paperwork rather than actual care.
Today’s politicians have taken dramatic action to turn health insurance into a gigantic wealth transfer scheme. That, indeed, is the entire premise behind the ObamaCare “mandate”; people must be forced to buy insurance because its artificially high costs subsidize the care of others. Consider, for example, the recent mandate from Health and Human Services that forces the insured who don’t need birth control to pay for the birth control of others.
If we dismantled the federal controls over health care and moved toward a free market, that would put patients back in control of their health care, help contain costs, make insurance affordable again, empower more people to manage their health care costs, and ease the burdens on voluntary charity.
To take one example, expanding untaxed health savings accounts would give people the incentive to save and pay for their own health care and insurance. People should be able to buy health insurance out of their HSAs and contribute to HSAs regardless of their insurance.
The health-policy debate deserves better than inflammatory rhetoric about letting people die. Free-market reforms make it easier for people to live and pursue a healthy and autonomous life. In moving toward that goal, all that needs to die are the misguided political controls on health care and insurance that have so thoroughly debilitated those fields.
Also read: “ObamaCare: Whether You Like Your Privacy or Not, You Don’t Get to Keep It“
Another part of the same problem is that health insurance is so expensive (and the Sword of Damocles uncertainty of Obamacare so impossible to quantify) that nobody wants to hire full-time employees if they can possibly avoid it.
The upshot is widespread underemployment, which is truly a national tragedy.
The reason health insurance is so expensive is because health care is so expensive.
The vast majority of your health insurance premiums goes to pay for medical procedures for yourself and others in your group (usually people that work at the same company).
Lower health care costs, and insurance costs will go down too.
And health CARE is so expensive because of the lack of a free market in it’s delivery. Compare the price of routine care with LASIK. LASIK isn’t usually covered by insurance so providers have to compete for business based on cost and quality and as a result, the price fir LASIK is less than half of what it was when the procedure was first introduced. This isn’t rocket science. It isn’t hard. It’s common sense economics. Competition ALWAYS results in lower prices, better service, and better quality because the losers go out of business.
Competition in health insurance leads to lower cost, too. Consider what happened when Wisconsin, having managed to rein in the teachers’ union just a bit, was no longer required to buy teachers’ health insurance from the union’s own insurance company. Some districts put the contract out to bid, resulting in lower health insurance costs; for others, the union’s health insurance company promised to lower their price to meet any other company’s bid, resulting in lower health insurance costs for those districts, too.
Such a shame the union lost their monopoly on teachers’ health insurance!! It’s so much easier to be profitable when there is no competition allowed.
Precisely.
In fact, someone I know quite well wrote about this, oh, nearly 3 years ago now.
In January of ’10, Rush Limbaugh (who has no health insurance — DUH!) became ill while on vacation in Hawaii. He received emergency medical care at a nearby hospital. When he told them he would be self-pay, they reduced his charges by quite a bit (I don’t think he ever said exactly how much).
Think of it, payment at time of service; no paperwork to fill out and file with insurance company; no danger of NOT being paid.
The point here is: how do we even have a hint of the cost of medical care when it’s all so heavily influenced by government meddling and insurance company caution, not to mention the danger of medical malpractice claims, all too often frivolous and always expensive, win, lose or settle?
There can be no doubt that when it comes to rates charged for procedures, a separate set applies to those of us who pay out of pocket. In my case, it concerned undergoing the cataract procedure with lens implants, which I underwent electively. They did try to rule out my eligibility for insurance coverage by assessing my eyes for the presence of cataracts; there were none. Not only did I get a discounted price from the doc (as there is a fee to his office for filing a claim), I received a whalloping $1699 refund from the surgery center at which I had the procedure done. Got a 20% discount from the anesthesiology practice as well.
I think it can be safely assumed that if healthcare were turned over to the private sector, competition would indeed play a role in bringing on lower prices, as evidence above clearly shows that healthcare providers gig the insurance industry for all it can get (& this also includes Medicare & Medicaid).
