# Conservatives: What should we do about people who can't pay for medical care? **URL:** \ **Category:** Great Debates\ **Created:** [March 31, 2012, 3:36am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350 "2012-03-31T03:36:04Z")\ **Posts on this page:** 20\ **Page:** 7
**Author:** ![brickbacon](https://avatars.discourse-cdn.com/v4/letter/b/898d66/32.png) [@brickbacon](https://boards.straightdope.com/u/brickbacon)\ **Post date:** [April 1, 2012, 10:53pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/121 "2012-04-01T22:53:43Z")
> [@Stratocaster](#): > > Yes, I do. As a matter of fact, I work for a company in the financial services industry that makes it a priority to treat customers fairly, disclose contract features, and to generally err to the customer’s side. I don’t know who you work for, but the reality is that most poeple feel companies in the financial services industry are not “fair”. Perhaps you are too close to the situation to appreciate that what you see as transparency and fairness is something many less biased people tend to disagree with. > [@Stratocaster](#): > > I know plenty of other companies who operate the same way. Companies that have tremendous repeat customer rates enjoy that because they believe there are no conflicting objectives between customers’ satisfaction and being profitable. In fact, they are essentially linked. But they are not linked in healthcare. People like low costs, and tons of cutting-edge services. Those things are not linked to an insurance company’s desire to make money. In fact, they hurt the bottom line. > [@Stratocaster](#): > > That is a shitty, failing business model. “The lowest standard of care” will lose you customers to someone who can do better, just as it does in any other industry. If you truly believe this, then why don’t all companies offer the maximum care? By that, I mean, why don’t all companies cover autism intervention, diabetes meds, lead poisoning claims, etc.? If you truly think that _not_ covering things is such a shitty business model, then why don’t you see companies covering far more things than they required to now? Why did legislators have to go through the tedious step of mandating it? There is nothing stopping Cigna from covering everything. Again, why don’t they? Surely their customers would prefer that given similar costs, no? Seriously, we’re not getting anywhere, and no one is going to convince the other, it is clear. [/QUOTE] ---
**Author:** ![IdahoMauleMan](https://avatars.discourse-cdn.com/v4/letter/i/71c47a/32.png) [@IdahoMauleMan](https://boards.straightdope.com/u/IdahoMauleMan)\ **Post date:** [April 1, 2012, 11:39pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/122 "2012-04-01T23:39:06Z")
> [@MandaJo](#): > > The insurer. I know if I am going to have a baby or two or three, if I am going to watch my weight, if I am the sort to comply with doctor’s orders, if I share needles or have unprotected sex or skydive. > > Insurance is a bet. If one bettor has a lot more information about the odds than the other, then the one with more information is always going to come out ahead in the long run. You can’t profitably sell insurance if you only sell it to people who think its a good bet to buy it. That’s why we have group insurance–every member of the group is required to have it (or demonstrate they are covered somewhere else) Than how come all life insurance and automobile insurance companies haven’t gone bankrupt? The last time I checked, some of them have been in business for over 100 years. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [April 1, 2012, 11:51pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/123 "2012-04-01T23:51:17Z")
> [@IdahoMauleMan](#): > > Than how come all life insurance and automobile insurance companies haven’t gone bankrupt? The last time I checked, some of them have been in business for over 100 years. Because in the case of car insurance, most states have assigned risk, which forces insurance companies to accept drivers with DUIs, too many accidents or too many tickets on their record. Is that what you want for health insurance? A mandate from the government that insurance companies accept people they don’t want to? ---
**Author:** ![drewtwo99](https://avatars.discourse-cdn.com/v4/letter/d/d07c76/32.png) [@drewtwo99](https://boards.straightdope.com/u/drewtwo99)\ **Post date:** [April 2, 2012, 12:03am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/124 "2012-04-02T00:03:42Z")
Scalia had it right. Society should not obligate itself to paying for poor people’s healthcare. Let them die. Fuck people who can’t pay for insurance. If they had worked harder they could have earned enough money to pay for it themselves. What an outstanding model of conservative belief Antonin Scalia is. Aren’t ‘we’ conservatives just so lucky to have him on our Supreme Court? ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [April 2, 2012, 12:28am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/125 "2012-04-02T00:28:46Z")
