This, the fourth Comment of the Day generated by the post on pre-existing conditions and health care insurance, is a comment on the original COTD on that post, and not on the more recent Comment of the Day on the Comment of the Day on that Comment of the Day, thus sparing Ethics Alarms the most ridiculous headline in its history.
The topic now holds the blog record for most re-published comments, and it could easily be more, since the number of excellent responses from readers on all sides of the issue is well into double figures.
But now it’s texagg04‘s turn. Here is his Comment of the Day on the post, Comment Of The Day: “No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’.”
… The beauty of being a Federalist, especially a Libertarian Federalist, is that with the nuance of the system, I’m quite content with communitarian solutions to problems — when they are applied at the *appropriate* level and the *higher* they go, the more they need to provide a value, which left to it’s own the devices the market cannot produce the value soon enough to avoid a catastrophic harm to the market. The lower they go the more they can fulfill the various market whims of the locals.
My wife and I run our *family* as a fairly communist regime, though a bit more free than say, Soviet Russia. We really enjoy our *city* Library system. But for the most part, we really love our State keeping out of our business. I think its great that in places like Chicago and other snow-clad northern wastelands, some communities have mandated that each individual be compelled to ensure his section of city sidewalk is clear of snow – I think its great that some communities don’t.
When a problem arises which threatens the balance of the market severely enough but the market itself cannot provide a solution quickly enough that it essentially cannot save itself, I would submit that is within the government’s purview.
The first and easiest example, War (certainly the defensive kind). Should a foreign invader be at the doorstep of a commercial republic, no market anywhere will form, equip, train and deploy a brand new army before the invader crosses the frontier and occupies the land. So, that commercial republic collectivizes its defense into a quickly deployable, already equipped and trained force.
Another example would be the decision of legal disputes. Despite what the truly hyper-libertarians we call “anarcho-capitalists” say, no there could not be a market solution to arbitrating the breaking of law. Standing courts and enforcement arms already have reason to be a collectivized institution. I don’t think police provide a “core service”, as Jack puts it. They are almost NEVER there to actually stop a crime. At best they provide clean up, pursuit and apprehension after the fact. They’re core role, depending, are as agents of the judiciary or agents of the executive.
Fire fighting services are a great example. They really don’t exist to save any particular property from a fire as much as they exist to prevent the spread of a fire to the rest of the community and if moral luck is on their side they may save some of the affected property. In a fire-fighter-less community, (with not “bucket brigade” style mandated response), if a fire broke out, the market itself would be much to slow to provide a community-saving response.
Several considerations go into deciding whether or not a particular risk is high enough for a particular community to collectivize a particular task, this is why you see some communities, typically rural with no fire department or a volunteer department only. This decision is also tempered by the scope of the need, is the area under consideration sufficiently intertwined that Individual A ought foot part of the bill for a collective task that protects against a risk he is likely never to face? This is why we have a National level and Nationally funded military – Everyone, even the most remote citizen is affected by a foreign aggressive take over…but this is also why it makes sense to have divided up fire departments, why should Individual A, living 50 miles from the nearest fire station have to foot the bill for a service he-will-NEVER partake of that only catastrophically threatens the community far away from him. His house may burn down, but no fire engine would reach him anyway.
Several considerations go into deciding what level of government is appropriate for the various institutions that arise to meet these contingent needs. The primary driving forces in our Republic which decide that proper place are 1) How does it balance the Rights of the Individual vs the Ability of the Government vs the Needs of the Community, 2) At which level can it be held most accountable to the People, 3) At which level is it most economical and responsive.
So no, this isn’t an argument about providing for fundamental rights, even though fundamental rights (especially to property) is a key consideration here, as the health care debate essentially boils down to the coerced appropriation of property (via taxes) to pay for 1) other people’s bad health decisions and 2) nature’s dealing of undesirable hands to some people. Now, I have yet to see a single substantive argument made for the notion that “health care” is a fundamental right. Feel free to try, but good luck avoiding arguments that boil down to “it’s the right thing to do” or “you’re a heartless bastard”, which is pretty much the emotional appeals that the arguers resort to.
Ethics Alarms 
Have you heard of Jimmy Kimmel?
http://www.newsbusters.org/blogs/nb/kristine-marsh/2017/05/09/kimmel-attacks-sick-and-sad-gop-again-ahca-gma-gushes-he-hit
My issue with the whole healthcare debate: If one doesn’t choose to have health insurance and a tragic/unforeseen event occurs one piles up a lot of debt. If one can’t pay the bill, either the hospital eats the debt or one files bankruptcy. Either way, the debt is passed to others for one’s irresponsibility.
