Why a health care mandate is essential

[Carmen813]

There is no point here to be missed. Yes, risk is spread across a pool of individuals, but it is done so consensually. The difference is exactly the same as the difference between asking a soldier into your house for dinner and having them garrisoned in your home against your will.

I suspect that if this bill was passed without the mandate, but still with the subsidies/ect, then the vast majority of those 30 million uninsured would choose to purchase insurance. What prevents the majority of people from getting insurance isn't a lack of desire, but a lack of a way to afford it or even the opportunity to buy it.

However, there is obviously no way to really guarantee this. Which is why the mandate is there (and let's be fair, it's a very weak mandate). In the context of this reform, the mandate is a necessity. That doesn't mean I like it.

My hope is that Republicans and Democrats will work together to curb costs, instead of repealing the whole thing. Right now this does not look likely. I think this bill did a pretty good job at curbing costs while expanding coverage because most independent analysis shows that it covers 30 million more people without really significantly impacting overall national costs, so this was a good first step. Simple fact is that if 30 million people were just given insurance without any cost containing measures, overall costs would skyrocket. Most analysis shows that isn't the case. Further efforts should be aimed at driving down overall costs and improving the transparency of costs between patient/provider.

 

[nonlnear]

I think that is a good question, but I think it is irrelevant to my hypothetical.

I can't imagine how such a fundamental question could be irrelevant. If you think that price si not an issue with treatment choices and approvals in either a government system or an insurance based system you're way off base. Sure it might not be apparent if you simply look at the information given to the decision makers (i.e. the doctor and administrators deciding on a specific person's treatment). However there are ways to factor cost "invisibly" into the system so that nobody is explicitly looking at the last dollar. My family in Canada deals with this all the time when they have loooooooong waits for specialists and treatments. I have stopped telling them how amazing my health care is because it's so hard to hear them describe how crappy their panacea is.

Insurance right now covers what I was talking about, say $1-2million for a series of surgeries to let a child live a normal life. That means that:

(1) there is no way that you are paying 1-2million in premiums if you have insurance, so the company is losing money on you, and you are by definition having other people pay for your care.

And your point is? (Hint: if you are trying to make a moral equivalence between voluntary and mandatory coverage based on the premise that they both "spread the cost around", read this post.)

(2) If you don't have insurance, you have no way of getting that kind of money, and even if you could, you would be broke/bankrupt/in-debt for the rest of your (and your childs) life.

If you go bankrupt, then you are not in debt for the rest of your life. I'm not saying bankruptcy is a good ending point for that part of the current system, but let's not overstate the case here.

So without insurance, basically, the child dies.

You lie. In life or death scenarios right now children live - at least as long as the hospital obeys the law. Yes it may be financially devastating, but the children live.

Is anyone really willing to let that happen. Do you want to go back to having indentured servants, where rich people will pay for your childs surgery if you serve them for 10-20 years?

Is anyone arguing for that? I must have missed that post...

 

[Carmen813]

Life isn't fair... sometimes people die. I'm 26 and would be considered middle class from my income levels and while I have great insurance I can say without a doubt that I would not get the level of care Magic Johnson got for HIV. Just becuase the cure is out there does that mean I have a right to it? No.

It's expensive and the simple truth is just because we can cure somebody doesn't mean we should. It's not a pretty or nice reality but that is life. Life isn't always fair. Some peopel seem to have a hard time dealing with it.

If it cost a billion dollars to save a child's life should we do it?

That fact that life isn't fair and that people sometimes get sick and die is a poor excuse for a good person to stand by the side and do nothing. It's my opinion that people often find out that money isn't very important when they are the one who needs the cure.

 

[Naeeldar]

That fact that life isn't fair and that people sometimes get sick and die is a poor excuse for a good person to stand by the side and do nothing. It's my opinion that people often find out that money isn't very important when they are the one who needs the cure.

So if it costs 1 billion dollars to save a child's life should we do it?

