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The McCain health care plan
Mr. McCain’s health plan centers on eliminating the tax breaks for employers who provide health insurance for their workers — a marked departure from the current system — and giving $5,000 tax credits to families to buy their own insurance. His goal in shifting from employer-based coverage to having people buy their own policies is to encourage competition and choice, and to drive down the costs of health insurance.
Here is more. Portability is good but so many of the uninsured families do not pay $5000 in taxes. Will this boil down to a subsidy to those who don't need it or to health insurance vouchers? InTrade says there is a 39.6 percent chance we will find out. And here is some vagueness:
Mr. McCain proposed that the federal government work with the states to cover those who cannot find insurance on the open market. With federal financial assistance, states would be encouraged to create high-risk pools that would contract with insurers to cover consumers who have been rejected on the open market.
Here is more detail; in part it sounds like revived HillaryCare (part I), but only for the high-risk cases rather than for the entire population. The "notches" problem is obvious as people at the relevant margin hold out for the subsidized pool, thereby making the pool size larger and larger.
McCain also emphasizes lifestyle as a factor behind health; that's empirically important -- more so than health care -- but after cutting various stupid subsidies the government should not be the main driver there. Megan McArdle comments overall.
Trade aside, so far I've yet to see many actual policy proposals from the McCain camp. Mostly I've seen attempts to signal that they won't do anything too offensive to the party's right wing. Very few of these trial balloons seem to be ideas that McCain had expressed much previous loyalty to. I don't even think we should be analyzing these statements as policy proposals. We should be wondering why the Republican Party has given up on the idea of policy proposals.
Posted by Tyler Cowen on April 29, 2008 at 08:37 PM in Medicine | Permalink
Comments
Here's what was said in the conference call:
http://race42008.com/2008/04/29/mccain-unveils-health-care-initiatives/
"Even so, those without prior group coverage and those with pre-existing conditions do have the most difficulty on the individual market, and we need to make sure they get the high-quality coverage they need. I will work tirelessly to address the problem. But I won’t create another entitlement program that Washington will let get out of control. Nor will I saddle states with another unfunded mandate. The states have been very active in experimenting with ways to cover the “uninsurables.” The State of North Carolina , for example, has an agreement with Blue Cross to act as insurer of “last resort.” Over thirty states have some form of “high-risk” pool, and over twenty states have plans that limit premiums charged to people suffering an illness and who have been denied insurance."
Doesn't really sound like HillaryCare at all. It's quite a federalist approach. McCain is saying that he won't tell the states to no pay for the uninsurables' health care. Well, fine with me...
Posted by: Alana at Apr 29, 2008 9:46:14 PM
"We should be wondering why the Republican Party has given up on the idea of policy proposals."
Realism. An incoming Republican president will be facing a strong, hostile Democratic congress. The main objective of President McCain will be to moderate and rationalize the policy proposals coming out of Congress, not to initiate his own.
Needless to say, I think this arrangement will be better for public policy overall compared to a Democratic President and a supplicant Congress, but your mileage may vary.
Posted by: Mario at Apr 29, 2008 9:49:13 PM
"We should be wondering why the Republican Party has given up on the idea of policy proposals."
You're kidding, right? I'll take "Softballs" for $1000, Tyler.
Perhaps because they realized:
(a) the more specific you are the more people can criticize you,
(b) nobody with less than a graduate degree understands the specifics on most issues
(c) nobody with less than a college degree cares about specifics, and certainly not as much as they say care about them,
(d) they are not penalized in any meaningful way, such as losing elections, for not providing specifics,
(e) most Republicans don't care about specifics because it implies the government *doing something*, which is anathema to Republicans c.2008 (see: the dismantling of FEMA prior to Hurricane Katrina; the whole planning for the aftermath of the war in Iraq by everyone in the administration except career State Dept folks who had no say in policy anyway), and
(f) having specifics implies having an understanding and interest in resolving the problem, which the Republican Party and its elected officials do not have, at least not at the federal level.
