It’s the kid you decided you need.
You don’t think that insurance should cover the cost of childbirth?
If that’s the plan you choose, sure. It should not be required coverage, because only a certain subset of individuals has any chance of that befalling them at all. You insure against the possible, not the impossible.
That’s why it’s not insurance. It’s really a giant social program. Money is being taken from one group of people to give it to another.
Another way to look at it is that money is being taken from us to give to us. A nation is a collective, and all of it belongs to us, the purple mountains, the waves of grain, ours.
And if they are not our people, well…who’s people are they?
Not as a routine procedure, no, I don’t. I think if it was really insurance it would cover unexpected procedures during a childbirth (if you elected that rider), childbirth (or abortion or adoption) as a result of rape or incest, complications resulting from an accident (not resulting from illegal acts on the part of the covered), etc…
I think if you want to have a kid and want someone else to pay for it, you should sign up for a birth plan. You could even get the all you can eat plan.
That’s a defensible position, but it’s not what ACA has been sold as, nor are the arguments supporting the individual mandate matching up to the reality of the program. It’s not insurance, it’s a social program to serve progressive ends.
If people get to pick and choose what health problems they are insured against, the concept of insurance as it exists today won’t work at all.
And when those people uninsured against, say, cancer, come down with cancer, guess who’s going to pay? Right. Society. Because we don’t want to let people with cancer just die, because that’s bloody inhumane. Even if they were stupid.
You’re right that people can’t pick and choose what they will be insured against IF it’s something that can actually happen to them. One does not insure against the impossible. Florida homeowners do not have earthquake insurance and Kentucky homeowners do not have hurricane insurance.
You *really *don’t understand how this works, do you?
People pay in. The premiums go into a pot of money. The pot of money is invested to make some interest. As people get sick, that money gets used to pay for treatment. The money in the pot isn’t allocated for cancer, heart disease, broken bones. It’s just in the pot.
If a chunk of change is gone from the pot (say, because men can’t get pregnant), that many fewer people cannot get treatment.
Now, if you admit that in your world, it’s all about you, that’s fine; we know where to file you. But if you think “insurance” will work if all the adahers pull out because they can’t get pregnant…
If this were to pass, though, I’m not paying school taxes. The hell with the little buggers.
School taxes are up front and were never sold as anything other than what they were. Whenever politicians first levied school taxes, they said, “This is for schools.” and voters could rationally decide whether to support that or not.
But ACA is not insurance. It’s true that group markets have coverage of things that many of the members will never encounter. However, the individual insurance market has always allowed consumers the flexibility to choose a plan that’s best for their individual situation. That’s why it’s called the “individual market”. The ACA takes the individual market and turns it into a group market, forcing healthy people to subsidize the sick. This is obviously necessary to health care reform, but when this tradeoff was pointed out to ACA supporters, like with everything else, they went into full denial mode.
This has real world consequences because a person who is 50 may decide they want more coverage for things like cancer and diabetes. They may want access to the best doctors rather than a limited pool. That choice has been taken from them in many cases. Now their cancer treatments cost them more money, they lost access to their doctors, but hey, at least if they get pregnant they are covered, right?
Earthquake insurance is usually a separate rider, even in places that are seismically active. (Florida is not, although it has had a few minor quakes through the years, and parts of the state have been rumbled by quakes in South Carolina, Cuba, and elsewhere.)
Meanwhile, Kentucky homeowners better have coverage that includes hurricanes, because hurricanes do indeed hit the bluegrass state. (Hurricane Ike in 2008, e.g., caused a state of emergency to be declared in Louisville, and 600,000 Kentucky residents lost electric power as the remnants of the storm blew through, taking down trees and power lines.) In non-coastal regions, though, “hurricane” coverage is usually just part of the wind and rain coverage rather than a separate peril.
In other words, your analogy is flawed.
The point still stands: with every other type of insurance, you insure against the possible only. Not what’s possible for someone else. You also don’t use insurance to cover light bulb changes. Likewise, health insurance does not have to cover routine expenses. A lot of people had such plans, plans that only protected them from financial ruin. That was a perfectly valid way to insure against health expenses, but since it did not serve the purpose of ACA, those plans were rendered unacceptable for the purposes of the mandate.
Women who are 50 may indeed get pregnant (I think the record for natural conception is 59, and IVF can push that into the mid 60s). More than one woman has discovered that her “menopause” symptoms were going to resolve in nine months. Pregnancy later in life is often high-risk, with a much-increased chance of maternal or fetal complications.
