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What Happens If The Affordable Health Care Act Is Overturned?

Evening Edition

Above: Chris Van Gorder, president and CEO of Scripps Health System, talks to KPBS about the Affordable Care Act.

Aired 4/2/12 on KPBS Midday Edition.

GUEST

Chris Van Gorder, President and CEO of Scripps Health System.

Transcript

Scripps Health System is one of the largest in San Diego County, with five hospitals, 26 clinics and 13,000 employees, so it has a lot at stake in the Supreme Court's ruling on health care reform.

Chris Van Gorder, Scripps' president and CEO, spoke to KPBS about the current health care system. He said he is in favor of an individual mandate that each person have health insurance because he believes the system needs everyone to have health insurance.

“I would agree that everyone in this country should have some insurance of one kind or another,” he said.

An individual mandate is an “attempt to try to get everyone insurance,” but, he added, “of course whether people use the insurance in the right way, for example, to try to keep themselves well instead of waiting until they get sick and then using the health care system.”

Van Gorder said the country's health care system is broken for those who are uninsured or underinsured, and said the system shifts the costs of people who don’t have insurance to people who do.

“About $1,400 out of everyone’s premium annually is to pay for those who are uninsured or underinsured,” he said.

Another problem is that "hospitals are a sick business," he said.

“If you aren’t sick, we’re out of business," he said. "We don’t get paid to keep you well.”

Van Gorder said Scripps is working to change that model.

In response to a U-T San Diego series on emergency room "frequent fliers," Van Gorder agreed, “we do have a national health care system, it’s called the emergency room.”

San Diego County has no county hospital system, so “if someone comes to our hospital, we have the legal responsibility, and frankly the moral responsibility, to take care of them, regardless of their ability to pay," he said. "That is the health care delivery system in this country."

Comments

Avatar for user 'educator'

educator | April 2, 2012 at 1:02 p.m. ― 2 years, 5 months ago

On the whole, I have always enjoyed and largely shared Chris Van Gorder's thoughts on healthcare and its economics. However, one aspect of healthcare costs that I have never heard him or any other pundit address are the costs associated with what I consider the enormous increase in the middle-management ranks of healthcare institutions, such as Scripps. For example, back in 1987 there were probably 3 layers of management between an healthcare technologist and the CEO of a hospital - nowadays, there are at least twice that many layers, if not more, and none of those people directly interact with patients. I contend that much of the exorbitant costs associated with inpatient hospitalization and the increased day-to-day costs of running a large organization like Scripps are directly attributable to the bloat of managers and administrators now found in those hierarchies.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 2, 2012 at 2:22 p.m. ― 2 years, 5 months ago

Unfortunately, this is not a constitutional issue, it's a poltical one.

The disappointing oral arguments demonstrated this, like so many other recent SCOTUS decisions, will be drawn down the ideological divide of the court.

It seems like democrats support it and republicans are against it seems to bethe dominating force in decision making, as opposed to honest constitutional analysis.

The thing that irritates me most about republicans is not that they find issue with this legislation, but that they have **no alternate plans of their own for reform.**

If republicans were so against aspects of this legislation, they should have offered up bi-partisan alternatives back when the reform was being discussed in congress.

Instead of doing so, they simply said they were against anything Obama and the dems proposed, period. No give and take, no viable alternate plans, just staunch obstructionism.

Perhaps the reason republicans refused to engage in any diplomacy when the bill was in congress is because they knew it would eventually reach the conservatively-tilted Supreme Court? Maybe this was their tactic all along?

In any case, I think it's reprehensible for conservatives to spend so much energy at defeating this reform but yet they can't spend any time or energy coming up with their own viable alternative.

What will happen if this is struck down will be what has been happening for the last many decades and includes:

**-The U.S. will be the only developed nation on earth to have a significant portion of our society (40 million people) without access to regular, prevetnive health care**

**-The U.S. will continue to spend far more per-capita on health care than any other nation on earth, including paying for the uninsured who have medical emergencies and need costly treatment because they have not been able to receive regular preventive healthcare**

**-The U.S. will continue to be the only developed nation on earth that has an epidemic of bankruptcies related to unpaid healthcare bills**

**-The insurance companies will go back to sleazy tactics to make up profits such as hammering people relentlessly on per existing conditions**

I guess the repugs are OK with this, but in the end we all end up suffering because this kind of mess does not discriminate against those who can afford healthcare and those who can't. This mess is big enough to harm our global competativeness when you consider the rat of the developed world provides all their citizens with health care.

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Avatar for user 'JeanMarc'

JeanMarc | April 2, 2012 at 3:19 p.m. ― 2 years, 5 months ago

We should replicate the healthcare system that Singapore employs.

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Avatar for user 'benz72'

benz72 | April 2, 2012 at 3:49 p.m. ― 2 years, 5 months ago

I agree that being against something without offering a superior alternative is childish. The problem I see is that the only good fix is so unpalatable to people dependent upon 'the kindness of strangers' that those of us who advocate for cutting that line of funding entirely are portrayed extremely negatively.
It is not that hard to make a stable system, but if the majority insist that someone else pay for the things they want, the economics and politics can never align. Rather, we will continue to limp along until the system eventually collapses under its own weight.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 2, 2012 at 4:28 p.m. ― 2 years, 5 months ago

I just heard another story on NPR today about a SCOTUS decision and I'm really disgusted.

The justices, in the ever so common 5-4 ideological split, voted to give prisons the right to strip search anyone arrested, regardless of the reason.

I'm still trying to figure out how "small government" advocates like Justices Scalia, Thomas, and Alito think it's a government overreach to make sure everyone has health insurance, but it's perfectly fine for the government to force anyone arrested for anything to be subject to forcing people to undress, bend over, spread their buttocks, and expose their rectum for a government prison worker.

Cass of people arrested for things such as unpaid parking tickets being forced to strip and bend over didn't matter to the majority conservative judges.

Neither did alternatives such as people arrested for minor non-violent misdemeanor crimes having to strip only to their underwear.

Nope, Kennedey, Alito, Scalia, Thomas, and Roberts want prisons to have free reign to strip search anyone who comes through their doors.

Our country is well on the way to becoming a police state.

My prediction is that by Novemeber, this SCOTUS will have an approval rating equal to or less than Congress. And well they should, they are just as dysfunctional.

Our country is on it's way to becoming a police state, and

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 2, 2012 at 7:11 p.m. ― 2 years, 5 months ago

By the way, the Manchester Pravda UT thinks they are pretty hilarious with their making fun of people without health insurance who need to visit the hospital frequently by calling them "frequent flyers", but what is **their** position on the health care bill?

With a known right leaning bias (shifted to a hard right bias after Papa Puke slithered in) I'm assuming they are against the health care.

Perhaps the awash with money Papa Putrid thinks we should just let them die at home, have the city shovel their bodies into a truck, transport to a landfill, then bill the family or estate for the shoveling and transport cost?

I have heard many conservatives who actually want this horrific scenario to happen.

