To those who oppose mandatory health coverage

[KillerDog]

You're not increasing demand artifically by mandating catastrophic coverage. The demand for catastrophic coverage (which has nothing to do with your examples, by the way) is already fixed, based on catastrophic emergencies. We're just more properly allocating things. In fact, by opening up a competitive private insurance market, which hardly exists now because of its small scale and prohibitive prices, you're expanding supply--driving down prices.

You are increasing the demand for the insurance. You are correct that you are not increasing the amount the insurance company has to lay off as payments. How much they have to pay out is irrelevant though unless you want to set price controls. You have increased the demand for the coverage. Before you had X% of the people buying catastrophic coverage and now you have 100%. You have increased demand by 100%-X%. I don't think there is another way to look at this but I'm willing to listen.

BTW, the law proposed isn't to force insurance carriers to offer catastrophic insurance to everyone. It is a law requiring that everyone own insurance. It is an increase in demand, not supply.

[ERCougar]

I paid my hospital bills. By definition, I'm not a free rider. Please explain how I am.

The point is, I had that choice to make. Explain to me why you believe my choice should be restricted. If I read your comments correctly, your discomfort comes because I "might have" been more seriously hurt and someone would be forced to care for me. Why is that? I assume that a law requires the assistance. IOW, a law was passed that transfered the risk from the party best able to deal with it to another party. You're doing the same thing now if you make health insurance mandatory. That's the problem here. Choice has been curbed and now we want to curb it further because we already curbed it once. That's fine as long as we understand there will be additional curbing required and the outcomes may not be pretty.

The point isn't to cite bravery and your emotion is making you sound like an ass. The point is that they offered to give me pain killers to put the staples in my head and I said "no" because of the cost. If you are to be believed on the level of pain for staples, it is insane that they even offered and I never would have made the correct choice without the experience of not having insurance.

You're a free-rider, regardless of what you paid for hospital bills, because you are enrolled in a sort of insurance policy that requires people to treat you for whatever life- or health-threatening injury you may sustain, regardless of your ability to pay. It's EMTALA and it's what covers the care of your subdural hematoma when you can't (and you wouldn't have been able to).

You call this a misallocation of risk, whatever that means. I call it the sign of a civilized society. I would refuse to work in a system where before I can treat you, comatose with a head injury, I have to contact the proper authorities to either ensure that you have insurance, or that I can use hospital resources to care for you, knowing that they won't be compensated.

Sorry for the staple example--I just found it very funny that you cited it, when I routinely do the same thing to a two yr old child. The reason why they offered it to you is the same reason I do--because it sounds brutal to repair a laceration without anesthetic, when in reality, the injection of the anesthetic hurts worse than the staple. Probably once every other shift, I'll put a staple in arm to show kids that it doesn't hurt. But this is all beside the point.

[ERCougar]

You are increasing the demand for the insurance. You are correct that you are not increasing the amount the insurance company has to lay off as payments. How much they have to pay out is irrelevant though unless you want to set price controls. You have increased the demand for the coverage. Before you had X% of the people buying catastrophic coverage and now you have 100%. You have increased demand by 100%-X%. I don't think there is another way to look at this but I'm willing to listen.

BTW, the law proposed isn't to force insurance carriers to offer catastrophic insurance to everyone. It is a law requiring that everyone own insurance. It is an increase in demand, not supply.

But as soon as a corporation starts making excess profits, new corporations join the mix, expanding the supply and cutting the price (and profit).

And yes, every reform plan out there being talked about that mandates insurance purchase, also forbids exclusions of coverage by the insurance company.

[KillerDog]

You're a free-rider, regardless of what you paid for hospital bills, because you are enrolled in a sort of insurance policy that requires people to treat you for whatever life- or health-threatening injury you may sustain, regardless of your ability to pay. It's EMTALA and it's what covers the care of your subdural hematoma when you can't (and you wouldn't have been able to).

You call this a misallocation of risk, whatever that means. I call it the sign of a civilized society. I would refuse to work in a system where before I can treat you, comatose with a head injury, I have to contact the proper authorities to either ensure that you have insurance, or that I can use hospital resources to care for you, knowing that they won't be compensated.

You aren't a free rider unless you get something for free. There may be a free rider problem but I was not a free rider unless I got the subterranean homofoba.

I gather from your post that something called EMTALA requires treatment of all people regardless of ability to pay. Is EMTALA a law or a voluntary program?

The above question aside, you state that you voluntarily would treat a person without the ability to pay because it is a mark of a civilized society. That is laudable largesse. Unfortunately, you don't mean it. You want someone else to help you bear the cost of your noble feelings in the form of mandatory insurance. Basically, you want to have your cake and eat it too. You nobly pronounce your deep seeded belief that health care is a right but deride those who don't want to pay for it and attempt to compel them to do so through governmental interference. It sounds to me like the only reason you dislike the free riders is because they don't pay you and you, like everyone else, want to get paid.

[KillerDog]

But as soon as a corporation starts making excess profits, new corporations join the mix, expanding the supply and cutting the price (and profit).

And yes, every reform plan out there being talked about that mandates insurance purchase, also forbids exclusions of coverage by the insurance company.

