Wednesday, May 3, 2017

Who Should Pay More for Sick People?

This is a fascinating topic.
VOX I'm Sick, Not My Fault and Should Not Pay More
NY Mag Rep Says Sick People Should Pay More
VOX Rep Says Sick Should Pay More
G2A Pre-Existing Condition Fraud


The reality is that some people cost insurance pools more money...  This can occur for many reasons, but there are three broad categories:


Bad Personal Choices:
  • Smoking
  • Over weight
  • Addicted
  • Hish Risk Lifestyle
  • Other
Bad Luck:
  • Genetic condition
  • Bad accident generates chronic issue
  • Complications from medical procedures
  • Other
Normal Life Issues:
  • Pregnancy
  • Aging
  • Other
With this in mind I support:
  • Mandating that everyone carry a defined minimum level of insurance
  • That premiums be increased based on the "Bad Personal Choices" criteria
  • That premiums not vary more than 2 times based on the Bad Luck and Normal Life Issues. Yes that means that old people, women and people with pre-existing conditions do need to carry some of their extra burden.  However the pools can also help.
  • Lastly if someone has chosen to not pay their insurance premiums and help fund the pool on an on going basis. They should receive no governmental assistance.  They should go beg for assistance from charities.
Thoughts?

61 comments:

John said...

This one fits either post.

NYT Both Sides Mislead regard Pre Existing Conditions

jerrye92002 said...

Could this have been stated more simply as, "everybody is responsible for their own health and health care"?

Thus, if you have insurance and the insurance contract covers what ails you, you planned wisely. If you thought you were invincible and spent your money on recreational drugs that nearly killed you, you're going to live with a massive debt. If you can't afford the most basic of health care, charity (preferably private) may help you, but in the meantime we have this basic Medicaid service for your emergencies, and we're going to ask you to pay /something/ for it.

John said...

I think this exchange fits better here...

"Yes, I have "nostalgia." My health insurance costs doubled and my health care was a lower quality after ACA. If I have to toss the baby out with the "bath water," it's worth doing..." Jerry

"Selfish much? So you want others to suffer because you, who can afford to do so, had to pay more for your insurance. Wow." Anonymoose

"Wrong. I want others to NOT suffer as I have (or worse). When we are promised that our costs will drop $2500/year, and then we see costs INCREASE $2500/year, we not only suffer, but think we have been lied to. And we were." Jerry

"There are things people say, and there are things people want enforced by law. Many times, they are not the same thing." Anonymoose

John said...

I guess I am somewhat with Anonymoose on this one. Jerry is a selfish capitalist...

"everybody is responsible for their own health and health care" Jerry

John said...

Now I would maybe agree with Jerry if "Bad Choices" was the big factor in Healthcare Costs.

However I think that unfortunately "Bad Luck" is a much larger factor.

And unfortunately most people can rationalize that they won't have "Bad Luck", therefore they rationalize that they can scrimp on their insurance payment.

John said...

So Jerry being a scrimper wants to save $2,500/yr on his premiums by removing certain coverage or having a smaller max benefit available.

Then when bad luck happens and he get a debilitating long term chronic condition... Loses his job and incurs big costs each year... Well past his savings...

Who pays for it? The question of the post.

John said...

Please remember that I am happy charging obese people, smokers, addicts, adrenaline junkies, etc more...

"That premiums be increased based on the "Bad Personal Choices" criteria."

The question is who help pay when a $10/hr employee comes down with cancer?

Anonymous said...

"The question is who help pay when a $10/hr employee comes down with cancer?"

The employee with cancer, because they pay for TrumpCare with their life.

Anonymoose

John said...

Anonymoose,

Well I don't think Trumpcare is fully to blame for their predicament, though I know you like simple answers...

I guess the question is why is that adult working for $10 per hour... G2A Why are poor people poor?

John said...

Which brings us back to that ethical / moral puzzle?

Does our society require that every citizen fulfill certain roles and responsibilities in order to earn all of the benefits that come with being a US citizen?

And if certain citizens refuse to fulfill those responsibilities what should we do about them?

John said...

The hard working citizens of the USA invest a huge amount in the public education of every citizen. Most citizens work hard and make that investment worth while. I assume that would be generally what we would expect from our responsible citizens.

Then those responsible citizens settle into jobs, marriages and start to give back to society and help to support the cost of educating future citizens. And thus the system works generation after generation, century after century...