Posted by: RSaunders at Apr 29, 2008 10:09:44 PM
Will this boil down to a subsidy to those who don't need it or to health insurance vouchers? InTrade says there is a 39.6 percent chance we will find out.
Um, no. This assumes a 100% chance that if McCain is elected he'll push for a plan similar to this to Congress. Let's face it, the only reason McCain has a health care plan is because he's expected to have a health care plan; I'm guessing it won't be a high priority in a McCain presidency. This is basically, "Okay, guys, I have a health care plan; can we talk about something else now?"
Posted by: Hei Lun Chan at Apr 29, 2008 10:36:37 PM
http://nathanbenefield.blogspot.com/2008/04/mccains-health-care-plan.html
Tyler Cowen asks a few questions and claims that this is new ground for McCain, but that is more due to Cowen not having paid attention until now, and relying on Politico for his information (watching McCain's ad alone would have answered Cowen's first question, as McCain emphasizes the word "refundable" tax credit).
Posted by: Nathan Benefield at Apr 29, 2008 11:56:18 PM
Of course with median family healthcare costs around $12,000, it won't go very far, which is probably what is intended.
Posted by: Lord at Apr 30, 2008 2:34:59 AM
I've been wondering about the lack of proposals and initiative from the McCain camp as well and, because of this, I have been questioning the prevailing assumption that McCain is benefiting from the continued Democratic nomination fight (apparently along with at least one other person; Division of Labour: "McCain on Clinton-Obama"). While this whole battle has been raging and Clinton/Obama have been all over headlines, for better or worse, McCain has hardly seen any press at all. He could be using this time to send out trial balloons and policy proposals, as Tyler suggests, to build a solid platform, but he seems to be doing nothing of the sort, or at least nothing of interest to the press. I don't profess to be any sort of genius political mind, but I just can't see how McCain's current obscurity and lack of any sort of platform works in his favor. Maybe the rumors that McCain has a terrible organization underneath him are correct.
By the way, I totally agree with Hei Lun Chan's assessment of McCain's healthcare plan. I'm sure discussing his own plan is probably one of the last things McCain would like to do.
Posted by: effay at Apr 30, 2008 3:16:04 AM
McCain isn't a policy guy. I don't think "stay the course" is a strategy, it's who he is. Not that his advisors can't trick him into a good idea now and then. If we wanted a bold policy guy we should have nominated you know who.
Why get rid of employer tax breaks? Why not just add personal tax breaks and add tax breaks for people who want to donate coverage to other individuals?
I still don't get the shock that people with pre-existing conditions are denied insurance. Insurance is a risk adjuster. A pre-existing condition is a certainty. They aren't denied insurance, they are denied a handout. Are they denied treatment? Letting pre-existings get insurance at the same premium as if they didn't have a condition isn't fair to other members of the insurance pool.
But, there are ways to manage this. How 'bout instead of insurance for pre-existing, encourage loans to them. Provide generous tax breaks for donors. Legalize payments to kidney donors (on balance this might reduce costs and will definitely increase productivity of those on dialysis).
We need to get our heads around the fact that a person shouldn't be allowed to bankrupt everyone just because some genius developed a super-expensive medical treatment.
I have GoldenRule catastrophic, a paid-for house, and an @$$load of cashish. It's really not that hard. My only healthcare problem is the terror that once I need it these jacklegs will have mucked it up. I'll be forced to pay other people to get in line in front of me.
Posted by: Andrew at Apr 30, 2008 3:18:27 AM
I noticed at this link:
http://money.cnn.com/2008/03/10/news/economy/tully_healthcare.fortune/
This comment
"McCain is targeting community rating for good reason. It forces the young and healthy to pay far more than their actual cost by making them subsidize the elderly and sick. Like the mandated benefits, it's pushed millions of Americans in their 20s to drop their health insurance."
True?
