Allegory wrote:
gbaji wrote:
Because the math on the "provide health coverage instead of paying at the ER" is horribly flawed. It works if you only look at the people who show up in emergency rooms. That person would have cost us less if he'd had health care. Maybe.
That isn't at all what we're talking about. This has nothing to do with providing preventative care.
Of course it does. I responded directly to a statement that it makes no sense to oppose paying for this stuff via public funding since we're already paying for it via subsidized costs in the ER room. This is incorrect because the costs go up if you replace that with public funded care.
Even assuming we don't provide them with "full care", it'll still go up. Want to know why? Because when you shift from the private industry absorbing the cost of folks who can't pay showing up at the ER, but which otherwise is profit driven, to a publicly funded system which is not only not profit driven, but driven by political agendas which desire to provide health care as a right/benefit for all citizens, you're going to see the amount which will be provided go up. And that will drive the costs up.
The private industry will absorb the cost, but will do everything it can to reduce that cost. A public system not only wont, but will actually have a vested interest in making it more expensive. This is the same argument raised in opposition to the "public option". Once government steps in like that, it can mandate service in such a way that private industry cannot afford it. Given that one of the major arguments for single-payer (ie: government funded) health care is that it would be cheaper because you take all the private industries out of the way it benefits the government to make costs in the private system as high as possible. But of course, it's only cheaper if you first create an incredibly inefficient system. Which is precisely what we've been doing for the last 30+ years.
This is obviously just a step to the next step, with full socialized medicine as the ultimate goal. For a whole lot of reasons, I oppose this, so I oppose that step. I'd rather we look at how poorly we manage health care and go in the other direction instead. But this health care bill had nothing to do with fixing any of the problems, and a whole lot to do with making the system (and the problems) bigger, so that in 15-20 years, when the subject comes up again, single payer will look even more attractive.
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That discussion has nothing to do with raising or lowering costs. It has everything to do with distributing those costs, because that was the topic of risk spread.
I reject the premise that we should be talking about "distributing costs" at all though. If the government wants to tell hospitals that they must provide emergency care, then that's their choice. If that means that the private industry has to absorb that cost, then that sucks, but that's what has to happen. This is no different than the government mandating any of a zillion other requirements into other industries which increase the cost of their products.
If said private industries can convince people to buy that more expensive product then that's great for them. If it can't, then that's no so great, but let's not lose sight of what placed that increased cost there (government). It is absurd to say that you're going to "help" the private industries out by having the government mandate that people buy their product in order to spread out the costs, and then fine them if they don't. Not only is that certainly a violation of the Constitution, it's also just a dumb idea.
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gbaji is a good citizen who pays his taxes and has bought health insurance. Allegory is a less than perfect citizen who pays his taxes but doesn't own health insurance. If gbaji gets sick, then only gbaji pays for it. If Allegory gets sick, then there are situations where the cost is paid for by taxes; it is paid for half by gbaji and half by Allegory. Here the risk is spread unevenly.
Yup. And as the guy paying for it, I can legitimately call you a lazy bum who needs to get a job.
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In one situation you pay everything (for yourself) and the other situation we split it equally. If Allegory is fined for not owning health insurance, then if I fall sick I'm not paying my taxes plus fine, and since the cost is the same gbaji is paying his taxes minus the fine. Now ine one situation you still pay everything (for yourself) but the other situation I now pay some amount over half for my care and you pay some amount less than half for my care. The risk is spread more evenly.
No. It's not fine. I'm still paying for your care. The government is collecting a fine from you. However, there is no indication in this system that my health insurance, which is paying the bulk of the extra costs for you to go to the ER will ever be paid back by the government. It's going to collect that fine and spend it on it's own programs. So someone on medicare will be funded (to a tiny degree) by your fines. I wont see a cent.
All it serves to do is get the government yet more involved financially in the industry. Needlessly. Let's also not forget that at the same time they are doing this, they're placing requirements for the insurers to insure even people with pre-existing conditions. What that means is that not only am I not going to see your fine money, but once you get sick, you can then sign up for health insurance, can't be denied, and the costs will go up even more for me since now I'm not just paying a relatively small amount to pay for the hospitals cost (which they'll keep to a minimum since it's straight loss for everyone right now), but I'll have to pay for the loss to the insurance company for having to cover you.
You get that if the hospital has to sneak the extra costs into their bills structure to subsidize a cost, it will always cost less than if that extra cost is realized and passed on directly to the insurance companies, right? Or do you need me to explain this to you?
You are making a classic mistake. You assume you can change the rules of the game, and the players will not change the way they play. That's simply not true. Right now, the extra cost born is a loss for everyone involved, so they work hard to keep that loss to a minimum. But if those costs are covered by the insurance system in some way, they are no longer a loss, but a potential source of profit. The cost per person in that situation will go up.
Edited, Apr 19th 2010 7:50pm by gbaji