For as long as health care reform has been in the news in its current incarnation, I've been silently opposed to it on principle, certain that somewhere in the thousands of pages of legislation would be at least one provision that I regarded as incompatible with common sense and basic morality, and a non-starter.
Actually, I was aware of one such provision from the beginning: the individual mandate. This says that every person must purchase health insurance or pay a fine. Obama claimed to oppose the individual mandate during his campaign; after all, you can't solve the problem of homelessness by requiring everyone to buy a house. It's too bad he changed his mind.
But the individual mandate is a gimme. It is obviously nonsense despite the fact that it almost certainly will be a provision of anything that is signed into law. I knew I must dig deeper and find something more substantive, more offensive, more asinine to serve as my reason for opposing health care reform. It took me about 15 minutes of reading.
As background, be aware that the House of Representatives and the Senate have each passed a health care reform bill. The differences between the bills must be resolved by a joint House-Senate committee, and the full House and Senate must then vote on the committee resolution. This is the sticking point because the Senate Democrats may not have enough votes for passage now that Ted Kennedy has been replaced by Scott Brown.
The offensive and asinine thing that I found in both the House bill and the Senate bill, which I have never seen mentioned in anything I have read or heard about this debate, is this: health insurance companies will be prohibited from considering your medical history when determining your premium rate. This means that the guy who exercises and eats vegetables, and is healthy because of it, will pay not one cent less than the guy who watches television and eats potato chips, and is sick because of it (all other factors being equal).
This is how Congress proposes to make health care "affordable": by outlawing the common-sense idea that those who exhibit a tendency to get sick should pay more for health insurance. Of course, it will make health insurance more affordable--for sick people. It will also make it less affordable for healthy people. So health insurance for sick people will not be subsidized by the government or taxpayer at large, or the insurance companies, or future taxpayers paying down the national debt. It will be subsidized by healthy people. This is a tax on being healthy and a subsidy on being sick.
In the Senate bill, I also found this gem: variance in insurance premiums on the basis of age and tobacco use will still be allowed, but limited to ratios of 3 to 1 and 1.5 to 1, respectively. This means that a 100-year-old cannot pay more than 3 times as much as an 18-year-old, and a smoker cannot pay more than 1.5 times as much as a nonsmoker. Instead of teams of statisticians with advanced degrees determining how much premiums should vary for such people, a handful of Congressmen have predetermined those numbers. These are taxes on being young and tobacco-free and subsidies on being old and smoking.
We don't make people who build houses on hills pay the same thing for flood insurance as those who build houses on the beach. We don't make 30-year-olds pay the same thing for life insurance as 80-year-olds. Such policies would defy common sense, as do the proposals I've described, which may yet become law.
Wednesday, March 10, 2010
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14 comments:
I have to disagree with you. Yes, people can choose to be smokers and be obese and not exercise and all that, but so much of health has nothing to do with personal choices. For example, a friend of mine found out that she had ovarian cysts during a period of time in which she had no health insurance, and since then hasn't been able to find anybody who will insure her for anything close to a price she can afford. For people who were born with medical issues--people with dwarfism or Down's syndrome for example-- often have huge struggles when it comes to obtaining health insurance, and many can't get insurance at all. What about the abundance of stories about people who have cancer who can never again get health care coverage?
With regards to preventable health issues caused by things like obesity and smoking, how would you propose to determine if their health issues are truly preventable? I'm not trying to cut any slack for the people who lead deliberately unhealthy lifestyles, but whether a person is sick and unhealthy due to something that was their fault or not would be impossible to judge without some kind of terrifying Big Brother-esque system. When can my health insurance premium go up-- when I develop an obesity-related disease, or when my weight reaches a level that the notoriously inaccurate BMI scale classifies as "obese"? What if I develop a generally obesity-related disease, like heart disease, but am not obese? What if I am technically obese, but do not suffer from any health problems? You see how something like that would be impossible to qualify.
I do agree that arbitrary ratios for the variance in premiums made up by politicians is ridiculous. But wanting affordable health care in case I develop cancer is not the same as wanting affordable flood insurance in case I build a house on the beach. In one case, I am in trouble because of my own error in judgment; in the other case, I am in trouble because of something entirely beyond my control.
...Basically, the point of health insurance is to help you afford the costs if you should happen to become sick or injured. As it stands now, healthy people can afford insurance, but sick people, or even people who were once seriously ill but who have since recovered, cannot, which defeats the purpose of the whole system. Of course, the situation shouldn't be reversed or anything-- but arbitrarily charging more for people who are supposedly predisposed for illness is one of the ways that our health care system became so messed up in the first place.
Great Comments, Ryan. I am very surprised to hear that you didn't know this. One of the first things mentioned about the bill was how the government gets to decide things for you. Just like Credit Card Reform- Who cares if people with 50+ years of experience and mountains of empirical data on millions of users have to say about the default rate of people who have a history of defaulting on cars and houses, raising interest rates on them are "Fat Cat bankers being greedy".