I've been calling BS on the "uninsured crisis" for a while. In my opinion, young people are often perfectly rational to go without health insurance as it is. Wouldn't it be great if a Clinton/Obama mandate plan was the last straw between younger voters and the liberal democrats?
From McArdle:
"The senator is proposing one thing that I think is a terrible idea, pharmaceutical reimportation. Naturally, this is the part of his health care plan with the highest probability of passage."
Reimportation is a joke. I'm all for price discrimination, but why should arbitrary government borders support it? But, since it is a joke and won't do much damage, that's why you use it as the carrot to get the camel's nose under the tent. That's political economics. Give something that doesn't cost you anything to get something valuable. McCain doesn't have to pass anything he doesn't agree with. So, if I were McCain, it wouldn't pass without being tied to something substantive.
Posted by: Andrew at Apr 30, 2008 3:57:22 AM
Oh yeah, and McCain doesn't know much about economics :)
Someone send him a link.
That tripped me out. It's like a guy trying to become a preacher admitting he doesn't know much about the bible. Pick up a book you twit! I mean, you don't even have to know much to fake out the plebes. And if it piques your interest, Ron Paul will be glad to give you a reading list.
But, at least he's honest. That's a plus.
Posted by: Andrew at Apr 30, 2008 4:02:37 AM
Andrew,
The reason you need to drop employer tax breaks is because with them, insurers have too many incentives to ignore the individual market. The incentives are 1) people with jobs are generally healthier than people without (so by "strategically" focusing on the "group"/employer market, you can discriminate without discriminating); 2) one sales process, multiple insurance premiums (seemingly reducing sales costs per contract, though I think this is a red herring given the innovation in, say, car insurance sales techniques); 3) an easy "out" for denied claims - "well, the policy your employer bought for you doesn't cover that" (instead of "the policy our agent sold you isn't the right one for you" and the potential liability that opens up); 4) save money educating the population on health insurance "details" (have you ever actually read the gory details of your employer provided policy? Most people haven't. Why bother? Health insurance is a "checkbox" when comparing jobs opportunities. Few people evaluate the quality of the employer-provided policy. Ever.)
To have a robust individual market, eliminating the employer-based market is at least an important consideration, if not an outright necessity.
Posted by: Richard at Apr 30, 2008 6:49:02 AM
After all those articles I`ve read about the health care issue I think that Hilary`s universal health care is the most objective one. Not because of the fact that I`m working for a Toronto life insurance company I think that health insurance is an essential thing to have in our age. The other question is that how it would be realized. As in other countries as well a greater pressure should be put on health education, it could solve a lot of problems in my opinion.
Posted by: life insurance broker Toronto at Apr 30, 2008 8:01:43 AM
After all those articles I`ve read about the health care issue I think that Hilary`s universal health care is the most objective one. Not because of the fact that I`m working for a Toronto life insurance company I think that health insurance is an essential thing to have in our age. The other question is that how it would be realized. As in other countries as well a greater pressure should be put on health education, it could solve a lot of problems in my opinion.
Posted by: life insurance broker Toronto at Apr 30, 2008 8:02:40 AM
I don't even think we should be analyzing these statements as policy proposals. We should be wondering why the Republican Party has given up on the idea of policy proposals.
Realism? Detailed presidential candidate policy proposals are usually pie in the sky.
Sense? Why are revolutionary "policy proposals" desirable every four years anyway? Has that mainly brought prosperity, or churn and uncertainty?
Posted by: holmegm at Apr 30, 2008 8:55:00 AM
It's silly to have detailed policy proposals when you don't control either house of congress.
Posted by: Chris at Apr 30, 2008 9:43:00 AM
Can anybody tell me how McCain's prosposal compares to Romney's in Massachusetts? And how Hillary's and Obama's differ from Romney's?
Posted by: massrepublican at Apr 30, 2008 9:58:46 AM
I would think he was proposing something like the earned income credit... which is actually essentially welfare for single moms to the tune of 3-5000 a year.
