# If Not For Medicare, How Would Seniors Get Health Care? **URL:** \ **Category:** Great Debates\ **Created:** [February 3, 2010, 3:46pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529 "2010-02-03T15:46:04Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![BrightNShiny](https://avatars.discourse-cdn.com/v4/letter/b/7bcc69/32.png) [@BrightNShiny](https://boards.straightdope.com/u/BrightNShiny)\ **Post date:** [February 4, 2010, 8:59pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/81 "2010-02-04T20:59:07Z")
> [@Bricker](#): > > True or false: > > “Regardless of the financial and lifestyle choices a person has made in his life, it is the obligation of society to prove him with necessary medical care.” I’ve asked you a question, I don’t see why you can’t answer it. If you think the answer to the above is false, then that has logical real world implications. But I’ll go ahead and answer this question: 1. I think people should be allowed to get out of medical debts by declaring bankruptcy. 2. I think if someone shows up at the ER in critical condition, the ER should be required to treat them. Based on those two, my answer to your question would have to be “true,” and what we’re left to argue about is (a) to what extent should society have to provide medical care and (b) what is the most cost effective way to provide it. Now, that doesn’t mean that I think society has to provide all medical care imaginable, it simply means that I’ve accepted that there is a base level of medical care which society is going to have to provide, and we are collectively going have to determine what that base level is and how to cost-effectively provide it. So, what’s your answer, **Bricker** , and what are the real-world implications of that answer? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [February 4, 2010, 9:05pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/82 "2010-02-04T21:05:06Z")
> [@Bricker](#): > > Because everyone DOESN’T pay into it. If you can’t pay, you still get covered. Which means that those that can pay are covering those that can’t. I’m happy to pay for my kid, and my wife, who can’t pay. But I don’t see why I should pay for you. You pay for you. I’ll pay for me. We’re not part of the same family. By agreeing to such a system, if for some reason you suddenly can no longer pay then I (and everyone else) have already agreed, in advance, to pay for you as part of the deal. In return, if we suddenly can’t pay, we’re still covered, too. That’s what makes it insurance as well as coverage. Perhaps there can be some additional incentive to encourage people to contribute as long and as much as possible. It would be interesting to work out such details hypothetically (not so much fun in real life). Perhaps those who are employed or otherwise able to kick in a little more than the minimum can get richer benefits, or a private room, or a fancier prosthesis if they suffer an amputation, or a free wig if they have cancer… or perhaps if you need hernia surgery you get to go ahead of the retiree or the the crazy person, neither of whom are paying into the system at the time they need the surgery. Just enough to provide that extra incentive without denying life-saving care to those who need it. Everyone still gets the hernia surgery they need, just that the one shouldering more of the burden at present gets to go first. As it stands now, someone born too disabled to ever work can draw benefits from your taxes and your social security payments _for life_… why should that person receive more protection and care than you? Why shouldn’t you have the same cradle-to-grave assurance of care? As an added benefit, if you should happen to be killed before your time (some dreadful accident, perhaps) you wife and children will _never_ have to worry about their healthcare. They will be just as covered and cared for as when you were alive. ---
**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:** [February 4, 2010, 9:05pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/83 "2010-02-04T21:05:12Z")
> [@Sage\_Rat](#): > > I would say that you’re the one who’s unclear about the concept of insurance. In what world does an insurance company pay out as much as you have paid in? Why would you think that I’m suggesting such a thing? > > Insurance leverages the amount of money that everyone has paid into a plan against the needs of everyone in that plan. You sign up for a better plan, you get more covered. But that amount isn’t equal to how much you have paid, it’s equal to how much everyone has paid in, up to the level at which the plan guarantees coverage. 😕 So, you agree that anyone in particular can get more than they paid in. The insurance company sets rates so that they do make a profit, of course. Most of them also have reserves to cover disasters such as hurricanes. Any health plan, with or without government involvement, is going to set rates to make a profit. The whole point of UHC is that this can be done more accurately with bigger risk pools. If the variance of claims is smaller, so can fees, because whatever sigma they use to make sure they profit will be smaller. You said > [@](#): > > 1. The amount that insurance pays should be based on your age and the total amount that you have payed in to-date. I.e. the amount you paid while you were still employed continues to affect the level of care you receive after you retire. > 2. You can switch insurers periodically (once a year, for example) and all money that you have payed in to health insurance should automatically transfer over with you to the new company. > 3. If you have never paid any money in, there is some minimum percentage of any doctor’s bill which the insurer will still have to cover. This percentage will be increased or decreased by the government as need be until a value is found at which enough people pay monthly insurance bills sufficient to cover the cost of care of those who have never paid anything. Premiums are annual. Why would a new company care about, or get, what you paid in last year? It sounds like you are describing a healthcare reimbursement account (or whatever they call it) where you own the money you pay in, not insurance. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [February 4, 2010, 9:07pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/84 "2010-02-04T21:07:43Z")
