Amazing that we’ve gone on for so long, considering we’re both in agreement on most of the issues at hand!
Read on to the end, I think I came up with a compromise we could both live with.

“As the % of the electorate that wants to throw out the entire Congress grows, eventually we’ll get majority turnover until these people start actually representing the People.”
The whole “throw the bums out” movement has been around for decades, with little real change. Though Congressional approval ratings are extremely low, people keep re-electing most incumbents. Most people agree Congress is bad, but insist their individual congressman is good. I commend you in your endeavor, and I do vote for whom I think can adequately represent me. But though seeking change for the better is noble, to expect it any time soon is not realistic. You may think me a fatalist, I’d consider myself a realist. It’s difficult for things to get better. I mostly concentrate on working on them not getting any wrose (fat chance of that with our new government)! I don’t see entitlement reductions coming any time soon, but I’ll do my best to fight entitlement expansions. The nation won’t collapse, but I do see it slowly morphing into a European-style former empire. I don’t like it (really), but historically, it’s been the fate of all great powers.

“Most people who aren’t retired see Medicare as just another tax on their income that benefiting someone else, paying for a benefit they’re not likely to ever get, just like Social Security. People who ARE retired either see it as the only option – because of the extortion the DHHS employs – or a major pain in the ass.”

Any facts to back up your opinion? Surveys show Medicare recipients actually quite satisfied with their service.
http://www.commonwealthfund.org/Content/News/News-Releases/2002/Oct/Survey–Medicare-Beneficiaries-Report-Greater-Satisfaction-With-Insurance–Better-Access-To-Care-Tha.aspx
In my economically depressed region of the country, people actually look forward to receiving Medicare, and many retirees do have Social Security as their primary source of income, so I disagree with your above stated contentions.

“a government-controlled insurance policy that starts out insolvent and perpetually steals Taxpayers’ money from the general fund to stay in operation.”
Agreed! The fact that people (particularly the underclass) may like Medicare has nothing to do with its solvency. They must be reformed somehow (though I see little political will to do so -yet).

“This is an argument based on the false premise that we have no way of bringing the costs of routine health care back down into equilibrium with other routine costs of living.”
Costs can and should come down. But to expect $40 billion in charity to cover what the government does with $220 billion is, borrowing your expression, straining the argument beyond the point of absurdity. The cost of technology/drugs can come down. But the cost of human services will be difficult to reduce. For example, considering our nursing shortage (there are 126,000 unfilled nursing positions in the US), it’ll be difficult to reduce nursing wages. http://www.accessnurses.com/nursingshortage/ Doctors’ fees comprise a sizeable chunk of healthcare costs, and considering there are areas with doctor shortages (particularly primary care docs), it will be difficult to reduce their wages as well. http://www.nytimes.com/2009/04/27/health/policy/27care.html?_r=1 Lowering reimbursements could even heighten a doctor shortage, encouraging older docs to retire, and discouraging medical school enrollment. How many will choose to be doctors, if faced with high litigation, low reimbursement, and up to $140,000 in educational debts?

“Education is a good way to address this. And changes in the tax laws that encourage behavior which addresses it.”
I’d encourage education, though I don’t see it as a panacea. There’s none so deaf as he who doesn’t want to hear. …Changes in the tax law to encourage behavior? Hmm… almost sounds like a subtle endorsement of the cigarette/snack taxes!!

“AFTER the costs of routine health care have been brought back into equilibrium with other routine costs of living, let’s look at the numbers of people still abusing critical care services. Likely, what’s needed is enforcement of the law rather than onerous legislation that penalizes the responsible for the benefit of the irresponsible.”
Here’s the core of our difference of opinion. I believe you overestimate the drop in costs and underestimate those abusing the system (or overusing it -at my expense- because of self-destructive behavior).

You strongly believe in your freedom to choose (or not) health insurance. I strongly believe in my freedom to fund (or not) other’s healthcare costs. I believe you freedom of choice stops when I am forced to fund it.