Otherwise the program is very stupid, since most poor families don't come anywhere near paying 5k a year in taxes or even having it withheld.
Posted by: Toxic at Apr 30, 2008 10:14:31 AM
Richard,
Thanks for the points. I agree with the end objective. I'm just wondering if the employer-payer link could die gracefully.
I'm no expert on insurance. I can't stand the stuff so I try to think about it a little more than I think about taxes.
It just seems like taking away my $9k tax break through my employer and giving me a $5k tax break directly is not an even trade. Plus, doing it all at once would choke the fledgling individual market, no? Short term prices would rise well beyond the $5k.
Posted by: Andrew at Apr 30, 2008 10:17:11 AM
Who needs policy proposals when the left is self destructing? Better to say nothing at all, and be the only candidate left who hasn't offended anyone.
Posted by: Doug at Apr 30, 2008 1:44:06 PM
McCain's speech accomplished a great deal. He showed that he wants health care to go in a fundamentally different direction than Dems. He adopts their goals, but not their means.
Consumer choice/control/responsibility vs governmental with tax breaks to help with the costs.
Portability via switching the tax break from companies to consumers.
National insurance market.
Special case the chronically ill.
These alone make for a fundamental rationalization of the system that will cascade to improvements in cost, quality, (over)utilization, and more by attacking the moral hazard of third-party payments.
The details that economists live by aren't important at this stage, not least because no proposal on anything as large and fraught as health care can become law without big compromises and endless refinements.
In this area as in so many areas, McCain represents a difference, not a mere distinction.
Posted by: Larry at Apr 30, 2008 3:57:22 PM
Even without tax breaks, employers will always have an advantage purchasing health care plans than individuals, it's called buying in bulk. That's why Dell pays less for its Windows licenses than you do, it's why WalMart pays less for toothpaste and why Costco is cheaper per unit than your corner grocery store. The employer link will likely never die, unless mandated by law.
Andrew,
Dems didn't always have an advantage in the youth vote. in 1992, 18-29 year olds were 50-50. Since the Clinton administration, the Republicans have been bleeding the youth vote and it accelerated under Bush.
Posted by: Mo at Apr 30, 2008 4:01:18 PM
It might be interesting to see doctors start taking cases on a contingent-fee basis, like attorneys do - it would arguably do a better job of aligning the interests of the doctor and the patient (goal = a cure). A doctor could take on any case and agree that he doesn't get paid unless the patient is cured, at which point he would make a substantial sum (i.e. the cost of the entire treatment, plus a healthy profit for assuming whatever degree of risk is involved). Obviously this would only work with ailments that have a definite end, but a per-treatment arrangement would still be available for the more risky patients and/or those with on-going conditions. Also, might raise collection problems for the doctor, but perhaps they can get the patients to pay a "retainer" up front.
That said, if they really want to reduce the costof healthcare, they should be busting the AMA monopoly on med school admissions.
Posted by: 12345 at Apr 30, 2008 4:04:14 PM
The tax credit is refundable. So it does not matter what your tax liabilbity is.
Posted by: John goodman at Apr 30, 2008 4:59:09 PM
The ideas on this site are among the most creative attempts on the web.
Yes let's reduce barriers to licensing physicians and surgeons and also cosmetic surgeons and psychiatrists and the rest. That will really save us money. Let’s have more of the people who generate the charges. That will control costs. NYC is wall to wall with medical professionals and medical facilities. That’s why medicine there is so cheap and especially cheap for the taxpayers to pay most of the bills.
Considering the concensus of this site why don't you also endorse open immigration for health care professionals, and would-be health care professionas, and pretend health care professionals. That will save us big time. I can tell since the biggest tract mansions in my are are owned by South Asian medical types.
Considering the consensus of this site, why don't you also endorse open immigration for health care professionals, and would-be health care professionals, and pretend health care professionals. That will save us big time. I can tell since the biggest tract mansions in my neck of the woods are owned by South Asian medical types.