> [@emacknight](#): > > So no interest in answer any of my questions? > > True or false: > > If Medicare wasn’t going to exist when you retired, your current retirement plan would not change. False, but not by much. ---
**Author:** ![dropzone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dropzone/32/7515_2.png) [@dropzone](https://boards.straightdope.com/u/dropzone)\ **Post date:** [February 4, 2010, 9:14pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/85 "2010-02-04T21:14:31Z")
> [@emacknight](#): > > True or false: > > If Medicare wasn’t going to exist when you retired, your current retirement plan would not change. True, but that’s because I never expect to be able to retire. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [February 4, 2010, 9:14pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/86 "2010-02-04T21:14:35Z")
> [@emacknight](#): > > If Medicare wasn’t going to exist when you retired, your current retirement plan would not change. I’ve already based my retirement plans on Medicare not existing. I’m not counting on it and I advise my friends to do the same. I think it will always be there but in “in name” only. There are so many ways for politicians to fiddle with the system (raise eligibility age, raise copays, reduce roster of doctors, etc) to render it useless. Politicians don’t have to vote it out of existence – that would political suicide. However, they can tinker with various details and water it down thereby giving the illusion that Medicare is still there. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [February 4, 2010, 9:16pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/87 "2010-02-04T21:16:28Z")
> [@Bricker](#): > > True or false: > > “Regardless of the financial and lifestyle choices a person has made in his life, it is the obligation of society to prove him with necessary medical care.” That is a setup. It should say, regardless of what befalls him in life, should he still have saved enough to pay his own way. There are some people who invested with Madoff and other ponzi thieves and got wiped out, losing huge fortunes. [http://www.bankrate.com/brm/news/investing/20020829a.asp](http://www.bankrate.com/brm/news/investing/20020829a.asp) Here are more scams. I know a guy whose wife had cancer . His insurance covered a million dollars of heath care. it was not enough. He went broke caring for her. ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [February 4, 2010, 10:08pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/88 "2010-02-04T22:08:53Z")
> [@Ruminator](#): > > I’ve already based my retirement plans on Medicare not existing. I’m not counting on it and I advise my friends to do the same. I think it will always be there but in “in name” only. There are so many ways for politicians to fiddle with the system (raise eligibility age, raise copays, reduce roster of doctors, etc) to render it useless. Politicians don’t have to vote it out of existence – that would political suicide. However, they can tinker with various details and water it down thereby giving the illusion that Medicare is still there. > [@Bricker](#): > > False, but not by much. Do you expect to be able to get private health insurance after you retire? What will you do if you are ineligible? As a matter of curiosity, how much do you expect your health care costs to be when you’re 85? ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [February 4, 2010, 10:23pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/89 "2010-02-04T22:23:19Z")
> [@emacknight](#): > > Do you expect to be able to get private health insurance after you retire? What will you do if you are ineligible? Do I expect to an insurance company to take my premiums and expect to pay out less in costs than what I paid in? Nope. Insurance companies are dumb but they can’t be that dumb. > [@](#): > > As a matter of curiosity, how much do you expect your health care costs to be when you’re 85? I’m thinking the medical costs can be quite expensive. Backbreaking expensive. However, I’m not counting on the government (Medicare) to cover it either. I give blue-collar workers a hard time about relying on benefits won by unions when the gravy was flowing but not planning for a situation where all that gets swept away by global capitalism. It would be silly to _not_ follow my own advice and depend on a Medicare program which is already insolvent now wouldn’t it? ---