The American people have been conditioned for 60 years that someone ELSE is going to pay for their healthcare. It all started with companies offering “free” medical insurance. People got conditioned to the disconnect between paying for the insurance and receiving the healthcare. I usually point out to people that they don’t have a problem with their homeowners insurance – if they don’t like the insurance company, they change it. They haven’t had that freedom with health insurance.
One simple change that I would recommend is to make health insurance premiums tax deductable ONLY for individuals, not for corporations – the exact opposite of what we have now. For the faint-hearted, we could add in some 2-3 yr switchover provisions that encourage companies to put what they now spend in premiums into individual accounts for their employees.
When you write the check yourself, you have much more skin in the game.
Imagine polling this question: “Someone has been severely injured and they don’t have health insurance. Should the government be responsible for their medical bill?” Ask it a little differently if you like – should the govt or private charity be responsible for them. What do you think the result of that poll would be? My guess is that it would poll in the 75%+ range.
What I’m getting at is the sense I have that most post people have the opinion that catastrophic problems should be taken care of regardless of the ability to pay. This would include severe injury, long-term expensive care (ie, child with cancer requiring long, expensive treatment, and especially end-of-life care).
Any govt bureaucracy involved even in catastrophic health issues will be a problem, but I’m pretty sure that’s what people in this country want. It’s a slope – we live most of our lives on a policy slope – neither all the way to one end or the other. It’s a matter of picking the most reasonable location on that slope.
However, this does not mean we need the government to take care of EVERYTHING! We need health insurance to go back to the concept of “insurance” – protection against unforeseen events. We do not need insurance to cover birth control pills or even annual checkups. These are hardly unforeseen events! And this is one of the many factors that drives up the cost of health insurance. Would you pay for your auto policy to include oil changes – not once you saw the price!
But the only reason people expect someone else to pay for it is because of government policies in the ’40′s, where government wage controls meant employers could not reward their employees for the incredible work they had done during the war. Since employers couldn’t raise wages, they started giving employees non-wage perks, specifically health insurance coverage. The whole employer-paid insurance phenomenon was another unintended consequence of government meddling in the free market. If employers had been allowed to raise compensation, health insurance would never have gotten tied to employment.
“considerable portion of each health dollar goes to insurance paperwork rather than actual care”
Most people have no idea what it takes to bill the insurance companies. Expensive software applications are necessary to navigate a very complex system of documenting the care and translating it into a bill. Even with the software many errors still occur because of restrictive, sometimes vague billing and coding guidelines that are set by insurance and the government. If the provider sends the bills electronically they also have to pay a clearing house that further prepares the bill into an electronic format that can be received by the insurance company. Then there is the issue of follow up on unpaid or improperly paid claims. As a health care biller for a hospital, my colleagues and I spend inordinate amounts of time calling insurance companies only to be told, after 20 minutes or more on hold, that they don’t have the claim on file even when we have sent it numerous times; electronically, by fax or even certified mail. We joke that the insurance companies keep a shredder in their mail room. But it isn’t all that funny. Between lost claims, data entry errors by the insurance companies, denial of what actually are covered services that we have to appeal and pre-authorizations we received that the insurance companies claim they did not give, it can take months to receive payment. Anyone who runs a business knows that timely payment is crucial. In most states insurance companies must pay or deny clean claims (that have no errors) in 30 calendar days, however, they seem to think it is 30 business days even when the claim has been approved for payment within in a week of their receiving it. If there are errors on the claim they have more time but, when the insurance company is the one who made an error, they will still stretch it out to 60 or 90 days before they will pay the claim.
I suspect that billing was easier back when most people only had major medical plans and paid for most or all of their own preventative care if they chose to get it. The demise of major medical plans and the inclusion of preventative care coverage has probably had a direct impact on the rising costs of health care. If we didn’t have to pay for the billing and the headaches that go with it as I described above, costs for most health care in general would be far less expensive for the consumers, insurance companies and the providers.