Posted by: thissiteissofunny at Apr 30, 2008 6:00:58 PM
McCain's health plan would affect me personally since I receive good benefits from my employer who would probably be only to happy to jettison the health care expense. The $2500 tax credit is not near the total expense of what a company pays per person for health care. That is a hidden expense which is not being mentioned.
Posted by: Dan at Apr 30, 2008 8:20:06 PM
Andrew,
The employer exclusion isn't worth as much as a $5,000 *credit*... ESPECIALLY to lower-paid workers. Assume a $12,000 employer-purchased policy, entirely paid for by the employer (a RICH benefit, to be sure!). For someone in the 25% tax bracket, that's the same as a $3,000 credit. (There's also the 7.65%/15.3% payroll tax exclusion to be considered, of course). For someone in the 38% bracket, it's worth more. That's right, the tax benefit is greater to those high-income people who "don't need it". ;-)
Underlying all this is your employer increasing your pay by the amount they currently contribute towards your health insurance to maintain the same net expense to employ you. Sure, it gets taxed on the way through your paycheck, but that's what the credit is intended to address, while eliminating the advantage for higher-income workers.
As for how much insurance a $5,000 refundable credit alone will buy (ignoring the extra income some people would see), that's something that can't be answered. It buys a lot of pure *insurance*, but employer-based health "insurance" is so far away from pure insurance (payment of an unpredictable, unaffordable, undesirable, uncommon expense in exchange for a risk-appropriate premium) it isn't funny. The tax exclusion has incentivized all of us to accept an additional dollar of "pre-paid health care" instead of a dollar of take home pay simply because it's worth more because it avoids taxes. But "pre-paid health care" isn't properly insurance at all. It's health care paid for with pre-tax dollars, but saddled with administrative overhead.
Not to mention all the mandated benefits that add to the cost of insurance. Ordinary maternity care isn't insurable... It's not undesirable, uncommon, unaffordable nor unpredictable (much of the time ;-). It's expensive, sure. But we're paying for it through ridiculous premiums... And even those of us who understand the moral hazard issues succumb to them. Why shouldn't I get a colonoscopy? After all, I've already paid for it, right? It isn't going to cost me anything MORE to actually get it...
There's very little cost/benefit analysis at any level of our health care system any longer. An expensive screening procedure that saves "one life" is justified for everyone in the minds of too many - IF it's covered by "insurance". And few people even consider a medical procedure if the insurance company won't cover it. How silly is that!?!? If you think it's important enough to petition congress to pay for, why won't you pay for it yourself??? But the LAST people I want making that cost/benefit trade-off is government...
Anyway, I've gone way overboard here. Sorry. $5,000 a year is plenty to buy a real insurance policy that protects the family savings (if any) and pays for expensive, unpredictable care. It's no where near enough for today's first-dollar, pre-paid health care "insurance policies." But I think we've got to stop thinking a blood test, or a mammogram, or a colonoscopy, or any of the hundreds of other "routine" expenses virtually everyone experiences should be paid for through an insurance policy. How does "spreading the cost" help an expense that we all incur??? We're just putting money in to a "savings pot" that others can dip in to, creating a mind set of "I'd better get mine". Are we really THAT incapable of saving, even if our life depends on it?
There are (or should be) other programs to help people who truly cannot afford even these common cost-effective life-saving procedures.
Richard
Posted by: Richard at Apr 30, 2008 10:21:32 PM
He said that the $5,000 would be granted automatically, even to families who normally do not file taxes. The special pool would only be for patients with pre-existing conditions (to prevent them from raising the price of insurance for everyone else, while still ensuring them coverage). I think it's a great plan. If he would only withdraw the troops, I'd actively campaign for him (and forgive campaign finance "reform").
Posted by: adina at May 1, 2008 6:20:04 AM
Mo: "Even without tax breaks, employers will always have an advantage purchasing health care plans than individuals, it's called buying in bulk. ... The employer link will likely never die, unless mandated by law."
