Conservatives: What should we do about people who can't pay for medical care?

Great Debates
1

Part of the reason medical insurance is so expensive is because when someone who can pay goes to the hospital, the bill includes the actual cost of the care provided, the profit margin, and a markup to make up lost revenue from other people who received medical care but couldn’t pay. Every time someone declares bankruptcy over 50,000 dollars of medical bills, he’s contributing to the rising cost of medical care for everyone else.

I think conservatives and liberals can all agree that this is a problem. People can’t pay their bills, so the cost goes up for people who can pay, so now more people can’t pay their bills, so the cost goes up even more. We’re seeing it happen now, with medical care costs that are skyrocketing an order of magnitude faster than the general inflation rate, and fewer people covered by medical insurance than even 10 years ago.

So, if the answer isn’t to mandate everyone buy health insurance, or just cover everyone through a government health care program…what exactly is the answer? How do we prevent so many people from receiving health care they can’t pay for? Should hospitals be allowed to deny life saving treatment to people who can’t pay? After all, why ought they be forced to provide a free service, just because the person needing that service is poor? Restaurants aren’t required to feed people who can’t afford a meal, even if they’re starving. Isn’t health care kind of the same thing?

Anyway, it may sound like I’m not asking this question in good faith, but I am. I’m not trying to play “gotcha” or trap anyone, I just honestly want to know the conservative side here. The health care debate is so bogged down with arguments about the merits and evils of Obamacare or other “liberal” solutions, that there hasn’t been much time to discuss what the conservatives would do if they had the power to address this issue.

All I want is for more people to have more access to more affordable health care. I don’t really care if the Democrats fix it or the Republicans do, and the only arguments I won’t even bother to listen to are ones which deny that there is in fact a problem in the first place. I support Obamacare, but would happily abandon that support in favor of another reasonable solution. Convince me!

2

Make health care free to anyone who wants it. But, the dollar amount of care which is covered on a free plan is only required to be X% of the national average of health care spending for someone in that age group, such that X is low enough to encourage sufficient numbers of people to buy paid insurance plans that the free plans are affordable for the insurance companies.

3

When OP asked why anyone should receive free care, my first thought was “Morals!” (because we’re a moral society and won’t let people needlessly suffer if we can help it). I believe that’s how the practice started (and IMHO, should remain) but suspect that growing portion of society is suffering from ‘compassion fatigue’. Maybe, you do what you can to help, but get tired of seeing people accepting help who you believe should be capable of taking care of themselves.

Back to the quoted post: I think we either have to provide free care or none at all. It doesn’t make sense to me to say ‘We’re compassionate enough to help you out, but not if you’re REALLY, REALLY sick’.

4

I disagree with Sage Rat, definitely. In fact, that’s kinda the exact opposite of what most conservatives are after. I’m also very dubious about the finances on his scheme.

I favor some more basic reforms and then seeing where things go. We could get some fundamental fixes. Right now, the medical system has many very stupid properties.

Here’s a few to start with:
(1) Insurance should be able to cross state lines.
(2) Change the tax code to push most predictable, ongoing costs are not covered by insurance. I can see a good argument for the odd checkup, but nowadays insurance covers many optional or easily-anticipated procedures along with drugs, which tends to make them all way more expensive.
(2.5) Insurance should cover, y’know, unexpected and catastrophic damages, just like every other damn insurance in existence. Right now, people want it to cover everything at all, with the result that it ends up costing a hell of a lot more. Insurance deductibles don’t mitigate this very well.
(3) Speaking of which, deductibles need to move towards a percent model.
(4) In the long run, insurance should be divorced from employment.
(5) Accept that people prefer spending more of their money on healthcare, and its happens.

The problem with most healthcare schemes is that they never realize, or try to ignroe, the plain fact that desire for healthcare is immediate and infinite, even more than most goods. Ask anyone who needs it, and they would rather no expense ever be spared. Ask them to pay for it, and its a different story. Unfortunately, society has limited resources, and medical needs are not infinitely valuable. This does not mesh well with the basic feeling people have that everything, including all the best and newest treatments, ought to be available to everyone, right now, for no cost.

That said, the above will mitigate significantly public medical costs. This should make it a lot easier to means-test those who truly do need it. The system has become a huge mess, and the new programs meant to “sort things out”, as usual, are simply going to make it more of a mess. I say this with a certain measure of confidence, because government does not have a good track record in this field. I have a hard time thinking of any such program which did not result in increasing costs and diminishing care, from Tenncare to Romneycare.

5

I’m not a conservative but the answer is so simple it is embarrassing, no insurance at all.

Use tax to pay for medical care for everyone with additional private insurance for those who want it.
Cheaper per person, coverage for everyone, end of problem.

6

From what I can tell, the conservative solution is very much like Obamacare. That’s why they have proposed it so many times before. However, we have wandered into a Twilight Zone where up is down, black is white, etc. When Mitch McConnell said that the GOP’s top priority was to make Obama a one term president, they turned their backs on their real responsibilities. As Joe Biden said, this is a big fucking deal. Obamacare’s success could make Obama a two term president, and the GOP has explicitly stated that they will burn the entire country to the ground in order to prevent that.