Again, evidence some right wingers don't seem to understand the concept of living in a **society**.

As far as the UT's attempt at embedding themselves into the healthcare debate, maybe they should stick with something they know - like giving Dirty Carl DeMaio some favorable page coverage or running a fluff piece for Issa after the NY times spotlights his corruption.

I actually stopped reading all forms of the Pravda UT last year, but I find it quite distasteful to hear they are calling people who can't afford health insurance and have serious conditions that bring them to hospital often "frequent flyers."

This isn't something funny. These are people's mothers, brothers, sons, daughters, etc.

Maybe if Papa Pinhead ever had to worry about how he would afford healthcare he wouldn't think this is all a big fat joke.

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Avatar for user 'benz72'

benz72 | April 3, 2012 at 7:10 a.m. ― 2 years, 5 months ago

Living in a society comes with responsibilities, not just benefits. One of those responsibilities is not to burden your unwilling neighbors with your problems. Asking for help is fine, demanding it when they see no possibility of being helped in return... not so much.
Be an ant, not a grasshopper.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 3, 2012 at 11:01 a.m. ― 2 years, 5 months ago

Benz, how can you say requiring health insurance burdens my neighbors who might not want to buy it?

The last time I checked, all my neighbors have bodies that they carry around with them that include skin, eyes, muscles, bones, and internal organs all of which require regular medical checkups to be maintained.

People have been floating around the car insurance example saying it's not comparable because if you don't own a car you don't have to buy.

Well in the healthcare marketplace **nobody** is exempt because **everyone** carries around a vehicle known as the **human body**.

Even the healthiest of people who might want to help out still need regular checkups in order to maintain standard health.

It makes sense that if you don't own a car, forcing ou to buy car insurance would be unconstitutional.

But forcing someone who has a body that requires services from the healthcare marketplace to have insurance is not unconstitutional.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 3, 2012 at 11:20 a.m. ― 2 years, 5 months ago

Re: the car insurance comparison:

Some conservatives are arguing that requiring someone to purchase medical insurance is unconstitutional because it forces a commodity to be purchased before it's needed.

They say there would be no constitutional problem with requiring someone to purchase insurance just prior to it being needed, for example before on decides to go to the doctor.

But as we all know this is impractical, and this is not how it works with car insurance.

If this argument were true, then car insurance should only need to be purchased at the time of an accident.

We require auto insurance because the mere act of owning and operating a vehicle is a liability. Other peope's liberties can be compromised either accidentally or maliciously by the owning and operating of a vehicle and nobody can predict when an accident may occur.

Just like you can't assume that someone with a clean drivers record and a new car won't get into an accident, you can't assume that a healthy young person won't get sick be injured.

We are individuals who are in charge of our own bodies. It is inappropriate for the government to tell us what to do with our own bodies, however it is appropriate for the government to regulate the liabilities imposed by each of us resulting from owning our own bodies because it has significant impact on the rest of society.

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Avatar for user 'benz72'

benz72 | April 3, 2012 at 11:33 a.m. ― 2 years, 5 months ago

There are two reasons I find that line of reasoning incorrect.
The first is that there are groups who eschew medical treatment. I think faith healing is bunk and cessation of terminal treatment is a very personal economic choice. There are groups that rely on the former and the government should not be involved in the later. The only way to accomplish that is to ensure the entity paying the cost is the same as the one making the decision. Just as it is legal but difficult to live in modern society without driving it should be legal to not accept medicine.
The second is that the assumption of risk is, and should remain, an individual choice. Motorcycle helmets are a good idea, motorcycle helmet LAWS are a bad idea. If I chose to forgo insuring myself against some calamity then I am responsible.
A third concern I have with this issue, though not one addressed directly by your question, is that, by law, the costs do not accurately reflect the risks. Pre-existing conditions with a known cost of treatment are not ‘risk management’ they are ‘wealth transfer’. I cannot buy car insurance after an accident and expect coverage of my already destroyed vehicle. Similarly, I cannot reasonably expect to acquire insurance while I have an $X per month condition without either exempting that condition from coverage or paying an $X per month premium on top of the normal insurance coverage cost.
Does that answer your questions?

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Avatar for user 'benz72'

benz72 | April 3, 2012 at 12:04 p.m. ― 2 years, 5 months ago

We are individuals who are also responsible for providing for the needs of those bodies. It is inappropriate for the government to force us to exercise, even though it is a good idea to stay fit. It is inappropriate for the government to forbid junk food, even though we all know we shouldn’t be eating it.
I agree it is appropriate for the government to regulate the liabilities we impose on each other in an effort to diminish or eliminate them. I am not responsible for your health, nor are you responsible for mine. Neither of us is responsible for the 400 lb., 3 pack a day smoking, junk food swilling diabetic’s health.

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Avatar for user 'DeLaRick'

DeLaRick | April 3, 2012 at 12:06 p.m. ― 2 years, 5 months ago

Benz,

I defer your prior questions on other threads about the feasibility of denying emergency treatment at hospitals to Chris Van Gorder:

"San Diego County has no county hospital system, so 'if someone comes to our hospital, we have the legal responsibility, and frankly the moral responsibility, to take care of them, regardless of their ability to pay,' he said. 'That is the health care delivery system in this country.'"

Don't be such a knee-jerk contrarian. You should realize when you stumble across people with a little expertise and be a tad more inquisitive than argumentative. That should be easy for a bright person like you.

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Avatar for user 'benz72'

benz72 | April 3, 2012 at 12:18 p.m. ― 2 years, 5 months ago

Mr. Van Gorder is certainly free to hold that opinion and to direct his company’s well earned resources as he deems appropriate. I will hold my own counsel on what is moral and immoral when those resources are derived from my taxes however. Perhaps you are right about inquisitiveness though. Why do you believe it is any more moral to force someone to pay for someone else’s gain than it is to deny that gain in the first place? Is there no limit on what you are willing to pay for another person’s benefit? If so, what is that limit for you and do you consider it moral for the majority to decide what my limit should be?

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 3, 2012 at 1:48 p.m. ― 2 years, 5 months ago

Benz, you make well thought out points but I still don't agree withthe premise that each one of us is in a bubble and choosing not to inure ourselves is a right above government intervention.

If medical care was not so expensive I would say the argument may be different, but a very, very small segment of the population can afford to pay for these services outright and this, coupled with the fact everyone at some point uses the healthcare system, makes it a special case in my opinion.

As to your points on the right to not be treated, I fully support those decisions but I fail to see how they are relevant in this debate.

Requiring someone to carry health insurance is different than forcing them to use it, and I think that's an important point.

First off, most people in the position of needing to make end of life treatment decisions are older and are on Medicare. Second, often times when people decide not to be treated they still require palliative care for things such as pain medications or hospice care which is expensive itself.

The comparisons of forcing people to exercise is a different scenario because it's forcing someone to live their life in a different manner, it's overy intrusive, whereas mandating someone carry insurance is not a burdensome ongoing activity that alters someone's life. Its a mainly a monetary transaction. The one burden would be for those who can't afford it, and that is addressed in the law with government supplementation.

