Health Care Reform

[River]

Ce If someone isn't smart enough to figure out they need to find a way to take care of themselves, I don't understand why I should be taxed in any way to help them.

Unless you're making over $200K/year, using tanning salons, or refusing to buy insurance and thus paying the penalty after the individual mandate kicks in, this law does not tax you. You've already mentioned you buy insurance through an employer. That's unlikely to change, unless your employer decides it is cheaper for them to just pay you more and have you buy insurance through the exchanges.

[yovargas]

If someone isn't smart enough to figure out they need to find a way to take care of themselves, I don't understand why I should be taxed in any way to help them.

From my understanding of the law, or at least the mandate, the exact opposite of this is happening. People who don't take care of themselves by getting insurance are being penalized ("taxed", says The Court) so that the people with insurance - like you - don't have to subsidize their health care costs with your insurance premiums.

[Primula Baggins]

Certainly not defending Republicans, as they haven't done anything to fix the problem either. I just don't believe that we should be forcing people to make good decisions for themselves. If someone isn't smart enough to figure out they need to find a way to take care of themselves, I don't understand why I should be taxed in any way to help them. If people are truly good and desire to help one another, why isn't the welfare system run on donations? In principle, I don't see much difference. I don't believe in rewarding irresponsibility. An ex girlfriend chose to move to LA and become an actor, and lamented her lack of health insurance. She could have chosen a career or job that provided insurance, but instead elected not to. She knew the associated risk but still felt it unfair. I think it was very fair, as it was a known price of the decision. I specifically chose an occupation that is in the top ten most dangerous jobs, with low pay but decent benefits because I wanted it. I love what I do. But I would not have chosen the job if it did not provide health insurance, because I knew I wouldn't be able to afford to pay for any medical care when unfortunate circumstances arose.

I watched my life's mentor waste away and die of a terminal illness over the course of three and a half years. He was my grandfather. Aside from my parents, no other person has had more influence on how I was shaped as a person. One of his medicatons cost over $3500 a month. What saved him from an earlier death and abject poverty was being retired military. And I purchased their residence to create the nest egg that got him and my grandmother through to their deaths. All of my grandparents were afflicted with terminal diseases that cost them dearly in many ways. I am no stranger to the cruelty of life, death or the societal systems we employ to delay or secure those things. Cancer, heart failure, Alzhiemers, diabetes are all prevelant in my extended family.

My family does not have deep pockets, which is why I despise the medical industry as mercenaries who sheath themselves in the guise of miracle workers, lance my own infections with a knife and selected a job where I was going to be provided medical insurance. If medical professionals truly wanted to help people, they would drive Camrys and Taurus sedans, and live in modest homes...and save lives.

Unless this legislation actually fixes the impoverishment of those saved by the medical industry, it only delays the financial destruction of anyone unfortunate enough to be compelled to be treated.

You can do everything right, and still end up short. I have done my best to pursue my own form of life, liberty and happiness, but circumstances outside of my control may still lead the the destruction of all that I have and all that I am. How I feel about that reality is immaterial. How I accept and adapt to my current reality will determine how I end this existence. I recognize every day as a blessing, and am grateful for opportunity to act on my own accord. The world is an amazing a beautiful place. Society...not so much.

I just don't believe in encouraging people to shirk taking care of themselves with utmost effort, and I think this legislation does that. And then I also think the decision is tainted. The timing is pretty good to keep Obama in office. Since its inception, the whole thing has smacked of a bid to purchase votes, because that is what politicians do. Obama, like any other politician, couldn't care less about individuals aside from votes, otherwise why is he such an egalitarian a millionaire?

But utmost effort doesn't save you from deadly illness. There isn't a "you failed to act correctly, therefore dying without treatment is what you deserve" aspect, because no one can act correctly enough to guarantee that illness will not strike them down.

"Shirking" isn't in it. Olympic-level athletes can and do develop deadly cancers, or die (or nearly die) of fatal cardiac conditions. How could they have worked harder? What could they have done to be more fit?

Making health care contingent on moral purity is absurd, dangerous, and pointless.

[Folca]

Errors specific to the wording in this law versus my thinking have been rightly taken to task, and I deserve that.

The penalty for not participating in this law is weak, with no criminal penalty or high fine, making it eye candy to my eyes.

I have always rejected this law according to my personal feelings, and still do. And I am crabby after three twelve hour shifts bracketed with a total of eighteen hours of sleep. Reading what I wrote in my last two posts reveals how antagonistic I was upon waking this morning.

I will never agree with supporting non-permanenty disabled individuals with anything but roads, law enforcement, utilities and other basic systems that a government should be expected to provide. This law and the SCOTUS decision are still political in nature and are not a moral victory either.