You don’t want a system “… that penalizes the responsible [who'll pay for their healthcare costs] for the benefit of the irresponsible [those who won't].”

I don’t want a system “… that penalizes the responsible [who'll pay for their insurance] for the benefit of the irresponsible [those who won't, and expect others to foot their bills].”

I wonder if we could reach a compromise.

Instead of mandating insurance, and instead of having the government come in to rescue the uninsured, why not have the government offer low interest healthcare loans? Imagine a program akin to federal student loans, whereby people with no insurance, who are suffering through medical hardship, can apply for a government loan? Instead of selling off the house, or dying for lack of treatment, or being bailed out for “free” by the government, you establish a program whereby the patient’s critical illness medical bills are paid by the government, in return for a promise to pay off the sum over an extended period of time. The loan should have some form of financial insurance, as some patients will no doubt pass away before completing treatment. The cost of this financial insurance would be factored into the loans being made. Hence, the cost of defaulted loans would be spread out among all the uninsured taking out loans. Some would no doubt still face economic hardship. But being without catastrophic insurance shouldn’t be “comfortable.” The point is to help people help themselves, not to give them a free pass.

Sounds kind of hare-brained, but it would be a mechanism whereby some could choose not to have insurance, and the government would not be obliged to bail them out for “free.”

What about the poor? They’d still be enrolled in some form of government healthcare system, though I would advocate it be reformed into high deductible type of insurance. What about the poor who engage in self-destructive behavior, and end up costing the system billions a year? It would be difficult to separate self-inflicted vs. natural diseases. But you could tax the things that make you more prone to become catastrophically ill -snacks/cigarettes/alcohol. These taxes would disproportionately affect the poor. But then again, they disproportionately benefit from the government healthcare system anyway. And nobody forces them to smoke/drink….

The only problem I’d see is with the “uninsurable”: people who do not qualify for Medicaid/SCHIP/Medicare, yet cannot get insurance because of “preexisting conditions.” Perhaps a special clause could be made whereby those turned down by several insurers could qualify for Medicaid?

So rephrasing my original tenets:
1) Establish cost/coverage transparency in the healthcare industry.
2) Insurance companies compete across state lines and become non-profit.
3) Establish all insurance as low-premium/high deductible, with government incentives for consumers to create and fund Health Savings Accounts.
4) Medicare/Medicaid/SCHIP convert to high deductible insurances. Those living under the poverty line could be eligible for HSA-funding government vouchers. I recognize I’d still be funding other people’s healthcare, but it would be cheaper than today’s system. Given today’s political landscape, it’s the best I could hope for. Besides, I’m not that heartless, to leave the poor completely out in the cold!
5) Raise sin/snack taxes, to discourage these self-destructive behaviors, and make those who choose to continue to engage in them pay a little extra.
6) Tort reform
7) Insurance would not be compulsory. But those who do not qualify for government healthcare are on their own. If they want to pay their way, fine. If they cannot, they could apply for a federal healthcare loan, which they would have to repay over time.

There, sound better?

It’s been a cool debate, but I don’t know if I can keep up much longer. I’m off to do some personal business -try to spend some of my cash before the government takes it from me! I respect your steadfast resolve in defending your constitutional rights -though I don’t adhere to them as strongly as you do (must be my Latin American upbringing…). I’ll see you around! We’ll have to get together one day, and go troll hunting!

188. Chileno: – “No dishonest politician.” Is there any other kind?? Most politicians are not in the business of running an honest, effective government.

As long as we blindly accept that and actively support it, there’s no point in discussing any of this, since it’ll never get fixed no matter how much “debate” takes place. So I don’t accept that. Guys like Paul Ryan give me hope. As the % of the electorate that wants to throw out the entire Congress grows, eventually we’ll get majority turnover until these people start actually representing the People. It’ll either be that or the complete breakdown of the Republic. There’s no third option.

“Medicare is completely insolvent” – Agree!
“Most Americans… would understand this simple truth.” – Disagree!