I have to ask you one question, if congress passes a single payer system would you support it? (you may not like it, but would you support it as legally/constitutionally justifiable if passed by congress)?

The reason I ask is because if this is struck down that is most likely the route we will head. I actually think that would be **better** than the current reform, but it will take a very, very long time to take shape, probably beginning with the gradual reduction in the age requirements for Medicare.

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Avatar for user 'benz72'

benz72 | April 3, 2012 at 2:27 p.m. ― 2 years, 5 months ago

1) Please note, I am not advocating that all payment must be out of pocket (though that should be an option). Insurance, lines of credit and private charity are all perfectly acceptable.

2) Forcing someone to pay for something they decide not to use seems odd to me, can you explain the logic you are using to see that as a moral requirement?

3) Persons at the end of life may DESIRE palliative care (which they may choose to have insurance for or cover out of pocket), but I fail to see in what context it is REQUIRED, especially since the very nature of the condition defies recovery.

4) As I understand the term, single payer health care would forbid private transactions for medical services. This I view as a gross and unsupportable overreach of government.
In general, I find the following characteristics fundamental for a sustainable and equitable system.
1) It must be financially self-sufficient (It must charge at least as much as it spends)
2) It must be available to any who choose to pay for it (No exclusion based on risk factors, though they may face vastly different rates)
3) It must be voluntary (No one should be forced to pay for something they decide not to use, regardless of their later likelihood for regret)
4) It must not be the only legal option (people should be free to find an alternative if they are unhappy with the service)
(I may have to amend that list if something I haven’t considered enters the discussion, but I think I hit all the major points)
It CAN be many other things, like part of a job compensation package in lieu of (some) pay, a donated item of charity or a reward for some outstanding service to an organization willing to fund it.

My proposal is the simplest one I see that meets my required criteria, but if you think something else is better, or you have other criteria then please present your case and supporting arguments.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 3, 2012 at 6:24 p.m. ― 2 years, 5 months ago

Benz, my solution is simple as well: Medicare for all citizens.

I have been looking at health care systems around the world, and Taiwan serves as an interesting case study.

They recently (1995) went from having a mess like we have to revamping their entire system. After much research they went with a single payer system similar to Medicare, and they have seen a huge improvement in health statistics, ratings from their populace, and their per capita costs in health related spending have **delined**.

I think Medicare is also a good start for looking at a single payer system because it's something we already have in place for a large portion of our population. We wouldn't be starting from a blank slate.

When the health care debate was going on there was talk of lowering the Medicare age to 50 or 55 and I actually supported that more than what ended up being passed, Why not lower the Medicare age to 55, and then study that group for 5 years. Look at everything in that demographic, and compare it to before and after Medicare eligibility.

Look at quality of care, costs, public health statistics, ratings from users, ratings from doctors and other hcw's, what do we have to lose? If we see it doesn't work then don't expand it for everyone, but if it is working expand it for everyone.

Medicare is actually a pretty successful program that has delivered and ranked high amongst those who use it. That's not to say that there aren't things that need tweaking, but overall I think Medicare for everyone is the way to go.

Keep this in mind as well - the people who already qualify for Medicare are by far the most expensive demographic in terms of health care. Seniors spend more on health care by far than any other demographic, somewhen we expand downwards it would not be as costly as it is providing for seniors.

As to your other points, the whole idea behind insurance is that you can't predict when or if you will need it. Just like you can't predict an auto accident, you can't predict when you will cut yourself and need a doc to sew our finger back on.

You keep talking about people who "won't use it" but how do you prevent not using it?

What if you are hit in the head by construction debris on the walking along the street and are rendered unconscious. You **will** be taken to the emergency room and you **will** receive care. Noody can say for sure they will no use the medical system at some point.

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Avatar for user 'benz72'

benz72 | April 3, 2012 at 8:37 p.m. ― 2 years, 5 months ago

An interesting position to consider, I was not under the impression that Medicare was financially self sufficient. I'm pretty sure they require government funding (more than 15% of the federal budget, unless I'm misreading it badly). Also, FICA certainly isn't optional. I believe Medicare part C is also a non-single-payer program. Do you propose canceling that portion, or have I mistaken the quick wiki synopsis I read?

I am also unclear how you see lowering the Medicare eligibility age solving the value transfer problem. Perhaps a fuller explanation would make it understandable to me.

As to not using the system, I am referring to the small minority who will choose to forgo treatment when it is offered in addition to those who would by conscious choice forgo preparation for payment and subsequently have no treatment option based on inability to pay for it.
The only reason your last statement is currently true (I believe) is that essentially all hospitals take federal funds and are therefore obligated to provide that care for free. If that restriction is lifted, or if the cost of unpaid treatment becomes high enough that these institutions are better off without that federal funding, then the situation will stabilize.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 4, 2012 at 11:25 a.m. ― 2 years, 5 months ago

Medicare is basically a social insurance provided by the government for everyone of qualifying age.

The reason it is so expensive is because it covers seniors who are the costliest demographic in terms of healthcare (by a huge margin) in society. Without it, there is no way our current insurance system would be able to remain in place. Most insured Americans get their insurance from their employers' plans, and the government program Medicare covers a group who not only spends far more on medical medical care than any other, but it's also a group where very few are employed.

If we didn't have Medicare and these people were in the current private medical insurance system, this system would either collapse or flat out not cover anyone over 65 because they couldn't afford it, and those employers and individuals who pay directly would not be able to afford what insurance companies would need to charge to cover this group.

That's why I find it so absurd to hear people talking about cutting or even doing away with Medicare. If you sit down and think about it, it would be **impossible**.

Now as far as expanding it, as I mentioned before similar things have been done in other countries, namely a single payer government system that works like a government issued insurance (different from the model in England which is more socialized by having doctors as employees of the government and hospitals run by the government).

Under Medicare, we still have a privatized medical system, but it's the **insurance** that essentially becomes public.

Before people freak out about "government control" of insurance, I think it's important to realize that our system as it stands now costs the American tax-payer MORE than any other tax payer on the planet, including nations like England where the tax payers pay for everyone's healthcare outright.

I don't think people realize just how significant the costs of uninsured people who seek ospital treatment really is. It costs tax payers a huge sum of money to pay for this cost, and I would argue that is already socialized medicine. It's like a back-door socialized system that costs us MORE than if the government just provided insurance outright for everyone, but we let it continue decade after decade because people say they don't want the government involved.

Another bennefit to the government providing insurance for all is that it eliminates another serious problem that is unique to the United States - bankruptcies from unpaid medical bills.

No other industrialized modern society on earth has a problem with this, yet it's an epidemic in the U.S. and it harms our economy.

No system is perfect, but I think a government insurance program like Medicare for all is the best scenario I can find.

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Avatar for user 'benz72'

benz72 | April 4, 2012 at 11:44 a.m. ― 2 years, 5 months ago

Having reread your argument, I still cannot find where you address how lowering the eligibility age for Medicare does not exacerbate the value transfer problem.

