# UHC Ethical Dilemma: Where do you draw the line? **URL:** \ **Category:** Great Debates\ **Created:** [December 29, 2009, 5:48pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930 "2009-12-29T17:48:03Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [December 29, 2009, 9:44pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/41 "2009-12-29T21:44:15Z")
> [@otternell](#): > > You make good points, but I am still torn about the idea of people abusing their health because healthcare is free. Why should I quit smoking if I won’t have to pay any cost for it? (which is only speaking of $ cost and I fully acknowledge that there is an emotional/physical cost as well, which they (and their loved ones will pay.) I’m with the ones who consider the notion of the opportunistic self-abuser a red herring. This critter is like the welfare queen; probably entirely non-existent, but even if they do exist, they’re likely rare enough that they can’t skew the numbers perceptibly. ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [December 29, 2009, 10:07pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/42 "2009-12-29T22:07:14Z")
> [@kaylasdad99](#): > > I’m with the ones who consider the notion of the opportunistic self-abuser a red herring. This critter is like the welfare queen; probably entirely non-existent, but even if they do exist, they’re likely rare enough that they can’t skew the numbers perceptibly. The opportunistic self-abuser may well be red herring, but under UHC, I would be forced to share the insurance pool with other, less extreme, idiots. As I have talked about before, I have taken hands-on control of my medical spending - HSA, catastrophic coverage, credit account for back-up, etc. Many, many people are completely unwilling to have any involvement in their own medical health or care, from the chronic alcoholic to the workaholic to the people who think they’re invincible to the mommy who drags their kid in for every sniffle. Under UHC, I am forced to subsidize all of those behaviors, because of the supposed social contract. I will most likely lose money, time and coverage because of it. This will be a huge sacrifice for my middle-class household. Why are those on the other side exempt from an ethical obligation, while I have to live up to mine? It is entirely possible that my daughter will have to wait to get her glasses in 2014, because I can’t afford them, and UHC doesn’t cover them. But that premie will get state of the art care, and more than likely die within a year. In this scenerio, I can’t help but feel that my money is being wasted, and my kid still doesn’t get glasses\* \*A prior thread about my UHC/HSA concerns is [here](http://boards.straightdope.com/sdmb/showthread.php?t=539393) for anyone who is interested… ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [December 29, 2009, 10:09pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/43 "2009-12-29T22:09:53Z")
> [@Rumor\_Watkins](#): > > Private insurance through an employer doesn’t hold them responsible for their choices, either. Other employees and the company are footing the bill for that one, or is that okay? > > Who have you ever heard of who makes bad choices (of the type that they are knowingly committing these knowingly bad choices) consistently with no regard for others who is either > > a) not incarcerated > b) not in a mental hospital > c) so on the fringes of society that they wouldn’t have the capacity to figure out how to go ahead and procure government-provided health services, and then actually follow through with a healthcare practitioner > > This is the same bogeyman in the welfare queen story. Mythical people who “abuse” the system. Are you kidding? I have several of them in my own family - for example: 1. My drunk dad 2. My drunk/druggie uncle 3. My cousin who’s in an abusive relationship 4. My brother-in-law who is a pill addict and hasn’t worked for years All of these people are knowingly making bad decisions that effect their health, with no regard for others. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 29, 2009, 10:15pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/44 "2009-12-29T22:15:22Z")
> [@otternell](#): > > You make good points, but I am still torn about the idea of people abusing their health because healthcare is free. Why should I quit smoking if I won’t have to pay any cost for it? (which is only speaking of $ cost and I fully acknowledge that there is an emotional/physical cost as well, which they (and their loved ones will pay.) > > Can we draw any line at all that makes sense, that holds people accountable for their choices? There might be a way, but I’m not sure how. Again, the problem is that there are tons of healthy and unhealthy behaviors, but usually only the ones that are socially and politically unpopular will be taxed and penalized. Besides, good oral hygiene might be as big of a risk factor for health as obesity. The reasoning is that poor oral hygiene leads to a buildup of inflammation and bacteria in the mouth which leaks into the cardiovascular system and puts a person at higher risk of heart attack, stroke, dementia, diabetes, etc. [http://www.perio.org/consumer/mbc.heart.htm](http://www.perio.org/consumer/mbc.heart.htm) But I doubt there will be a tax on people who go to dental checkups and have gingivitis or periodontal disease. The problem with incentives or taxes is that they are put through a social and political filter. Anyone who wants to tax people with oral hygiene problems will be laughed at while a tax on obesity or smoking will probably pass. A tax on working too much or not having enough close friends (both of which are bad for health) will probably be rejected out of hand. Incentivizing good behavior and penalizing bad behavior isn’t wrong per se. But how do you do it w/o it becoming a tool of social control designed to punish unpopular behavior under the guise of health? ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [December 29, 2009, 10:19pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/45 "2009-12-29T22:19:19Z")
If someone is a chronic fuckup, you’re already paying for their health care, because when one of these chronic fuckups show up at the emergency room, they get treated regardless of their ability to pay. So you already pay for the undeserving poor. We pay as much for government health care here in the USA as they do in Britain, only in America that same amount of money only pay for a few people to get goverment health care, whereas in the UK they manage to treat everyone. You pay the same amount as they do in the UK, but you don’t get health insurance for yourself, you have to buy that, or find an employer who will include it in your compensation package. Not that UHC is my ideal solution, but the health non-system here in the United States offers the worst of both worlds–socialist prices and efficiency, and capitalist inequality. ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [December 29, 2009, 10:28pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/46 "2009-12-29T22:28:39Z")
> [@Lemur866](#): > > If someone is a chronic fuckup, you’re already paying for their health care, because when one of these chronic fuckups show up at the emergency room, they get treated regardless of their ability to pay. > > So you already pay for the undeserving poor. We pay as much for government health care here in the USA as they do in Britain, only in America that same amount of money only pay for a few people to get goverment health care, whereas in the UK they manage to treat everyone. You pay the same amount as they do in the UK, but you don’t get health insurance for yourself, you have to buy that, or find an employer who will include it in your compensation package. > > Not that UHC is my ideal solution, but the health non-system here in the United States offers the worst of both worlds–socialist prices and efficiency, and capitalist inequality. No snark - but do you have any actual numbers as to what added cost these people cause? I see this all the time, and it makes sense, but I’d like to do some math to compare costs. ---
**Author:** ![Diogenes\_the\_Cynic](https://avatars.discourse-cdn.com/v4/letter/d/e99b99/32.png) [@Diogenes\_the\_Cynic](https://boards.straightdope.com/u/Diogenes_the_Cynic)\ **Post date:** [December 29, 2009, 10:36pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/47 "2009-12-29T22:36:12Z")
It would certainly cost less if the profit margin was removed. ---
**Author:** ![flickster](https://avatars.discourse-cdn.com/v4/letter/f/7bcc69/32.png) [@flickster](https://boards.straightdope.com/u/flickster)\ **Post date:** [December 29, 2009, 10:46pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/48 "2009-12-29T22:46:15Z")
> [@Diogenes\_the\_Cynic](#): > > It would certainly cost less if the profit margin was removed. After all, I’m sure none of those institutions or operations need to fund improvement projects of any type ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [December 29, 2009, 10:48pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/49 "2009-12-29T22:48:34Z")
> [@Lemur866](#): > > If someone is a chronic fuckup, you’re already paying for their health care, because when one of these chronic fuckups show up at the emergency room, they get treated regardless of their ability to pay. > > So you already pay for the undeserving poor. We pay as much for government health care here in the USA as they do in Britain, only in America that same amount of money only pay for a few people to get goverment health care, whereas in the UK they manage to treat everyone. You pay the same amount as they do in the UK, but you don’t get health insurance for yourself, you have to buy that, or find an employer who will include it in your compensation package. > > Not that UHC is my ideal solution, but the health non-system here in the United States offers the worst of both worlds–socialist prices and efficiency, and capitalist inequality. Once you have the principles of UHC in place, you think differently. Perhaps the first point is it will never be acceptable to the electorate to ever revert back - you’ll never sell it and the party not in power would never advocate it. So, in one form or another, it’s a permanent shift. With that in mind the focus shifts to how to make the system more efficient, what can be done to reduce the burden on services, to do more with what you have, etc. And that takes you into areas like why is this person a fuck up, how can we prevent this cost in the future - obviously people are fuck ups for reasons. So now you have motivations - economic advantages - to work out why this is such a cost and would it be cheaper for example, to deal with this in a preventive way. A market mechanism, if you will, that plays into government efficiency. ---