That may happen eventually but the barriers to entry into the insurance field are astronomical. Further, it is irrelevant for purposes of the analysis. As more enter the field, the profits will decrease but the new stasis will be based on the increase in demand that was artificially created and, as shown by the auto insurance industry, will be higher in cost. This isn't necessarily a reason not to make insurance mandatory but it is a cost that people are ignoring. You can't decrease the cost of health care by raising it.

[ERCougar]

You aren't a free rider unless you get something for free. There may be a free rider problem but I was not a free rider unless I got the subterranean homofoba.

I gather from your post that something called EMTALA requires treatment of all people regardless of ability to pay. Is EMTALA a law or a voluntary program?

The above question aside, you state that you voluntarily would treat a person without the ability to pay because it is a mark of a civilized society. That is laudable largesse. Unfortunately, you don't mean it. You want someone else to help you bear the cost of your noble feelings in the form of mandatory insurance. Basically, you want to have your cake and eat it too. You nobly pronounce your deep seeded belief that health care is a right but deride those who don't want to pay for it and attempt to compel them to do so through governmental interference. It sounds to me like the only reason you dislike the free riders is because they don't pay you and you, like everyone else, want to get paid.

Wrong again. This has nothing to do with me. With my contract, I couldn't care less if the patients I'm treating have insurance. I'm paid by the hour and not the patient's bill. I guess in some weird indirect way, I could renegotiate a higher wage if the hospital were making more money off of me, but this is indirect and not timely.

Where this really comes into play is the neurosurgeon who is required by law (yes, EMTALA's a requirement for any hospital that accepts Medicare) to get up in the middle of the night, take you to the OR, and drill a burr hole in your head to drain the blood that's compressing your brain, all out of the goodness of his heart. Oh, and by the way, thanks to the ABA, you could turn around and sue him if everything doesn't go just right. You could also sue the hospital, which financed the CT scanner that discovered the epidural, all of the nurses who cared for you, the medications they administered, and the OR staff (and anesthesiologist) who also had to get up in the middle of the night to care for you. MRD, care to step in and detail the costs of EMTALA-related care?

And yes, the very peace that comes from a civilized society that won't let you die on the street as a result of EMTALA is a "good" that you're receiving but not paying for. If Robin withdrew a portion of his taxes proportionate to the amount that would be spent on defense spending, I would call him a free-rider too, even if we weren't in the middle of a war.

[ERCougar]

That may happen eventually but the barriers to entry into the insurance field are astronomical. Further, it is irrelevant for purposes of the analysis. As more enter the field, the profits will decrease but the new stasis will be based on the increase in demand that was artificially created and, as shown by the auto insurance industry, will be higher in cost. This isn't necessarily a reason not to make insurance mandatory but it is a cost that people are ignoring. You can't decrease the cost of health care by raising it.

You're mixing up terms here. The demand for catastrophic care doesn't have a whit to do with whether people are paying for catastrophic coverage. WE'RE ALREADY PAYING FOR THIS CATASTROPHIC CARE. It's just the wrong people who are paying for it. This "stasis" doesn't change at all. We're reallocating the costs from the responsible people in society to those who are out buying snowmobiles, boats, and motorcycles instead.

[UtahDan]

We agree on most political things, but not on this one. I don't want you to have the choice not to buy it in case you hit me.

I have no problem with forcing people to do somethings in order to particiapte in the society as a whole.

Folks do have choices. You don't have to buy the car insurance. You just won't get to drive a car. The same choice should be given to people on health insurance, they don't buy it and you could, they you don't get treated.

That is the perfect analogy and is a good argument for requiring insurance. If you don't have insurance and go in for life saving procedures, it is just as if you have hit me while driving. I will end up paying for it, so you shouldn't have that choice.

[UtahDan]

You nobly pronounce your deep seeded belief that health care is a right but deride those who don't want to pay for it and attempt to compel them to do so through governmental interference.

That sounds dirty. I think you mean "deep-seated."

[KillerDog]

This is my last post because I don't think this is profitable.

The fact that there is a law which requires hospitals to treat all comers is something that has created a negative externality which we are now trying to accomodate. It put the burden of health care coverage on the doctors and hospitals and essentially made them an insurer. If, as a society, we don't think that was a mistake, we then have to decide whether hospitals are the appropriate party to bear the costs. Personally I believe they are but then again, I don't like the idea of a law requiring care. Hospitals for the indigent have existed for a long time. Pro bono publico medical care has also existed for a long time. Forcing unwilling people to treat others is a relatively recent creation and is a mistake. If society disagrees with me, that is fine but they then have to bear the costs of that decision as well and that cost may be government forced health care and the increased costs associated. I understand your arguments relative to the increased costs but I don't agree with them. I think your analysis of the S-D curve is incorrect. I think auto insurance supports my analysis.

I don't agree with your explanation of how I was a free rider. You refer to "peace" as the good that I got for free. Someone who avoids paying for military or police protection may be a peace-based free rider but unless there is a penumbra of protection, I don't see how a free rider can exist when he/she is paying for the good they use.