> [@Stratocaster](#): > > Right, in the same way that the life insurance industry was destroyed by it. Keep trying. Look at what you’d pay for life insurance if you are 95. Think about exclusions for suicide right after buying a policy. Even for my work coverage, I’d need a checkup report if I dramatically increased coverage one year. Not to mention that people collecting on health insurance are trying to get better. People collecting on life insurance are dead, which is an excellent way of not abusing the system. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [April 2, 2012, 12:31am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/126 "2012-04-02T00:31:09Z")
> [@Fear\_Itself](#): > > Because in the case of car insurance, most states have assigned risk, which forces insurance companies to accept drivers with DUIs, too many accidents or too many tickets on their record. Is that what you want for health insurance? A mandate from the government that insurance companies accept people they don’t want to? Plus being a bad driver, by definition, is reflected in claims and tickets, which gives insurers far more information. The only thing that is similar for health insurance is smoking, which already causes higher premiums. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [April 2, 2012, 8:47am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/127 "2012-04-02T08:47:59Z")
> [@IdahoMauleMan](#): > > Than how come all life insurance and automobile insurance companies haven’t gone bankrupt? The last time I checked, some of them have been in business for over 100 years. Others have answered this, but to expand on their points: the imbalance of information is nowhere near as extreme in those sorts of cases: for car insurance, a sloppy driver will have tickets and accidents. For life insurance, people don’t want to die, and if you have reason to suspect you might, the life insurance company can often figure that out by talking to your doctor and looking at your medical records (and if you get life insurance that is not through your doctor–i.e., where everyone is forced to buy it) they WILL check these things. There is nothing in life or car insurance that has even close to the same impact as a woman knowing how many kids she would like to have. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [April 2, 2012, 11:45am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/128 "2012-04-02T11:45:04Z")
nm ---
**Author:** ![The\_Tao\_s\_Revenge](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@The\_Tao\_s\_Revenge](https://boards.straightdope.com/u/The_Tao_s_Revenge)\ **Post date:** [April 3, 2012, 1:07am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/129 "2012-04-03T01:07:51Z")
> [@drewtwo99](#): > > Scalia had it right. Society should not obligate itself to paying for poor people’s healthcare. Let them die. > > Fuck people who can’t pay for insurance. If they had worked harder they could have earned enough money to pay for it themselves. > > What an outstanding model of conservative belief Antonin Scalia is. Aren’t ‘we’ conservatives just so lucky to have him on our Supreme Court? I sense much regret and sarcasm. At least I hope! I almost feel bad for you all, having a dickhead like that smear your name. Almost. 🙂 ---
**Author:** ![IdahoMauleMan](https://avatars.discourse-cdn.com/v4/letter/i/71c47a/32.png) [@IdahoMauleMan](https://boards.straightdope.com/u/IdahoMauleMan)\ **Post date:** [April 3, 2012, 3:47am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/130 "2012-04-03T03:47:34Z")
> [@MandaJo](#): > > Others have answered this, but to expand on their points: the imbalance of information is nowhere near as extreme in those sorts of cases: for car insurance, a sloppy driver will have tickets and accidents. For life insurance, people don’t want to die, and if you have reason to suspect you might, the life insurance company can often figure that out by talking to your doctor and looking at your medical records (and if you get life insurance that is not through your doctor–i.e., where everyone is forced to buy it) they WILL check these things. > > There is nothing in life or car insurance that has even close to the same impact as a woman knowing how many kids she would like to have. I think you’re making a bigger deal out of this that needs to be, if you let willing parties come together in the free market. For example, there could be insurance policies that become void if a woman has more than a certain number of children that are pre-agreed to, as part of an insurance policy. And even without that, I would wager that there are many, many insurance companies who would be willng to take an acturial bet on a woman’s propensity to have children based on her ethnicity, religion, geographic location, age, etc. and offer her a policy based on those variables. Credit companies and other types of insurers do it all of the time. Why wouldn’t a health insurance company do the same? ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [April 3, 2012, 8:53am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/131 "2012-04-03T08:53:39Z")