I agree. Large employers will also continue to have an advantage over small employers. Some may argue that individuals and small businesses will be able to pool their buying power. But such pooling happens today, yet large employers still demonstrate their superior bargaining power.
Posted by: John Dewey at May 1, 2008 6:43:38 AM
Richard: "Health insurance is a "checkbox" when comparing jobs opportunities. Few people evaluate the quality of the employer-provided policy. Ever."
Perhaps that is true for young workers who have no families. It is definitely not true for workers who have health problems or who have families with health problems. It is not true for workers who have large families.
Though most large employers have similar health plans, small employers do not. Small business owners - I am one - generally cannot offer anything remotely close to what the big guys provide. So we either give up trying to attract workers who require extensive health options, or else we provide something else that compensates for our inadequate bargaining power with insurance companies.
Posted by: John Dewey at May 1, 2008 6:55:46 AM
John,
As a small business owner, I'm curious how many of your prospective employees ASK you for a copy of the details of your health plan BEFORE they accept an offer? I know some small businesses can't even answer questions like deductibles, co-pays, lifetime caps, exclusions, etc. even AFTER employment without some difficulty. It surprised me. Of course, I'm sure there are small businesses that have a standard one-page description of their plan that they can post on their web site or give to prospects that answer most of these questions. Hopefully, kept up-to-date. ;-)
Personally, it sounds like we both would prefer a system that would get employers out of the "business" of providing health insurance to their employees. I still don't understand why I - as am employee - would turn over responsibility for my health insurance to an employer. Except, of course, for the incredible cost advantages, which are entirely artificial.
Richard
Posted by: Richard at May 1, 2008 7:44:12 AM
We all pay for the uninsured now. Bush said they can go to the emergency room right? Good plan! Face it, screening and testing SAVE medical expenses by catching conditions early.
A great example is the Baltimore boy who had a tooth infection, the mother did not have the $80, nor could she find a dentist who would accept medicaid...the nerve in the boys tooth eventually died and stopped hurting. But the infection went to the boys brain, he ended up in the 'emergency room' care Bush advocates.
Total cost to society? $250,000 for a couple of brain surgeries. OH, and the boy died.
You all need to watch SICK-O.
I have always been self employed and have a catastrophic ($5,000 deductable) plan from BCBS. Each and every year, my premium goes up and the benefits of the policy go down. I have tried to file ONE claim in 20 years for a broken bone in my hand. The original policy stated I had a one time benefit for a accidental broken bone of $500. Guess what? They fazed out that benefit the year before I broke my hand.
Health insurance is a scam, it is money for nothing. This is the only contract that can be changed without the consent of the signatory each and every year, or more often as they see fit.
Posted by: shano at May 1, 2008 4:50:08 PM
And just wait Richard, even if you think you have your plan figured out, the insurance company can custom design it to put the odds in their favor of making money off you.
In my teens I had a problem with my thyroid. No trouble, ever, since then. But when I applied for health insurance-ANYTHING to do with my thyroid was excluded. So while my policy may pay for 'cancer', (after the $5,000 per year deductable and then only 80%) it will not pay if I get cancer in my thyroid. Or if I have to treat my thyroid in conjunction with any other medical problem.
Yes, welcome to the wonderful world of individual policies! I am probably missing something, but I dont have time to read all the packets of boring legalese and notices they send me every year.
Posted by: shano at May 1, 2008 6:28:55 PM
Bush doesn't like the current system either. That's why he proposed a 15,000 deduction per family last year...That went nowhere, nor was any alternative put forward by Dems.
Posted by: Larry at May 1, 2008 7:49:34 PM
Larry, do you have a 'link'? Because I do not believe you. Bush has never addressed this issue except to veto others.
Here is the CURRENT Democratic proposal:
http://www.sltrib.com/ci_9125503
Posted by: shano at May 2, 2008 12:13:11 AM
shano,
First, I'm not defending the current system. I'm among the "everyone" who thinks the current system is broken. But you cannot use today's dysfunctional individual insurance market as a model for what the individual insurance market would be like in the absence of employer subsidies.
