What should we do about the health care mandate? (Poll the first)

Specifically, what should we do about the uninsured. The individual mandate, coupled with taxes (fines) and credits to help those that can’t afford it is one solution to the problem. I am curious about what those who are against the mandate think we should do instead, thus this poll.

So imagine we have a 27 year old healthy high school graduate who is living hand to mouth working as a waiter and slowly putting himself through nursing school. He decides that he is healthy enough that he does not purchase insurance and takes care of any medical needs he has using cash. Well and good, until he gets and appendicitis and goes to the hospital. The cost of the appendectomy and the complications is going to run $50,000 (instead of the usual $15,000 because it ruptured), money that our otherwise healthy nursing school student does not have. He also does not have this kind of credit approved for him. How should we as a society handle these types of cases?

Note, he could just have been a she and the appendicitis could have easily been an aggressive form of breast cancer needing a mastectomy and chemotherapy for a total cost of $300,000. Does this change the calculus?

Poll to follow.

Sorry about all the stupid typos, getting the poll options under 100 characters was a pain!

I was really torn with this. Of the options, pre-ACA we were using options 3 an 4 with option 6 for those older than 65 (at least this is my understanding). I do think that the mandate is an improvement over 3 and 4, but I would prefer having rationed universal healthcare with supplemental insurance available in the commercial market.

I am going to post a poll momentarily on this topic…

Finally, the person who chose gambled and lost, damn… I would love to discuss this option with you because I am curious about the stance. Any chance you will identify yourself and defend the stance?

There should not be any need to gamble with one’s health for financial reasons. It should not even be possible. Anyone who does so is not acting rationally wrt the financial wellbeing of society as a whole. UHC for all, and to all a good night.

I’ve always thought that single-payer universal health care, ala Canada, was the most sensible way to go about these things. Failing that, I believe we should keep the mandate, ala Germany. Letting uninsured people die in the street? I’m against that. I’m also against letting young, ostensibly healthy people “gamble” on this when they know full well that if they lose, society will step in and pick up the tab eventually.

I’ve lived under 3 health care systems in my life:

  1. American Military Style - the US military, where you show up, show ID, get treated. It rocks.
  2. American Insured - show up, bicker with the people at the doctors, bicker with your insurance, get hosed by your insurance. It sucks
  3. Canadian Socialist Style - Show up, show ID, get treated. It rocks.

Note that military and socialist are exactly the same. This is what the US should do.

The Canadian system needs some work. Would you like to wait 14 months for a colonoscopy ? I did, hoping the whole time something evil wasn’t festering inside of me.

We need a mixture of both private and public, I believe Sweden has the best system out there.

Details? What does Sweden do?

I think rationed universal care with supplementary insurance or care for those that can afford it would work the best. For rationing, making decisions on the basis of outlook and patient health would be best. No 27 year old should die from an appendicitis and no 90 year old should get a government paid for organ transplant.

Have any conservative chimed in yet? Well, at least one has, but any that want to talk about the best way to address this for society?

It wasn’t me, but…

It’s indefensible under either Obamacare or the pre-Obamacare system. It’s only defensible under the premise of having an actually market-based system.

The short answer is that you need to avoid moral hazards to have a functioning market, and that ER rooms as they exist are the ultimate moral hazard. Your student made an entirely rational decision in not purchasing insurance if he knows that the ER will take care of him.

Of course it’s true that the cost of losing the student is tremendous–millions of dollars by most metrics. But the cost of treating him is not $50k; it is $50k plus the value of the market itself (since you would lose it), which is worth far more.

It is not like humans cannot learn to make life-or-death decisions. Humans would not fear walking too close to cliff faces if we thought that nature would throw up a net if we fell. With a proper market-based health-care system, we would need to feel the same visceral fear at not having coverage.

All that said, it’s simply never going to happen. The vast majority of the public just isn’t going to let an uninsured woman die outside the ER due to a hard pregnancy, for instance. So we can’t avoid the moral hazard, and therefore can’t have a functioning market, which is why we have the clusterfuck we have today, and why we need something resembling UHC to correct it.

My apologies I meant Switzerland

We ought to have single-payer, but somehow too many people in the country insist on giving for-profit corporations too much money and too much power.

I’m unclear whether your scenario assumes Obamacare or not. Either way its probably worthwhile to understand how Obamacare would/will solve the problem…

He pays his tax and gets care from somebody right?

Darn. I guess I didn’t understand. I was assuming that Obamacare was in place, and that he had elected to pay the penalty instead of getting insurance. That’s why I chose #2.

If you were purchasing your health insurance as one large group, (what universal healthcare really is, not subsidized by the government), rates for full coverage would drop so low, (because the risk, for people like our unfortunate student, would now be spread over an enormous country wide group), you could easily afford to cover the insurance premiums for university students. Problem solved. (Note: you’re not paying for his health care, your funding his insurance premiums, so he’s covered!)

(Didn’t vote in the poll, couldn’t make any of the options fit!)

There was a period in my early 30s when I was unemployed and failed to pay my British Columbia medical insurance premium for 8 months. Then I had to go to the hospital and got the bill in the mail. I was given the option to pay up my premiums which I did and since then I’ve always paid my monthly health insurance premiums regularly. I felt like I dodged a bullet.
To me it is good citizenship to help support our government insurance system even in times when we think we don’t need it.