- Most see Medicare as a sacred entitlement.
No. Have you ever had to deal with Medicare – as a beneficiary? I don’t think so. Most people who aren’t retired see Medicare as just another tax on their income that benefiting someone else, paying for a benefit they’re not likely to ever get, just like Social Security. People who ARE retired either see it as the only option – because of the extortion the DHHS employs – or a major pain in the ass. They key – while demonstrating the system’s moral and financial bankruptcy – is to present viable alternatives.

- How will the government keep it afloat?
The only way to keep it afloat is to do exactly what they’re trying to do: fold it into a larger version of the exact same thing: a government-controlled insurance policy that starts out insolvent and perpetually steals Taxpayers’ money from the general fund to stay in operation.

- But as it stands right now, ignorance is a common justification to punish everyone else with covering the ignorant’s health care bills!
Wrong. Absolutely wrong. The current dynamic is NOT justified. It’s precisely what encourages skyrocketing costs. You’re simply saying that the two types of ignorance are unavoidable and that one is no better than the other. I contend that ignorance – just like skyrocketing costs – IS avoidable, and that public awareness and education, combined with appropriate legislation, is the way to do avoid it.

… top 200 US charities raised only $40 billion in 2006. Federal government outlays for Medicaid/SHIP were about $220 billion.
This is an argument based on the false premise that we have no way of bringing the costs of routine health care back down into equilibrium with other routine costs of living. We need to think OUTSIDE that box if we’re ever going to resolve this issue.

Come one down to my hospital, and we’ll see how absurd this really is.
I’d prefer to examine some actual numbers rather than rely on anecdotal information. The simple fact is that EMTALA exists now. Medical facilities are not going broke covering the costs imposed by that legislation. And what’s more, there are better ways to handle the costs that ARE imposed.

- “Most people want to be healthy.” Indeed they do! They just don’t want to pay for it… Or at the very least, suffer the inconveniences associated with health maintenance. They have other priorities!
Agreed. Education is a good way to address this. And changes in the tax laws that encourage behavior which addresses it.

I read your link. It supports my thesis and proposal completely. Non-critical care isn’t gratis under EMTALA just because someone goes to the ER. And both Vanity Fair and the NYT know that. And if it can be demonstrated that this legislation is being abused by a large enough segment of the population, then it needs to be modified to provide compensation or repealed.

AFTER the costs of routine health care have been brought back into equilibrium with other routine costs of living, let’s look at the numbers of people still abusing critical care services. Likely, what’s needed is enforcement of the law rather than onerous legislation that penalizes the responsible for the benefit of the irresponsible.

Wow, the never ending thread!

“No dishonest politician.” Is there any other kind??
Most politicians are not in the business of running an honest, effective government. They’re in the business of getting themselves re-elected. Running a modestly successful government is simply a tool to that end. But the best tool they have is giving the majority what they want, and that includes “free” safety nets (at the expense of that “top 5%” who don’t pay their fair share anyway).

“Medicare is completely insolvent” – Agree!
“Most Americans… would understand this simple truth.” – Disagree!

Most see Medicare as a sacred entitlement. Hell, all of us working are paying into it, we BETTER get something out of it! It will not go away. I’d love to see the government reform Medicare to a high-deductible -type insurance to keep it solvent and truly help reduce the cost of routine care. But too many angry citizens/special interests would rise up to stop this.

How will the government keep it afloat? Just like it plans to impose socialized medicine on the rest of us -raising taxes, rationing services, or lowering reimbursements. I can see the government reducing benefits for future retirees, or phasing out benefits for “the rich.” The latter would worry me. Medicare/Social Security have always been a contract between the government and the people, whereby we put in money expecting one day to receive something back. If the rich pay in, and receive nothing in return, it effectively becomes a transfer of wealth tax. Of course, the definition of “rich” is an arbitrary number, which the government could alter to meet its needs…

“ignorance on the part of some regarding their health is no justification to punish everyone else with mandatory insurance.” But as it stands right now, ignorance is a common justification to punish everyone else with covering the ignorant’s health care bills! Don’t get me wrong, I would only consider mandating high-deductible insurance. Let everyone -ignorant or not- cover their routine expenses. But if someone develops a catastrophic injury/illness, they can’t be left to die, even if they were ignorant, or negligent, or miscalculated their level of risk tolerance. So who will pay if they cannot?