Politicians are using make believe numbers to impose caps on insurance rates just to get re-elected. Damn what the actuaries have to say about who should pay more. Lets let someone with 40 years of work experience (and presumably the ability to pay with years of savings) pay only 3 times what a healthy 18 year (with an entry level job and no savings) pays for insurance.
Let us not forget about little ol' Massachusetts "obamacare" going on right now. People there pay a small fine for not having insurance and go without it because its cheaper, but as soon as they get cancer or sick they buy insurance and because you can't take into account their present health, they just pay the rate- YOU HAVE BEEN PAYING FOR YEARS!
Keep absolute control of our lives out of the government's hand. They only do things to get elected.
Thanks for the change Obama!!!
"And I will confront another form of bias: the soft bigotry of low expectations." -George H. W. Bush
Emily, as to your first post, I'd like to clarify that in regards to opposing the limitation of rate variances, I do not draw a distinction between unhealthy choices one may make and unhealthy genes one may be born with. I oppose having to pay a tax on being healthy to subsidize the sickness of others, no matter the cause. Subsidizing unhealthy choices is more obviously stupid than subsidizing unhealthy genes, hence my use of the potato-chip-eater as an example.
If we were to attempt to draw a legal distinction between sickness due to choices and sickness due to genes, first we'd have all manner of court cases by people challenging the authorities' verdicts on their unhealthy choices, then we would have Big Brother watching our every move like you said. While no one is proposing such a distinction, I think it's entirely possible that one will be adopted someday and we will have exactly that Big Brother reality. Sound crazy? Look at the drug war. The government has determined that the public costs of some people putting certain plants and chemicals in their own bodies are too great to bear; therefore, the substances themselves are outlawed. To enforce this, the government must search and scan as many bodies, bags, vehicles, houses, lands, bank records, and library records as it possibly can. All in the name of preventing people from burdening the system with their bad choices. A hundred years ago, people would have thought it impossible for any government to operate such a program. A hundred years from now, people might think it obviously necessary for the government to conduct a "war on candy".
As to the second post, I disagree with your use of the word "arbitrary". Insurance companies use your actual medical history as a predictor of your future medical costs. No one's arguing that the science behind that is bad. And when the companies use that history, and statistics, to determine what to charge you for coverage, surely that is not arbitrary.
Ryan Conley said:
"I oppose having to pay a tax on being healthy to subsidize the sickness of others, no matter the cause".
Why is that? Survival of the fittest? Also, the word "subsidy" implies that this policy actually encourages people to get sick, as in we "subsidize" home ownership or college loans. Is that what you're saying?
Finally, it's not a "tax" if the money is going to private companies. It's corporatism.
Or perhaps it's "capitalism"
Survival of the fittest has done wonders so far, hasn't it? I'm fairly confident that everything we do to stop it will have little effect in the long run, thank goodness. Capitalism is a nice idea. I hope some government tries it out sometime.
No, the reason I oppose the tax is the same reason I oppose all taxes that cannot be avoided: I oppose violence. All government laws are eventually enforced by someone carrying a gun. That is violence. I can morally accept that use of violence when government is protecting someone from force or fraud inflicted on them by another person. I cannot accept it in enforcing a redistribution of wealth from the healthy to the sick. This is far and away the most important issue to me in terms of the role of government.
"The word 'subsidy' implies that this policy actually encourages people to get sick." Well, doesn't it? Are not millions of people in this country sickly because of their own choices, and will they not directly benefit from this legislation for no reason other than that they are sicker than the median? Making the right decisions in your diet and exercise are not easy. They take money and effort. But at least currently we have the reward of lower health care costs.
As I said, I think it is only logical for the government to eventually pursue a policy of restricting or outlawing foods that they (or, more accurately, the agribusiness lobbyists) determine to be a money drain on the system, and the result will be worse than the drug war. Of course, this is already happening, as in NYC banning trans fats in restaurants. I wonder how many kitchens have been raided by men carrying guns.
So I see this as a measure backed by violence to punish the healthy and reward the sick, which may result in a dramatic expansion of government surveillance and intrusion.
"Finally, it's not a "tax" if the money is going to private companies. It's corporatism."
It's the redistribution of wealth from the healthy to the sick, administered by corporations, and enforced by government gun-carriers. I call it a tax.
Finally, I believe that it is my role in life to help provide for people who are less fortunate than me. I give away money all the time and I hope I'm someday able to give away a lot of food. If I were a true believer in "survival of the fittest" I might not do that. But I recognize that so many people are poor and sick in part because of the actions of governments and corporations, and that isn't natural either. So I try to counteract some of that damage to help give everyone a fair chance. But I see no reason to assume that that is a role for everyone in the world to take on. I personally believe in living and working, in part, for the benefit of other people. But other people do not believe in that. And I have to make peace with that, because I am not okay with the only other alternative, which is violence.
Any and all regulations could be called a "tax" or a "subsidy" according to those criteria. A law that companies can't dump toxic waste wherever they want? A "tax" that subsidizes waste disposal companies.
