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Erica Ravin-Anand

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Should health insurance be related to a patient's risk?

If a patient is diagnosed as pre-diabetic, but does not improve his/her lifestyle habits (i.e diet, exercise), and the condition deteriorates, should it be the responsibility of the insurance company to pay more money for medication and treatment? This also applies to dental treatment and other health-related fields. When a patient is diagnosed with periodontal disease, but oral hygiene continues to regress, why should dental insurance have to pay for more extensive treatment when the complications could have been prevented?

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    May 16 2012: In Belgium, yes to a certain extent:
    if you take a mortgage to buy a house, you need to have a life insurance policy, for which you will pay more if you are a smoker.
    Dental care is reimbursed but only if you go at least once a year to the dentist.
    But for bigger problem it becomes philosophical: Yes a patient with diabetes needs to eat and live healthier, but the cause and effect is not automatic. People who lead a healthy lifestyle may get diabetes. So to punish people because they get sick is IMHO totally unfair. Take cancer, and the debate gets even more acute. Would we deny someone with cancer a proper medical treatment because his or her health insurance would prove too expensive, hence not profitable for the insurance company?
    Can we let someone die in the 21st century because of money, whereas there is a treatment?

    I'm proud to pay 50% of my income in taxes (yes, 50%...) because it means even a poor person with cancer can get an appointment with a good doctor (and not wait for months) and receive the best treatment there is. I believe rich countries are not the ones with the highest number of billionaires but the ones with the fewest poor people. BTW, China, Russia and India are in the top 5 countries with the highest number of billionaires, where poor people with cancer have fewer chances to survive this disease...
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      May 16 2012: what do you mean by unfair? a sickness in itself is unfair. how do you make it fair by forcefully taking money from another individual? i say forcefully, because a free market solution will never result in an insurance that does not reflect to current health situation. the fair solution of course is that people get insurance before they get sick, so by the time they get sick, the cost is already set by the contract. it is either fixed or changes in a pre-agreed manner. both are fair, since they are based on mutual consent.

      helping out those few that failed to cover themselves, and got in trouble is another issue. but today, a tiny fraction of healthcare expenditures is used for such cases. most people could afford medical procedures on market price, although surely with serious difficulty. those few exceptional cases when people don't have insurance, but face huge medical costs they can, in no way, pay, we can solve through the usual channels: charity.

      you are proud to pay the taxes, because you think it is used for good. you choose not to know how wasteful the state is, even in the few cases in which they actually finance something that is needed. you choose not to know the economic progress forgone. you choose to see what the state provides, but you don't want to know about the unseen, all the things that didn't come to life, because the state took away vast amount of resources from the people. with the economic growth that money could have provided, we would long since have solved problems like cancer or diabetes.
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        May 16 2012: Krisztian,
        I think your view and my view are opposites.
        PS: I'm not an idiot who thinks the state doesn't waste money on stupid expenses (Belgium has a population of 11M and 65 ministers...) but agree that some of this money is wasted and some is well spent.
        "Free" market led to the 2008 crisis, remember? Perhaps you trust the invisible hand and I do not.
        I wouldn't go further since it is another debate and I wouldn't want to divert the topic created here.
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          May 16 2012: yes, "free" market led to 2008. free market would never have led. that's why we don't want things to be "free". "free" healthcare, "free" education, "free" press and all those things in quotation marks that the state provides are bust.

          but this was not the essence of my comment. the essence was: you could have used the money you paid to the state much much better. if you spend 15 minutes to find good charity organizations, you do it better than the state does. sorry, but you have wasted your tax euros. you have a good excuse, it was not voluntary.

          and that trust argument i don't buy either. gravity does not depend on your trust. nor the success of an economic policy. it either works or not, it is not up to taste.
  • May 15 2012: If one assumes that costs are mediated by insurance companies, then it is important that they all play by the same rules, and the less latitude, the better. If one assumes that the question is how to charge for care, the perhaps Beat Richner has demonstrated by example that the least expensive system of health care is that which socializes the cost of care the most. That is, don't use money for incentives, use it for salaries and medicine, and do so until the queues get short. This is similar to the demonstration in the United States that the least expensive form of fire protection is to provide excellent service paid for by taxes, not user fees.
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    May 14 2012: @peter lindsay: "You don't have to pay for it. You could always ensure your income is below the threshold. You still get the coverage"

    so your argument is it is not socialist, because it is even more extreme. it is not like everyone pays proportional to his income, but rather a few unlucky people pays for other people's services. it is no longer socialism indeed. it is slave labor.
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      May 14 2012: In your ideal stateless existance who is going to maintain the roads and the hospitals and the schools? Who is going to finance research into cancer? There are all these state run facilities that 90% of the population don't use, so don't see the need for, so the state mandates that public buses must be wheelchair accessable and the state runs special schools for kids with intellectual disabilities. In Australia the state does these things because the people asks it to. We have publicly funded healthcare because the people voted for it.