“Set up charitable organizations”
Charities are an honorable endeavor -really. But the top 200 US charities raised only $40 billion in 2006. Federal government outlays for Medicaid/SHIP were about $220 billion. True, if all health insurance was high-deductible, the cost of covering the underclass/uninsured could drop significantly. But I doubt they would drop to the point charity could cover it all. Rather than having the government step in to pay, I’d mandate catastrophic insurance.

“…statistically significant segment of the population is going to allow themselves to go through the enormous discomfort of becoming critically ill, just so they can get ‘free’ health care. That suggestion strains the argument beyond the point of absurdity.”
Hmm… Come one down to my hospital, and we’ll see how absurd this really is. It’s not that people consciously decide to become critically ill to get that “free” healthcare. It’s that they delude themselves into thinking they’re all right -until they’re not. There is none so blind as he who does not wish to see. And it doesn’t take a large segment of the population to drive up costs. I could easily tick off a half dozen patients who have spent over a half million dollars each in care over the past year, all of whom were on some form of government insurance (Medicaid/Medicare).

“Most people want to be healthy.” Indeed they do! They just don’t want to pay for it… Or at the very least, suffer the inconveniences associated with health maintenance. They have other priorities! Young people, for example, will gladly shell out $200 and wait for hours to get into to a sold-out Shakira concert, but some won’t bother buying insurance, or go for a routine checkup. Alcoholics could spend thousands on booze every year, but not get insured, because they don’t believe they’re ill. And it wouldn’t bother me, really, if they got sick and “paid their way.” But all too often, I’m the one footing their bills!

“the notion that a program like EMTALA – which already exists – is somehow going to change people’s priorities and basic survival instincts…” EMTALA has ALREADY modified people’s priorities.

From http://www.nytimes.com/2000/10/25/us/emergency-room-to-many-remains-the-doctor-s-office.html

“In New York City, three out of four visits to an emergency room are for non-emergencies, according to a new study by the Commonwealth Fund, a private philanthropic organization.

“In many areas of the country, especially in cities with large numbers of uninsured, emergency rooms are being crushed under the increased volume and patient care is often compromised, doctors said.
‘
‘We are not adapting very well,” said Dr. Daniel Higgins, the medical director of emergency service at St. Francis Medical Center in Lynwood, Calif., where 27 percent of the patients are uninsured and emergency room visits have risen 13 percent in five years.

”A good one-third of our population is uninsured so we would not expect any change in utilization with that group,” said Virginia Hastings, the director of the Los Angeles County Emergency Medical Services Agency.”

From Slate: http://www.slate.com/id/2199645/pagenum/all/

“If you are uninsured, it’s even more rational to get your care in the E.R. Federal law requires a screening exam and treatment for any patient who shows up, regardless of whether they can pay. And hospitals, after a string of negative press reports, are less likely than ever to aggressively pursue patients for delinquent medical bills. In contrast to ERs, primary-care clinics routinely fail to provide urgent appointments for patients who are uninsured, even if they have a serious condition or are willing to pay cash for their visit.”

Granted, even insured people are flocking to the ER, as “In the E.R., a single $100 co-pay may feel like a relative bargain compared with the alternative: fees for multiple trips to the doctor and testing centers, hours on the phone arranging the whole process, and days of missed work.” So not all the ER congestion is because of the uninsured. But a significant proportion is, thanks to EMTALA.

The crux of our debate centers on personal freedom vs. personal accountability.
I’m sure you are a responsible person, and don’t feel the need for government to tell you what to do, much less order you to buy insurance.