Additionally, the most logical solution to noting that a back door has been left open at great expense is not to open the front door as well, but rather to shut the door.

I believe I do have a grasp of the unsustainable cost of treating people who will not pay their bills. Rationally, we should cease doing so. You seem to be arguing for expanding a system that charges others for the care they receive. If I have mistaken your intent, please clarify. Otherwise, do you not see how this is immoral and unsustainable?

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Avatar for user 'Studying_Nomad'

Studying_Nomad | April 4, 2012 at 1:50 p.m. ― 2 years, 5 months ago

What’s immoral about pay-upfront health care? The part where we as a society have officially decided that the value human life is based on how much money one has accumulated or has access to in their life. It’s about time we are open about it.

We can have a TV show called “Sick American” where we text votes for which patients get to receive sponsorship money for treatment. We can learn their entire life story and judge the decisions they’ve made that have brought them there. Entertaining!

I’m on board with this idea if the following conditions are met:
- All drugs are made legal without prescriptions (Heroin to Prozac)
- Public schools are required to start teaching real health classes (Nutrition to Emergency care)
- Anyone in prison receives absolutely no health care under any circumstances
- No more health care for gov employees
- Abortion shall never be questioned again
- Euthanasia is made legal without limitations
- A system that removes poor sick people from the streets
- A system that allows one to receive expense reimbursement for getting sick from another

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Avatar for user 'DeLaRick'

DeLaRick | April 6, 2012 at 10:34 a.m. ― 2 years, 5 months ago

I hope this thread and discussion are still going. Benz, the "moral" argument of transferring value within different classes of society can be applied to lots of other areas, e.g. public works, highway and emergency services usage. Our taxes fund fire and police departments. When was the last time you used those? In my case, I haven't needed an ambulance or police assistance in more than 25 years. I have no problems paying taxes towards those services because they are for the greater public good and I might be needing them someday. Absent a system of true taxation, where each of us receives a tax bill only for those services we used throughout the year, paying into a general fund which allocates resources in the public's best interest is the best system we have.

If we can, let's talk about two of the core issues in the health care debate: access and reimbursement. Please remember that "access" and "ability to pay" are two different things altogether. For example: Don't discount the fact that hospitals are writing-off just as much money in patients' out-of-pocket liabilities after their health plans pay than they do for charity cases. Also, don't discount the fact that the wealthy benefit from being in the same insurance pools as the middle-class because they would much rather pay a premium than pay their hospital bills privately.

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Avatar for user 'benz72'

benz72 | April 7, 2012 at 8:02 p.m. ― 2 years, 5 months ago

I am intrigued by the comparison of public services, but those are different from medical care in a number of ways. First, my lifetime cost for fire, road and police protection can reasonably be expected to differ greatly from that of my medical care. Secondly, at least in the case of police, they perform a function that cannot be transferred to a private entity (competing private police forces would be chaotic). Third, the closest medical comparison I can come up with to the fire department is vaccination, which I agree should be provided for free, since it only works correctly if the vast majority of people get it. I do not have a problem paying for many group services either, but most health care is a very specifically targeted service, the cost of which is more appropriately directed to the recipient of said service. The CDC, FDA, public vaccination, &c. are good examples of group services that are appropriate to bill to the group. A heart transplant is not. Fire spreading through a city is too great a threat to everybody to take chances with. Mr. Smith reaching room temperature is not a threat to Mr. Smith's neighbors.

How do you define access, so that we can properly discuss it? I view access as 'available for purchase', what perspective do you hold?
Everybody who belongs to an insurance pool believes they are better off being in it; otherwise they would not endure the cost of membership. The most economically efficient size will vary with the details of each pool and plan.

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Avatar for user 'DeLaRick'

DeLaRick | April 9, 2012 at 10:30 p.m. ― 2 years, 5 months ago

It's true that your share of cost for emergency personnel will be less than medical insurance. If you believe that value transfers within police services don't occur, I urge you to observe then acknowledge the police "value" being transferred between City Heights and La Jolla. I believe your point is that the general public benefits from those services. Okay, I get it. No one can argue against that. However, I'd like to be on the panel where you explain how much more important saving a singular house from fire is than saving a tax-paying citizen with a lifesaving heart transplant. I bet the recipient of the transplant wouldn't take too kindly to your rationalization.

The growing number of uninsured Americans is a public health crisis which affects all of us. It's no different in scope than other public crises. It causes congestion in emergency rooms, which endangers the lives of those in ambulances which bypass emergency rooms because no beds are available. It has driven up the price of hospital charges to the point where only the wealthy could afford to pay privately for their services. (The increased prices lead to greater out-of-pocket expenses for insured patients.) Higher treatment costs lead to higher premiums which affect small business disproportionately. (Why? Because they don't have the same purchasing power as larger groups.) All of this affects our neighbors, relatives and fellow citizens.

"Access" in the health care world means treatment, regardless of purchasing ability. Our countrymen have established that access to medical treatment is as essential as fire and police protection. For that, what more proof do you need beyond the fact that the phone number for all three is 9-1-1?

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Avatar for user 'benz72'

benz72 | April 11, 2012 at 7:27 a.m. ― 2 years, 5 months ago

The emotional response of the man who is not worth saving is not the best determinant of a policy. Of course there are going to be people who object to being cut off from the subsidies they have been receiving. You see the same response from every special interest group when their 'good-deal' is threatened. To your hypothetical man I would ask what he has done to earn that very expensive surgery.
The underlying points remain unaddressed though.
1) There isn't enough for everybody to have as much health care as they would like
2) Limited service has to be distributed according to some fair measure
3) Mandatory service without compensation is going to either drive providers out of business (bad for everyone) or costing everyone who subsidizes that service (bad for everyone who pays taxes).
4) Price is a disincentive to consumption that allocates distribution. If the cost to me of any beneficial service is zero, I am likely to consume as much of it as I can.
I am not arguing that it isn’t sad that people get sick and die. I am arguing that without a rational value judgment we are likely to mis-spend resources, encourage overconsumption and foment resentment against those who are benefiting from that overconsumption at the expense of others.
The public health crisis IS different than other crises for a number of reasons that I have already pointed out. For that matter, every crisis is different from every other crisis. Do you believe that there will still be a shortage of beds if payment is required for a service? Will ambulances have to drive to more remote hospitals in that scenario?
By your definition of access, the only conclusion I can reach is that it cannot be sustainably provided without a massive increase in government revenue. Given that choice, It needs to go away since we can’t afford to provide for the things we are already spending on and it is unlikely to break even (for reasons outlined above).

Do you have some way to reconnect service to price without turning people away?
Can you find a way to provide for those who don’t pay without impoverishing those who do?
Do you believe that you are responsible to provide for me without limit or restriction? Do I not have any responsibility to advance my own interest? If I don’t, how do you see such a system ending up?