I think once again our argument has boiled down to your assumption that "all other things are equal", and they're usually not. Poor people get sick more often, they can't afford to eat right, they may not even have the education so that they know what is healthy. It's hard to reconcile opposition to a policy that will help sick people with your assertion that it is your purpose to help the less fortunate. And yes, evolution has worked wonders, like the evolution of empathy in humans.
Also, every other industrialized country in the world has a healthcare system run by government gunmen, and they're doing great.
Let's get back to the core argument, your side of which I can only assume goes something like this: Because I am healthier than the median, partly due to luck and partly due to my good choices, it is fair and just for my health care to be made less affordable so that others' can be made more affordable, and the reason is that SOME of the bad health of SOME of those people is due to unfortunate circumstances beyond their control. Have I got that about right?
I guess my main criticism of your argument in the comments section here is that you are drawing a distinction between "sick people" and "well people." But that's not true-- everyone gets sick sometimes, and most people are sick some of the time and well some of the time. There are some chronically ill people out there, but outside of the very elderly, they aren't the majority.
The point of insurance is to spend a money when you're well and capable of working, so that you can afford your bills when you're sick and not able to work. The whole point of the system is so that "the well" financially take care of "the sick"-- be that your current well self taking care of your future sick self, or you taking care of your sick neighbor/fellow health care customer, who will, when they are well, take care of you.
Also, based upon this imaginary Sick People vs. Well People dichotomy, you are classifying yourself as a "well" person. All throughout this argument, you are implying that, as a well person, you are superior to sick people and do not deserve the punishment of financially caring for them. To that, I say you should knock on some wood, my friend, because, as you admit in an earlier comment, lots of what makes you healthy is just luck, and you never know when your luck might run out and you'll suddenly be one of the sick folks.
Also, I think it's sort of short-sighted to think that the people who are sick due to unhealthy lifestyles are fine with being sickly and will continue to be sickly thanks to a cut in health care costs. Nobody really wants to be sickly, even people who make themselves that way because of their failure to take care of themselves. No obese person is going to say, "Well, I did have a heart attack from all the McDonalds I eat, and that really sucked--but since that hospital stay was so cheap for me, I'm not going to bother trying to get healthier now" --any more than an obese person would currently say, "Jeez, that heart attack was cripplingly expensive, I think I'll start eating healthy immediately!"
You may have inferred that I feel superior to sick people, but I most certainly did not imply it. My health is superior to that of sick people by definition. That does not make me a better person.
My distinction between healthy and sick people is not even relevant. Health insurance companies are making distinctions between these groups by charging them different rates based on their answers to extensive interviews on their medical history. How can you call this distinction imaginary? And how can you say that a cripplingly expensive heart attack is not likely to make someone rethink their diet??
Yeah that's pretty much how I see it, although I think the distinction here shouldn't be healthy/sick but rather rich/poor. But healthy/sick can serve as an imperfect stand-in in a lot of cases.
It's just like the redistribution of wealth, which I assume you would also oppose. But that assumes that people earned that wealth and deserve it, just we would be assuming that you earned your good health and deserve that. Conversely, poor people earned their bad health and deserve it. If you don't believe the above, then you have to be open to considering a mechanism to address that inequality.
Also, the mechanism for this redistribution should the government, rather than a profit-motivated corporation.
By the way, by no means am I satisfied by the current health care legislation. But, I doubt I will be satisfied until we have a universal single payer system and we all start speaking French.
Clearly, some part of everyone's health and wealth is earned and deserved, and some part is not earned and not deserved. I am part of a mechanism that is already in effect and doing wonders to help people.
Here, I have illustrated the difference between my mechanism and yours:
http://img237.imagevenue.com/img.php?image=48734_mechanisms_122_228lo.jpg
With my mechanism, no one has to justify to me the expense or the need or whether it is deserved. I do it of my own free will and can stop any time I want.
Clearly, we both want people to be taken care of. It's just that your way involves force, violence, bureaucracy, politics, resistance, cheaters, enforcement, corruption, and waste. Also, it may never happen anyway.
I would listen to this NPR story: http://www.npr.org/templates/story/story.php?storyId=124170302&ft=1&f=1001
I do think that it is unfair that you should have your health insurance premiums increase when you have not had any health issues. However, the reason both parties agree that insurance companies shouldn't be able to look at a person's health history is, I think, much more based on the fact that stories like the ones mentioned in that NPR story are becoming more common, not less. Of course, that doesn't mean that everyone should pay exactly the same, and I certainly don't think that the way to solve the problem is to go to the exact opposite extreme. However, the system as it is is ridiculously corrupt, and it is just insane that people die in this country not because they never had health insurance and can't afford it, but because the health insurance bureaucrats are trying to make more money through these extremely cruel practices. Both parties agree that that's a big issue, and though I haven't read the text of the bills so I can't argue accurately, most of what I've heard about this topic is that this kind of thing is what they're attempting to stop-- not trying to "tax the healthy".
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