But I’ve come across too many irresponsible individuals who are unwilling or unable to pay their bills. I hold myself accountable. I don’t feel the need to be held accountable for other people’s healthcare bills.

If all healthcare was high-deductible, and costs were lower, perhaps the number of people opting not to have insurance would decrease, and general costs would decrease as well. But I still feel there’d be a significant number of people who would opt not to have coverage, to terrible consequences to themselves, and to me.

Good debate! Party on!

Precisely the reason that Job One is to bring down the cost of routine care, rather than endlessly looking for ways to “cover it” while allowing it to continue skyrocketing. That requires breaking up the insurance companies’ monopoly control of prices and going back to a standard commodity market like the ones that keep all other routine costs of living relatively affordable.

- Unfortunately, EMTALA/Medicaid/Medicare are entitlements so ingrained in the public’s mind that no politician would dare dismantle them.
No dishonest politician.

Take Medicare, for instance. An honest politician would print out E-Sized charts from the Trustees’ own published report (scroll down to Chart D, for example) and explain to all of America why Medicare is not a feasible mechanism for funding health care. The fact that Medicare must steal, outright, increasing amounts from the general fund each year – which effectively comprises a secondary (tertiary?) Medicare Tax that doesn’t actually appear on one’s W-2 – demonstrates that it is not feasible. You can’t simply keep stealing larger sums to fund a failing enterprise. And the fact that it can only be sustained after 2012 by deficit spending demonstrates that it’s insane. EMTALA is a drop in the bucket by comparison, but socialized medicine will be more of the same, just on a much, much larger scale.

An honest politician would clearly explain all this, and also explain how the DHHS uses extortion to force retirees into Medicare, rather than allowing them to opt for alternatives that might reimburse on par with private plans, providing access to better care.

Medicare is completely insolvent and, were it a business, would have been declared bankrupt and sold off for its few assets long ago. Most Americans – especially most retirees – would understand this simple truth.

- What about those who are unaware or who deny that they are sick, like the alcoholics?
Well first of all, skyrocketing routine health care costs are not caused by alcoholism or the general public’s ignorance. And even if it were, just as ignorance of the law is no excuse for breaking it, ignorance on the part of some regarding their health is no justification to punish everyone else with mandatory insurance.

Help these folks all you like. Set up charitable organizations. No one’s suggesting you shouldn’t. The government is well within its authority if it funds large-scale programs to educate the public on these issues. Perhaps we can divert a few billion$ from the War On [Some] Drugs™ to fund this effort. But the feds just don’t have the authority to legislate what an individual does with that information or how an individual decides to manage their own risk. Trying to legislate against ignorance is no different from endlessly looking for ways to cover skyrocketing costs. In both cases there is an underlying – false – assumption that one can’t address the root cause.

- But you’re still funding EMTALA with the leftover 5%.
That’s the whole idea. And that funding becomes easier over time as long as you simultaneously break the insurance companies’ monopoly over the price of health care. The free market will force the costs of health care back into equilibrium with other routine costs of living. It’s a package deal.

- Some would take the 95% home and spend it on what pleasures them, fully expecting the leftover 5% to pay for whatever illness comes their way.
Uhm… “whatever illness” is not how the law reads. In order to make this logic stick, you have to be suggesting that a statistically significant segment of the population is going to allow themselves to go through the enormous discomfort of becoming critically ill, just so they can get ‘free’ health care. That suggestion strains the argument beyond the point of absurdity.

Most people want to be healthy. They’re mostly scared to death of being critically ill. The vast majority of responsible adults will ensure that they and their children never reach that point. Right now that’s perceived as ‘hard’ because the cost of health care is perceived as prohibitively high. And for some it may be. We can’t know because right now, the true value of health care is completely hidden by a morass of reimbursement schedules, provider/insurer agreements, government price-fixing and misleading co-pays that don’t reflect what the consumer would pay for it in any way, shape or form.