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benz72 | April 11, 2012 at 9 a.m. ― 2 years, 5 months ago

What more proof do I need to convince me that ambulance service is as much a public good as fire protection than the observation that the telephone number is the same?

Rationalization. I would need a much better rationalization for how an individual not receiving medical care directly affects me in a way detrimental enough that it is worth the cost of funding that care for him.

Just so you know what you are up against in this explanation though, world population just surpassed 7 billion, The US has more than 8% unemployment and there is no shortage of people who would love to live and work here in San Diego.

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DeLaRick | April 11, 2012 at 10:37 a.m. ― 2 years, 5 months ago

Benz,

I'm glad you're keeping this thread alive. ERs are overcrowded because both insured and uninsured persons use them as their primary care providers. The uninsured are more of a burden because they cannot be referred to another provider for immediate follow-up care, so they end up coming back to the ER for it. The ensuing negative feedback loop is one factor in overcrowding.

Most of your suggestions tilt towards personal accountability, which I support. (I don't know how an active individual would feel secure without medical insurance. It's beyond me.) The individual mandate in ACA would solve a lot of access problems. Absent the I.M., there has to be a way to incentivize the uninsured to buy medical insurance while at the same time keeping their access to treatment open. That's the crux. Any ideas?

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benz72 | April 11, 2012 at 11:28 a.m. ― 2 years, 5 months ago

Absolutely, require payment. This can be any combination of; Insurance, Cash, Line of credit, Property transfer, Charity, Loan from the provider, etc. etc.
People will choose the way that they feel the most comfortable or able to pay. If they can't, then that is a very strong signal that

1) They have not been productive enough to earn the treatment (cash, property
transfer)

2) Nobody cares enough to provide that care for them (charity)

3) They have not taken the precaution of preparing for their need (insurance, line of credit)

4) They are not worth investing in (loan from the provider)

And / Or

5) The treatment is not worth the cost to them

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Studying_Nomad | April 11, 2012 at 2:41 p.m. ― 2 years, 5 months ago

Let me state that overall I agree with Benz, but I’m unconvinced that Benz falls into the “average” income perspective and I think there are real problems with the application of his ideas. Personally, I think it’s time we start talking about population, resources, and the future as the two grow in separate directions.

How much should one have on hand for emergencies? We are talking about something without using real numbers, not that they are advertised anywhere, but I’m saying, let’s be real. My friend had had some digestive problem and needed surgery, it ended up costing $65,000. Friend with cancer has debt in the hundreds of thousands. People can’t get home loans, banks are going to start to lend to sick people? I can’t imagine someone making less than $50,000 being able to afford any serious emergencies, maybe some routine care, but just ask them about their dental today to get a general idea.

What would it do to our economy? Something like 70% of it is based on consumption, if we all start saving our pennies for a prosthetic leg, doesn’t that put a whole lot of companies that depend on consumers’ disposable income out of business? Taxes, rents, energy, insurance are all expected to go up, and the average salary is expected to go down. I see riots…

Charity – um seriously? I’m already getting hit up EVERYDAY in my mail boxes, not t
to mention on the street. Let’s say charity organizations somehow increase their available money, does that mean one has to be the perfect little Christian/Muslim/Jew to catch some of that? Who decides who is “worthy”?

What do we do with all of the mentally ____ (idk what the politically correct term is) on the street? Where do they fall into this? As far as I’m concerned they are already neglected and are dangerous on the street.

As for being a productive member of society, labor isn’t worth anything anymore, so how much “productivity” do you think the average citizen is going to have the opportunity to achieve in their lifetime? Companies are lowering the benefits that they offer and I doubt that trend is going to change. To push this problem onto the private market will just make it harder for small businesses to survive.

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DeLaRick | April 11, 2012 at 3:33 p.m. ― 2 years, 5 months ago

Our value judgements sound egalitarian enough. How about some viable ideas for providing access to emergency medical treatment for our uninsured while not legalizing the individual mandate?

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benz72 | April 11, 2012 at 3:43 p.m. ― 2 years, 5 months ago

If by "access" you are still using the definition decoupling payment from receipt of services then I don't have a sustainable suggestion and no viable ideas for generating one. Would you fund this access? Can you think of anyone who would, given that there are no restrictions on it?

I believe the unanswered questions remain, 'What is the (specific) value of providing this service for free?' and the closely associated question 'Is that value worth the cost to the people who will be paying?'

Did I miss those explanations?

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DeLaRick | April 12, 2012 at 11:44 a.m. ― 2 years, 5 months ago

Medical treatment at hospitals is not free. Charges are incurred from the moment a patient arrives for unscheduled treatment or is scheduled for planned treatment. Hospitals then submit bills to medical insurance companies as a courtesy for their insured patients or send "self pay" bills and statements to those without medical insurance. The latter begins about 45 days after discharge.

Benz, those are the facts. Please understand that nothing is "free" at hospitals. You're hanging yourself on some frivilous esoteric point. In retail parlance, self pay patients are extended "same as cash" terms for about 120-180 days. Some Self Pay patients pay their bills entirely; others exercise "prompt pay" discounts and pay their full balances with savings of 10%-25%; some set payment arrangements spanning 3 months to 3 years; some seek public assistance from the state in the form of retroactive Medi-Cal coverage; some seek public assistance from County Medical Services; some self pay balances are screened for "charity" write-offs; some, unfortunately, choose to do nothing and their debts are referred to collection agencies. What I just described for you is the status quo of self pay billing.

What does that mean to the argument your hauling up a slippery slope? Current laws, Hill-Burton, mandate rendering emergency treatment to all who present to hospitals which receive federal reimbursement from Medicare, i.e. just about every non-military treatment facility in the country, REGARDLESS of ability to pay. Let me help your point: "What is the specific value of providing medical services to the uninsured which hospitals are writing-off at record levels?" That's the correct way to frame the question. The answer is for society to decide. My vast experience in health care finance has thought me that there are lots of reasons why some people don't have medical insurance. My belief that every sick person's illness should be addressed regardless of economic means is informed by my experience as a human being. I have lots of friends who are physicians who are willing to treat anyone at anytime. They're waiting for society to maximize their collective talents.

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benz72 | April 12, 2012 at 12:35 p.m. ― 2 years, 5 months ago

DLR, I do not debate that, per current law, the situation is as you describe it. If I have inadvertently given the impression that I was I apologize. The point I am attempting to make is that the system, as it is set up, is unsustainable and we are seeing it begin to unravel. We are not able to supply everyone with as much health care as they choose to consume. The only logical divide I can identify is that those who want it badly enough to earn it win out over those who do not. What mechanism are you seeing that will counteract overconsumption to a degree that supply will not be so grossly out of line with demand?

Either the law must be changed, hospitals must stop accepting Medicare payments, hospitals must increase costs to cover non-payment (and enough people must be willing to pay that price) or hospitals will bankrupt themselves. I list these in decreasing order of desirability and it is possible there are more options I have not identified yet. Does your medical financial expertise offer some other balanced and sustainable method?

