If I was running for President in 2008, I would campaign that every U.S. citizen gets health insurance coverage through either their employer or through the government. Every single person has access to health coverage.
Unless you smoke. Then you don’t get health insurance. If you use illegal drugs, you don’t get health insurance. If you drink and drive, you don’t get health insurance. If you smoke, do drugs, etc. and have dependents, no one in the household gets insurance.
I know people who haven’t been to a doctor in 10 years because they take care of themselves. Meanwhile, folks abusing their bodies with terrible substance habits drive up the cost of care and the tax burden for everyone else. No problem. You want to abuse your body with that crap, go right ahead. You don’t get health coverage.
That’s the basic premise. The more I think about it, the more I like it.
Clever
Very interesting. Don’t forget general alcohol consumption (at least a liver exemption). And high-fructose corn syrup. And people who fail to properly document their 3x per week aerobic exercise schedule (subject to random audit or neighbor reports). Or women who miss their annual gyn exam.
Actually, as long as the government’s doing stuff it has no moral justification for doing, let’s just have it be the sole retail outlet for food. Then it will all be healthy stuff, and people who break laws (speeding, failing to separate recyclables, etc.) Could be dinged on their rations. And their kids, too.
I like it….
Justification
The justification is that smoking and drug use are health-related choices that have a direct, large effect on the general populace’s cost of health care. You’re right, Daniel. I went a little too far with suggesting drunk-driving, but it’s only because I feel so strongly against idiots who get drunk and take the lives of others.
I think if I was running for President that this idea could succeed in shifting the social wedge issues off minuscule crap, like abortion and gay marriage (impacting tiny % of the population), and onto issues impacting almost everyone in the union. I would look right in the camera, and say:
“This is my plan for national health care. Everyone will get coverage. Unless you smoke. If you smoke you will not be covered or cared for by my administration. If you are a smoker, do not vote for me, because when I become President you will have no health coverage for the terrible choice you are making and the terrible health burden you are putting on the rest of the country.”
At that point the national debate would shift.
Problems with health care in the US
The chief issue I see with health care in the USA is that, for a large and growing proportion of the population, it’s too expensive, largely because of the way corporations are shoving expenses off onto contractors, and secondarily due to our increasing litigiousness. The only way to get Medicare is to show long-term destitution. Health care for a family will cost you around $700/month.
(Note that last number is to insure a family of four or more. If you’re talking about actual medical bills, that is, of course, highly variable. When we have had insufficient insurance, we’ve paid over $10,000 in a year, PLUS the cost of insurance.)
If it were not for insurance companies and their routine insistence on arbitration and litigation to extract maximum penalties from one another, I strongly suspect that our society would be much less litigious. It is litigiousness which has driven up the cost of medical care with the commensurate drive in prices for insurance.
How do you solve that underlying problem of people being willing to sue other people for as much as they think it’s possible to get, and more? And the mandate of corporations to extract maximum profits for their shareholders, which drives this kind of behavior on a larger level?
—
Matthew P. Barnson
Disagree
I disagree. Following your language, the chief issue I see with health care in the USA is that, for a large and growing proportion of the population, people are unhealthy because of their personal health choices, and as a result of their choices end up creating strain on the health care system.
How does that follow?
Regardless of whether you’re healthy or poor, the cost of medical care is higher because:
1) There is no such thing as bad luck. Only someone’s fault 2) Therefore, we should sue and try to get rich quick. 3) To sue, you need lawyers. Lawyers cost lots and lots of money 4) As a doctor, chances are you will get sued. You don’t have time to combat all those lawsuits, so you get insurance to protect you. 5) Insurance companies hire lots and lots of lawyers, which costs lots and lots of money 6) Insurance companies pass on those costs to the doctors/hospitals/etc 7) Doctors/hospitals/etc pass those costs on to us.
My sister works in the OB/GYN field. Their malpractice insurance rates are astronomical, because when something goes wrong with a highly complicated natural process like childbirth, it must be the doctor’s fault.
Now, doctors do make mistakes. However, the prevailing idea that if a doctor screws up and you suffer, you should get 7 digits in recompense is ridiculous. I think doctors should be punished for making gross mistakes, but not by paying the family $$$. The family should get its costs reimbursed if it causes a permanent condition or a little something in the case of death or inconvenience. But not enough to go looking for a McMansion.
As for people living unhealthily, I agree. I think insurance, regardless of gov’t or private, should limit payouts if it can be proved that your lifestyle causes your condition (for things like obesity, alcoholism, etc). However, I’m against a national health care system. The system as it is would work fine with tort reform and common-sense damage caps.
My $.02 Weed
How Does That Follow?
Wait a second…”regardless of whether you’re healthy or poor”…are you writing that all rich people are healthy and that all poor people are unhealthy? And that because poor people are unhealthy they are buying health insurance as a means to sue a doctor and get rich? How does that follow?