 

[nageov3t]

So if it costs 1 billion dollars to save a child's life should we do it?

think of the children

 

[nonlnear]

think of the children

That argument never fails to convince... some.

 

[Naeeldar]

Lets make it a really fun debate. Spend 1 billion dollars to save one child or spend a billion on improving the lives of many people.

Which should we do?

 

[Carmen813]

So if it costs 1 billion dollars to save a child's life should we do it?

I would factor in a great deal more in reaching that decision than the simple monetary cost of doing so.

 

[nonlnear]

I would factor in a great deal more in reaching that decision than the simple monetary cost of doing so.

A child is dying and will be dead in one week if they don't receive a treatment which costs one billion dollars. If the treatment is received, the child will live (i.e. this condition will not be the cause of the child's death in the foreseeable future).

What else do you need to know? I'll flesh out the scenario with whatever you need so we can see how you believe this decision should be made.

 

[Carmen813]

A child is dying and will be dead in one week if they don't receive a treatment which costs one billion dollars. If the treatment is received, the child will live (i.e. this condition will not be the cause of the child's death in the foreseeable future).

What else do you need to know? I'll flesh out the scenario with whatever you need so we can see how you believe this decision should be made.

I have to leave for work in a few and I have a midterm to take tonight, so I won't be able to respond again until later. If you'd like, PM me. Here are the questions I would want answered before reaching a decision, but in reality this is a small list. The world does not work in the black and white way you are trying to portray it as.

1. How painful will the treatment be for the child? Will receiving said treatment have any long term lasting impact on their physical or psychological quality of life?

2. Do we know the potential benefit to having this child kept alive?

3. What is the billion dollars being spent on? In reality, I can think of no disease that comes close to costing this much to treat, even my wife's cancer (which was one of the most severe) was under $2 million. That said, I'll bite. How much of this money is going to the providers, to pay for the research/manufacturing cost of the treatment, to the hospital, and how much of this money is going to extraneous costs that have nothing to do with saving the child's life?

4. If it's a question of saving one life versus improving quality of life of others, what specifics are involved? Is this quality of life improvement related to basic human needs that are needed to survive?

5. How can you guarantee the treatment works? There are no such guarantees in medicine when dealing with life-threatening illness.

6. Is this my child?

 

[shira]

lol, you people are hilarious. Anytime we call you out on your facism you resort to some emotional whining and make claims about wanting the "status quo" when it just isn't true.
I will pay for MY Insurance needs. I do not want to pay for YOUR INSURANCE needs, nor will I tell you what your exact needs are regarding insurance. What you and your merry band of thugs are forcing on all of is more requirements both in scope and cost. You are also doing it the wrong way because you aren't pooling risk - you're just trying to widen the pool to include everyone ignoring risk.

I have a family with 3 kids. I know my risk is high but it's normal for a family of 5. I should not be lumped in with a higher risk family nor with higher risk individuals. The same goes for lower as well. It's just how INSURANCE should work. Now much of the problem stems from INSURANCE being bastardized by the gov't to the point where it is barely INSURANCE anymore and is just a payer for health costs(note - not "healthcare").

Boy, are YOU confused, as usual.

First, you're already subsidizing the healthcare of higher-risk and un/underinsured people. And MY health policy (single, no children) is subsidizing YOUR health care. Furthermore, my property taxes are subsidizing YOUR kids' educations. MY higher income taxes are almost certainly paying for a greater fraction of defense, police, and social services than your piddly income tax, if our relative IQs are any indication.

You receive a tax exemption for each kid. You receive tax-subsidized child-care services through Flexible Spending Accounts.

Somehow, you're not outraged that YOU are being subsidized by everyone else.

 

[Naeeldar]

I have to leave for work in a few and I have a midterm to take tonight, so I won't be able to respond again until later. If you'd like, PM me. Here are the questions I would want answered before reaching a decision, but in reality this is a small list. The world does not work in the black and white way you are trying to portray it as.