I started a separate thread, thinking it best to let conservatives get their signals straight without interference, so we could get clarity. But instead, here we get diversions and no clarity. Some think only the cheapest medical services should be provided to the indigent; some think only expensive procedures need be publicly financed. (No one proposed a focus on medium-cost procedures as a compromise? 🆒 ) OP’s question was   _What should we do about people who can’t pay for medical care?_ but some conservatives seem to have overlooked the question altogether, for example: > [@The\_Other\_Waldo\_Pepper](#): > > The overwhelming majority of people were happy with their insurance before the latest meddling. … I’m falling victim to a different conservative delusion: the one where I figure the market that was already handling it just fine for the overwhelming majority of people can probably handle it just fine for the overwhelming majority of people. What’s your (falsifiable?) definition of “overwhelming” and what percentage of Americans do you think lack insurance? One conservative does deserve credit for both understanding the question and answering honestly: > [@Shodan](#): > > if we want to do something about health care costs before they bankrupt us … we need rationing. And thus accept that we are going to let people die in order to save money. > > Regards, > Shodan ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [April 3, 2012, 9:26am UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/132 "2012-04-03T09:26:28Z")
> [@IdahoMauleMan](#): > > I think you’re making a bigger deal out of this that needs to be, if you let willing parties come together in the free market. > > For example, there could be insurance policies that become void if a woman has more than a certain number of children that are pre-agreed to, as part of an insurance policy. Yes, but an unplanned pregnancy is one of the most common expensive medical emergencies for women. What good is insurance that doesn’t protect me from that? > [@](#): > > And even without that, I would wager that there are many, many insurance companies who would be willng to take an acturial bet on a woman’s propensity to have children based on her ethnicity, religion, geographic location, age, etc. and offer her a policy based on those variables. > > Credit companies and other types of insurers do it all of the time. Why wouldn’t a health insurance company do the same? There are, and they do, and this is why individual policies are tremendously more expensive than group policies–often several times higher–and simply impossible to get if you have any sort of chronic condition or a significant lapse in coverage. Group insurance is cheaper because the mandated coverage spreads the risk pool out further. This is not controversial. Get rid of group coverage and any sort of mandate and the price of insurance skyrockets. ---
**Author:** ![The\_Other\_Waldo\_Pepper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/the_other_waldo_pepper/32/12370_2.png) [@The\_Other\_Waldo\_Pepper](https://boards.straightdope.com/u/The_Other_Waldo_Pepper)\ **Post date:** [April 3, 2012, 1:21pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/133 "2012-04-03T13:21:10Z")
> [@septimus](#): > > > [@](#): > > > > The overwhelming majority of people were happy with their insurance before the latest meddling. … I’m falling victim to a different conservative delusion: the one where I figure the market that was already handling it just fine for the overwhelming majority of people can probably handle it just fine for the overwhelming majority of people. > > What’s your (falsifiable?) definition of “overwhelming” and what percentage of Americans do you think lack insurance? Back when Obamacare was being debated, I remember seeing the former as north of 80%; a quick check on google turns up the USA Today/Gallup poll that said _“the 85% of Americans with health insurance coverage are broadly satisfied with the quality of medical care they receive and with their healthcare costs”_ and went on to spell out that _“The 15% who are uninsured are far less satisfied with the quality of their medical care (50% are satisfied), and only 27% are satisfied with their healthcare costs.”_ ---