**Author:** ![flickster](https://avatars.discourse-cdn.com/v4/letter/f/7bcc69/32.png) [@flickster](https://boards.straightdope.com/u/flickster)\ **Post date:** [December 29, 2009, 10:59pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/50 "2009-12-29T22:59:55Z")
> [@PrettyVacant](#): > > Once you have the principles of UHC in place, you think differently. Perhaps the first point is it will never be acceptable to the electorate to ever revert back - you’ll never sell it and the party not in power would never advocate it. So, in one form or another, it’s a permanent shift. > > With that in mind the focus shifts to how to make the system more efficient, what can be done to reduce the burden on services, to do more with what you have, etc. > > And that takes you into areas like why is this person a fuck up, how can we prevent this cost in the future - obviously people are fuck ups for reasons. > > So now you have motivations - economic advantages - to work out why this is such a cost and would it be cheaper for example, to deal with this in a preventive way. A market mechanism, if you will, that plays into government efficiency. After all, the citizens of countries currently operating on socialized healthcare all have outstanding health habits. None of them smoke, drink to excess, or have problems with obesity and the UK doesn’t have any dental issues. ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [December 29, 2009, 11:15pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/51 "2009-12-29T23:15:47Z")
> [@PrettyVacant](#): > > Once you have the principles of UHC in place, you think differently. Perhaps the first point is it will never be acceptable to the electorate to ever revert back - you’ll never sell it and the party not in power would never advocate it. So, in one form or another, it’s a permanent shift. > > With that in mind the focus shifts to how to make the system more efficient, what can be done to reduce the burden on services, to do more with what you have, etc. > > And that takes you into areas like why is this person a fuck up, how can we prevent this cost in the future - obviously people are fuck ups for reasons. > > So now you have motivations - economic advantages - to work out why this is such a cost and would it be cheaper for example, to deal with this in a preventive way. A market mechanism, if you will, that plays into government efficiency. I think this is a fair analogy… In the climate change debate, there has been much ado about how to control pollutants, and identifying and targeting the biggest polluters, under the rationale that the biggest polluters should be subject to penalties. Factories and refineries are obvious targets, but the SUV became a popular whipping boy. There is motivation to prevent pollution, so lots of people tried to control it with incentives - positive ones for buying “green”, like a tax break for hybrids, and negative ones, like a per-mile tax for gas guzzlers. Something like this could easily happen with UHC. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [December 29, 2009, 11:23pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/52 "2009-12-29T23:23:24Z")
… ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [December 29, 2009, 11:29pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/53 "2009-12-29T23:29:45Z")
> [@flickster](#): > > After all, the citizens of countries currently operating on socialized healthcare all have outstanding health habits. None of them smoke, drink to excess, or have problems with obesity and the UK doesn’t have any dental issues. Oh “socialized”! How’s that propaganda working out for you? I’ve never experienced UHC dental work, you’ll have to tell me more about that? What I described is a mechanism, one of many that not immediately apparent if you’re unfamiliar with the general principle. There are many reasons why countries with UHC spend, on average, 9.5% of GDP on healthcare to get a better outcome than the US does on 17%. I know it baffles some on here - I’m pointing out it’s a very different mindset. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 29, 2009, 11:39pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/54 "2009-12-29T23:39:21Z")
> [@Sateryn76](#): > > No snark - but do you have any actual numbers as to what added cost these people cause? I see this all the time, and it makes sense, but I’d like to do some math to compare costs. The uninsured cost the average family about $1100 in extra health insurance costs, the average individual policy holder pays about $480 extra. [![](https://www.americanprogressaction.org/wp-content/uploads/sites/3/2015/02/the-Great-Cost-Shift-cover.jpg) ](https://www.americanprogressaction.org/wp-content/uploads/sites/3/2015/02/the-Great-Cost-Shift-cover.jpg) So roughly 10% of the health care costs via insurance go to covering the uninsured. ---