**Author:** ![Kimstu](https://avatars.discourse-cdn.com/v4/letter/k/ecd19e/32.png) [@Kimstu](https://boards.straightdope.com/u/Kimstu)\ **Post date:** [February 4, 2010, 10:26pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/90 "2010-02-04T22:26:17Z")
> [@Bricker](#): > > True or false: > > “Regardless of the financial and lifestyle choices a person has made in his life, it is the obligation of society to prove him with necessary medical care.” I think you must mean “provide” rather than “prove”, and if so, I’d say the obvious answer is “True, for some definition of ‘necessary’.” Clearly, no society can make an open-ended promise to all of its members that it will always be able to provide them with any imaginable type or level of medical care that they need. But many wealthy societies manage quite successfully to provide all their members with a quite decent level of medical care. Personally, I think the optimal system is one like New Zealand’s UHC with optional additional private insurance for those who want and can afford it. > [@Bricker](#): > > But I don’t see why I should pay for you. You pay for you. I’ll pay for me. On the level of fairness between two individuals, this reasoning is fine. On the level of considering the impact of catastrophic health care costs on an entire population, it’s stupid. Risk pools exist for precisely the purpose of mitigating the effect of the health-crisis roulette wheel. You pay premiums into a common fund, and I’ll pay premiums into a common fund, and so will lots of other people, and then when either of us needs care, the common fund pays for it. Much more stable and efficient than having some of us bankrupted and/or dead just because our number happened to come up on the health-crisis roulette wheel. And clearly, you understand this, because you currently pay premiums for health insurance coverage that operates on precisely this principle. So it evidently isn’t pooled risk and pooled resources _per se_ that you object to. It’s just that you don’t want to share your risk/resource pool with anybody who’s significantly sicker or poorer than you. ---
**Author:** ![The\_Tooth](https://avatars.discourse-cdn.com/v4/letter/t/c67d28/32.png) [@The\_Tooth](https://boards.straightdope.com/u/The_Tooth)\ **Post date:** [February 4, 2010, 11:03pm UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/91 "2010-02-04T23:03:12Z")
> [@Bricker](#): > > No reason. You don’t. And yet your argument is entirely based on everyone else respecting your one-way isolationism so you obviously think we should cater to your wishes. For no reason. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [February 5, 2010, 12:59am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/92 "2010-02-05T00:59:29Z")
> [@emacknight](#): > > Do you expect to be able to get private health insurance after you retire? What will you do if you are ineligible? I expect my employer will continue to permit me to participate in their group plan, as they are required to do by my contract. > [@](#): > > As a matter of curiosity, how much do you expect your health care costs to be when you’re 85? In 2010 dollars, I expect they’ll be about double what they are now. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [February 5, 2010, 1:01am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/93 "2010-02-05T01:01:16Z")
> [@The\_Tooth](#): > > And yet your argument is entirely based on everyone else respecting your one-way isolationism so you obviously think we should cater to your wishes. For no reason. Not at all. It’s you who seek a change to the status quo. It’s up to you to persuade me, or, if not me, enough other people who have similar misgivings to mine. I’m happy to have you not listen to me, and leave everything alone. But as the proponent of change, you bear the burden of persuasion. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [February 5, 2010, 1:04am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/94 "2010-02-05T01:04:16Z")
> [@Starving\_Artist](#): > > As far as what conservatives would do without these programs, they would likely do what they did before: invest and save and pay their own way when they retire. Many would continue to work right up until the end. These programs didn’t come about because conservatives needed them, they came about because people who weren’t conservatives needed them. For an exceptionally narrow value of “conservative.” ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [February 5, 2010, 1:04am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/95 "2010-02-05T01:04:53Z")
> [@Kimstu](#): > > On the level of fairness between two individuals, this reasoning is fine. On the level of considering the impact of catastrophic health care costs on an entire population, it’s stupid. Risk pools exist for precisely the purpose of mitigating the effect of the health-crisis roulette wheel. You pay premiums into a common fund, and I’ll pay premiums into a common fund, and so will lots of other people, and then when either of us needs care, the common fund pays for it. Much more stable and efficient than having some of us bankrupted and/or dead just because our number happened to come up on the health-crisis roulette wheel. Yes. On a voluntary basis, that sounds like a fine approach. > [@](#): > > And clearly, you understand this, because you currently pay premiums for health insurance coverage that operates on precisely this principle. So it evidently isn’t pooled risk and pooled resources _per se_ that you object to. It’s just that you don’t want to share your risk/resource pool with anybody who’s significantly sicker or poorer than you. Yes, because I’m “sharing” the risk but not the resources. The ones that can’t pay, but still drain the pool, are what I object to. Which is why I ask the philosophical question about society’s obligation above. You haven’t sold the majority of Americans on the proposition that health care is a societal obligation just yet, you cannot steal it via court rulings (yet) and so you are stymied. ---