1. How painful will the treatment be for the child? Will receiving said treatment have any long term lasting impact on their physical or psychological quality of life?

2. Do we know the potential benefit to having this child kept alive?

3. What is the billion dollars being spent on? In reality, I can think of no disease that comes close to costing this much to treat, even my wife's cancer (which was one of the most severe) was under $2 million. That said, I'll bite. How much of this money is going to the providers, to pay for the research/manufacturing cost of the treatment, to the hospital, and how much of this money is going to extraneous costs that have nothing to do with saving the child's life?

4. If it's a question of saving one life versus improving quality of life of others, what specifics are involved? Is this quality of life improvement related to basic human needs that are needed to survive?

5. How can you guarantee the treatment works? There are no such guarantees in medicine when dealing with life-threatening illness.

6. Is this my child?

You don't get it. Just because somebody's life can be saved does not mean it should. It would be great to live in a fantasy world where everything is perfect and nobody dies. The reality is though money does not grow on tree's and just because we coudl spend millions upon millions to save a human life does not mean we should. If we did that everytime than our nation would be broke. There is a reason why most universal healthcare systems take awhile to adapt new techniques/cures. It's expensive. Theres also a reason why most universal healthcare countries have higher taxes than us.

but nobody wants to pay attention to that point.

 

[nonlnear]

I have to leave for work in a few and I have a midterm to take tonight, so I won't be able to respond again until later. If you'd like, PM me. Here are the questions I would want answered before reaching a decision, but in reality this is a small list. The world does not work in the black and white way you are trying to portray it as.

1. How painful will the treatment be for the child? Will receiving said treatment have any long term lasting impact on their physical or psychological quality of life?

Minimal pain, and the child will have a perfect recovery within a year.

2. What is the billion dollars being spent on? In reality, I can think of no disease that comes close to costing this much to treat, even my wife's cancer (which was one of the most severe) was under $2 million. That said, I'll bite. How much of this money is going to the providers, to pay for the research/manufacturing cost of the treatment, to the hospital, and how much of this money is going to extraneous costs that have nothing to do with saving the child's life?

It requires manufacturing a new and exotic isotope which has a half life of 3 minutes. This isotope can only be manufactured in the largest nuclear reactor in the world and running it in an unconventional mode which does not produce power, and will require a new international treaty to be negotiated due to the especially toxic nature of the waste created. Current storage and disposal methods simply don't work. Because of the short half life, the child must be brought to the reactor site in order to administer the isotope before it decays. Of course this will require new security protocols to be implemented.

This must be done daily for a year, after which the condition is cured.

3. If it's a question of saving one life versus improving quality of life of others, what specifics are involved?

The specifics of the other lives are quite irrelevant. You can do a LOT of good with a billion dollars. Fill in the details as you like.

4. How can you guarantee the treatment works? There are no such guarantees in medicine when dealing with life-threatening illness.

You are setting an impossible standard. You just said there are no guarantees, so why are you expecting one for this treatment? If you need assurance, let's say that it has been done a thousand times already for one thousand billionaires and worked every time, including a number of cases with complications.

Is this my child?

If that affects your answer, please give an answer for both cases: yes and no.

 

[CADsortaGUY]

Boy, are YOU confused, as usual.

First, you're already subsidizing the healthcare of higher-risk and un/underinsured people. And MY health policy (single, no children) is subsidizing YOUR health care. Furthermore, my property taxes are subsidizing YOUR kids' educations. MY higher income taxes are almost certainly paying for a greater fraction of defense, police, and social services than your piddly income tax, if our relative IQs are any indication.

You receive a tax exemption for each kid. You receive tax-subsidized child-care services through Flexible Spending Accounts.

Somehow, you're not outraged that YOU are being subsidized by everyone else.



In fact, my GROUP policy is subsizing your family's health care. My property taxes are subsidizing the school system you send your kids to.