To those whom I have offended in any way that appeared to be a personal attack, I apologize.

[vison]

If medical professionals truly wanted to help people, they would drive Camrys and Taurus sedans, and live in modest homes...and save lives.

Well, there you are. This comment makes my head go wuggawugga, but I'm pretty sure that's not what you intended.

What did you intend?

And you did not offend me at all.

[yovargas]

I will never agree with supporting non-permanenty disabled individuals with anything but roads, law enforcement, utilities and other basic systems that a government should be expected to provide.

I'm curious - would you include education on that list? Not being snarky, genuinely curious. Again, I lean pretty strongly libertarian but often have a hard time reconciling those basic moral ideals with the pragmatic realities of society and it's pretty hard for me to say that we'd in any way be better of as a society without government-provided education. And I've come to the conclusion that health care may fall in the same boat as education in that you can't support one and oppose the other on principle.

[axordil]

Making health care contingent on moral purity is absurd, dangerous, and pointless.

And Calvinist. I swear Melkor could have learned something from that guy.

[vison]

Making health care contingent on moral purity is absurd, dangerous, and pointless.

And Calvinist. I swear Melkor could have learned something from that guy.

No kidding.

No offense intended: I often get the idea that in the US for SOME PEOPLE, any "failure" is because, 1. You are morally imperfect, 2. you didn't "try hard enough", 3. you are stupid and weak.

I know this is not a universal truth and I say again, this is not true of all Americans, but these notions seem to have a poweful grip on the public consciousness, just the same.

The human race would not have survived and prospered if we had not taken care of each other.

There are too many of us, now, and we have lost the connectedness that is necessary. It is obvious, at least to me, that Nature will deal with that, one way or the other.

[River]

The penalty for not participating in this law is weak, with no criminal penalty or high fine, making it eye candy to my eyes.

Indeed. To make it viable, the penalty for not carrying insurance needs to be more expensive than having it. That's something that may end up needing to be fixed. But that part of the law hasn't even kicked in yet. We'll see what happens...and hope any necessary repairs actually get made.

Looking forward to affordable insurance without being tied to an employer. Maybe then I can cut loose and start a business like my husband did. He's so much happier working for himself. I'd love to try it. Or maybe I'm just dreaming because I'm hating my job right now.

And as for getting sick/hurt being tied to a moral weakness...when I was an EMT I did see people who had hurt or sickened themselves through some really bad decisions, or who for one reason or another just opted not to manage their chronic illness properly (it's not always a lack of insurance or lack of education; it's the same mentality behind not finishing one's antibiotics, they feel better so they quit their meds and then...oops). But I also saw people who'd just gotten frakked over. A 33 year-old man in heart failure because a relatively rare virus that's generally only dangerous to children attacked his heart. How do you prepare for that?? Some guy who was just out doing his Sunday errands when a moron ran a light and plowed into him. Can you avoid that without barricading yourself in your house? A 45 year-old man with a bad set of genes whose heart stopped while he was at the gym. We couldn't get him back. We tried. We failed. Mother Nature deals the cards and she's a bitch sometimes. And so on. And, in my own family, I saw pure bad luck happen. A rare cancer usually seen in kids under three or adults over 65, in a teenage girl. No risk factors, no family history of this cancer, and all of us ate healthy and got exercise. It just happened. What was she supposed to do? Just not be alive?

[nerdanel]

No offense intended:[/b] I often get the idea that in the US for SOME PEOPLE, any "failure" is because, 1. You are morally imperfect, 2. you didn't "try hard enough", 3. you are stupid and weak.

No offense taken, because I more or less think you're right. #2 is how I was raised, with a bit of #1, but no #3 - and I'll go further - #2 is, for the most part, what I believe about most things in my own life. That is, I can't recall ever truly giving 100 percent and failing. I've failed plenty, but I have always been able to "post mortem" those failures and see how they correlated directly to insufficient effort. And I've observed this to be true of most of my friends, too - they might cry that they tried their hardest immediately after a failure, but usually after a week or two of reflection will acknowledge that there is more that they could and should have done. I think that if we are honest with ourselves, virtually all of our failures could have been addressed with more thorough effort, and I think it is very much a virtue of America that we recognize this, expect ourselves to work as hard as possible, and hold ourselves responsible for our failures by recognizing that we could usually have chosen to do better, work harder, try more.

But I still support universal health care for two reasons:

First, Prim's point: health is one of those things where you can do absolutely everything right but still face illness, pain, and suffering for reasons outside your control, like genetic loading, unwitting exposure to environmental toxins, medications with side effects that the medical profession itself could not foresee, etc.

