Third Party Liability
Like most of you, I suspect, I've been having lots of conversations with angry conservatives about the Health Care bill. One issue that's come up right away is the controversial mandate that everyone MUST buy insurance. Those with a more libertarian streak don't much care for this provision since isn't it somebody's personal responsibility as to whether they should have insurance or not. If they want to take the risk of not covering themselves, isn't it their lookout?
The argument for forcing people to buy insurance in order to drive a car is not completely analogous. Forcing everyone to buy insurance, you guarantee that innocent third parties will not have to bear the costs of accidents that are not their fault. But rates are determined by people's behavior, something that can't be as effective in health insurance. If your rates are so high that you can't afford the insurance and you don't buy it, you can't legally drive a car. If you can't afford your health insurance and don't buy it, somebody will pick up the tab down the road when you have a health care expense that you can't pay. And if you don't see a problem with making people pay for their own choices, one way or the other, there will be some clearer innocent third party cases. The recent S-CHIP and Medicare expansions probably cover them already but most conservatives (including myself) didn't and don't favor that solution.
The benefit of forcing the healthy and the sick to buy insurance is that you get a lot of cheaper people in the pool to help cover those who will be more expensive. The healthy people are actually buying insurance against some catastrophe. The sick people are buying pre-paid and in some cases subsidized health care. If you want the system to be fair, this isn't a solution. It's practical but not principled.
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written by Ed Salden , August 03, 2009
"If they want to take the risk of not covering themselves, isn't it their lookout?"
Health cost exposure goes up with people's bad habits, like overeating, or their bad luck, like a genetic disease. Some will be be priced out of the market.
Is society willing to deny ordinary health care to those unable to pay? If no, then it becomes a question of the best way to spread out the cost.
written by MoonliteSonata , August 03, 2009
If you mean preventative care, checkups, simple treatments for simple ailments etc, that would be considered "ordinary", to me. Anything that nearly anyone can pay out of pocket for, in most cases, would be considered "ordinary". Anything that would take years and years to pay off would be considered "extraordinary". And those are the things I think that you're talking about helping people pay for, not "ordinary health care".
I've already posted that making arrangements with hospitals and clinics is still not only possible, but happens all the freaking time, and used my own parents as an example. It took over 20 years for them to pay for those catastrophic medical bills, but they did.. without YOU or ANYONE ELSE having to foot the bill. Why oh why is it that people don't believe it is acceptable, desirable, or possible for people to do the same now?
written by Nobody , August 03, 2009
Ed my youngest son blew out his ACL in a pick up BB game. he was treated had the surgery and is payinf off the last of the bills. It started north of $20K.
written by Barthélemy Barbancourt , August 03, 2009
Our society does not deny critical care to anyone. All AIDS drugs are free for anyone that asks. I know a woman that was treated for lung cancer and she had no insurance. The hospital ate over $100,000 in bills. It is illegal to deny care in America. Everyone in America has access to excellent care. They may go into debt getting that care (unless they are an illegal alien, then they just walk) but that is what insurance is for.
Let's be honest in this debate and use the correct terms. We are debating how to pay for this care.
written by MoonliteSonata , August 03, 2009
I do vaguely remember my mother telling me how much it was, and I recall it was over $100,000 (in 1963 dollars). I can't remember the exact figure, though.
But lets just go over what I know they did have to pay for, just of my mother's bills.
Emergency Ambulance services in 1963; emergency room treatment of massive head injury and broken femur- stabilization treatments; multiple Xrays to head and extremeties; Cranial brain surgery (she had her skull drilled into in multiple places to relieve the pressure, and 127 stitches in her head from that alone); 2 orthopedic surgeries on her femur (another 240 stitches for that, twice- once when they put in the rod, and once when they took it out, just to give you an idea of the severity of her injuries); 6 days in ICU; obstetrics services/childbirth; 3 weeks regular hospital stay; drugs, supplies and miscellaneous charges. Add onto that what they paid for funerary services for my dead brother; and my father also had medical bills from the accident, but because he got up out of the hospital bed to go to work, they were minimal by comparison. . What would you guess all that would have cost in 1963 dollars?
written by Margaret , August 03, 2009
Despite some people's wish to have health insurance purchase be optional or the idea to have "customized" insurance so that people can pick and choose what they want covered (in order to have cheaper plans).
I don't think either will happen. I think politically, it is too easy to provide a plan to the public that undercuts private insurers (and kills them off) and gets its cost savings, first, by stiffing doctors and the medical industries and then by rationing patient care.
There are a lot of interesting solutions out there between the massive single payer and a totally free market (which doesn't exist). For the illegal alien non-payment problem, the swiss have an interesting solution. Employers who hire illegals must either buy them insurance or cover their medical bills if they get sick/hurt etc. The health insurance issue is treated separately from the immigration issue. Leave it to the Swiss to be practical about money. Regina Herzlinger of Harvard Business School gave a talk last week at a Freedom Foundation event and talked about it.
written by Jim W , August 04, 2009
That is the only way to motivate people to GET insurance. Of the 40M of uninsured, a majority have chosen to put their toys before their insurance. WHy the hell should I care about those folks? I know a number of poeple that don't want insurance, it cuts into the fun budget. So when they get sick, guess what happens? they get health care, just like I do, and then blow off paying the bill. These are people that do not care about anyone or anything but themselves, would rather drink, smoke and gamble over making sure they are covered with insurance, and ultimately know that they'll be able to get any care if htey need it. There is currently NO motivation. So until they are motivated, why in the hell would they get insurance? the best way to do it is to MOTIVATE them. And if that doesn't work, well, we cannot protect people from themselves and while that's unfortunate, it is what it is.
written by Margaret , August 04, 2009
YOU might be willing to deny care but politically, it's a non-starter. Even in the quasi-free market system we have now, no one is denied care. The worst that might happen is that insurance won't cover it. They may not get the best care or the most appropriate care but no one who needs care and seeks it out or has someone do it for them is denied.
It's like we've already answered the question and it's time to move on to the next question.
The irony is that with a public health care system, people are denied heath care (not insurance coverage) all the time. By being made to wait endlessly for procedures or to see specialists and sometimes they are flat out denied treatment because of a cost benefit analysis that doesn't balance the cost of someone's life to themselves, but to society as a whole. That's a completely different way of thinking about health care and one that Americans will either have to resoundingly reject or get used to, if this bill does or doesn't pass.