Insurance is high in any industry. Look at the auto industry. What if we could eliminate all those bad drivers from the system, those who don’t wear seat belts or those who have a history of at-fault accidents because they speed. It has nothing to do with litigation. It has to do with removing from the herd those who are predisposed because of their choices and who raise the cost for the rest of us.
I’m completely in agreement with you guys that litigation is out of control. Fine. What does that have to do with the general health of the U.S. citizen? Are we physically unhealthy because we are granted the ability to sue doctors left unprotected by a tort cap?
How does that follow?
Oops, ‘Twas a Typo
Meant healthy or sick. Listen to what I mean, not what I type
My $.02 Weed
Follow This
I think the reason universal health care is even discussed is because most people can’t afford health care. I think one of the drivers of cost of health care is because of litigation and its effects on insurance costs. I’m sure the fattening of America contributes to it. I’d debate alcoholism and addictions, because I don’t think the quantity of these have changed out of proportion with the populace. However, the average size of an American has increased, so I can grant you that.
Part of the problem, be it whatever you discuss today, is the sense of entitlement Americans feel for anything and everything. The government should protect me from eating fatty foods. No! The government should provide health care for me. No! If someone makes a mistake, and I suffer, then I should get a exorbitant amount of money for my “pain and suffering”. No No NO!
Get your own willpower to eat right and exercise. If you don’t, your private insurance company can cover less of your care because it’s your actions that are causing your health problems. You can’t afford health care? Go out, earn your keep, and get health care. Someone made an honest mistake and you suffered? Punish the person to the level of their mistake, compensate you fairly for your troubles, and move on with life.
The problem is that for the first thing, it’s a “condition” or a “disease” which causes me to eat too much, or do drugs, or whatever. IT’S NOT “MY” FAULT. The problem with the second is that decent, hard-working people can’t afford health care because it’s too expensive. I grant you that the costs might be due to covering uninsured people who don’t take care of themselves, but I bet it’s also due to my third point. There is way too much litigation in everything today. The common sense behind “reasonable doubt” is gone, replaced by greediness and stupidity.
As for other industries, do you think that litigation doesn’t affect auto insurance rates? It takes 3-5 years in the courts, as your insurance company fights with the other person’s insurance company, to settle any claim. How much in lawyers fees do you think that costs? A lot more than any settlement, probably. and a lot more than what it would have cost to fix the car and cover medical bills.
My sister-in-law was in an accident where she was rammed from the side by a woman who ran a red light. The woman had a medical condition and shuoldn’t have been driving. He statement was, “I saw the red light, but I couldn’t move my leg to press the brake”. Her insurance company contested her fault, saying the “accident was an ‘Act of God'”. It took 3 years before my sister-in-law won and was reimbursed for car damages, medical bills, and a small amount in pain and suffering ($20K ish?). That kind of stuff happens all the time, I don’t think its just anecdotal.
How do you remove those from herd who have displayed poor judgments? How many people drive without licenses already? Are you going to throw them into jail? There’s a law that says hospitals must treat the uninsured in the emergency room? You don’t think those costs are passed to the ones with insurance? You going to change that law? If you’re not insured because your fat and insurance won’t cover you, and you have a heart attack, do we tell hospitals to turn you away and let you die? Lack of insurance doesn’t mean no care. It just means hospitals must eat the cost, and that means we eat the costs.
Nothing. But it’s not the gov’t job to make you healthy. It’s not the gov’t job to protect you from yourself, just outside threats.
My $.02 Weed
How did we get here?
I agree Matt, healthcare is getting much more expensive. It’s also doing a much better job of extending life expectancy, so if I’m trading $ I used to spend on food and shelter for healthcare, that’s not really “bad” in my mind.
The insurance problem is the result of immoral government policies, aimed at “soaking the rich.” Back when salaries were capped (around the time of the Depression?) companies had to come up with new ways to incent executives. Enter health insurance. Companies get to offset this with tax savings (35% off) while individuals do not, so it soon became standard fare. As insurance companies grew in clout, along Medicare (which is a slightly different monster), they could demand lower prices: health providers began having to make up profits by charging more to the uninsured, who cound not collectively bargain. So if you’re uncovered, you get hit extra hard!
Litigation is also a serious issue.
People have a completely screwy idea about healthcare in this country. Insurance is about purchasing protection from catastrophic loss, not turning every visit into $25. People who have known risks are obviously bad insurance deals–it’s like offering hurricane coverage on a beach house in FL. Ideally, parents could purchase insurance on pre-born kids (in case of genetic problems, pregnancy issues, etc.), then people would buy insurance against cancer, serious accidents or illness, etc. Other bills would be paid out-of-pocket. Philanthropy could close the gap, just like it used to. Remeber when most hospitals were run by churches? Think this doesn’t work? Read more about the Amish, who completely self-insure.
You can also get on Medicare by getting end-stage renal disease–it is the entitlement of every US citizen to get free dialysis. This might explain why renal therapies have not advanced much in 20 years.