Either way, the notion that a program like EMTALA – which already exists – is somehow going to change people’s priorities and basic survival instincts such that they wait for treatment until it’s critical care? Just so they can get it for ‘free’? That’s just a little bit silly.

Cheers!!

“EMTALA requires that critical care must be provided”

Indeed, it boils down to a government assurance that, regardless of your capacity to pay, you will get treated. For the underclass unable to pay, and the unscrupulous unwilling to pay, that’s essentially free government insurance. True, EMTALA only covers acute care. But when left untreated, chronic illness (e.g. diabetes) becomes acute illness (e.g. renal failure, gangrene, heart attacks).

In an EMTALA-free world, where people were actually responsible for their own acts, and made to pay for their high threshold of risk tolerance – I’d likely be in agreement with you. Unfortunately, EMTALA/Medicaid/Medicare are entitlements so ingrained in the public’s mind that no politician would dare dismantle them. It would be political suicide. I understand the true freedoms you propose. But so long as a “free” healthcare choice exists (i.e. government, i.e. my expense), many will not take responsibility for their acts.

What about those who are unaware or who deny that they are sick, like the alcoholics? How do they consciously gauge their level of risk tolerance? There’s too many people out there who just don’t know or don’t want to know what their risk is, and continue to engage in self-destructive behavior, until it all comes crashing down. “I just didn’t know,” is what they’ll say. Will the government let them die? Would I? So I must respectfully disagree on this point.

“I believe we should consider taking 95% of what employers pay for insurance, and giving it to employees as an instant raise” Interesting proposal, I’d agree. But you’re still funding EMTALA with the leftover 5%. Some would take the 95% home and spend it on what pleasures them, fully expecting the leftover 5% to pay for whatever illness comes their way.

I think we’re not going to convince each other on this point, and are starting to run around in circles! Anyway, it’s been cool, goy. We’ll keep talking, if not here, on some other thread, hopefully as comrades in the fight against the evil trolls that lurk in this site!

- I guess I misarticulated my point.
I figured that was likely, but unlike the lefty trolls who hang out here, I’m not comfortable assuming – let alone redefining – the meaning of what other people write.

Clearly, we are long past the point of having proved that FDR’s socialist policies were (are) not workable over the long term. Individual freedom requires individual responsibility – at every level.

EMTALA requires that critical care must be provided, as I’m sure you’re quite familiar. If government were considering actual reform of the health care system – instead of largely looking for a way to increase federal revenue and a basis on which to ram through associated limitations on liberty – they’d address that aspect of EMTALA and provide a mechanism to recoup expenses for critical health care mandated by the government, but which is ultimately caused due to one’s own conscious choices.

Personally, I believe we should consider taking 95% of what employers pay for insurance, and giving it to employees as an instant raise (tax exempt for the first 5 years after passage of the law that would make this a tax advantage to employers). This would be used to direct-pay for routine health care while costs are settling back into equilibrium AND to fund their own high-deductible/low-premium health care policy. The remaining 5% would go toward the cost of EMATALA-driven health care expenses – inversely proportional, of course, to any tax advantages an institution is already enjoying (tax freeloaders like Yale / New Haven Hospital spring to mind).

In addition to pushing up the cost, as demonstrated in Mass., mandatory insurance punishes the responsible in order to lessen the economic impact of the irresponsible. Auto insurance is really no different. There’s no moral justification for it, only an economic one, supported largely by the insurance lobby, the ambulance-chaser lobby, politicians and leftists who think government should think for us.

- Hmm… Promoting a tax?
Overall, what I proposed was a combination of specifically-applied taxes AND specifically-applied tax relief. Initially, the federal revenue generated would work to the benefit of government. And in an enlightened world, that increased revenue would provide a financial basis for the creation of, say, a network of low-cost health clinics or, preferably, low-cost business loans for private enterprises who want to provide them. Over time, the behavior triggering the taxes would decrease because people would opt out of the activities that drive up the cost of routine health care, i.e., those activities where the tax would be most strongly applied.

he Constitution gives Congress the power “‘to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States,’ thus empowering the federal government to levy taxes and leverage these revenues to benefit the American people.