I'll ignore your little tangent whining about taxes as it's not at issue here. But for you to suggest that you are subsidizing my "healthcare" is laughable. Not only do I have I carry INSURANCE, my policy is a family policy which is separated from individual policies. Do I pay the equivilant of 5 singles? No, but I'm not 5X the risk even though there are 5 of us on the policy. My risk is obviously greater than 2X but I pay more than 2X an individual policy you twit. Also, for the record - I am actually subsidizing others within my risk pool as I've been a net payer regarding INSURANCE - even with having 3 kids. 2 were born in an Ambulance(which we had to pay for out of pocket mind you) so there was no birthing suite(or the like) ever charged. The rest of the bills from birth to now for everything has been way less than we've paid over the last 12 years. We've been lucky so far with few emergencies or sicknesses. Only a stitch or two and 1 set of ear tubes. So... in plain terms(incase you don't understand what "net payer" is) - If I would have forgone INSURANCE and just paid cash for the last 12 years, I'd be money ahead.

 

[flavio]

Obviously our opinions differ. Tell me one good reason why I should give up part of my income so you can treat an illness you can't pay for.

The same reason we all pay for police and fire services. We all pay so that whenever any of us needs the services they are there.

Where is your family? Why aren't they helping you through your illness? Why is it the responsibility of strangers?

Many people don't have any family or any family that would be able to help anyway. A week in the hospital costs 10's of thousands of dollars. Not a lot of families have that kind of cash to cough up.

You may have a job and insurance now but if you get a crippling illness you could lose both and go bankrupt. The current system of using emergency rooms when you can't pay is not working and many treatments aren't available that way.

Countries with universal healthcare spend far less and get better results. It's just a better system.

 

[CADsortaGUY]

The same reason we all pay for police and fire services. We all pay so that whenever any of us needs the services they are there.

A private health INSURANCE policy is not on the same level as police and fire services. To attempt to use that argument shows how desperate someone is to try to support this gov't intrusion.

 

[Fern]

There are many treatable (but expensive) problems. For a congenital heart defect, a baby could have multiple surgeries as he/she grows up. But is treated, the child can live a full normal life. So I am not talking about some terminal disease or condition.

So you could be on the hook for easily 1-2million over 10 years. With insurance, it would be covered. Without insurance (loss of job, can't afford it, etc...) what do you do? Like I said, 99% of us couldn't pay millions.

Go read up on Medicaid, it would cover the child's expenses under the circumstances you describe above.

Fern

 

[flavio]

A private health INSURANCE policy is not on the same level as police and fire services. To attempt to use that argument shows how desperate someone is to try to support this gov't intrusion.

I don't think Jack was talking about private insurance but now that you mention it you pay for other people's illnesses that way too.

 

[Jack Ryan]

Carmen,

I think you bring up very good points. What struck me the most was your statement of "social responsibility" vs "personal responsibility". We definitely differ in our opinions there, but I can respect yours.

Thanks for healthy debate to the table.

-Jack

 

[GarfieldtheCat]

If you go bankrupt, then you are not in debt for the rest of your life. I'm not saying bankruptcy is a good ending point for that part of the current system, but let's not overstate the case here.You lie. In life or death scenarios right now children live - at least as long as the hospital obeys the law. Yes it may be financially devastating, but the children live.Is anyone arguing for that? I must have missed that post...

How can one on one hand want people to pay for their coverage themselves, either through insurance or paying themselves, and not get treatment if they don't pay, but still expect hospitals/doctors to provide care?

What most people here are saying is either pay or not get treated. That means people will die.

So why should ED's treat people if patients can't pay? Why should Life and death conditions get different treatment somehow?

 

[GarfieldtheCat]

Lets make it a really fun debate. Spend 1 billion dollars to save one child or spend a billion on improving the lives of many people.

Which should we do?

1 billion is not realistic. Why don't you use $1-2 million, like in my post. That at least is a realistic number, unlike your 1 billion.