That’s the thing that a lot of people don’t seem to understand- if your insurance covers everything possible (or on a laundry list of progressive causes), then your rates automatically go up. More things covered means more likelihood the insurance company is going to be billed by the insured. This means more administrative costs, the need to keep a larger pool of capital (i.e., the healthy having higher rates regardless), and probably more time stonewalling in order to preserve capital.
Think about it- if car insurance paid for your oil changes, your tire replacements, your overhauls, or your 30/60/90k-miles major maintenance, the rates would be obscene. As it is, through the owner being responsible for maintenance, competition for business for major coverage, a decent driving record (age factors here, so I’ve been told), and a couple of incentives (combined property insurance), I now pay less for full coverage on a car I’m making payments on than I did for discounted liability-only on an inexpensive, fully paid car back in my 20s (so, 10 years ago- you do the math). If we returned competition, including across state lines, and removed mandates, you’d see a comparative reduction in costs.
If we had simple catastrophic or major medical insurance widely available (think Geico or Progressive for health insurance), then most likely, that healthy 30 something would have afforded a much less costly major medical program over a full-coverage, and his coma would be totally or partially covered. And I do realize this is kind of apples-to-pears in comparison, but the driving factors remain the same- the more personal responsibility a customer has for maintaining their health, the lower their insurance costs will be.
You write: “To many on the left, need automatically warrants political intervention.”
Where is the empirical data to support this claim?
Oh, wait a minute — I understand — you’re posting on PajamasMedia, you don’t need to provide proof, just throw some bullshit on the wall and hope it sticks.
Look around you.
Uninsured people = government intervention.
Unemployment going up = government intervention.
Arsenic in apple juice (a natural phenomenon, as there’s arsenic in apple seeds) = government intervention.
I could go on, but what’s happening is clear to anyone with two eyes and more than two functioning brain cells.
The majority of independent voters elected Obama in 08, and many still espouse that he’s the smartest man in the room, or they are talk about being completely unaware of his lack of experience and political acumen, or how they were fooled by his eloquent speaking.
I think that is direct proof that a large percentage of people in this country do not have two brain cells to rub together.
Armstrong makes an excellent point about not treating “society” as some sort of super-entity. The reification of society as somehow greater than the individuals that compose it has been the source of numerous bad ideas in politics and economics — not just in health care.
If America is to survive, we need to rediscover the primacy of the *individual* as the proper unit of political thinking. Fortunately, more and more Americans are starting to get it.
What made health insurance so expensive is that it has ceased to be insurance at all. Its a means to make Peter subsidize Paul’s health care, especially in regard to coverage that Peter doesn’t want or need. In some states, for example, you cannot buy health insurance that only covers catastrophic events, and of course, you can’t buy health insurance across state lines.
And the whole idea of mandatory health insurance is a joke. The same people who get “free” health care because they are poor are still going to be getting “free” health care once and if the individual mandate comes into effect.
#3. Rick H posits a polling question that “[if] Someone has been severely injured and they don’t have health insurance. Should the government be responsible for their medical bill?” I wonder what the response would be if the question was “if someone has been severely injured and they don’t have health insurance. Should YOU be responsible for THEIR medical bill?” I suspect that the response would not be the same.
Thus showing how polls are frequently skewed to support a particular viewpoint and are therefore worthless for determining what the populace actually thinks. Of course, even with skewed questions they also cherry pick their crowd. I hate polls.
My point was not about polling. I was just trying to express the sense I get from friends, neighbors, relatives, etc. Ask your own friends – people who are not regulars at sites like this – that vast middle ground. Ask them what should happen with people who have a catastrophic health problem but can’t afford to pay. Leave it open ended like that – without a choice of answers. What I’m saying is that I think we’d find that there’s a vast consensus on the general answer. And we free-market types won’t like the answer.