      On a different note the vast majority of people pay the Medicare levy. In Australia minimum wage is $29000 per annum so it is really only the unemployed or those with partial employment that don't pay their share and unemployment is currently 4.9%.
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        May 15 2012: the need for a simple answer feeds statism. we don't need a single worldwide strategy to finance those. since people need roads and hospitals, they figure out how to finance them. private service providers, communities working together, insurance companies or solutions i can't even imagine happily emerge on the free market. if the free market is good at something, it is serving needs. that is, providing supply for any demand, in the economic sense.

        in another post you said it is easy to avoid, so it is free. now you say almost everyone pays. i'm lost.
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          May 16 2012: It doesn't need to be world wide but its helpful if you can travel around without having to change the side of the road you drive on every 50km. Its also helpful if I move to a different town for the schools to be run along the same plan as the schools where I moved from. In 1901 the six Australian settlements joined to form the commonwealth precisely to avoid the problems caused by having independantly run settlements. Before federation there were three different rail gauges in use now there is one. Keep in mind Australia is the size of Europe but with only 20million population so we tend to move around a lot.

          We choose not to avoid the medicare levy out of civic duty.
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      May 15 2012: I would like to invite you to comment on the conversation I started regarding whether voting should be compulsory in a democracy as although we disagree, I do like people that have an opinion and aren't afraid to state it.:-)
  • May 12 2012: Deane,

    Please don't put words in my mouth. I do not advocate mob rule and I typically agree with people I live with. I also don't want to live in the "prison of the strongest." Not sure where you're getting this stuff but you're certainly not describing my views.

    You may think that freedom has been picked apart by wise philosophers, I respectfully disagree. I think that enlightened people need freedom and I'd be happy to put the logic of my philosophers up against the logic of your philosophers. I seriously don't understand what's immoral about not wanting to initiate force against innocent people which is the core tenet to any freedom oriented philosophy (often called the non-aggression principle). Freedom is in no way "a vacuum" that sucks sickos in and no I'm not "one of them" (very rude comment on your part). How human beings being fallible equates to freedom being bad I don't understand. In fact, I would argue that the fallibility of people is dramatically amplified by the immoral power of the state, which has led to the unnecessary death of millions of people. Ted Bundy didn't kill a fraction of the innocent people that Obama and Bush have killed because he didn't have the power of the state to do his bidding.

    Regarding your neighbor, I would help her and if I were in the same shoes, my friends and family would help me. I don't need the Govt to force me to do the right thing and if they wouldn't take so much of my money, I could help a lot more.

    No more straw man arguments, no more ducking the Q, please tell me why it's okay to initiate force to force your social agenda on others? If it's not okay, then why do you support it?

    Spence
  • May 11 2012: Deane,

    Not sure what arguments I'm ignoring so I'll ignore that one.

    Why you'd think I'd like to kill myself if beyond me and couldn't be further from the truth. I love life, I love freedom and I'm I love interacting peacefully and voluntarily with other people. I do get a little irritated with people thinking that they have the authority to force me to give money to wars I don't believe in, football stadiums I don't think should be subsidized, welfare systems that turn able people into wards of the state, legal systems that put marijuana users in prison, and "healthcare" systems that destroy health. Whether I'm right or wrong about any of these things is not the point, it's my life, my earnings, my choice to support what I think is right. The 51% has no moral authority to force me to support the opinions of others UNLESS I am directly hurting them (e.g., self defense). My view asks nothing of you other than to interact with others on a voluntary basis. Your view is violent to the core even though I'm sure you would never act violently yourself. Why outsource something that you know to be wrong if you did it yourself?
  • May 11 2012: @ Krisztian --- you say this 'in pure libertarian principle, there IS NO government at all'

    then you say 'principles don't exist in reality. principles are concepts, mental structures' and complain about me using the P word. Evidence you are not really arguing here -- just trying to draw us into your twilight zone.