7

Define “medical care” … and then cut it in half or a third and pay/give that to the “people who can’t pay” using existing programs.

Then look at all the “people who can’t pay” and make sure they don’t have any other “luxuries” that are less important than medical care.

8

Ok, and what portion of a kidney transplant does a big TV buy these days?
Is it not more sensible to consider all consumers and taxpayers as contributing according to ability and deserving of treatment according to their needs?

9

Basic medical care should be provided to those who truly can’t afford it, to the extent that we can afford and sustain it. I’m a small-government conservative, but I do believe we need a societal safety net for those who are down on their luck or unable to care fore themselves. During the last presidential election, I asked that of my brother (who is a large-government liberal, extremely so) why we need to overhaul the insurance industry so much, why couldn’t we just expand Medicaid to cover those currently unable to afford insurance? He couldn’t come up with a reason. It was (and is) axiomatic to him that an overbearing act like Obamacare (actually that doesn’t go far enough for him) was (is) required.

But that means basic medical care. This might seem harsh, but someone who can’t afford medical coverage can’t be given a level of care that is unsustainable. Compassion is fine, but “can we afford this?” is a practical question that mature adults ought to ask.

So, as with all government programs, I apply the same logic:[ul][]It should only cover something that is best left to the government, and I place “large portions of the public without medical care because they can’t afford it” in that category. If the majority of the population requires no assistance, leave them out of the fix. Government programs should be as small, leaving as minor a footprint, as it possibly can, given the objectives.[]It should minimize its effect on personal liberties (e.g., don’t “fix” the problem by compelling select private entities to offer services they would prefer not to). I personally think a health insurer ought to be able to offer whatever coverage they want, and turn down any application they’d like, for example.And it is not enough to have the angels on your side, you have to be able to actually afford it.[/ul]To me, people without medical coverage because they can’t afford it are in the same category as those receiving food stamps, and the solution ought to be the similar. We don’t compel supermarkets to give out free food, or to have certain kinds of food on their shelves, or whatever. But we do provide help to those who need it, to the extent we can afford it. Provide Medicaid (or something like it) to cover essential medical expenses, to the extent we can afford it. Change the idiotic laws that restrict options. Leave everything else alone.

10

Radically deregulate the insurance market, as described by other posters above. There is no reason for regulators to prevent insurance from crossing state lines, or for dictating what needs to be available in each policy, or anything else.

I think you would see a very large number of high deductible, customizable policies come into existence to address catastrophic events that cannot exist today.

Pursue aggressive tort reform on a national level, such as a number of states have already done.

If people are poor, give them money or vouchers to purchase whatever they want.

And that’s about it.

11

Just wanted to snip this little point. Yes, we do compel supermarkets to stock certain foods if they want to participate in food assistance. In addition, a certain percentage of their revenue must be from certain staples.

12

Would you regulate insurance at the federal level, or let each state set up its own regulations?

13

Why does it need to be regulated at all?

14

That’s probably a debate for some other thread. Assuming regulations are necessary (as they are, now)- would you have them be administered at the state or federal level?

15

That wouldn’t do a damn thing. Insurance companies would just set up shop in the state where they can write their own regulations, just like the credit card companies do.

16

Why would it make health care cost less if, instead of charging other people higher insurance fees to cover that $50K, we charge other people higher taxes to cover the $50K? ISTM the $50K is just coming out of a different pocket, not that it costs less than $50K in either scenario.

As to the question of the OP, if we want to do something about health care costs before they bankrupt us, as they are projected to do, we need rationing. And thus accept that we are going to let people die in order to save money.

That drug for your AIDS infection may work 10% better, but it costs three times as much. So no, you can’t have it, and if you die earlier as a result, sorry. No, we aren’t going to pay for a gastric bypass for you. If dieting doesn’t work, too bad. Sorry that your baby was born weighing less than a kilo, but we are going to give her drugs to make her comfortable and leave her to die. We aren’t going to treat your father’s congestive heart failure - he has dementia and will die anyway in a couple of years.

Or we can make exceptions in each of these cases, send the bill to the government, and Medicare and Medicaid and Obamacare will all bankrupt us.

Regards,
Shodan

17

That is the most cold blooded thing I’ve read in quite awhile.

How about instead of drugging up babies and leaving them to die, we just institute a British or Canadian style healthcare system?

18

So, any conservatives want to address the fact that, “buying insurance across state lines” will cause all insurance companies to go to the state with the least regulations, which will mean insurance will be worse than it is now?

Across state lines is a catchphrase, it isn’t intelligent policy.

19

That’s just scaremongering Shodan and it should be beneath you.

As has been pointed out time and time again, the healthcare systems in place elsewhere in the world cost less per head that the USA pays now, cover everyone, and can ensure that the majority of the rationing scenarios you list above can be dealt with on purely medical grounds rather than financial (which is the rationing system you currently have)

Once again, for emphasis, the answers are already known*, take your pick of the solutions open to you.*

Of course the USA would need to accept a more radical solution than is currently under discussion and possess greater vision than is being shown at present.

20

From what I can gather from talking to many Americans: “Because that is socialist.”. End of argument.

It does not matter if something is better, or more efficient, or less costly, or helps more people for less money. If it can conceivably be called “socialist”, then it is bad.