My belief that every sick person's illness should be addressed according to their value is informed by my experience as a human being. The fact that we reach different conclusions indicates to me that we have differing assumptions about the world. I would like to ask your physician friends if they are willing to treat anyone at anytime without limit. I suspect that there is some threshold beyond which they will decline to pay, out of their own pockets. If not, how do you think they plan to sustain themselves?

I did not see an answer to the question of public good I posed to you above. Similarly, the line of questioning regarding personal and interpersonal responsibility remains unanswered. Are you still formulating a response?

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DeLaRick | April 15, 2012 at 7:09 p.m. ― 2 years, 5 months ago

Access to emergency treatment and conservative follow-up care is, and should continue to be, part of our social safety net. Someone's employment or medical insurance status should not be the determining factor into whether someone lives or dies. That's my answer now; it was my answer last week; it'll be my answer 1 year from now. You could lose your job and/or medical coverage tomorrow and require emergency medical treatment. It can happen to any of us. Access to treatment, itself, is the valuable commodity for the greater public good.

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benz72 | April 16, 2012 at 6:50 a.m. ― 2 years, 5 months ago

I see a repetition, but not an explanation. How is that construct stable? Does it have limits, and if so, what are they?
I assume you are saying something other than 'I want everyone to have it, so they should, no matter the cost to others' but that is all I can see from your posts.
Please explain how you intend this system to reach equilibrium.

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DeLaRick | April 17, 2012 at 1:04 p.m. ― 2 years, 5 months ago

Benz,

Like lots of other government spending, e.g,, war, equilibrium is not tangible. Metrics don't exist for that. Why do you expect health care to be any different?

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Studying_Nomad | April 17, 2012 at 2:57 p.m. ― 2 years, 5 months ago

Good point, DeLaRick. I didn't think about it like that.

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JeanMarc | April 17, 2012 at 4:23 p.m. ― 2 years, 5 months ago

Benz, I have never seen you type one thing that I did not agree with whole-heartedly. You often articulate what I am thinking much better than I am able to.

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jrpcs | April 17, 2012 at 4:32 p.m. ― 2 years, 5 months ago

If the Republican leaning supreme court votes down healthcare reform....then the Republicans get the same healthcare they have always been able to afford, and the working poor get left behind due to unaffordable rates and lack of insurance for pre-existing conditions. What a sacriledge that this should be decided by Republican activist judges.

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benz72 | April 18, 2012 at 7:17 a.m. ― 2 years, 5 months ago

DLR, The assertion that war is not sustainable is absolutely correct. This drives us to end it and stop paying for those increased costs. Defense, as distinct from war, is a continuing expense (though less than health care according to Wikipedia) and has extremely negative consequences to defunding. By this I mean that it imperils the nation as a whole. There are very reasonable arguments that we could do with less of it, transitioning to a more isolationist / less interventionist policy but I have yet to hear a sensible argument for doing away with that collective good entirely. Some sustainable level is appropriate.

I would expect health care to be different because you expect (I assume) it to be indefinite. If your aim is to provide a large health care subsidy for a short period of time and then win a 'peace dividend' of better health without continuing to fund it then please outline that plan. If, on the other hand, you expect the system you describe to be solvent in perpetuity I am convinced it needs to obey those same conditions I noted above. Do you have such a plan in mind? Can you articulate it please?

From my perspective, there are also appropriate and sustainable federal health expenses as I have mentioned above (inoculation, research, information distribution, CDC). What is not appropriate is a blank check with no more stable financial underpinning than ‘someone should really pony up for that’.

JM, thank you very much. I have done a fair bit of thinking about some of these issues. Please add to the conversation with your own comments, questions and answers, as I’m certainly going to miss important perspectives and facts.

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benz72 | April 18, 2012 at 7:51 a.m. ― 2 years, 5 months ago

JRPCS, Health care benefits are not distributed by political parties. Republican poor will have the same burdens as Democrat poor, Independent poor and politically unaffiliated poor.

The issue isn’t ‘Be Republican, Get health care’ it is ‘Earn health care, Get health care’.

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Peking_Duck_SD | April 18, 2012 at 7:26 p.m. ― 2 years, 5 months ago

Benz, one problem with your argument as I see it is that you have a strict view of individual responsibility that is too lopsided and largely ignores what's in the best interest of our society as a whole.

For a nation of 300 million inhabitants to be successful and remain the worlds's hegemon, there must be a balance between individual responsibility and also practicality with safety nets.

Simply demanding individual accountability in totality out of spite can end up harming **everyone in society**, not only the individuals in need of help.

Case in point, the estimated 40 million people without health insurance. The consequences of them not having regular access to affordable health care are not theirs alone, but they impact all of us. Public health statistics show that humans are more productive and healthy when they have adequate access to appropriate healthcare.

Having nearly a sixth of our populace without such access which is rampant in the segment we refer to as "the working poor" causes more sick days and greater unproductivity when compared with our global competitors who do offer all their populace acces to health care. The working poor contribute greatly to laborious jobs in our society, and their productivity and vitality can directly impact the companies that more wealthy people run.

This is just one example of how the perils of having so many in our country without adequate access to healthcare can actually circle back and cause negative consequences to even those with means, and puts us at a disadvantage globally.

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Peking_Duck_SD | April 18, 2012 at 7:53 p.m. ― 2 years, 5 months ago

And any discussion of sustainability should include not only government programs, but corporate sustainability as well.

I hear many conservatives quick to point out government programs are not sustainable, but as we see every number of years with market downturns and even recessions/depressions, corporate sustainability is not much better (and I would argue worse) than government programs.

Take social security, for example. It enrages me when people call this a "Ponzi Scheme". Social Security has an over **SEVENTY YEAR** history of delivering as promised. Few private sector companies can claim this, and those that can have weathered good and bad times as well.

Social Security is also the main reason seniors have fared better in the current recession than the rest of the public. It's proof that capitalism needs safety nets in place. This recession would have been *far* more costly to us as a nation had social security not benn in place.

The reason social security and Medicare need much more funding today and will continue to for the next 30 years or so is **not** because there is any inherent problem with the programs themselves (and certainly not because they are "ponzi schemes"), it's because of the population trends in our country namely the low birth rate vs. the baby boomers entering their senior years.

I think the benefits of the government providing health care for everyone make more sense when you look at the big picture. Yes, there is an argument to be made about personal responsibility, but there are also the realities of the world today.

The idea of government involvement in health care is not a radical one, in fact we are the only industrialized nation on earth that doesn't provide healthcare to everyone, and what do we have to show for it :

- lower and continually declining morbidity and mortality statistics

- more spending per capita on health care than any other nation on earth (by far)

- we are unique amongst first-world nations as being the only one with an epidemic of financial bankruptcies due to unpaid medical bills

It frustrates me that government supplemented health care has become a political/partisan issue that makes people not see the bigger picture. It's like anthropogenic climate change - its become so politicized that relevant facts and statistics are blindly ignored because one political group has demonized it. The facts show that government supplemented health care is better than the mess we have now.