**Author:** ![flickster](https://avatars.discourse-cdn.com/v4/letter/f/7bcc69/32.png) [@flickster](https://boards.straightdope.com/u/flickster)\ **Post date:** [December 30, 2009, 12:28am UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/55 "2009-12-30T00:28:05Z")
> [@PrettyVacant](#): > > Oh “socialized”! How’s that propaganda working out for you? About as well as the utopia you outlined once we we will all be living under UHC and how society will be able to control everyone’s health related habits ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 30, 2009, 12:37am UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/56 "2009-12-30T00:37:19Z")
Dentistry, now that you mention it, is actually a very good example as to why this “ethical dilemma” isn’t a dilemma at all. OHIP (Ontario Medicare) doesn’t cover dentistry. NHS in England does. Wow, imagine that - two different sets of universal health care policies were crafted to without the population running around self-immolating because of the quandaries involved with choosing what the government will and will not pay for. Edit: what winds up happening is that the gray area stuff that governments may or may not pay for winds up getting covered by extremely profitable yet very affordable supplemental health insurance. it’s not rocket science. ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [December 30, 2009, 12:49am UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/57 "2009-12-30T00:49:56Z")
> [@Rumor\_Watkins](#): > > Dentistry, now that you mention it, is actually a very good example as to why this “ethical dilemma” isn’t a dilemma at all. > > OHIP (Ontario Medicare) doesn’t cover dentistry. NHS in England does. Wow, imagine that - two different sets of universal health care policies were crafted to without the population running around self-immolating because of the quandaries involved with choosing what the government will and will not pay for. > Edit: what winds up happening is that the gray area stuff that governments may or may not pay for winds up getting covered by extremely profitable yet very affordable supplemental health insurance. it’s not rocket science. So, how about taking UHC out of the equation, and going for a catastrophic plan that covers every American - say, a policy that kicks in when you have more than $50,000 a year in medical expenses? Then, insurance companies would only have to offer “gap” plans that would cover up to the $50,000. All sorts of plans could be offered, and people would be taken care of in the event of medical disaster. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 30, 2009, 12:59am UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/58 "2009-12-30T00:59:21Z")
> [@Sateryn76](#): > > So, how about taking UHC out of the equation, and going for a catastrophic plan that covers every American - say, a policy that kicks in when you have more than $50,000 a year in medical expenses? > > Then, insurance companies would only have to offer “gap” plans that would cover up to the $50,000. All sorts of plans could be offered, and people would be taken care of in the event of medical disaster. Ignoring the fact that that’s a form of UHC, I’m not against the concept of something like that. Obviously, studies and details need to be fleshed out. The only problem with an indemnity-only type of plan is that there are no (even probably less than there are now) downward pressures on medical costs from that side of the equation. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 30, 2009, 1:05am UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/59 "2009-12-30T01:05:21Z")
Also, not that i doubt you, but what do you see as the effective benefits to this from a citizens standpoint and also from the standpoint of government cost? I mean I can’t really see much difference here than full-blown single payer, but that’s me. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 30, 2009, 2:45am UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/60 "2009-12-30T02:45:17Z")
> [@Sateryn76](#): > > So, how about taking UHC out of the equation, and going for a catastrophic plan that covers every American - say, a policy that kicks in when you have more than $50,000 a year in medical expenses? > > Then, insurance companies would only have to offer “gap” plans that would cover up to the $50,000. All sorts of plans could be offered, and people would be taken care of in the event of medical disaster. As a side note, that is similar to the plan John Kerry proposed in 2004. He wanted to take all annual health expenditures per person that were over $50,000 and pay 75-100% of them via public funds. That way private insurance only had to pay the first $1-50,000 a year in coverage (after deductibles and copays) and the public sector would pay most/all of the $50,000+. He claimed it would reduce insurance premiums by $1000. So even if a plan like that did happen, a family premium would go down by $1,000, but only from $12,000 to $11,000. [Previous page](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930.md?page=2) [Next page](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930.md?page=4)