Now I agree that our society owes something to all of us hard working cogs that make America function.

The question is what does society owe the tarnished cogs who squander the education investment, make babies they can not afford, barely work and in general just keep taking from society decade after decade?

John said...

Do we maintain the unhealthy co-dependency right up to the bitter end?

Society spends $250/000+ on education...

Citizen fails in school and makes babies they can not afford to raise...

Society pays for citizen and children's home, food, and healthcare... While offering training opportunities...

Citizen still flounders...

Society makes more payments...

Citizen gets terminal and/or chronic illness...

Society does what?

Anonymous said...

John-

Some people don't succeed. There will always be those who don't succeed. I don't understand why it's so difficult to wrap your head around the idea that they will need health coverage, no matter if you feel they are deserving or not.

I like to compare it to the theology of Grace. By our fallen nature, we can never be deserving of God's Grace, yet it is free and abundant to us. I suppose the question is: What do we need to do to receive it?

Anonymoose

John said...

Interesting. But even us ELCA folks need to fulfill a requirement to get into Heaven

"Like any Lutheran Church, the ELCA believes that people are justified, or given the right to enter heaven, by faith in Jesus Christ alone. Martin Luther famously called this the doctrine on which his church stands or falls. The doctrine was the main source of conflict between Luther and the Catholic Church, which believes grace can be gained through both faith and good works. Lutherans, on the other hand, are wary of any doctrine which suggests that the actions of people can earn them a place in heaven."

"The ELCA references the "three alones" of Lutheranism on its website, a concept which is commonly used to explain Lutheran beliefs to outsiders. Lutherans believe that we are saved by grace alone, that grace is attained by faith alone and that the Bible -- not church tradition -- is the standard for determining Christian doctrine. For salvation, the first two "alones" are the most important. God's grace is given to people without merit. It cannot be earned, and is attainable only through faith, which is defined as a radical trust in God."

John said...

And I am pretty sure God does not rob from Peter to provide Paul with salvation.

Where as that is a requirement of society provided care.

John said...

As for this very limiting belief / soft bigotry of low expectations comment.

I agree that there will always be some mentally disabled or very physically disabled people who will struggle and need to be cared for by society. This is why we have a disability system.

As for everyone else, I think we just have not found the right sticks, carrots and/or support system to help them work to succeed.

John said...

And don't forget my Biggest Easily Avoidable Pet Peeve that traps most of the "don't succeed" folks into that category.

Anonymous said...

Well, now we get to see how quickly Paul will die when Peter removes life support.

Hopefully, our Senators have brains.

Anonymoose

Anonymous said...

"Where as that is a requirement of society provided care."

What you seek is a group of individuals, not a society.

Anonymoose

John said...

Apparently our society does have listed Freedoms and Responsibilities

John said...

I like this list from TownHall also. Liberals will likely disagree with some of the line items... :-)

John said...

No, I think I am correct.


society
1. an organized group of persons associated together for religious, benevolent, cultural, scientific, political, patriotic, or other purposes.

2. a body of individuals living as members of a community; community.

3. the body of human beings generally, associated or viewed as members of a community: the evolution of human society.

4. a highly structured system of human organization for large-scale community living that normally furnishes protection, continuity, security, and a national identity for its members: American society.

jerrye92002 said...

How quickly we've gone far afield! What is wrong with "everybody is responsible for their own health care choices, and for paying for them"? John, you are always claiming people have to take responsibility for getting an education, for having babies, for finding a job, for getting off the dole. How is having "society" DICTATE how the responsibility for health care MUST be exercised contributing to the taking of personal responsibility?

Your $10/hr chappie that gets cancer-- was he working for an employer that offered health care? If not, was he ALLOWED to buy a catastrophic policy for himself, with none of the frills?

jerrye92002 said...

"I don't understand why it's so difficult to wrap your head around the idea that they will need health coverage, no matter if you feel they are deserving or not."

That's not true, and one of the great fallacies of Obamacare. These folks who can not or choose not to pay for their health insurance, still need health CARE. Those wealthy enough cover it out of their own pockets and don't need the insurance. Those young folks living prudently can take a chance, with good odds, and buy insurance later. Those deadbeats that cannot pay and aren't insured SHOULD get saddled with a serious debt for their care, whether or not it is ever collected from them. Those simply unable to pay will or should have the option of charitable care, rather than giving them "insurance" paid for by somebody else. In other words, everybody responsible for their own health CARE and how to pay for it. And on a side note, if government would get out of the marketplace, actual health care would be a lot cheaper and more people could afford it, or the insurance to pay for it.