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benz72 | April 19, 2012 at 8:07 a.m. ― 2 years, 5 months ago

PDSD, I’ll address those statements in reverse order. Companies have a self interest to be stable. The fact that many of them fail to achieve that stability is perfectly acceptable though. Markets shift, Investments don’t pay off, Companies fail. There is nothing wrong with that. Those resources will be purchased by someone who can put them to better use, including the productive labor of those who are no longer employed there. In contrast, countries whose governments fail are an entirely different story. I don’t think we have any disagreement about the undesirability for that catastrophe.

You mention safety nets. I do not have a particular problem with the concept, but the purpose of a safety net is to temporarily arrest an accidental fall. It is most emphatically NOT a place to lounge for long periods of time. The correct term for such an object is “hammock”. The point I am attempting to make is that I agree that limited duration assistance can moderate transition problems, but if there is not a requirement to repay then the system becomes unstable. Specifically, if the potential for future repayment is sufficiently suspect then the term “bad investment” is appropriate and we need to be willing to decline that request.
Per your statistics, there are 40 million without health insurance. What current productivity do you view these 40M people as providing that justifies investment in their future productivity? If there is no market for their skills, what is the purpose of maintaining that excess population? The lack of obvious answers to these fundamental questions, combined with considerable levels of unemployment, leads me to question the validity of the conclusion you seem to reach that loss of low skill workers will have a significant impact on a company. Should your assertion prove correct though, it gives the employer a strong incentive to provide for health care for the aforementioned workers.

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benz72 | April 19, 2012 at 8:07 a.m. ― 2 years, 5 months ago

When you describe the interests of “society as a whole” you seem to indicate that those interests must be served regardless of the detriment to the individual. Is this a correct interpretation of your position? If so, do you see any limits to this service? To take a ridiculous example, I think we can both agree that despite the fact you have an ‘extra’ kidney no one may claim that you must give them one even if they would soon expire without it. Somewhere between ‘extra kidney’ and ‘spare pocket change’ there is probably room for agreement between us on what is appropriate to donate to the cause of others, though I am extremely wary of enforced donations. How much of what I have earned do you morally have a claim to? How much of what you have earned does some random stranger have a claim to?
As an aside, I’d like to assure you that my disinclination to provide for strangers has nothing to do with spite. I do not bear the persons we are discussing ill will or wish to harm them. I only seek to keep them from harming me. Their self-provision is their concern, and I do not ask them to consider mine.
As to your final statement, “The facts show that government supplemented health care is better than the mess we have now”, that is certainly true from the perspective of many. This would be especially true for those who benefit to a larger degree than they pay for. The valid question remains, how popular must something be before it is enforced on those who do not agree?

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Peking_Duck_SD | April 20, 2012 at 9:23 a.m. ― 2 years, 5 months ago

Benz, the reason I say spite is because you want to hurt yourself and your country just so everyone is responsible for themselves.

That's what I have been trying to explain.

YOU and ME are both impacted by the 40 million uninsured in this country.

Even though we have medical insurance those who do not are driving up costs, causing poor productivity, and causing our vital health statistics to sink below those of our competitors.

Sometimes you have to be practical and let things go.

If everyone in our country were wealthy, our country wouldn't function.

I have tried to make my points without putting morality into it - forget the moral obligation any nation, and in particular the richest nation on earth, has to our poor. And just look at it for what's good for our nation globally and long-term.

Your slippery slope argument about forcing someone to give up a kidney is to relevant because many nations have government Heath care and such a scary thing has it happened.

You ask what the limits are, and there are two:

The government should be more involved in health care than in other areas because health care is one of a handful of critical issues (like the military) that:
-impacts everyone
-is one of the 3 largest expenditures by our government
-is something that directly impacts the morbidity and mortality of our country, statistics used in determining which countries lead the world

It's scary to think that while we were spending trillions on unnecessary wars, other countries have been catching up to us in terms of health care, infrastructure, and technology.

We need a more balanced nation right now that spends **less** on military and the domestic prison industrial complex and **more** on technology, infrastructure, and the health care needs our country. Our nations economy right now is so lop-sided in favor of a prison and police state that we are starting to fall behind. Countries with high standards of living do not spend this much on war, military, and prisons at the expense of the health and welfare of their people. It's North Korea that does this.

You seem to be advocating that if someone here can't pay, they should not received each care. This would leave people literally on the streets dying.

While that would never happen because most Americans wouldn't let it, I find it disturbing that proponents of such a thing don't realize how just the stigma would hurt us. We would no longer be the worlds leader. People would not want to visit here. And we would become like North Korea in terms of a country other nations would likely cut off ties with due to human rights abuses.

This debate needs a little practicality involved.

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Peking_Duck_SD | April 20, 2012 at 9:24 a.m. ― 2 years, 5 months ago

I'm not suggesting any be forced to a doctor if they don't want to, but health care should be made available for **all**.

In the UK and other nations that provide health care to all, nobody of forced to see a doctor or have a procedure done, so how such lunacy has crept into the American healthcare debate is beyond me. Likely invented scare tactics.

And by the way, you seem deeply troubled by any government plans that help the poor. Do you feel the same way about government plans that help the rich? Because there are plenty.

You think people who can't afford healthcare getting a handout for care is wrong, but what do you think about millionaires paying **lower tax rates** than the middle class? Is *that* fair?

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Peking_Duck_SD | April 20, 2012 at 9:31 a.m. ― 2 years, 5 months ago

Correction in my first post, auto correct failed again. In countries where health care is provided or supplemented by the government, nobody is forced to have a procedure, certainly not forced to give up a kidney. Medicare is government supplemented health care, and it's rated pretty high by this who use it. I haven't heard of a senior on Medicare being forced to give-up a kidney.

Arebyou in favor of getting rid of Medicare?

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DeLaRick | April 20, 2012 at 1:04 p.m. ― 2 years, 5 months ago

PDSD and Benz,

We ALREADY have a public health crisis caused by the uninsured. I've already articulated just a few of the repercussions. There are more, but the ones I've already listed will suffice at any meeting of directors in any hospital board room. (They are hot topics at meetings across San Diego's health care system.)

Benz writes as if he lives on an island with himself as the lone inhabitant. Arguing about the merits of good collective public health is an awfully long walk to take just to end up at the same doorstep where you started.

It's not too complicated: The crisis will alleviate by repealing Hill-Burton or applying creative solutions which guarantee continued access. If you don't care about the health of your uninsured compatriots, you're for repeal; if you do care, you're for creative solutions. In the short time it took to read this post, the price of health care rose as a direct result of our public health crisis.