The bottom line for me is that I don't think our medical care problems were created out of whole cloth 10 years ago. I think they have been created over time by a number of decisions where people did not pay sufficient attention to the changes their decisions would make. That was stupid. Failing to do so again not only makes us stupid, it makes us unteachable. I think mandatory health insurance is not an appropriate function of government and creates serious external consequences that are not being dealt with.

[KillerDog]

That sounds dirty. I think you mean "deep-seated."

Seems I used a misbegotten metaphor and a malapropism. You and Bryan Garner have corrected me.

[UtahDan]

Seems I used a misbegotten metaphor and a malapropism. You and Bryan Garner have corrected me.

Now I know you are trying to be dirty!

[CardiacCoug]

This is my last post because I don't think this is profitable.

The fact that there is a law which requires hospitals to treat all comers is something that has created a negative externality which we are now trying to accomodate. It put the burden of health care coverage on the doctors and hospitals and essentially made them an insurer. If, as a society, we don't think that was a mistake, we then have to decide whether hospitals are the appropriate party to bear the costs. Personally I believe they are but then again, I don't like the idea of a law requiring care. Hospitals for the indigent have existed for a long time. Pro bono publico medical care has also existed for a long time. Forcing unwilling people to treat others is a relatively recent creation and is a mistake. If society disagrees with me, that is fine but they then have to bear the costs of that decision as well and that cost may be government forced health care and the increased costs associated. I understand your arguments relative to the increased costs but I don't agree with them. I think your analysis of the S-D curve is incorrect. I think auto insurance supports my analysis.

I don't agree with your explanation of how I was a free rider. You refer to "peace" as the good that I got for free. Someone who avoids paying for military or police protection may be a peace-based free rider but unless there is a penumbra of protection, I don't see how a free rider can exist when he/she is paying for the good they use.

The bottom line for me is that I don't think our medical care problems were created out of whole cloth 10 years ago. I think they have been created over time by a number of decisions where people did not pay sufficient attention to the changes their decisions would make. That was stupid. Failing to do so again not only makes us stupid, it makes us unteachable. I think mandatory health insurance is not an appropriate function of government and creates serious external consequences that are not being dealt with.

It's clearly immoral to turn away people with life-threatening medical conditions that have relatively simple, straightforward, and permanent (though expensive) solutions.

Do you really want to live in a society in which we would just let a 40-year old father and breadwinner for his wife and young children die of a completely treatable condition because he didn't choose to purchase health insurance?

Thankfully, we will never live in that type of society. We will always help people with life-threatening conditions who are brought to medical attention. So we need a system that will properly spread the costs of treating these patients to all citizens who will receive the benefit of this emergency treatment.

[SloanHater]

...Your prevention and usage problems can easily be solved with mandatory insurance coverage depending on deductible setup, premiums, and copays.

It absolutely addresses the coverage mandate in two ways. First, it allows the government to require that insurance companies not deny people coverage based on pre-existing conditions. Second, it brings down the price of insurance plans because everyone (and not just those likely to use it) purchases insurance.

I agree that mandated coverage would be a step in the right direction. However, I think you would still see the same people who currently lack insurance filling up the ER with basic coverage. If these people are allowed to receive the same treatment/services, I don't think you see a substantial drop in premium prices.

EMTALA should be (needs to be) retooled to allow refusal of service to know ER abusers (ie the boy who cries wolf for a demerol shot) or garnishment of wages to repay services. Preventative practices should also be a requirement for anyone receiving 'free healthcare.'

I do find it amazing that 22 States believe the status quo is better than the more equitable mandate option.

[woot]

This is my last post because I don't think this is profitable.

The fact that there is a law which requires hospitals to treat all comers is something that has created a negative externality which we are now trying to accomodate. It put the burden of health care coverage on the doctors and hospitals and essentially made them an insurer. If, as a society, we don't think that was a mistake, we then have to decide whether hospitals are the appropriate party to bear the costs. Personally I believe they are but then again, I don't like the idea of a law requiring care. Hospitals for the indigent have existed for a long time. Pro bono publico medical care has also existed for a long time. Forcing unwilling people to treat others is a relatively recent creation and is a mistake. If society disagrees with me, that is fine but they then have to bear the costs of that decision as well and that cost may be government forced health care and the increased costs associated. I understand your arguments relative to the increased costs but I don't agree with them. I think your analysis of the S-D curve is incorrect. I think auto insurance supports my analysis.

I don't agree with your explanation of how I was a free rider. You refer to "peace" as the good that I got for free. Someone who avoids paying for military or police protection may be a peace-based free rider but unless there is a penumbra of protection, I don't see how a free rider can exist when he/she is paying for the good they use.

The bottom line for me is that I don't think our medical care problems were created out of whole cloth 10 years ago. I think they have been created over time by a number of decisions where people did not pay sufficient attention to the changes their decisions would make. That was stupid. Failing to do so again not only makes us stupid, it makes us unteachable. I think mandatory health insurance is not an appropriate function of government and creates serious external consequences that are not being dealt with.

Do any other advocates against mandating health care want to step in here? I don't think this sort of immoral tripe is what you want representing your position.