    I thought we had a discussion, but you seem incapable of discussing anything but your puritan views. Consider what hitler did with the 'handicaped' and consider what your arguments lead to. Not low, just reality that you have to face. bye now
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      May 11 2012: you do that. you mix concepts with things.

      and we never had a discussion. you just keep repeating that i'm wrong, without even trying to tell why. did you present any arguments here, for example?

      is this "hitler and the handicapped" supposed to be an argument? since when the non-aggression principle consistent with killing people? how can such a thought even cross your mind? what hitler's got to do with liberty? with libertarianism? with the non-aggression principle? with free cooperation of people? hitler is the very antithesis of libertarianism. hitler is on the same side with you, actually. he had a vision how to do things, and he declared all other views jew or communist or mentally ill that should be eliminated. that is the way of thinking we are up against.

      in your society, no matter what i think, i have to do what you think. i my society, even if you are horribly wrong, and i can prove you wrong, you still can do that, as long as you don't hurt other people. it boggles the mind how can *you* compare *me* to hitler, and not taking ridicule and outrage from a dozen of people immediately.
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    May 11 2012: @peter lindsay: "If you don't like what the government is doing vote for the other guy."

    why? i just explained that i have a problem with the entire concept of the state. how would "voting for the other guy" in power solve this? similarly, you can't solve the problem of robbery with replacing the robber with another one.
    • May 11 2012: Your idea of libertarian morality is way off. There have been a long line of phliosophers and thinkers (much more prolific and considered than you or I) who have picked these false libertarian presumptions apart from their basis. Read them instead of insisting on your own inconsidered and morally twisted ideas. My own conclusion is that there is no inherent morality in having a 'state'. The morality comes in when people, human beings like you and me, do and say things that are detrimental to others. Therefore, you can't leave a vacum for people and tendencies like, say, Sadam Hussein, Adolf Hitler, Stalin, Lenin, and the sickos in Hungary and the East Bloc (to name a very few--NorthKorea comes to mind) and all those other humans who accept and join in on these sick tendancies. Sickos like this exist and your ideology gives them free reign. I therefore firmly hold that your ideology seriously ignores the reality that is a basic part of our human existance -- that all humans are inherently fallible, and subject over their lifetimes to making wrong choices or simply going nuts. Luckily though this doesn't happen to everyone all the time. A quick look at human history, with all its troubles and killing, most humans together have been able to overcome this fallibility.

      Your ideology also ignores the other side of our human fallibility, which I will exemplify in my neighbor's ten year old daugher. She has had a medical condition from birth that limits her capacity to interact fully with others. The old fashioned word for this is handicapped. Your ideology ignores her, and all those others like her, entirely. And that is the height of immorality.

      You're trying to say humans should have nothing to do with each other, not join together to consider rationally how they should behave toward one another. That didn't work 10,000, 1,000, or 100 years ago. It won't work with 7 bn people in this world. You can't hate everyone else in the wold and live in your own thoughts!
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        May 11 2012: you are here to repeat "you are wrong" endlessly? it is kind of fruitless. either tell me what's wrong with my arguments, or don't write at all. this "i could tell you why it is wrong, but i won't" is a waste of everybody's time.

        sadam hussein, hitler, stalin, lenin where state leaders. so your examples don't help your case at all. we claim that the state is that evil by its nature. some states are more, like the north korean, some are less, like the US or sweden. but it is just a difference in degree, not in principle.

        the fact that humans are not perfect does not support statism in any way. the leaders of a state, and the voters that elect them are also human, thus the state can not solve this problem.

        and yet again, just because we didn't have a free society 1000 years ago, it does not mean we never will. we didn't have woman suffrage 100 years ago, and now we have. slavery also ended. there is progress in the world.
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      May 14 2012: I guess the main difference between you and I regarding the state is that having grown up in a democracy with regular changes of government on the whole Australians see the "state" as something that we are in control of. I don't perceive the state as the other guy I feel part of the state. As we speak the federal government has no clear majority. For any bill to pass there must be a consensus between different parties or one party plus at least four independant members. I know nothing of Hungarian politics but get the impression that the situation is somewhat different to ours
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        May 14 2012: if you feel part of the state, it just means that your knowledge is lacking. by its very definition, the state is an organization. it has a leader or leaders, it has departments and agencies. the country is not the state, the people are not the state. the country has a state, the state manages the country.

        but yes, they do everything in the book to identify with the people. all leaders do in the modern era, even the vicious murderer communist dictators did. as the people have more power today, consent became a more serious issue. at its current form, states are not even run by a man or a group. it is run by a convoluted system that everyone participates in. if we want a state, democracy might be the best way to go. but it does not remove the inherent evilness of the state, as i pointed out numerous times.

        and the argument, yet again, is: if two adult people come together, and decide to do something with their own property, the fruit of their time and labor, and hurt nobody else, the state or any 3rd party has no right to interfere with it. if they do, that is morally the same category as car theft or breaking a window.
  • May 11 2012: Why didn't you tell me socialized health care was "free." Sign me up!
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      May 11 2012: Of course the irony is its only free for you the rest of us chip in just incase some one falls off their high horse.
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        May 11 2012: that is called insurance, and used to be voluntary. and of course nobody calls that free.