Hospitals (most) are a businesses and the government forces them to provide care regardless if one can pay. So the government has determined that some level of healthcare is a “right”. Someone has to pay.
When people talk about this, they rarely remember how inflated hospital care is. Going to the hospital without insurance, my husband paid $250 for a nurse to wash off a cut, decide it didn’t need stitches, and give him a bandage. Time spent with a nurse: about 15 minutes. Treatment: $5.
If we hadn’t paid, would the hospital have had to eat $250, or $20? (Of course, they would have told the government they had to eat $250.) And this happens at all levels of care, with ridiculous inflation on materials, fees for things that were never used, and charges for staff you never spoke to.
I was about to say I’d love to see an audit of the actual price of major surgery, then I remembered the Surgery Center of Oklahoma, a cash only hospital that lists its prices online. Their most expensive heart surgery is $11,400 for pacemaker placement… hardly bankruptcy level for an individual, and a hospital would have to be handing out an awful lot of those for free to have problems (or to justify the amount of inflation other patients see.)
(I was a bit off, the most expensive is $20,570 for an implanted defibrillator power pack change (including the device.) But we’re still not talking about hundreds of thousands for emergency care here.)
When you need to pay cash for services at a hospital it is often possible to negotiate the fee. Doing a Google on “negotiating cash price with hospital” will reveal many articles and the two I looked at from Time and WSJ seemed to be very good and hit the points I know of. Go over the bill looking for errors. Medical billing is extremely complicated. Everything has to be coded and there are over 69,000 diagnostic codes and 71,000 procedure codes with lots of rules about how to apply them. Honest mistakes will sometimes be made and the wrong code used. I caught one on a bill for my wife that would have resulted in about a $2,000 charge not covered by our insurance. You can look the codes up on line to learn what they mean and see what Medicare allows for them to get an idea about what the cost should be. Just like anywhere else, do your best to be sure you get what you paid for.
Reduce the need to go to the ER by learning what you can safely treat yourself. Take a course in first aid. There is a lot of good information on self-care on line. Going to the ER exposes you to hazards other than those to your bank account. There are a lot of sick people in ERs and a lot of nasty germs some of which are resistant to most antibiotics. The risk is very low and if you have something that really needs emergency treatment (blood squirting out that won’t stop, chest pain, etc.) go in but why expose yourself or your family when you don’t have to? For a lot of the more minor things that you can’t treat yourself a “Doc in the Box” will be perfectly adequate and cheaper.
I hadn’t heard of the Surgery Center of Oklahoma before. I looked at the price list and it seems really reasonable. All of the procedures do seem to be elective rather than emergency. I believe doctors accepting payments directly from insurance companies (assignment) has caused part of the problem. It takes the patient out of the loop so they don’t really feel the full financial consequences of medical care. If you could buy whatever you wanted at the grocery and you only had a $20 copay (because of your grocery insurance–after all food is a right), what incentive would you have to try to economize? As an example, if the wrong charge on my wife’s bill had been covered by insurance, I probably never would have caught it and it would have caused a microscopic bump in the cost of healthcare. A lot of those microscopic bumps have now added up to a mountain range.
My favorite analogy is this: if you had two apartment buildings that were exactly the same in every way, except one building decided to take the entire utility bill and divide it among the residents, and the other direct billed each resident based on their individual usage, what would happen to the utility costs/usage in each building?
Great analogy. Get ready however for a Leftie response that probably miraculously has just a study you need where they’ve cherry picked one apartment building that does this and by pure coincidence of lucky factors has tenants who all use very few utilities therefore keeping costs down.
Of course you know the best part about that analogy is that costs in the collectivized utilities scenario CAN be kept low.
…
By putting governors on every thermostat controlling how cold you can run the A/C and how hot you can run the heater as well as putting usage limits on water and electricity.
….
What a great analogy. I think I’ll borrow it.
Moreover, in such a system, how likely is someone to notice rapidly increasing prices? Unless the invoice is sufficiently detailed, there’d be no way to attribute increased expenses to volume, price, or some combination of both. You’d eventually end up with a wildly overpriced, overused economy and no one would be able to identify why, and no one would have incentive to decrease their usage.
Thank you, though. You often express the same things I’m thinking, but in a much better way than I can. Well deserved COTD.