Second, and perhaps even more importantly, I think that there are some things where society needs to mitigate even the consequences of poor individual decision-making or failure to try hard enough, and healthcare is one of those areas. First, to state the obvious, failure to universalize healthcare will penalize innocent children for their irresponsible parents' errors, which is unacceptable. Second, I think society is greatly demeaned by lecturing the smoker suffering from lung cancer or the drinker who requires a liver transplant, "Aha! You brought this on yourself, and we can't be arsed to pay for it, because we were responsible, unlike you. Sit there, suffer, and die." I think this treatment of ill people, even those "complicit" in their own illness, is unnecessary and lacking in compassion for the ill person - and fails to comprehend the ways in which their illness and death might again harm innocents, like their dependents. (However, there are plenty of other areas where I think that demanding individual responsibility, with no societal mitigation, is fitting.)

[vison]

Excellent post, nerdanel.


"Failure" is often only in the eye of the beholder. But certainly illness, pain, suffering, and death are not "failures". Sometimes they are the result of poor decisions and/or ignorance, but, in the end, they get us all.

[River]

"Failure" is often only in the eye of the beholder. But certainly illness, pain, suffering, and death are not "failures". Sometimes they are the result of poor decisions and/or ignorance, but, in the end, they get us all.

Indeed. These things are the price we pay for being alive in the first place.

Second, and perhaps even more importantly, I think that there are some things where society needs to mitigate even the consequences of poor individual decision-making or failure to try hard enough, and healthcare is one of those areas. First, to state the obvious, failure to universalize healthcare will penalize innocent children for their irresponsible parents' errors, which is unacceptable. Second, I think society is greatly demeaned by lecturing the smoker suffering from lung cancer or the drinker who requires a liver transplant, "Aha! You brought this on yourself, and we can't be arsed to pay for it, because we were responsible, unlike you. Sit there, suffer, and die." I think this treatment of ill people, even those "complicit" in their own illness, is unnecessary and lacking in compassion for the ill person - and fails to comprehend the ways in which their illness and death might again harm innocents, like their dependents. (However, there are plenty of other areas where I think that demanding individual responsibility, with no societal mitigation, is fitting.)

Not to mention that if a large enough fraction of the population is sick, even the healthy people get dragged down in terms of economic productivity, military preparedness, and so on. Poor food choices are linked to obesity and obesity sets you up for a host of other problems, but we're at a point where enough people are having these problems that it's not just a particular individual's problem anymore. It's starting to affect the collective. I think.

Anthy, could you put on your MPH hat and explain this?

[Frelga]

Among many economical consequences of tying health coverage to employment is the undermining of that American spirit of enterprise. Too many people are stuck in jobs where their potential is not tapped. They can't leave for a smaller, promising company, or start their own because they have a child with medical problems, or had cancer, or donated a kidney to their partner, or have poor family history and know they are at high risk down the line. They can't risk losing health care, and we all lose on the things they never create.

[Folca]

I'm curious - would you include education on that list? Not being snarky, genuinely curious. Again, I lean pretty strongly libertarian but often have a hard time reconciling those basic moral ideals with the pragmatic realities of society and it's pretty hard for me to say that we'd in any way be better of as a society without government-provided education. And I've come to the conclusion that health care may fall in the same boat as education in that you can't support one and oppose the other on principle.

That is an excellent question, and set me back for a minute. I would include education on the list of things to be supported, but not health care. Health care costs are very expensive, but supports only a limited number of industries. It is a drain on an entire society but only benefits a section of it. Education benefits a nation in almost every aspect: industrially, militarily, scientificly, artisticly...


PRIM- You misunderstood me, I believe. What I meant by taking care of one's self was not intended to be about health activities or illness prevention specifically. What I meant was that people need to address their own needs themselves as if no one will help them: gambling by not getting health insurance or even vehicle insurance and hoping never to need either is absurd. I don't believe in rewarding people who feel that someone else should be providing anything for them besides law and order, protection, education, transportation networks and other basic systems that maintain the core of a society. Illness, genetics, and external factors outside of our control can all strike a person down. I have no illusions about that.

NERDANEL- I can't agree with you about those who make themselves sick (drug/tobacco/alcohol abuse). Those are avoidable, readily documented and unnecessary risks. There is no morality about that either. Excessive conduct comes with known risks and consequences. I don't think subsidizing such behavior is responsible use of taxpayer funds. And yes, I have family and friends who participate in these things.