What I desperately want is for the government to leave me alone, stop taking my money from me to force me into programs in which I don’t want to participate, and just leave me the HE!! alone to take care of myself.
I would love it if the salary I received from my employer were the actual salary I negotiated plus the value of all my benefits plus the employer portion of Social Security. I would be more than happy to purchase health insurance on my own and I’d use the money currently confiscated from me for Social Security to increase my 401k contributions.
I currently have a high deductible, low premium health insurance plan with an HSA and I love it. I recently looked into going to an allergist due to an annoying sinus problem. I contacted the allergist’s office and they wanted $750 just for an evaluation. Because this problem is just an annoyance and not in any way life impacting I declined to go. Why? Because I would have had to spend my own money and made the decision that it just wasn’t worth it. If I had a traditional health insurance policy I would have gone and the insurance company would have picked up the bill.
A couple years ago I had to go to the ER. They sent me a bill and because I had to pay it out of my own pocket via my HSA I called the hospital and was able to negotiate a 20% discount because I made the transaction easier for them by being able to cut out the insurance company for this transaction.
My deductible is one of the highest available, $6,000, so it’s unlikely I will use my insurance more than a couple times before I retire unless something catastrophic happens to me. THAT is what health insurance is for.
Can everyone afford a $6,000 deductible? Of course not and the FREE market would create products that met people’s needs if only the government would get out of the way. And for the poor I would have the government subsidize their HSAs and have them then take care of their own health care needs with no additional support, regulations, or meddling from the government.
The government’s health care bill is so enormous because it inserted itself in the market. When people are allowed to take care of themselves then the government’s obligations disappear.
I’ve never before hated the government. I used to get angry and disgusted but now I actually hate the government with a burning passion that is only exceeded by my hatred, yes hatred, of statist, socialist liberals who seek to control our lives. Free people will only take this for so long before an eruption occurs.
When my husband and I went into our early 60s, our FL health insurance monthly premiums (with the largest allowable deductibles) rose to $1000/mo EACH!!!!! We couldn’t afford $2000/mo for health insurance…BUT-WE-PAID-IT!
The cost is so ridiculously expensive that far too many non-govt worker residents simply don’t have health insureance! It’s $2000/mo or nothing!
We don’t need our small preventative exams covered. Any preventative exam under $400 should be paid by the policy holder. Catastropic care ONLY should be covered by health insurance. If those $2000/mo insurance premiums could be cut to …say, $350/mo…many more people would buy health insurance.
I ask the legislators: could YOU afford $2000/mo for just you and your spouse?
Pam, check out eHealth.com. There are a lot of policies with a lot of different options from a lot of different providers there.
Wow, thanks Eric! You’re right! Our insurance was with Blue Cross/Blue Shield of FL and NEVER were we told that there was a less expensive option!!!! I guess the lesson here is not to listen to a company’s official rep…but rather to go on-line and try to find options that don’t involve an insurance co’s rep!
Thanks Eric!
Pam,
It’s called caveat emptor.
The people selling you things, be it health insurance or cotton candy, aren’t gonna look out for you. You have to do that yourself.
Many of the really expensive health insurance policies are for those “cadillac” health plans, usually going to Union members or Government workers. But we don’t reall NEED those policies. If more people had health plans that had a high deductible, say $5,000, and then the rest was covered for a catastrophic illness, you would see how fast premiums would go down. If people realized that the first $5,000 was coming out of their pockets, you would see how fast they would also STOP abusing the system, and not run to a doctor the first time they have a cold or a pulled muscle. Also, make a percentage of that first $5,000 tax deductable to help people afford this policy. This is the way insurance used to work about 40 years ago and it seemed to work. People were not dying in the streets and the world moved on. But now, unless you have a cadillac plan, it seems like you’re not being covered at all.
Tort reform would also go a long, long, way in bringing down costs too. Having an affordable insurance plan would help a lot more people and for those who truly cannot affor it, there still are charities and hospitals willing to help them.