**Author:** ![Rand\_Rover](https://avatars.discourse-cdn.com/v4/letter/r/db5fbb/32.png) [@Rand\_Rover](https://boards.straightdope.com/u/Rand_Rover)\ **Post date:** [February 5, 2010, 1:08am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/96 "2010-02-05T01:08:19Z")
Kimstu, a risk pool run by the government that everyone must participate in is a very different thing than a risk pool run by a for-profit company that its members choose to participate in. And a government that forces everyone to participate in one risk pool is very different from one that doesn’t. I prefer the latter in both cases. ---
**Author:** ![Kimstu](https://avatars.discourse-cdn.com/v4/letter/k/ecd19e/32.png) [@Kimstu](https://boards.straightdope.com/u/Kimstu)\ **Post date:** [February 5, 2010, 1:13am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/97 "2010-02-05T01:13:19Z")
> [@Bricker](#): > > Which is why I ask the philosophical question about society’s obligation above. You haven’t sold the majority of Americans on the proposition that health care is a societal obligation just yet We’re getting there, though. As noted by many posters in this thread, Medicare has extremely broad and deep support, and CHIP (Children’s Health Insurance Program) is expanding in support and coverage (it doesn’t hurt that children are usually pretty cheap to care for so you get a lot of coverage bang for the buck). So that’s most of the over-65 and under-18 population already. And the inefficiency of the current high-overhead patchwork system for the rest of the population is becoming more and more widely recognized. It may take a few more years but the overall trend seems clear: the US is eventually going to join the civilized world on the healthcare issue. ---
**Author:** ![Blalron](https://avatars.discourse-cdn.com/v4/letter/b/35a633/32.png) [@Blalron](https://boards.straightdope.com/u/Blalron)\ **Post date:** [February 5, 2010, 1:13am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/98 "2010-02-05T01:13:30Z")
> [@Bricker](#): > > Well, yes. But I accept it. My problem is that I’m forced to subsidize a program that I won’t ever benefit from. But there are many such programs. They’re water under the bridge. I seek now to prevent the addition of yet another program to that list. I’d rather be responsible for my own and my family’s fate, and let you be responsible for you and your family. You want us all to act as though we’re one big family. **No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.** -John Donne ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [February 5, 2010, 1:15am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/99 "2010-02-05T01:15:22Z")
> [@BrightNShiny](#): > > The government defines stabilized, and we’ve had this requirement long enough that there’s a pretty good definition of it. Yes, some emergency rooms will illegally kick people out who can’t afford to pay before stabilization, but that’s not my question. > > Right now, we have a rule which says the emergency room has to offer treatment regardless of ability to pay. Having that rule will by necessity require other people to pay for the treatment, since the ER will never be able to collect payment from some people. If you are opposed to other people paying for your treatment, then logically, you should be opposed to this rule. > > If you get medical care and then declare bankruptcy before paying, then you have gotten other people to pay for your medical care. Declaring bankruptcy doesn’t make the cost of the treatment go away–it shifts the cost of the treatment to other people. > > ETA: Yes, you’re last post makes it clear that some people who need treatment are being turned away. My question is whether you think ER’s should be allowed to do this, or should ER’s be required to treat critical people regardless of ability to pay. Why ERs. There are cheaper and better ways of dealing with the poor. There are clinics in cities that charge according to ability to pay. There should be a lot more of them. Except our health care system is driven by profit. You have a strange idea of declaring bankruptcy. It actually involves lawyers and court. It is not just granted because you want out of paying bills. ---
**Author:** ![Kimstu](https://avatars.discourse-cdn.com/v4/letter/k/ecd19e/32.png) [@Kimstu](https://boards.straightdope.com/u/Kimstu)\ **Post date:** [February 5, 2010, 1:21am UTC](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529/100 "2010-02-05T01:21:22Z")
> [@Rand Rover](#): > > Kimstu, a risk pool run by the government that everyone must participate in is a very different thing than a risk pool run by a for-profit company that its members choose to participate in. True: the latter is much better at making money (especially since it can increase its profits by cherry-picking its members and excluding applicants who seem likely to require expensive health care). The former, however, is much better at efficiently providing health care access to **all** its citizens. And that, I think, ought to be the primary goal of a nation’s health care policy. As I noted in my comment about New Zealand’s two-tier system above, I have no problem with private companies selling health insurance for profit to provide more lavish coverage to those who can afford it, but we clearly can’t rely on them to provide adequate health care to **all** our citizens. The incentives for the for-profit companies to deny coverage to the innately unprofitable part of the population, namely the poor and the sick, are just too big an obstacle to universal coverage. [Previous page](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529.md?page=4) [Next page](https://boards.straightdope.com/t/if-not-for-medicare-how-would-seniors-get-health-care/527529.md?page=6)