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benz72 | April 20, 2012 at 2:39 p.m. ― 2 years, 5 months ago

Thank you for your responses PDSD & DLR. Multi-part response for length limits.
I agree that both of us are currently affected by the 40M uninsured. I believe you are clear on my opinion about whether or not we SHOULD be affected. I have not yet seen a convincing moral argument, but if you choose to make one I’d love to hear it.
Regarding the ridiculous example I brought up and the repeated request for your view on the limits of obligation, I do not yet see where you view the end of public obligation to private health. I contend that there is none, and I understand you disagree. The limit you list (that the expense should be higher than that of the military) seems to set a lower bound when I was asking for an upper bound. I apologize for being unclear. Please allow me to rephrase the question. Is there any expense that is too high, and self -inflicted condition that is so unworthy, or any chance of recovery so low that your proposed system would decline to pay for the care of someone who will not pay themselves? I see the answer to this question as crucial to understanding the rationality and practicality of your system as PDSD claims my proposal does not provide it. The possibility that we view different things as practical is not a surprise, but we should be able to reach consensus. As an aside, could one of you please specify why allowing people to die is impractical? It seems to me an unavoidable end state. Yes I am advocating that those who do not pay are left where they are and can make themselves as comfortable as they can while they expire. I have already explained why I think this is the best available response. Is there any part I have not made clear?
As to the stigma associated with that outcome, I am unconvinced that foreign opinion is a sufficiently powerful force to concern ourselves with. Right now Syria is massacring the citizens of Homs with artillery and the international response is… tepid. Attacking civilians is abhorrent and criminal, declining to help is a different story entirely. As to world leadership, I don’t see a direct correlation. Are you claiming we would face embargo? Invasion? Ejection from the UN? What specifically do you foresee as the consequence?

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benz72 | April 20, 2012 at 2:40 p.m. ― 2 years, 5 months ago

I absolutely concur with the necessity of more balance and endorse your call for lower war expenses. That is a completely separate debate and I suspect we will discuss our reasons and thoughts eventually.
I am deeply troubled by government programs to help any individual. There are many reasons for this, but the one that most closely relates to this discussion is that it will increase expectations to an unreasonable level (i.e. that a government can and should provide this service without limit for free).

As for taxation, again I suspect we will have another opportunity to discuss it later, but my main view is that it should be equally applied to ALL persons living in the country. I don’t think income is the metric by which we should figure tax, but if that is how we are doing it, then Bill Gates and grocery baggers should be using the same rate. Anything else is a manipulation and difficult to justify morally.
For Medicare, I would advocate allowing it to operate as an opt-in form of insurance and require it to charge enough to cover the outlays is distributes.
I recognize that I do not live on an island. I understand that it can be advantageous to help others, and I do. I do not believe it is appropriate for the government to do it. Charity is a private choice, and no one should be able to demand a contribution.

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Peking_Duck_SD | April 20, 2012 at 6:09 p.m. ― 2 years, 5 months ago

Benz, I apologize as I didn't articulate very well above. There is so much to say on this topic that it's easy to get side-tracked and ramble.

As far as limits, I think there is a pretty clear distinction between making healthcare available to all versus forcing people to use it.

If you look at other countries or our own Medicare, the stats show the number of people that don't want to use healthcare at all is very small. And I think forcing someone to actually see a doctor against their will is clearly unconstitutional.

You have to keep in mind that our Supreme Court has already established the constitutionality of far more intrusive public health measures such as mandatory vaccination (Jacobson v Massachsetts, 1905) and quarantine powers. Each individual law or court opinion contains reasonable exceptions (for example, a child with a documented illness that makes vaccination more risky can be exempted).

The reason we have historically given the government such power is in the name of the public's health and safety. If someone has a highly contageous disease like smallpox, the constitutional interpretation has been that the individual's personal freedom may need to be infringed upon to protect the community at large (via quarantine).

Keeping in mind that our country has generally upheld public health and public safety measures as long as they are carried out reasonably, I don't see where simply providing health care for all due to the collective negative consequences to society of having tens of millions without access would pose anything unreasonable or unconstitutional.

Of course limits and protections for individual coil liberties would need to be worked into any such endeavor.

But I do need to go back to the point tht we already have Medicare. I am presuming fom your arguments you are against Medicare? From what I've read, it has a pretty high rating amongst seniors, and the number of testimonials from people who say they would have been destitute without Medicare far outweigh any complaints from seniors that it's a government over-reach.

I'm glad to hear you agree with everyone having an equal tax rate :)

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Studying_Nomad | April 20, 2012 at 6:10 p.m. ― 2 years, 5 months ago

I get what benz is saying. I think we should be able to "opt-in" for all government expenditures. I don't like that my tax dollars subsidize foreign aid, foreign intervention, either of the two recent wars, the tax-free status of religious and "charity" or non-profit organizations (including kpbs), political campaigns and an entire list of other .gov issues. I wish the 1040 allowed one to rank in order how you would like your money to be dispersed. I also don’t like the idea that I’m paying for people that I don’t like or respect to be treated. We are all going to die and I’m totally cool with that fact.

However, this medical system is crazy. How are we to expect that grocery handlers can afford health care? These costs are out of control. Oh it’s the uninsured peoples fault, oh it’s the cost of malpractice…blah, blah, blah…yet, profits all around, while people go bankrupt. Why are we treating people who are prison for violent crimes? Why do we have money (borrowed, yes) for wars, but we can’t put some money towards subsidizing education (interest rates or scholarships) for people to become doctors. Why aren’t we coming up ways to encourage the growth of the supply side? I’m not looking for a society where everyone gets a heart transplant up to the age of 120, but we can’t expect to have cheap labor and a populace that can afford regular check-ups. We could reduce the need for medical intervention by simply teaching people about their body and creating a culture of healthy living (but then a lobbyist screams that we are violating free market principles as they broadcast ads of healthy people doing unhealthy things with no side effects).

Reality check, Americans don’t want flippin charity. From my perspective and experience we want to not be taken advantage of by people willing to exploit whomever (the sick) for a profit, and we want to be able to live in place where it is possible to take care of oneself without needing a handout. As you can tell by the unrest from right to left, more and more people are finding it hard to take care of themselves. Understand that the above statement is not against profits, but against the current extremism that has taken over every single issue in this country.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | April 20, 2012 at 6:13 p.m. ― 2 years, 5 months ago

De la Rick, I agree we already have a PH crisis. If I posted something to make you think otherwise, it was a mistake on my part.

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Avatar for user 'benz72'

benz72 | April 23, 2012 at 7:19 a.m. ― 2 years, 4 months ago

PDSD, I see that my arguments are being conflated. The limits I am asking about are not the legal ones, but the financial ones. When do you propose to tell someone they are not worth saving? There clearly needs to be a line, and I suspect mine lies in a different place than yours. Whet expense, extreme condition, negligent behavior or advanced age would disqualify someone from receiving costly treatment subsidized with taxes?

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Avatar for user 'kstmarfot'

kstmarfot | July 15, 2013 at 1:37 a.m. ― 1 year, 2 months ago

Simply demanding individual accountability in totality out of spite can end up harming **everyone in society**, not only the individuals in need of help.

Case in point, the estimated 40 million people without health insurance. The consequences of them not having regular access to affordable health care are not theirs alone, but they impact all of us. Public health statistics show that humans are more productive and healthy when they have adequate access to appropriate healthcare.

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