Pajamas Media: The Logic of Liberty: Whose Responsibility Is Your Health?

Today’s post is over at Pajamas Media.

PJM

The editors came up with the title, which is a vast improvement on my original “A Dialogue Concerning Health Care.”

They also wisely inserted little “M”s and “J”s—these will be obvious once you see the article.

As I have been saying, it’s not too late to influence the outcome of the government usurpation of health care.

34 Comments

  1. “recognizing the rights of its citizens to health insurance”

    Health is a personal condition, not a commodity or service you can buy, so you can’t insure for it. Same for health care. The only person who can really care for your health is you. The government, the insurance company or the doctor can’t provide health care. The last person that tried to care for your health was your mother, and you still got sick. If you could buy health or health care, then Ted Kennedy and Michael Jackson would still be alive.

  2. So here are my questions to you, with the kind of health insurance plan you and I “enjoy” in mind,

    1) Should we, the young/healthy, subsidize the old/sick? (I know… it’s not clear whether I am considered young when it comes to the calculation of a health insurance premium.)

    2.N) If you answer is no, should an employer (who offers group health insurance) offer separate policies for different groups, say, the young/single, young/family,… and just old? Why or why not?

    2.Y) If your answer is yes, in your view, what are the differences (if any) between “rich subsidizing poor” and “young/health subsidizing old/sick”?

    I am just curious as usual.

    P.S. Spammy comments!

  3. Your friend Julius is not very vocal. He scores on the lower side of my vocalometer among people who would label themselves as socialist or whatever.

    OK, I understand that you think you should not pay for other people health care.

    We know that the young/sick subsidize the healthy/old in a group health insurance. No secret here.
    Therefore, the premium is cheaper for the sick/old in the sense that, to receive the same benefit, they would have to pay more if it’s not for the young/healthy. Which is probably one of the reasons that the proposed health plan forces people to purchase health insurances. Otherwise, taxing the rich alone probably won’t make if affordable for people who earn less.

  4. JH,

    Quick reply: I have no idea what’s going on with my antispam. It’s very much on the fritz. I’m trying to fix.

  5. You DO KNOW that one of the major causes of people going bankrupt in the US is through having to pay medical bills and that around 47MILLION people in the US cannot afford health care cover?

    And you think that this is a GOOD SITUATION ? Words fail me!

  6. Just send all your bills over to me, Dave Andrews. I’ll be happy to pay them.

    After all, that would only be fair, right?

  7. A question for JH. Hypothetically speaking, at age 30 the work one agrees to take on “earns” her an acceptable level of health insurance coverage. Moreover, her contract promises the same level of coverage for the rest of her life IF she meets longevity goals set by the entity “paying” insurance coverage. Over the years she meets those terms and eventually retires.

    At what age, then, in your mind does she begin subsidizing the young? At 35? 40? 50? 60? 70? 80? 90? Or should the entity never have made such a foolish offer? Even if it desperately needed her skills and talents right then, and made beneficial and financially successful use of them over the intervening years?

    Just trying to follow the long-term logic of your point If the anti-spam gods will permit, of course..

  8. Young/healthy don’t subsidize the old/sick. They prepay for future benefits they WILL receive.

    When the health legislation passes and it’s all filled with crappy amendments and bad policy, republicans in congress will have themselves to blame for not participating in making it better. When you are a super minority all you can do it make the best out of the legislation that comes through. Opposing everything just means you don’t get any concessions. The damn thing will pass so why not try to make it better. You can still vote against it on principle.

  9. At some point, health care is the ultimate luxury good. As wealth increases, demand for better health services grows faster than income. Are rising healcare costs merely a function of rising wealth? If they are, then why fight it?

  10. Do we have the right to food? As far as I know, the government not declared food to be a universal right. And yet, very few people starve to death in this country (except anorexics, and that’s their own fault).

    Do we have a right to be educated by the government? It’s not in the Bill of Rights.