Second, the SL Trib article you cited is NOT the "current Democratic proposal". It's a bi-partisan plan called the "Healthy Americans Act" and it ELIMINATES the tax benefit for getting insurance through an employer, replacing it with an individual tax benefit that will offset the cost of purchasing insurance and a requirement that employers raise wages according to their savings on health insurance. The best current summary (it isn't actually introduced legislation yet) I've found is at http://wyden.senate.gov/issues/Healthy%20Americans%20Act/HAA_Section_by_Section.pdf
To see President Bush's proposal, see http://www.whitehouse.gov/infocus/healthcare and pay particular attention to the "Documents" section. You could have found that yourself - it's the first link under a Google search for "Bush Health Care Proposal".
You'll note at least one similarity between Bush's plan, the Healthy Americans Act, and McCain's proposal, in that they ALL attempt to give individuals, employed or not, the same tax benefit currently only available for health insurance provided through an employer.
Richard
Posted by: Richard at May 2, 2008 9:04:04 AM
"Are they denied treatment? " Yes. Try getting a doctor to see you without insurance.
"Letting pre-existings get insurance at the same premium as if they didn't have a condition isn't fair to other members of the insurance pool." Which, of course, is a complete lack of understanding of the "insurance pool." The purpose of insurance is to spread the risks and the costs over the "insurance pool." If subsidizing those who incur more in medical costs than they pay into the pool is the problem, the solution is (the logical conclusion of) self insurance. If I pay for my own medical care, I am subsidizing no one and I am not leaching off any one.
In any event, the obvious solution for Andrew is to opt out of the pool since it is causing, and will likely cause, many problems for him. When he needs it, I certainly do not want to subsidize his whiny ass.
"Even without tax breaks, employers will always have an advantage purchasing health care plans than individuals, it's called buying in bulk." No, it's called the law of large numbers. The larger group of people results is experience closer approximating the true distribution of health care claims of the total population. Better predictability of costs for the insurance company.
"Considering the consensus of this site . . . " Let's do this with education too. I'm tired of subsidizing the education of other people's kids. Let them pay for it themselves. The majority of my real estate taxes go to the schools in my town (per town statements). I'm sick and tire of subsidizing Andrew's kids.
Posted by: Karbunkle at May 2, 2008 9:19:52 AM
Karbunkle,
It's easy to get a doctor to see you without insurance. Just pay for it yourself. Many docs even offer discounts for cash at time of service.
An insurance pool is a group of similarly situated individuals. Auto insurance companies do NOT charge the driver with no tickets the same rate as the guy with 3 DUIs. Health insurance companies ought not be required to charge the smoking alcoholic the same rate as the Olympic swimmer. Insurance is about spreading unpredictable expenses (risk) across a pool, not about spreading predictable expenses (subsidy) across a pool. We already force the younger, healthier, less well-off members of our society to subsidize the health care of the older, sicker, richer members. Let's not further add to the moral hazards already in the system by refusing to acknowledge the very real costs of personal choices like smoking, drinking, doing drugs, etc. Unless, of course, you actually enjoy hearing the religious right arguing that they should be able to control more and more of your vices... After all, if you're going to make them pay for the consequences of your choices, that will certainly justify them complaining about your choices.
Posted by: Richard at May 2, 2008 4:48:35 PM
Richard,
No, most doctors refuse to see you if you don't have insurance. Even if you offer to pay yourself.
The logical conclusion of your second paragraph is self insurance. At least as long as you see the need to eliminate subsidizing those less healthy than you. I agree that insurance is about spreading risk across a group of people (corporations, etc.). The very nature of insurance is subsidizing those who have to file a claim. Again, if you are against the subsidization of members of the pool, try self insurance. You will only pay for your losses - no one else's.
Posted by: Karbunkle at May 6, 2008 12:42:52 PM