**Author:** ![IdahoMauleMan](https://avatars.discourse-cdn.com/v4/letter/i/71c47a/32.png) [@IdahoMauleMan](https://boards.straightdope.com/u/IdahoMauleMan)\ **Post date:** [April 3, 2012, 1:59pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/134 "2012-04-03T13:59:26Z")
> [@MandaJo](#): > > Yes, but an unplanned pregnancy is one of the most common expensive medical emergencies for women. What good is insurance that doesn’t protect me from that? > > There are, and they do, and this is why individual policies are tremendously more expensive than group policies–often several times higher–and simply impossible to get if you have any sort of chronic condition or a significant lapse in coverage. > > Group insurance is cheaper because the mandated coverage spreads the risk pool out further. This is not controversial. Get rid of group coverage and any sort of mandate and the price of insurance skyrockets. I think we are talking past each other. You use words like “Get rid of” as if there is some pressure building, somewhere out there, by somebody to use force to “get rid of” group coverage. I submit no such pressure or force exists, unless arbitrary distortions are created by the government. In fact, if the market were freed up and deregulated I submit such groups would arise naturally, as they do in other insurance and credit risk pools. For example, let’s assume for argument’s sake that you are - A woman - Hispanic non-smoker - Age 22-30 - Educated and employed in a managerial role - Living in California - Have some minor pre-existing conditions: asthma, for example I submit that there is a large, national pool of people like you that can have highly accurate, actuarial predictions of pregnancy and childbirth. A health insurance company can take these variables into account and design a number of different policy options and different menus and provide them to you with a corresponding premium. Perhaps you will choose a policy that covers the cost of childbirth. Perhaps you won’t. There will be differing prices and terms of coverage for each. That is a “group” insurance policy tailored to your needs. It behooves the insurer to create natural groups to tighten the expectation on their statistical models and expectations. It behooves you to join a group of your choosing. That is exactly what happens in other types of insurance and in credit risk pools, for products such as credit cards. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [April 3, 2012, 2:14pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/135 "2012-04-03T14:14:00Z")
Those are voluntary groups. Employer-based group insurance carries a mandate: the insurance company agrees to lower rates because everyone at the company is forced to join the risk pool. Yes, insurance companies could accurately determine risk and adjust rates accordingly, but once they did that, many many people would not be able to afford insurance at all. This is different from other types of insurance because medical care has become too expensive for many individuals. I mean, if you could identify those people with a 1% chance of having a car wreck that costs $1M, do you think they could get insurance anywhere? Do you think someone who rock climbs and skydives on the weekend can get term life insurance? The difference in health insurance is that when people can’t get car or life insurance we expect them to accept it. But we don’t expect people to go off and die if they can’t get health insurance, we expect society to pick up the tab. Mandatory group policies are how we spread the risk now. If you get rid of the “mandatory” part, the rates go through the roof because all the people that are pretty sure they won’t need it don’t get it and the ones who are positive they will need it always sign up. ---
**Author:** ![IdahoMauleMan](https://avatars.discourse-cdn.com/v4/letter/i/71c47a/32.png) [@IdahoMauleMan](https://boards.straightdope.com/u/IdahoMauleMan)\ **Post date:** [April 3, 2012, 3:10pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/136 "2012-04-03T15:10:19Z")
> [@MandaJo](#): > > Those are voluntary groups. Employer-based group insurance carries a mandate: the insurance company agrees to lower rates because everyone at the company is forced to join the risk pool. > > Yes, insurance companies could accurately determine risk and adjust rates accordingly, but once they did that, many many people would not be able to afford insurance at all. This is different from other types of insurance because medical care has become too expensive for many individuals. I mean, if you could identify those people with a 1% chance of having a car wreck that costs $1M, do you think they could get insurance anywhere? Do you think someone who rock climbs and skydives on the weekend can get term life insurance? > > The difference in health insurance is that when people can’t get car or life insurance we expect them to accept it. But we don’t expect people to go off and die if they can’t get health insurance, we expect society to pick up the tab. Mandatory group policies are how we spread the risk now. If you get rid of the “mandatory” part, the rates go through the roof because all the people that are pretty sure they won’t need it don’t get it and the ones who are positive they will need it always sign up. I certainly don’t expect society to pick up the tab for me. Maybe that is the fundamental difference underpinning this whole argument. If I don’t pay my credit card bills, or save enough for college tuition, or don’t plan carefully