Health Care in the United States

[3278]

Seriously, it's like I'm prescient. As I've mentioned before, it's only fair that if the government [read: the taxpayers] pays for your health care, then the government [read: the taxpayer] should get to dictate your health choices to some degree, or penalize you for doing unhealthy things. So here's an Arizona governor, proposing a $50 annual fee to obese people who didn't follow a doctor-approved fitness plan, and smokers. It makes a strong sort of sense, but its logic is far too tempting to apply universally.

[Ancient History]

But where do you draw the line? At some point you're going to have somebody argue that people in certain lines of work are more prone to health issues, at least certain health issues, than others and either have to take costly precautions or suffer a penalty - and that's just a poor tax or a whore tax, one way or the other. You'd do better to reward healthy behavior, like a token tax refund for showing up to your mandatory yearly physical and having shown some effort to have followed the doc's advice.

[Salvation122]

And they'll impose this fee how, exactly? Medical and financial records are protected. The government doesn't get to just browse through them to see who is obese or a smoker.

[Bonefish]

Well, yet, right? Why can't the change it so they can?

[Salvation122]

Well, yet, right? Why can't the change it so they can?

The right to be secure in one's persons, houses, papers, and effects.

[Bonefish]

Well, yet, right? Why can't the change it so they can?

The right to be secure in one's persons, houses, papers, and effects.

But can't they make the case that if your health is a matter of public interest, that your privacy can be infringed where it impedes the public good, or something like that?

[FlameBlade]

*coughs on Bonefish*

whoops. Sorry about that, man.

[Bonefish]

*coughs on Bonefish*

whoops. Sorry about that, man.

Eh, what? Iwas sharing dirty needles with a junky, did something happen?

[paladin2019]

And they'll impose this fee how, exactly? Medical and financial records are protected. The government doesn't get to just browse through them to see who is obese or a smoker.

They, the government, won't/can't. It can be an option for the insurance companies, though. Which, of course, the government becomes in the limited case of Medicare. See? all neat and tidy

[Salvation122]

Well, yet, right? Why can't the change it so they can?

The right to be secure in one's persons, houses, papers, and effects.

But can't they make the case that if your health is a matter of public interest, that your privacy can be infringed where it impedes the public good, or something like that?

It would require the Supreme Court to overturn a whole lot of precedent, which is extraordinarily rare.

[3278]

But where do you draw the line?

And I think that's the sort of magical question: at some point, we have to hold individuals responsible for individual behaviors, and I'm the sort of person who wants that point to be clear and simple [which most real things aren't]. To me, it seems like it's just more logical to have the individual simply be responsible for all their own health issues. Their health is more personal and individual than anything else, and pretty much defines "personal responsibility." To me, making this very individual right into a public good is completely illogical, and that's why I, too, wonder where the point should be in this quagmire of illogic.

You'd do better to reward healthy behavior, like a token tax refund for showing up to your mandatory yearly physical and having shown some effort to have followed the doc's advice.

That seems like probably an easier-to-verify condition, and would put the burden of proof on the individual rather than the government, which would make it easier for them to administer.

And they'll impose this fee how, exactly? Medical and financial records are protected. The government doesn't get to just browse through them to see who is obese or a smoker.

Yeah, but neither of those things is exactly hard to test for, either. At that point, it becomes more like a drug test, and while I agree that the constitutionality of drug testing for government benefits is questionable, I don't perceive it as impossible that this sort of "conditional benefit" eventually make its way into law and precedent. I agree that we're not there yet, and I profess absolute uncertainty as to how likely it is that we'll get there, but I definitely think it's possible.

That aside - I mean, you know, a lot of these discussions basically occur in a political vacuum, under the assumption that somehow the conditions for them can be met - I think that it's actually pretty reasonable to do things like this: giving away some of the responsibility for your own health, in my opinion, should also remove some of the rights you have to your own health. I don't see anything wrong with the government saying, "You're going to cost everyone a lot more, so we're going to ask for a little more from you."

[Ancient History]

The distinction between the individual and the public gets to be a fine one. When one person suffers, one way or another everyone suffers, and when one person prospers vice versa. A large part of government has historically been devoted to community projects for the benefit of the community and its health as a whole: sewer systems, distribution of clean water, etc. The general difference is that those projects are beyond the scope of any one individual to accomplish with their own means, while it is generally accepted that individuals have the means to control, say, whether or not they choose to smoke and exercise, and consider those activities part of their personal liberties.

Digressing a bit, it comes back in many ways to public welfare in general. There is among many (though not all) the general agreement that public assistance is a good - perhaps a mandatory or necessary - thing for those who do not have the means to support themselves: the elderly, the orphaned, the utterly impoverished. Providing goods, services, and money to these people is the humane thing to do, and the money is not so much "lost" since it continues to circulate in the economy. Where the problem lies is that there are always - will always - be individuals that attempt and succeed at gaming or defrauding the system, or whose lifestyles, choices, and circumstances keep them subsidized on public assistance for years on end.