You cannot save a person from themself. In my job I have seen cops, firefighters, medical professionals, clergy, family, friends and complete strangers genuinely attempt to intervene in another's life as they self destruct. Such actions do have influence, but ultimately the individual has to make the choice to address the problem. Compulsion does not work. Again, this is not a morality statement, it is reality. Individuals are responsible to themselves, regardless of the outcome.

We as a society are enablers, I think. With legal and especially medical advances, we actually perpetuate a great many problems. We mitigate the costs that many individuals inflict on themselves by inflicting those costs on others. How does that make society stronger? It doesn't. It punishes all to accomodate some. I find that objectionable and counter intuitive.

[yovargas]

That is an excellent question, and set me back for a minute. I would include education on the list of things to be supported, but not health care. Health care costs are very expensive, but supports only a limited number of industries. It is a drain on an entire society but only benefits a section of it. Education benefits a nation in almost every aspect: industrially, militarily, scientificly, artisticly...

I think that's a fairly reasonable answer but some would argue that lack of reliable healthcare hurts society in almost every aspect.

[Folca]

Health care costs are a drain upon the society in general, but the money goes to support only a segment of the population. Creating a government subsidized system costs everyone to support some, because it is the health care industry alone the benefits the most. Unless a nation has a negative population rate then there will be others to put time, effort and money into the national system. There is time-loss at work for those who are ill, but illness isn't going away. And a subsidized system in a capitalist society will be taken advantage of by the industry being paid. Unless price caps are placed on proceedures and supplies ($8.00 for two tablets of ibuprofin being a prime example), do you really think the medical industry is going to charge less and reduce the strain on taxpayer funds?

[vison]

A public health scheme, such as is in place in Canada and many European countries, is much, much less costly than what passes for health care in the US. Americans pay TWICE as much per capita for health care as Canadians and the British do.

The issue is not the "industry". Why should any industry not charge what the market will bear? I get the idea that you think doctors and nurses and other medical professionals should "take less" for the public good? Would you, in your job?

[River]

You do realize that everyone gets sick at some point, right? Sometimes they get batter, but sometimes they don't. Not many people manage to stay healthy and drop dead or get hit by a bus or something. In most cases, bodies just gradually decline. Even if you took good care of yourself, parts just wear out. Eyes film over with cataracts. Hearts falter. Kidneys and livers say "Bugger this, I quit." Random cells turn cancerous. Minds crumble. My grandfather was on no medications save glucosamine (and you can get that in the vitamin section at the store) until his early eighties. Then dementia kicked in. Runs in our family. He's in a home now, slowly slipping away.

Also, some health care costs don't go to the sick. They go to things like vaccines and pre-natal care and screenings, stuff that prevents trouble before it starts (if you think a polio jab is costly, consider paying for an iron lung).

What exactly do you propose anyway? The sick people just go hang? You do understand that when you buy insurance you're still paying for someone else, right?

It is true, however, that health care costs in the US are bloody high. Americans spend more on health care than any other industrialized nation. We also lack a nationalized health system. I'm not sure how much the two are inter-related. I do know, however, that there are huge mark-ups on medical supplies. I also know that there is a strong tendency among doctors to order more tests and prescribe more drugs than are necessary. I also know that very expensive treatments are offered that have minimal, if any, actual benefit. And, at the end of life, doctors throw everything they've got at patients, trying to give them another hour or another day. But the minute anyone tries to have a conversation about that, someone screams about death panels and everything gets shut down in a fit of hysterics.

[Primula Baggins]

I am a bit boggled at the concept that health care dollars are less worth spending because they go to a smaller industry. Does the economic benefit to the patient count for nothing? And the people for whom the patient will continue to work if he/she does not die? And the house payments that will continue to be made if the patient does not go bankrupt? And the children who will be able to be brought up by two parents and get their help to go to college?

I don't mention the reduction in human suffering, because that's an intangible and this is evidently all about benefits to the economy.

Let's consider some more. As has been mentioned on this thread, what about the would-be entrepreneurs who can't reach for their dreams because they can't give up their employer-subsidized insurance? What does that cost society? What about the employers who have to spend increasing sums on health care for their employees, whereas their competitors overseas do not because their employees are covered by "socialized medicine"? Is that not an economic benefit to the foreign companies?

And what about the entire structure of health care in this country, where a significant part of every health care dollar has to go to advertising, overhead, and shareholder profits? If we were truly focused on efficiency, why wouldn't we cut out the profit-taking middleman and go instead to the Medicare model, where 97% of every premium dollar goes to buy care?

[axordil]

There are billboards in my city advertising a local ER, where you can use their website to check in before you go in, as if it were a discount hair salon.

Something has gone terribly, terribly wrong here.