John said...

Jerry,
Pretty much any expense is catastrophic for Chappie. Good try.

As for the scrimpers... I am happy to let them die if they make the wrong bet. Unfortunately our society is not... So we should make them carry insurance and fund the pool they may need.

Anonymous said...

You people are morally bankrupt.

John said...

As always, please leave a name... Any name will do...

Now assuming you are aiming that comment at Jerry and myself... From what I understand we both consistently give at least 6% of our gross income to help the needy each year. And it sounds like Jerry is in the 10% range plus volunteering.

Where as most Liberals seem to personally give far less. Instead they argue for the government to forcefully take money from the Peters so it can be given to the Pauls...

Now who are the morally bankrupt folks? Those who give of their free will to help their neighbors... Or those who stand there demanding that others do something?

jerrye92002 said...

Thanks, John. Still, it pains a bit to have one's moral standards disparaged by people who have none themselves.

Anonymous said...

What does yours and jerry's personal giving have to do with anything? You trot that old canard out whenever you're challenged. It just means that you want to give your money to the people you know or think are deserving...AND...you want to be able to tell people how generous you are. As a friend of mine recently said, "I'll gladly pay more in taxes so that someone I don't know can afford to stay alive."

It's a shame Republicans and Conservatives don't believe in it.

Anonymoose

jerrye92002 said...

Maybe this will help. Smile!

TO WHOM IT MAY CONCERN:

My present financial condition is due to the effects of federal laws,
state laws, county laws, corporate laws, by-laws, brother-in-laws,
mother-in-laws and outlaws that have been foisted upon an unsuspecting
public.

Through the various laws I have been held down, held up, walked on,
flattened and squeezed until I do not know where I am, what I am, or if I
am.

These laws compel me to pay a merchant's tax, capital stock tax, real
estate tax, property tax, auto tax, water tax, gas tax, light tax,
cigarette tax, cigar tax, street tax, road tax, school tax, occupation
tax, processing tax, gasoline tax, personal property tax, state income
tax, state franchise tax, electricity tax, federal income tax, cotton
tax, payroll tax, old age pension tax, and--I almost said--carpet tax.

I am suspected, inspected, disrespected, examined and re-examined until
all I know is that I'm supplicated for every known need, desire or hope
of the so-called human race. And because I refuse to go out and beg,
borrow, or steal money to give away, I am cussed, discussed, boycotted,
talked to, talked about, lied to, lied about, held up, held down and
robbed until I am plum ruined. The only reason I am clinging to life is
to see what the hell is coming next.

jerrye92002 said...

Moose, you are the one with the canard (French for "duck" by the way, which is what you are doing). If your friend would "gladly pay more in taxes" let him do so! Nobody is stopping him. But why should his, or your, desire that some poor fellow be helped require GOVERNMENT to take from ME, involuntarily? Why should I not be allowed to find this poor soul and help him myself? Wouldn't that be FAR, far more efficacious?

I'll also point out that among those NOT willing to pay more in taxes to help the poor are a couple of people who understand the difference, Bill Gates and Warren Buffet, who tax-sheltered about $70 Billion in their private foundation.

Point being that John and I are helping, whether you like the people we choose to help or not, while what you insist on is that we be forced to "help" (ineffectively) those YOU want to be helped, without having to do anything yourself. At the risk of offending, it sounds rather hypocritical.

jerrye92002 said...

"It just means that you want to give your money to the people you know or think are deserving."

Right. And you want me to (be forced to) give to people who are undeserving. What does that get us, other than you feeling good for having "done something"? Private charity works because it is discerning of those who "want to help themselves" and those that just want to freeload. Government welfare does it poorly, if at all.

John said...

And ironically... I have no idea who receives most of my charitable giving...

The primary recipients are:
United Way
My Church
PRISM
Red Cross
GoodWill
Seven Dreams Foundation

And I put no limitations on how it can be used.

Outside of that I have at times given significant gifts to friends and family to help them through hard times.

John said...

So again I ask...

Now who are the morally bankrupt folks? Those who give of their free will to help their neighbors... Or those who stand there demanding that others do something?

Or what about the people who choose to not help themselves? By taking advantage of all the free training and education that is available to them?