I had the misfortune of a neck ailment a couple of years ago. 9 months of Chiropractic improved but did not fix the problem. A surgical specialist did. the I saw that the cost to my insurer for a half hour procedure (of which the doctor took 15 minutes) was $250,000! I was astounded. And I might think twice next time.
I am not a surgeon and of course have no knowledge of exactly what procedure was done. A typical anterior cervical decompression and fusion would be in the range of $25,00 give or take depending on number of levels and other complications. Other procedure may be more or less. Just for reference, a cardiac bypass graft would usually be around $100K depending on complexity. I am familiar with ACDF because my wife had one years ago. I recommend checking the line item bill to see what all the charges are. $250K looks like about 10X what I would expect but there may be something that legitimately accounts for that although to be honest I can’t conceive of what it might be. Happy to hear that the surgery worked for you.
I also want to say, that except in an emergency where you obviously can’t do it, it is OK to ask beforehand what the anticipated cost will be. Even if insurance picks up most of it you may still have a copay. You wouldn’t buy a new car without asking the price and probably doing a little haggling.
[mock indignation] Northern? Yup. Snow-clad? Often. But I take umbrage with “wasteland”. [/mock indignation]
I didn’t come out right. I meant snow-clad wasteland to be a single phrase. My best friend lives in Chicago and I always ask him how life is north of the wall with the Wildlings and white walkers.
That’s such a racist term. They’re called the Free Folk. Check you Andal privilege.
You know nothing, valkygrrl
Texagg04, the last paragraph you wrote is the most important, at least in my mind. Some people don’t plan very well and when personal disaster strikes they are in a fix. Medical cost are going to keep going up due to the fact that the incredible research that has been done although costly has even allowed the medical community in one case to cure a virus. So people should think very carefully about their discretionary spending. It’s like the fable of The ant and the grasshopper: Winter will come and if you haven’t saved enough, you are screwed!
Interestingly enough, in industries permitted to operate in the closest to a free market they can, new products are always the most expensive and generally only the wealthy can afford them, but as more wealthy people buy them, production costs creep down until not long after introduction, just about anyone can afford the product.
And thanks by the way.
texagg04 wrote, “Now, I have yet to see a single substantive argument made for the notion that “health care” is a fundamental right.”
I’ve been thinking long and hard about this growing argument that healthcare is a “right” and I’ve finally collated my thoughts in one place. Here we go…
Let’s start with a few reasonably simple definitions.
Right: A moral or legal entitlement to something.
Human Right: An entitlement that “belongs” to every human being.
Civil Right: The entitlement of a citizen to based on law.
Health: A person’s mental or physical condition.
Healthy: In good health.
Care: (as related to health) the services rendered by members of the health professions.
Service: The action of helping or doing work for someone
Now let talk about some reasonable knowns.
1. The human body is the “biological vehicle” that carries our essence through life.
2. Healthcare is a service providing maintenance and repair to biological vehicles.
3. The level of maintenance needed to maintain any individual biological vehicle is determined by genetics and the amount of use or abuse that the specific biological vehicle has endured.
4. Physicians are professionally trained and licensed service personnel specializing in maintenance and repairs of biological vehicles; the purpose for their service is to prolong life.
5. No one has the “right” to be healthy, not you, not me, no one!
6. Cost associated with maintaining a individuals’ personal biological vehicle is the responsibility of the individual or the legal guardian of that individual.
7. You do not have the legal right to a service that you cannot pay for, how much and how you choose to pay for services performed is up to you and the provider of the service.
Now the big question; are health care services a right or not?
In my opinion health care services are not a human right (hate me if you must) and they are not currently a Constitutional right. Since health care services are a service, I don’t think they should be a right. Making a service a right would open up a whole new can o’ worms.
For the sake of argument let’s look at what would change if we actually had an Amendment to the Constitution making health care services a right, how about something simple like…
“A healthy citizen population is necessary to the security of a free State, the right of the people to health care services shall not be infringed.”
Think about it, does that change anything?
Having the “right” to health care services doesn’t define who pays for the health care services performed, just like having the right to keep and bear arms doesn’t define who pays for the arms you have the right to bear. Having the “right” to health care services doesn’t define the level of services or if those health care services are competent, just like the 2nd Amendment doesn’t define the type or quality of the arms you have the right to bear. Having the “right” to health care services doesn’t define that the medical provider must be the state, just like having the right to bear arms doesn’t define that the state be the provider of the arms you have the right to bear. Like the 2nd amendment, an amendment about health care would say the right of the people to have access to health care services shall not be infringed, or something along those lines. Having the “right” to health care services doesn’t mean a thing if there are no doctors providing the services to the people, just like having the right to bear arms means nothing if manufacturers of arms and ammunition cannot provide their products to the people.