    Do we have a right to die; that is, government assisted suicide? Well, we do in Oregon, but it’s not universal. You have to prove that you’re going to die pretty soon anyway, and that you’re not depressed or mentally incompetent (in practice those limitations are not always adhered to).

    Do we have a right to be governed by people who are not crooks and thieves? Obviously not.

    The whole concept of rights needs a bath. I don’t think most people even know what a “right” is, or how rights are the opposite of freedom.

    Chew on that!

  11. 49erDweet,

    One should be grateful that she works for an employer who offers group health insurance coverage (HIC). I’d like to think that she has earned it. There are plenty of less fortunate hard-working people without such benefit. Haven’t they earned an acceptable level of HIC? I guess their employers are not obligated to offer HIC.

    The old subsidize the young? You mean, e.g., while the cost for a group stays the same but people over a certain age pick up the tab? Well, the old do make more money and have higher medical expenses on average. This may not a bad idea in recruiting high-quality young people.

    One may have “earned” an acceptable level of HIC, and it’s your prerogative to think old subsidizing young is foolish. I still fail to see why the young should subsidize the old.

    What’s the long term logic of my point? Can it be applied to the health care plan? In fact, what is my point?

    john,

    I agree that if House Republicans can’t beat Democrats, it’s wise to join Democrats to make the health legislation better. I understand your view that the young/healthy prepay their future benefit… you really mean the benefit of being subsidized by the young/health when they are old, no?

    Many young employees have felt that it’s only fair they pay less now (and more when older) because of their smaller medical expenses, family expenses, job uncertainties and lower income. And they ask to think of how our car insurance rates are being calculated.

  12. Seems I hear more and more about health care being a right…

    What is a right? Somebody wrote “that they are endowed by their creator with certain unalienable rights”, which implies a definition. I prefer something simpler: you have the right to be left alone. Rights restrict other peoples (including governments) ability to interfere with you doing whatever it is you want to do. Conversely, rights restrict your ability to interfere with other people doing whatever it is they want to do.

    What is healthcare? Healthcare is seeing a doctor, getting medicine or vaccines, diagnostic tests, procedures, expensive lifesaving cutting edge surgery – in other words: a collection of goods and services provided by certain people.

    Those who claim healthcare as a right are, in effect, claiming the goods and services of certain others. They are claiming the right to have government force certain others to work for them. They claim the right to steal!

    ECONOMICS is the study of the delivery of goods and services. Efficient healthcare delivery requires a free market. Obama-Care is anything but.

    Healthcare delivered efficiently is cheap. Healthcare delivered inefficiently is expensive. More people, get more and more of things that are cheap. Fewer people, get less and less of things that are expensive. And that is the promise of Obama-Care.

    …my $.02

  13. “Those who claim healthcare as a right are, in effect, claiming the goods and services of certain others. They are claiming the right to have government force certain others to work for them. They claim the right to steal!”

    have you ever checked out a library book, benefited from police services, needed the fire department to save your house or the house of someone near you, sent your children to public elementary school?

    I fail to see why medical services and goods should be a privilege.

    I’ve never needed the fire department to save my house, but I’ve never complained about paying into the service. Many other people will receive more of a benefit from this service than I will; I will pay more or less than others depending on my tax burden, but it is essential. If fire services were pay per use and I don’t want to pay them to put out my house fire, my neighbors’ houses are all likely to catch fire as well.

    Similarly, if half the US doesn’t want to get MMR vaccines because they are willing to take their chances and it is too costly, all the sudden measles becomes rampant in the US and change significantly enough the vaccines don’t work anymore. Sick people who go unprotected and untreated cost me much more than what I might/do/will pay for health care. They increase my health risk, they cost me available labor, and they reduce the services available to me. All the while I still pay for my own healthcare.