What would you say to a woman of 50 who has foregone maternity coverage in favor of coverage for things like cancer and diabetes, and who now discovers “oops”? If very expensive care for a complicated pregnancy is neither covered by insurance nor within her budget, do you make it a law that she has to have an abortion, or are you okay with her sticking the rest of us with the bill?
Now extend that to other people who misjudged their risks and made their choices badly.
[ol]
[li]insurance != taxes[/li][li]People select riders on insurance all the time. Sump pump coverage, collision, replacement value, the list goes on.[/li][/ol]
For the most part, a birth is either planned or you couldn’t defer gratification and it’s unplanned. In either case, why should I subsidize it? If you want a physical every year, why should I subsidize it? If you opt for a colonoscopy, why should I subsidize it?
If you can’t afford these things and want them, use welfare or join a price club. Don’t bury the costs in what should be a private transaction between me and my insurer.
You’re talking about a kind of coverage that I don’t think existed in the real world. Do you know anyone who actually could choose a plan that had better cancer coverage, for example? I’ve always had at best a few plan choices from my employer. Usually my choice has been take the one and only company plan or don’t take the plan.
Or a plan where one can choose “better” doctors, as opposed to being stuck with whichever doctors were in network?
And IME as a the customer I could not tell in advance which doctors or medications were covered by a plan before I signed up. Often not even after I signed up. My former boss, who was also the plan administrator, was unable to find out whether her meds would be covered, even after multiple blood-pressure raising calls to the insurance companies. Incorrect claims rejections are also common. IME correct claims processing is rare enough to be notable.
Your argument here appears to be based on a theoretical idea of choice that did not really exist. The additional coverage from PPACA does exist. Can you provide any supporting examples?
So I should be compelled to subsidize some woman in her 50s or 60s who decided the time is now right? Or the unfortunate couple who can’t seem to have a child.
In my experience, the only error that I’ve ever encountered was during my gall bladder removal. The insurance company discovered it during an audit several years after the procedure and I received a check for the error.
And I think that ‘kind of coverage’ did exist in the real world.
I don’t see doubling my exposure to health care costs (as I documented earlier) as a benefit.
No, but you don’t have a lot of options about the woman in her 50s who thought she was post-menopausal and stopped using birth control and now “oops”–an unplanned, very high-risk, and quite possibly very expensive pregnancy/delivery is on the way. Either you help subsidize comprehensive insurance for her or you help pick up the pieces when she can’t pay the bill. Either way, you get to help, voluntarily or otherwise.
Similarly, what do you think happens (or should happen) to the people who didn’t think they were at risk of X disease or Y condition and so didn’t have coverage for it, if they really do end up with said problem?
After the unfortunates you’ve described above have expended whatever resources they have, they do what everyone else does who doesn’t have the wherewithal.
But you’re just describing people who don’t have the appropriate insurance coverage. If we as a society want to get involved - that’s fine. It becomes a program or set of programs we can monitor, evaluate, adjust (of which we have many). We know what we’re spending on it. Probably help to make medical debt to public medical providers nondischargeable (private providers can fend for themselves as creditors in the bankruptcy courts).
As a side note, there are less than 200 women who give birth in their 50’s (and quite likely less than 1,000 who get pregnant). The number of those pregnancies that aren’t a result of medical intervention is likely quite low. It’s silly to drive the process using this set of circumstances and I don’t think anyone thinks we should finance women in their 50’s who decide they need a child and search out medical solutions.
Yes, they’d stick everybody else with the bill. That’s the point: we as a society are going to have to pay one way or another. Maybe we subsidize insurance for them; maybe we eat the losses when they declare bankruptcy, or we pay more for our insurance to cover the uncollectible bills. It’s all still money out of everyone else’s pockets.
We do want to get involved, and the program we’ve chosen is comprehensive insurance coverage for all conditions, likely and unlikely, for everyone.
How would that help? If somebody can’t pay, they can’t pay. Neither public nor private medical providers can get blood from a turnip, or a multi-hundred-thousand-dollar payment out of somebody with a low income and few assets. A nondischargeable but uncollectible debt still gets paid out of somebody’s pocket, mostly yours and mine.
Pregnancy past 50 is a stand-in for all of the medical issues people don’t expect to face, may not think they even can face, that can lead to expensive bills. (And anyway, your stats are outdated: the CDC’s National Vital Statistics System shows 571 births to women aged 50-54 in 2010 alone.)
If you want to pick a different condition, fine. No matter what disease or illness or incident you pick, there’s going to be somebody who is perceived as low-risk who ends up with it, and if people only have insurance to cover the “likely” conditions, then somebody else (you + me) ends up covering the tab for these.