Gov’t has no legitimate role in health care routinely. Gov’t regulation of the medical marketplace, primarily through the medical practice acts and the FDA, increase the cost of providing medical care, reduce the availability of medical resources, and markedly raise the cost, leading to a situation in which the cost of medical care is, or is perceived to be, too high for the average citizen to pay for readily. This in turn has led to the development of the gov’t paying for medical care for some, and health insurance paying for others.
The solution is to eliminate all gov’t involvement in health care. Let the patient or the patient’s representative decide who will provide his medical care, what medicines he will take. Get rid of the medical practice acts and the FDA, and watch the cost of medical care drop like a rock. The entire debate about Medicare, Medicaid, the cost of insurance, etc, will become a completely moot point.
How about this scenario: Say a self employed family paid $12,000 per year (we pay this much) for 20 years for health insurance, that is $240,000. Mr. Hippy Happy go lucky anthropologist spent those 20 years traveling the world, living it up, and becoming so much more enlightened than all of his non oikophobe ethnocentric American peers, not paying a dime for health insurance (or his student loans, but that is a completely different story to tell on another day). It turns out his happy days come to an end when he finds out his party hardy days have led him to a decayed liver and diabetes. So should Mr. Happy Hippy preexisting condition get health insurance for the same price ats the family that has been paying all along or should he have to compensate for the years he did not pay in? In the first scenario the responsible family has had to pay $240,000 more than the Happy Hippy, did not get to enjoy traveling the world, and will suffer from higher premiums as Mr. Hippy enters the insurance pool. Sounds like a pretty good deal for Mr. Hippy, not so much for the responsible family.
Ghosts Of Independence: Old Ink, Eternal Ideals. The tea partiers know its not just about the high taxes. Its about the rulers behind them who have lost touch, like too many of us, with a simple question: why are we Americans? Bill Whittle finds a simple answer in recalling our founding ideals.
http://www.youtube.com/watch?v=OEdLPq9YSlU
“The basis of our political system is the right of the people to make and to alter their constitutions of government.” George Washington
Ella8 hit on exactly what I learned when my wife had emergency vascular surgery to save her leg because she had smoked and not managed her Type I diabetes, both in disregard of medical advice. Walking the hospital while she recovered, I had an epiphany and asked one of her surgeons if I was right: “The biggest problem with the American health care system is the American patient. We turn our bodies into train wrecks and drag ourselves into the E.R. and demand that you fix us up so we can go out and do the same thing again.” He agreed.
Health care is headed to a regime where you have to behave yourself or else, regardless of whether it’s total EuroNationalObamaCare or complete free-market. Meds and procedures — and the “check everything” tests we demand — are becoming more expensive. That means we are demanding that the insurer pay out more and more money that ultimately comes from us. Even private health insurance is a form of socialized medicine, a private compact where the partners pay. I have excellent health insurance through my employer, but we are getting subtle pressure — wellness clinics, checks on basic vitals, health competitions — to do the right things and thus hold down costs. It’s only fair.
But people being what they are, I doubt it will work in the long run. Eventually everyone will have mandatory cholesterol, BP, A1c, lung function, and other checks every quarter. If your numbers go out of bounds, you get a prescription for diet and exercise. If you don’t shape up, your insurance rate rises until you have to drop out. If you have a chronic, unavoidable disease, like my wife’s Type 1 diabetes, you should not be penalized for that alone. But if you don’t take reasonable steps to manage it, you should.
It’s invasive. It’s fascist. It’s inevitable.
You want someone to pay your bills? Then they own you. And they have a right to demand that you live responsibly so they don’t have to pay for the live transplant ella8 mentioned.
Liver transplant, not “live transplant,” though it sort of makes sense.