    I would rather pay into a system that guarantees me coverage. Some people will pay more than they receive in lifetime benefits, some people will pay less. Overall the general health of the community will benefit. The lady in the elevator next to you with active TB who cannot afford treatment just cost you a whole lot more than any Public Option.

  14. “Do we have the right to food? As far as I know, the government not declared food to be a universal right. And yet, very few people starve to death in this country”

    I believe food is provided for free to women, infants and children on a need based system (WIC), heavily subsidized to need based families (food stamps), provided to needy families through community outreach programs (meals on wheels, soup kitchens) and extremely subsidized on a grass roots level lowering costs across the board by lowering costs to farmers for land, seed and machinery.

  15. “I understand your view that the young/healthy prepay their future benefit… you really mean the benefit of being subsidized by the young/health when they are old, no? ”

    or I can view it that young john is subsidizing old john. Old john just doesn’t exist yet.

  16. john,

    You miss the point. Libraries are not federally mandated; they are locally supported, funded and run by a city’s citizens for their own benefit. Fire departments are also not federally mandated; they are locally supported, sometimes even run by volunteers. And the same with police (and even some areas have volunteers).

    The other argument about the young “pre-buying” their services fails on many levels, not the least of which it fails miserably in a society with falling population (not here, I know).

    The one area in which you can make a good argument for federally mandated medical coverage is in vaccinations of dread disease, defined such that if vaccinations were not provided there would be a reasonably probability of a large fraction of the population suffering or dying.

    I notice nobody tried to answer Uncle Mike’s suggestion of “Why not food as a right?” You need food before you need medicine, after all.

  17. So in the end, this turns into the old question of whether our society or our political community has an obligation to provide its citizens with a social minimum and what the social minimum should be.

  18. Briggs,
    It matters not if the social service is federally funded or funded by the state, county, city or township. If you live in NYC you are mandated to pay for all of these services whether you use them or not because you are covered by them, so to speak. You are merely changing the scale of the entity but the principle is the same. To paraphrase your post – A government healthcare system would be nationally supported, funded and run by the country’s citizens for their own benefit.

    Let’s even reverse the situation. Let’s say New York County decided to cover all of it’s residents’ health care, payed by county taxes applicable only for the county’s medical services. At this point how is it different than the county sherriff’s office or the city fire department.

  19. So John,

    Why stop with health care (medical services and goods)? How ’bout others – housing, transportation, vacations in the islands?

    Does my the fire department justify my “right” to a big house, nice car, vacation on the beach?

    And how do we make sure that you and I get same amount of “rights”.

  20. Ah, john, but it’s different. If each city were allowed to have the debate—in the open—I imagine the outcome would be very different. I would support that debate, too. And I would abide by any outcome.

    But without the secret wish of everybody thinking they’re getting federal money for nothing, few, if any, municipalities would opt for paying for their citizen’s health.

  21. kdk, transportation and vacation are not necessities, but basic housing is and is already available at full price over a range of sizes and locations, subsidized (housing projects or income scaled rent assist communities) for lower income people, and ultimately guaranteed via public shelters.

    JH is spot on : does our society have an obligation to provide its citizens with a social minimum and what should the social minimum should be.

    Currently a social minimum for healthcare exists and is, a public hospital cannot refuse emergency need care. I think this is too low of a standard, and current Senate Republicans think it is just fine.

    Briggs, the only difference is the weight of a single citizen’s voice. But then that’s just how representative government works. But you can’t be against representative government ruling without supporting popular vote.

  22. I agree that morality compels us to provide a “social minimum” for the poor (no matter why they are poor – we’re not willing to let people starve in the streets). Where to set the bar and what mechanism ought do the providing are subjective choices – there is an argument for private charity.

    I agree that an organized society must tolerate (my word) a bit of socialism, but how much is subjective. I find public schools a powerful argument for free markets. Rent control isn’t far behind.

    None of the services provided by #1 or #2 are individual RIGHTS.