By the way, I forgot one of the simplest things I give... Every 16 weeks I donate the equivalent of to units of red blood cells to the Memorial Blood Bank... And all that costs me is about 2 hours every 4 months...

John said...

Jerry, Regarding...

"Thanks, John. Still, it pains a bit to have one's moral standards disparaged by people who have none themselves."

I have to find that section in Atlas Shrugged where the Hank finally figured it out... For the Liberal blood suckers in his family to be successful, they relied on him working hard and living by a high set of values that they lacked...

About that time he finally left his self serving wife and nephew...

Anonymous said...

"Point being that John and I are helping, whether you like the people we choose to help or not..."

That's the point. It doesn't matter if I like the people the government helps or not. If they need help, they should get it. You don't agree. That's fine...but immoral.

Anonymoose

Anonymous said...

"Those who give of their free will to help their neighbors... Or those who stand there demanding that others do something?"

Why are those the choices?

Moose

Anonymous said...

"Or what about the people who choose to not help themselves?"

Did Christ only heal those that could heal themselves?

Moose

Anonymous said...

"Every 16 weeks I donate the equivalent of to units of red blood cells to the Memorial Blood Bank..."

Well...good for you. Did you know...there is an entire group of people, who would love to be able to donate blood, that are denied that opportunity because Conservatives fear gay people?

Moose

John said...

Moose,
"That's the point. It doesn't matter if I like the people the government helps or not. If they need help, they should get it. You don't agree. "

I am fine with them getting help from other citizens who choose to give of their free will. Just like Jesus did.

Jesus did not stand there demanding that the government take from Peter at the point of a gun so that Paul could receive free money and services.

To Conservatives that is just a form of theft. Which I think many would find morally questionable.

Anonymous said...

"To Conservatives that is just a form of theft."

That's your problem. You think that doing the things that help make a group of individuals into a society is theft.

In other words: morally bankrupt.

Moose

John said...

Gay Men and Blood Donation

John said...

Moose,
I would make some time to look in the mirror and ask yourself. What can I personally do today to help others? How can I change my habits to do more of it in the future?

"Everyone thinks of changing the world, but no one thinks of changing himself. Leo Tolstoy

Labeling and complaining about other people accomplishes nothing.

G2A Principles

Anonymous said...

"Labeling and complaining about other people accomplishes nothing."

Freeloaders, lazy, undeserving....I guess you're right.

Moose

jerrye92002 said...

"If they need help, they should get it. You don't agree. That's fine...but immoral."

And if they take the government check and do NOT need the help, is that the immoral action, or are you the immoral one who demanded government take from the unwilling to help the undeserving? And before you answer that, consider that government spends the equivalent of $60,000/year on each family of three living below the poverty line, yet we still have people below the poverty line? Do you think we are actually "helping"?

On the other hand, I've watched private charities pick up families and people that had nothing but the will to better themselves, and make them successful in relatively short order. Now which would you call more moral, helping people from nothing to self-sufficiency in 6-12 months, or keeping people alive but in poverty for generations?

jerrye92002 said...

Moose, do you really want to deny that some people on welfare are "Freeloaders, lazy, undeserving"? Every dollar spent on welfare goes directly towards helping people out of poverty? I think you should reconsider your belief that others are immoral until you reconsider your belief that taking from some by force, just to give to others you believe more deserving, sounds more like theft than Christian charity.

jerrye92002 said...

As for "making a society," the fundamental of that is the sense that everyone in the society adopts a core set of values, are treated fairly and equitably, and makes a contribution to it. Taking from some to give to freeloaders violates all those definitional rules.

Anonymous said...

"...your belief that taking from some by force, just to give to others you believe more deserving..."

Don't put words in my mouth. I've never said they are MORE deserving. I said that whether they are deserving or not is irrelevant to whether they should receive help.

"Taking from some to give to freeloaders violates all those definitional rules."

Then, by all means, take away their citizenship, put them in concentration camps, whatever, but you don't get to claim to be moral if you let them suffer when society has the wherewithal to alleviate their suffering.

It is you who are labeling them as freeloaders. Not me. You've convinced yourself that what's yours is yours and being asked to contribute via taxes is theft. There is no help for your ailment.

Moose

jerrye92002 said...

You keep missing the point. I do not object in the least to helping folks that need it. I do it regularly. I object mightily to being told, at the risk of jail, that I must pay for government to take care of folks, whether they need it or not, and that some liberal that contributed nothing will claim all the credit for the "compassion" involved.