…Long-term care constitutes a difficult and expensive challenge in any health system. But the American patchwork, full of cracks through which people fall, has a special problem with medical expenses of all kinds bankrupting couples.
A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.
M. still helps her husband and, quietly, continues to live with him and care for him. But she worries that the authorities will come after her if they realize that they divorced not because of irreconcilable differences but because of irreconcilable medical bills. There were awkward questions from friends who saw the divorce announcement in the newspaper.
“It’s just crazy,” she said. “It twists people like pretzels.”
The existing system doesn’t just break up families, it also costs lives. A 2004 study by the Institute of Medicine, a branch of the National Academy of Sciences, found that lack of health insurance causes 18,000 unnecessary deaths a year. That’s one person slipping through the cracks and dying every half an hour.
In short, it’s a good bet that our existing dysfunctional health system knocks off far more people than an army of “death panels” could — even if they existed, worked 24/7 and got around in a fleet of black helicopters.
So, for those of you inclined to believe the worst about President Obama, think it through. Suppose he is indeed a secret, foreign-born Muslim agent who is scheming to undermine American family values while killing off as many grandmothers as possible.
If all that were true, why on earth would he be trying so hard to reform our health care system? We already know how to prod families into divorce and take a life unnecessarily every 30 minutes — all we need to do is reject reform and stick with exactly what we have.

“So they’re not simply a passive actor in all this. They’re going to apply the considerable leverage they have to maintain the status quo – that’s where they’re culpable.”

Fair enough, I’ll agree to that.

“Well, if your rationale for this is that someone has made a “mistake” by contracting a catastrophic illness, or by being involved in a catastrophic accident not covered by auto insurance…”

I guess I misarticulated my point. I was referring to people who consciously place themselves in harm’s way (e.g. smoke, drink/eat in excess, drive recklessly). People have right to engage in these behaviors (with certain restrictions). If they enjoy the right of living dangerously, they should also assume the responsibility of paying the price for the high level of risk they were willing to tolerate (i.e. pay for their “mistake”). But all too often, once they get sick they expect others to foot the bill. True, some may not. But my experience is that those are a minority. I work in healthcare, in an economically depressed region. I often see morbidly obese diabetics -many who still smoke- come in for amputations, bypass surgeries, dialysis, etc. all at government expense. I feel sorry for the miserable state they’re in. Yet at the same time it angers me to think how they must’ve ignored years of medical advice to eat better, lose weight, and stop smoking, because they preferred the joys of overeating/smoking. And now I (through my taxes) have to pay for the mess they’ve made with their bodies.

In terms of unanticipated catastrophic illness/accidents, I’d agree that the government has no business deciding one’s own level of tolerance, IF one is willing to pay the price. But again, all too often, an individual decides he has a high tolerance for risk (e.g. gets no insurance) and when disaster strikes, he looks for ways in which the government or the hospital can offset his costs. If they were rich enough to “pay their way,” sure, the government should not have to tell them what to do, but that’s often not the case. That’s why I believe it’s not unreasonable to expect that, if the government (with my money) finds itself bailing people out from their illness/accident/self-destructive behavior, it should have some say in where the risk tolerance line is drawn.

“Properly applied taxation could encourage behavior that would discourage health care cost increases…” Though imperfect, that’s one of the reasons why I favored higher cigarette/snack taxes! I know, sin taxes wouldn’t change the fundamental flaws in the system, but they would discourage risky behavior, and ultimately curb our healthcare demand.

Hmm… Promoting a tax? Didn’t you say (regarding higher sin taxes), “…this approach just puts more money into the hands of Congress…. I don’t know about you, but I’m for taking every dollar OUT of these career criminals’ hands that we can possibly manage.” Just a thought..