I do agree that I should not have to pay for other people’s self inflicted health problems, the point of my comment was more about the amount of money the responsible family had already paid. Perhaps those with prexisting conditions should have a deductible of (number of years uninsured) x (going rate for health insurance). In the case of Mr. HIPPY, his deductible should be a hypothetical $240,000. I don’t see anything unethical about that since the responsible family would have paid that much over the course of 20 years for insurance. As far as not paying for someone elses bad habits, we could allow for voluntary drug and tobacco testing and those who opt in and test negative could be part of a cleaner insurance pool. Also, everything should have at least a small co pay, nothing should be completely free, because nothing is ever free, somebody will pay for it, the cost is just socialized within the pool of those who are insured). We should be allowed to pick what kind of plans and what kind of services are covered in our plans. If I don’t want to be a part of a plan that socializes the cost of birth control by demanding no copays, I should not be forced by government mandate.
Agreed.
I am now wondering about the mandate to buy health insurance, would this apply to all American citizens regardless of where in the world they are living. In fairness the mandate should apply to them. I know people who are happy go luckily traveling the world in their state of perpetual adolescence. It would really be unfair if all land tied Americans were having this shoved down their throats, and the happy go lucky’s were getting off scott free, only to return home later when their health deteriorates and expect to hop on the gravy train and get insurance regardless of whether they have been paying in or have a preexisting condition, while driving up my premiums.
Ari Armstrong, and Paul Hsieh, are right: The uacknowledged idea underneath socialized medicine, is that there is somehow some super-entity, “society”, which is above and greater than the individual, which can impose unchosen obligations on individuals, chaining them to each other.
There is no such thing as “society” as a separate entity. Only individuals exist as separate, real entities. It’s individuals which get sick, and it’s individuals who are responsible for paying for their health care. Voluntary good will, voluntary charity between individuals is real and is responsible for a great deal of good. What is crucial is that it is voluntary, and not an obligation.
With all the (justified) complaints about the MSM treatment of the Republican candidates, and the absolutely correct observation that letting Progressives shape the debate, perhaps it’s best to steal the ball. So…
Hey, Roger L. Simon! Host a debate.
Don’t make it available on TV. Stream it.
Ask Bill Whittle, Alexis Garcia, or Bill Hicks to moderate. Perhaps get Allen Barton or Glenn Reynolds to pinch hit…
Obamacare, the Stealth Abomination
A Democrat friend, (yes, I do have a few of them), said to me yesterday, “Well, I’ll at least be able to keep my own insurance when Obamacare kicks in, right?”
Her question demonstrated what is one of the slickest aspects of the intentionally-mislabeled Patient Protection and Affordable Care Act of 2010 which few in Congress read before voting on it and passing it: Few Americans outside Congress know what’s in it, either.
The very questionable constitutionality of the PPACA will, hopefully, soon be settled by the United States Supreme Court. The issues on SCOTUS’ docket include but are not limited to whether our federal government can legally–forget morally–order citizens to purchase health insurance or be subjected to financial penalties.
Constitutionality aside, assuming Associate Justice Elena Kagan fails to recuse herself in the proceedings and the Court decides in favor of President Barack Hussein’s signature statute designed to seize control over one-sixth of the nation’s economy, another issue becomes almost as significant, my friend’s and millions of others’ ignorance of PPACA’s provisions.
Justice Kagan has as little integrity as the president and despite having labored on behalf of Obamacare during her employment as Solicitor General is unlikely to choose honor over Democrat loyalty by recusing herself.
To bolster her anticipated non-recusal and the unethical Obama administration, Democrats launched a smokescreen pre-emptive attack on the financial ethics of the lone African-American (conservative) member of the Supremes, Clarence Thomas, but that’s a whole other story.
Back to my friend.
She’s not a stupid person, despite being a Democrat . . . (Read more at http://www.genelalor.com/blog1/?p=5621.)
We’re a gaggle of volunteers and starting a new scheme in our community. Your website provided us with helpful info to work on. You’ve done a formidable process and our entire group will be grateful to you.