Public healthcare is an intelligent form of public assistance, as it is both preventative and reactive - if people keep better track of their health, then they tend to have fewer major health problems in the long run, and those with an immediate need can receive immediate care instead of making a difficult decision about how healthy they can financially afford to be. However, as a form of public assistance you run into much the same problem - individuals whose lifestyles, choices, and cicrumstances will keep them drawing on the system for a considerable time, with the cost supported by the community.

The issue is, there is no specific hard and fast metric to be applied to address the source of the issue - personal responsibility. Some men and women will continue to have children they cannot afford to feed, house, clothe and raise. Many people continue to smoke and use damaging and difficult drugs despite knowing full well the effects they have on them. It is not just a matter of education, it is a measure of willfully pursuing certain paths - or, in the most upsetting cases, individuals that are forced by circumstances to continue in such a fashon. Those people, the true victims as few as they may be, are the ones public assistance is reallty meant for, and the reason we don't perform hysterectomies automatically after a woman has a second child, or castrate a man who owes back child support on two children. Instead we penalize and try to educate, by taxing cigarettes and liquor, outlawing cocaine, and talking about safe sex in schools, and even those efforts are undershot by those who believe taxes are unfair to business and abstinence is the only way to prevent teenage pregnancy.

...that was a long fucking way to say: you can't trust people not to be bastards, you can't stop people from being bastards, but you should treat people like they aren't bastards and hope they stop acting like bastards.

[3278]

Huh. I'll be damned. I didn't realize it, but all my "employer-provided health insurance is what's wrong with health care in America" talk had already been said by someone plainly better at it than me.

[Ancient History]

That's...retarded, inaccurate, and hyperbolic.

[3278]

That's a strange way of saying, "wise, and exactly correct." You have anything to back that up, or just your qualifications as one of the most influential economists of all time? Oh, no, wait, that's him.

[paladin2019]

Hmmmm, and health insurance was provided by employers rather than unions (as the UAW wanted) as a means to retain trained employees.

What are the reasonable costs associated with what this country considers normal health maintenance? Are they manageable on minimum wage or even the median income? Is the negotiating power of an insurance company preferable to this?

What is the likelihood of innovation if your customers can't be expected to give you a return on investment? Does the large provider promote innovation by having the means to reward it?

[paladin2019]

Let me add the international angle.

How much does the US spend on direct and indirect foreign military aid, money the recipients do not have to budget for? How many of those nations are modern, industrialized nations, ie, our competitors? How many of them have a single payer system? How does this lack of medical expense aid their companies?

We subsidize single-payer systems already. Lower defense budget -> money for healthcare -> reduced expense for corps -> corp money for R&D, marketing, infrastructure, etc. -> better posturing of competitiors vs us.

Take the burden of health insurance off of employers, but don't destroy people's ability to get effective healthcare without bankrupting themselves.

[Ancient History]

That's a strange way of saying, "wise, and exactly correct." You have anything to back that up, or just your qualifications as one of the most influential economists of all time? Oh, no, wait, that's him.

Well, I'll cite another wise, influential, and Nobel-prize winning economist: Paul Krugman on Milton Friedman.

For example, Friedman's comparison of medical insurance to other types of insurance is fundamentally flawed - regular medical check-ups and preventative care are a large part of preventing the major (and costly) injuries, illnesses, and disasters and are just good business; other insurances typically have benefits or lower costs for proper upkeep or improvement.

I'm also not sure that Friedman - who was grounded in the Depression - is completely accurate about the start of employer health insurance. I know federal and state governments made at least some provisions for the care of wounded veterans going back to at least the Civil War.

Now, I'm not saying he's completely wrong in all particulars - employer health insurance as a job benefit really took off in the 1940s and 50s, and as far as I know it could be for exactly the reasons he ascribes. Those aren't exactly bad reasons, mind; tax write-offs are something plenty of people look for today - but I think he waxes hyperbolic when he goes on about how it should logically lead to company stores. That's Shadowrun-level megacorp think. There are a couple other technical points you could argue vis-a-vis third party payers - which also applies to basically any government-subsidized anything.

I mean, when you boil this rant down to basics, Friedman is arguing that health care is an optional luxury, not a necessity or even desired standard-of-living thing. Which you might agree with 32, and there are some good arguments towards the fact that nobody needs health insurance all the time, and plenty of people can save money by doing without. Most of the world manages to get by like that. Of course, medical insurance is a numbers game - at some point, you will get sick or injured, you will need more care than you can afford with whatever money you have socked away - and that is what health insurance is explicitly for. Moreover, in the long run it may be cheaper for society, because health insurance tends to lead to a healthier, longer-lasting workforce who don't go into crippling medical bill debt or draw on unemployment insurance quite as often.