  23. Consider rent control. Once imposed, the landlord has no incentive – and possibly can’t afford – to maintain – much less improve – the property, so he let’s the building deteriorate. Eventually, the building is, strictly speaking, providing housing for the poor; but in reality it’s a slum.

    One solution would be to let government make up the difference between the controlled and the fair rent. But how to determine the fair rent? The politically connected will get an attractive fair rent; others not so much. Even then, the landlord is now incentivized to lobby government, not please tenants.

    Now consider health care. Once government assumes responsibility for covering the uncovered, they will discover that it is a very expensive proposition – in part because government delivers services very ineffeciently, but mostly because government programs cost 5X their projected costs.

    So, government will implement price controls – as they already do for medicare. In the short term, costs will shift to private insurance, but sooner or later that will be too expensive and price controls will be universal. Eventually, the US government will, strictly speaking, be providing health care for all americans; but the reality will be very different.

    …and that’s my $.02 + $.02 + … heck, just call it a quarter. I’ll now return to lurking.

    Luv the site!

  24. Maybe you can explain this to me since you talk like a republican. Republicans had no problem supporting the war in Iraq that has cost $trillions and killed people. Why do they so vehemently oppose healthcare reform that would cost much less and can save lives?

  25. Candy,

    The decision to spend money on a war is not relevant to whether we should (further) spend money on health care. It would be just as irrelevant to the question if I asked, “Since we spend money on social security, how can we spend money on health care.” Or on “the space shuttle”, or whatever.

    In answering with a question about an unrelated matter, one commits the logical fallacy of changing-the-subject.

  26. Briggs,

    I’m a UK citizen so should have no need of paying for my healthcare, but even so I might send you a bill since you offered to pay for it. That would be the smart, market, thing to do presumably?

    Do you have no concern for the 47 million compatriots of your country who can’t afford basic health care cover? Don’t you want to improve their life chances so they, too, can enjoy the privileges you take for granted?

    Why have you got such a problem about spending money on health care?

  27. Dave Andrews,

    If we follow standard re-distributionist thinking, I should only pay for your care if I have more money than you. How much do you have? So we can compare.

    My “privileges” are earned, and so are not privileges.

    Actually, I care so much that I think people would better off if they did not think they could get something for nothing.

  28. I think people would be better off if they stopped thinking that they work so much harder to get what they have than do people who have nothing, most of whom bust their ass just to get by.

    When I was in grad school making all of 12K a year, $600 a month for medical insurance wasn’t an option. Nor was getting sick. If I had developed pneumonia I would probably still be paying off the hospital bill, assuming I didn’t have to wait until I was nearly dead to get admitted for treatment I couldn’t pay for.

  29. Here’s the rates for the coverage(principal financial group) at my work.

    Monthly: Employee contribution Emlpoyer contribution

    Employee only $48 $447
    Employee + Child(ren) $97 $897
    Employee + Spouse $116 $1,071
    Employee + Spouse + Child(ren) $145 $1,435

    Gnarly Dude!!!

  30. You can buy a high deductable (catastrophic coverage) for a mid-20’s nonsmoker single graduate student for $75 a month though Aetna, Signa, United, or Human.

    I paid my own health insurance in grad school. It wasn’t $600 a month.

  31. Don’t worry, folks, the social-engineer’s old nemisis, the law of unintended consequences, will foil their attempts to force this down our throats. When faced with a 40% excise tax over a set amount, what is the logical response, both for the employer and the employee? Of course all benefit plans will be re-crafted to fall just below the limit. The gap in coverage will be made up by either a separate supplemental insurance policy, or other benefits, such as contributions to flexible spending accounts. Alternatively, all employees will join one of numerous arbitrary “unions” with little or no dues, and claim the exemption. Either way, the “revenue” (I love how liberals apply this to term to confiscated wealth) that they expected will predictably vanish, as will the political future of the Democratic Party for the next decade or so.

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