And if you want to remain fuzzy about the morality involved, consider the practicality. After trillions spent in the War on Poverty, we have the same number of poor as we had before. Money well spent?

John said...

Moose,
The good news is that you have no standing with me, therefore your judgment means nothing. However if it makes you feel better, please proceed.

"You've convinced yourself that what's yours is yours and being asked to contribute via taxes is theft."

As for that statement, that is just silliness... No one is asking people to contribute.

Contribute
1.to give (money, time, knowledge, assistance, etc.) to a common supply, fund, etc., as for charitable purposes.
2.to furnish (an original written work, drawing, etc.) for publication:

Liberals like yourself are demanding payment, and that people are placed in jail if they refuse. You can rationalize as you wish, but that is no way a "contribution".

jerrye92002 said...
This comment has been removed by the author.
jerrye92002 said...

Let's back up 40 posts or so, somewhere nearer the original topic.

"Pretty much any expense is catastrophic for Chappie. Good try.

As for the scrimpers... I am happy to let them die if they make the wrong bet. Unfortunately our society is not... So we should make them carry insurance and fund the pool they may need."

Poor Chappie. His employer did not offer health insurance. He made too much to qualify for Medicaid. Obamacare was WAY overpriced, even with the [illegal] subsidies. O'care severely limited HSAs-- catastrophic-only policies-- and Chappie might have, according to you, been unable to pay the deductibles. Even the AHCA does not include the "pre-loaded" HSAs that would cover him for non-catastrophic care, though it does increase the number of HSAs available.

The answer for Chappie, just like for all the "scrimpers," is to take advantage of the law requiring hospital emergency rooms to treat all comers, insured or not. And that is what makes your formulation so curious. These "scrimpers" are people that have decided they do not want or need, nor can they afford, to buy insurance, and we already have to give them health CARE. So how do you propose to "MAKE" them buy insurance?? We already have 6.5 million people who have made the choice otherwise, under O'care's individual mandate. (And notice, under O'care, emergency room visits are way UP?)

No, the solution for the poor is to give them health CARE directly, and then mark up a debt against them. If they were just freeloading, they'll end up paying something on it and may decide it's cheaper to get insurance for "next time." If they're truly poor, they will get cared for by funds from the whole society-- charitable, tax deduction or write-off, or government payment-- and you don't get a larger "pool" than that.

jerrye92002 said...

And Moose, think about this: Let us assume that all government spending goes towards the "public good," including roughly 20% on "means tested"-- i.e. for the "poor"-- programs. There has always been a federal fund where voluntary contributions to the government are accepted. Of all the BILLIONS of dollars made by rich liberals, less than $3 million found its way into the "voluntary contributions" federal fund last year. Compare that with the $300 BILLION given to private charity. States who have made the top tax rate voluntary have had similar results. For example, Elizabeth Warren, a millionaire US (Democrat) Senator, does NOT pay the optional higher income tax rate. People simply do not believe that government does "charity" well.

Anonymous said...

"After trillions spent in the War on Poverty, we have the same number of poor as we had before. Money well spent?"

It may have been, but the War on Drugs has dampened the effect that Welfare could have had.

Moose

Anonymous said...

"No one is asking people to contribute."

You act as if you have no say in the governance of this country.

Moose

jerrye92002 said...

"...the War on Drugs has dampened the effect that Welfare could have had."

???

jerrye92002 said...

"You act as if you have no say in the governance of this country."

Moose, you are in good company now, sounding like Hiram. Here is the way I see it.

I did not vote for Obama, or Franken, or Klobuchar. They don't call and ask for my advice, and they do not even respond when I write to them or phone them about my concerns. Explain to me exactly how much "say" I have.

John said...

Moose,

"You act as if you have no say in the governance of this country."

Thank you for your support in passing ACHA !!! :-)

And passing the big tax cuts that are coming!!! :-)

John said...

You are correct... This democracy thing is pretty cool !!! :-)

John said...

Jerry,
Maybe Moose means those families would have had more money if they had stayed married, worked hard in school and avoided buying, selling and/or using drugs...

I know that worked for my extended family and myself... :-)

jerrye92002 said...

I knew we could get back to the topic at hand, eventually. Question: Who should pay for drug rehabilitation treatment? Who should pay for problems resulting from illegal drug use, such as heart attack, overdose or AIDS?