If it cosst $1million to save a child's life, knowing the treatment would let him live normally to at least 65 yeras old, barring unrelated problems, would you be for it?

What if it was your own child? I think you would say yes. I don't think any parent would say no.

 

[GarfieldtheCat]

Go read up on Medicaid, it would cover the child's expenses under the circumstances you describe above.

Fern

I know about medicare, but was making a point about people that believe that it is solely up to the individual to pay for healthcare, either by themselves or paying for insurance. According to their views, Medicare/Aid should even be possible.

 

[Carmen813]

Carmen,

I think you bring up very good points. What struck me the most was your statement of "social responsibility" vs "personal responsibility". We definitely differ in our opinions there, but I can respect yours.

Thanks for healthy debate to the table.

-Jack

No problem. As I said, social responsibility isn't socialism or communism, which are very authoritarian top-driven systems (at least in practice). It's a belief that rather in acting strictly in the interest of the self, people/groups/organizations/government seriously consider the impact that their decisions will have on society. It doesn't mean a company should sacrifice profit motive or an individual happiness, just that the drive to maximize profit/happiness should be weighed against the potential societal harm/benefit it could cause. Personal responsibility is still important because without individual's being responsible for their actions, regardless if they are rich or poor, the entire idea of social responsibility collapses.

I felt the need to clarify because it comes off sounding a lot like collectivism, communism, or socialism, but it has a few important distinctions.

 

[Carmen813]

Nonlnear,
Now that you fleshed this out a bit. In this scenario I would do the following. I'd start by asking myself (in no particular order):
1. What is the potential good that could come from this treatment? What is the potential harm that could be caused?
2. Will the creation and implementation of this drug treatment protocol seriously disrupt or potentially harm the lives of future generations?
3. How else could this billion dollars be spent to improve the lives of individuals facing disease?
4. What is the likelihood that this billion dollars will be spent in a way that directly impacts the chances of survival for other individuals?
5. What is the potential societal harm for having a cure to a disease that is out of the reach of more than 99.9% of the population? In addition, since this cure would disrupt power generation for others, how would this impact hospitals that rely on this nuclear station for electricity?
6. What are my feelings about death and loss? Is it possible to die with dignity in this society? Are the parents of this child adequately prepared to cope with the loss of a child? What can I do to help them if they are not?
7. Is a billion dollars in this culture worth what I think it is?
8. If this my child, is there some way I could obtain the treatment without a billion dollars, including methods which are not legal?

After contemplating those questions I would....

And that's the point. It doesn't really matter what I would do. What matters is the process I use to getting to that decision.

 

[cubeless]

Nonlnear,
Now that you fleshed this out a bit. In this scenario I would do the following. I'd start by asking myself (in no particular order):
1. What is the potential good that could come from this treatment? What is the potential harm that could be caused?
2. Will the creation and implementation of this drug treatment protocol seriously disrupt or potentially harm the lives of future generations?
3. How else could this billion dollars be spent to improve the lives of individuals facing disease?
4. What is the likelihood that this billion dollars will be spent in a way that directly impacts the chances of survival for other individuals?
5. What is the potential societal harm for having a cure to a disease that is out of the reach of more than 99.9% of the population? In addition, since this cure would disrupt power generation for others, how would this impact hospitals that rely on this nuclear station for electricity?
6. What are my feelings about death and loss? Is it possible to die with dignity in this society? Are the parents of this child adequately prepared to cope with the loss of a child? What can I do to help them if they are not?
7. Is a billion dollars in this culture worth what I think it is?
8. If this my child, is there some way I could obtain the treatment without a billion dollars, including methods which are not legal?

After contemplating those questions I would....

And that's the point. It doesn't really matter what I would do. What matters is the process I use to getting to that decision.

if you have to answer all those questions in complete paragraphs prior to treating the kid there won't be a problem...

the question is very simple in real life: is it my kid or your kid?