In my opinion, making health care services a right changes nothing and it’s wrong; the right itself wouldn’t make health care more accessible to anyone regardless of social status or wealth. In my opinion, access to emergency health care services is available right now as a de facto right; anyone can call 911 and get emergency medical treatment from professionally trained medical staff including emergency room services.
Zoltar,
Clearly a lot of thought has gone into this and I think you make a number of important points. Definitions that everyone can agree on are essential. Your conclusion that health care services are available right now as a de facto right is true. In fact it is more than a de facto right, it is a legal right (Civil Right by your definition).
The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 makes it a legal obligation to provide services to everyone coming into an emergency department requesting examination or treatment for a medical condition regardless of their insurance status or ability to pay. If after examination the individual is determined to be suffering from an emergency medical condition, the hospital is required to provide treatment to stabilize them. If it is a woman in active labor, they are required to care for her until the baby and placenta are delivered. EMTALA is an unfunded mandate. Possible penalties for violation include: termination of the physician’s and hospital’s participation in Medicare, $50,000 fine for the hospital per violation, and $50,000 fine for the physician per violation including on-call physicians.
I do have a quibble with number 4 under Service. I would change that to something like, “the purpose for their service is to relieve pain and suffering, restore functioning, or prolong life.” As one of many possible examples, having a broken arm will not necessarily reduce lifespan but it will be extremely painful and could result in permanent loss of function.
John Billingsley wrote, “I do have a quibble with number 4 under Service. I would change that to something like, “the purpose for their service is to relieve pain and suffering, restore functioning, or prolong life.” “
I agree.
I’ve taken your suggestion and updated my blog so the next time I copy and paste it it will reflect that change.
P.S. I didn’t know about EMTALA.
A few years ago, I actually wrote a brief article about this issue, back when Obama said “being a woman is not a preexisting condition”, which not only dodges the basic questions involved and ignores how insurance companies work, but is also false in every literal sense of the sentence. (I know what he meant, but he deliberately phrased it to create cognitive dissonance and get his constituency up in arms instead of thinking.)
In the article, I explained the basic principles of insurance, covered more thoroughly here by Jack and others (shout-out to Alex for pointing out on the original post how pools can become high risk over time). Insurance companies are for-profit organizations that have the right to refuse to do business with people if they predict they will lose money on it. Since we’ve gone over that, I suggest we look at the null hypothesis of “health insurance”. What would the world be like without it?
With current technology levels, there comes a point in every person’s life, some earlier than others, where the amount of money that it takes to keep them alive, let alone functional as a regular person, approaches infinite. Insurance can’t change that. For people who only require finite money to keep them functional, having no insurance would mean they would have to pay that money, regardless of accident, disease, or other malady.
It’s a simple enough world to envision, and we know that’s not what we want. For the vast majority of people, it doesn’t pass the Veil of Ignorance test (what social policies would you design, if you didn’t know who you would be born as?) https://en.wikipedia.org/wiki/Veil_of_ignorance
It does seem odd to use the term “insurance” to deal with conditions that we already know people have. Insurance is by definition a gamble, and gambles are defined by the unknown. If we want to help people whom we already know to have health conditions, we essentially create an insurance system based on the Veil of Ignorance, pretending that we don’t know what conditions people have (i.e. a socialized system). We recognize we couldn’t predict or choose who we would be born as, so we pay “insurance” premiums if we can, and that pays the people who have disadvantages.
This is something that we might decide to do as a society, but it can’t be called a “right” that people have. it would effectively be a national charity.
There can be no moral requirement to put in infinite effort for some individuals just so they don’t have to worry about the things that most other people don’t worry about. The real question is whether efforts towards that end are good for society, and to what extent. We already acknowledge that we physically can’t give everyone what they need, so asserting that everyone deserves everything they need is pointless and intellectually dishonest.
The real question is how much we are willing to sacrifice, and from where, in order to give people what they need to maintain a typical lifestyle. After collecting the resources, distributing them is already a known process, called triage. There isn’t a “right” or “fair” answer much of the time, if at all, because we’re up against luck (chaos) and death (of options as well as people). Eventual defeat is, at present, assured. The question is what we are willing to do and what criteria we are willing to use to contain and shape the force of death in the world, given that we can’t get rid of it.
Ultimately, I’m rooting for transhumanism so that we hopefully don’t have to worry about illness or aging anymore.