for my retirement, there are consequences. Bankruptcy. A lower career trajectory and lower standard of living for me and my family. Indolence and starvation. Those are pretty powerful motivators for me to get my act in order. And yes, of course if I am truly destitute and on the street, I would expect society to provide a basic safety net of a warm bowl of soup. Maybe even a cot in a gymnasium somewhere to spend the night. But if I needed that night after night for years on end, I would probably be mentally ill and require institutionalization. You seem to be saying something different. Like, it would be nice if we could figure out a way to get everyone to pay a reasonable price for these wonderful, innovative services that require the best the world has to offer in training, technology and biology…but if we can’t, we’re morally obligated to give them away anyway. Just because. Otherwise, we’re bad people. Am I close? ---
**Author:** ![Larry\_Mudd](https://avatars.discourse-cdn.com/v4/letter/l/f14d63/32.png) [@Larry\_Mudd](https://boards.straightdope.com/u/Larry_Mudd)\ **Post date:** [April 3, 2012, 3:25pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/137 "2012-04-03T15:25:19Z")
> [@Lobohan](#): > > Competing against each other will have them lower costs for the healthy, it won’t have them insuring the sick. Optimistically. Most corporations aren’t in a huge hurry to compete themselves out if significant profits. If the aim is to reduce the cost to the consumer, why not consider an established model that delivers a comparable standard of care for half the per capita cost, and only incidentally covers the whole population? (Like most of the developed world?) ---
**Author:** ![Aji\_de\_Gallina](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aji_de_gallina/32/260_2.png) [@Aji\_de\_Gallina](https://boards.straightdope.com/u/Aji_de_Gallina)\ **Post date:** [April 3, 2012, 5:10pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/138 "2012-04-03T17:10:33Z")
To the OP: Encourage high-deductible health insurance as the national norm. People (tend to) get economically crippled by one or two high-cost events rather than multiple instance of a broken leg or apendicitis. High-deductible (catastrophic insurance) is cheaper and it forces you to shop around for other items (x-ray, root canals, pregnancy) and you can find better prices, because you see the cost upfront. ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [April 3, 2012, 5:20pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/139 "2012-04-03T17:20:21Z")
> [@Larry\_Mudd](#): > > Optimistically. Most corporations aren’t in a huge hurry to compete themselves out if significant profits. > > If the aim is to reduce the cost to the consumer, why not consider an established model that delivers a comparable standard of care for half the per capita cost, and only incidentally covers the whole population? (Like most of the developed world?) I totally agree. I was trying to speak to the insane notion that somehow the free market™ can make it profitable to pay healthcare bills that cost more than someone’s premiums. Every other industrialized country on Earth does it better than us. Cheaper, more coverage and (mostly) better health care results. Anyone who prefers our system is delusional. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [April 3, 2012, 5:49pm UTC](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350/140 "2012-04-03T17:49:24Z")
> [@Aji\_de\_Gallina](#): > > To the OP: Encourage high-deductible health insurance as the national norm. > People (tend to) get economically crippled by one or two high-cost events rather than multiple instance of a broken leg or apendicitis. > High-deductible (catastrophic insurance) is cheaper and it forces you to shop around for other items (x-ray, root canals, pregnancy) and you can find better prices, because you see the cost upfront. Unfortunately, unless you are in your twenties, insurance companies still want to be paid premiums only justified for cadillac coverage. Catastrophic coverage for catastrophic premiums that are rising 10-30% per year. As rates for even the cheapest coverage rise faster than wages, more relatively healthy people will make the calculation that the risk is acceptable, and drop out of the system. This will cause two things; 1) insurance will cover only the older, sicker people, causing rates to spiral upward: fewer healthy people in the sytem results in higher rates, which results in even fewer healthy people buying insurance 2) more people without insurance will show up at emergency rooms with uncovered illnesses and accidents, placing even more burdens on hospitals to raise costs that are passed on to the insured. It is a road that leads nowhere. [Previous page](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350.md?page=6) [Next page](https://boards.straightdope.com/t/conservatives-what-should-we-do-about-people-who-cant-pay-for-medical-care/617350.md?page=8)