        so far, we were told that the proposed healthcare is

        1. voluntary, though you can not choose to leave
        2. free, though you have to pay for it
        3. not socialist, though everyone pays for it proportionally to income, and everyone takes proportionally to his needs
        • May 11 2012: Insurance has never been voluntary, your concept of libertarian voluntary is totally twisted and immoral. Answer this, how long has insurance existed in human existance. Your historical horizon is rather too limited, and you view of other human beings is not entirely sound.
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          May 14 2012: You don't have to pay for it. You could always ensure your income is below the threshold. You still get the coverage
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        May 11 2012: @Deane Goltermann: "Insurance has never been voluntary"

        ugh, what? i have two life insurance policies, both of them totally voluntary. many people has insurance on their house and car. what are you talking about? do you know what an insurance is? there are no insurance companies in sweden? i feel like i'm in twilight zone.
  • May 11 2012: You may accept that 51% gets to do whatever they want to the rest of us. I never agreed to that and never will. The majority may get me to do what they want by threatening me, but that doesn't make it right. Instead of mob rule, I choose freedom.
    • May 11 2012: 'I never agreed to that and never will'
      But what you advocate is mob rule, since you don't want to agree with anyone you live with. Your concept of freedom is twisted to the extent that you want to live in the prison of whoever is strongest at the moment.

      Your idea of libertarian morality is immoral. There have been a long line of phliosophers and thinkers (much more prolific and considered than you or I) who have picked these false libertarian presumptions apart from their basis. Read them instead of insisting on your own inconsidered and morally twisted ideas. My own conclusion is that there is no inherent morality in having a 'state'. The morality comes in when people, human beings like you and me, do and say things that are detrimental to others. Therefore, you can't leave a vacum for people and tendencies like, say, Sadam Hussein, Adolf Hitler, Stalin, Lenin, and the sickos in Hungary and the East Bloc (to name a very few--NorthKorea comes to mind) and all those other humans who accept and join in on these sick tendancies. Sickos like this exist and your ideology gives them free reign. Are you one of them? I therefore firmly hold that your ideology seriously ignores the reality that is a basic part of our human existance -- that all humans (including yourself) are inherently falable, and subject over their lifetimes to making wrong choices or simply going nuts. Luckily though this doesn't happen to everyone all the time. A quick look at human history, with all its troubles and killing, most humans together have been able to overcome this fallability.

      Your ideology also ignores the other side of our human failty, which I will exemplify in my neighbor's ten year old daugher. She has had a medical condition from birth that limits her capacity to interact fully with others. The old fashioned word for this is handicapped. Your ideology ignores her, and all those others like her, entirely. There arAnd that is the height of immorality.
  • May 11 2012: The WHO uses different standards then I do to judge a system. I start with the Q, "Is it voluntary?" Socialized health care relies on force which makes it a non-starter for freedom loving people. You can dig up any stats you like but the only way to get us in is by threatening to hurt us if we don't comply. Is that really the answer?
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      May 11 2012: If ever you're in Australia you better make sure you make your wishes clear, otherwise if your in an accident some stinking socialist paramedic might take you to a hospital so another socialist can heal you. All for free and against your wishes. The HORROR
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        May 11 2012: the horror part is not that, but when the tax collector comes for half of my income.
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          May 14 2012: In Australia the Medicare levy is zero up to $18000 per annum, 1% from $18-77000 per annum and 2% above that. You just take it into account when negotiating your remunerations package.
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        May 14 2012: this is an illusion. companies don't have property, only people have. if a company pays a tax, it is paid either by its shareholders or its employees or its customers.

        a worker has a marginal productivity (marginal revenue product). wages tend toward this marginal productivity. with tax, this is lower. so wages tend to be lower if there is a tax. it is just a trick, and you fell for it.
  • May 10 2012: That's funny.

    I'll take your response as an acknowledgement that socialist health care is not a voluntary system.
  • May 10 2012: Lots of assertions with little evidence. Which premise is incorrect, the premise that interactions should be voluntary or the premise that you can't be compassionate with another person's resources or maybe the more basic premise that you own yourself (including your time and resources)? I think those are all valid but I'd be willing to consider arguments against any of them.

    Is socialized medicine voluntary?
    • May 10 2012: "Don't point a gun at me, tell me to pay and then tell me how you're being compassionate."

      1) Who is pointing a gun at you? False premise, false all around. It is disconcertingly paranoid, too.

      2) Tell you to pay -- this argument is an old one that denies the basis of democracy. We live in a representative system and all taxes are imposed on the basis of representation. You don't want to accept that there are others who think differently than you (that is, raising taxes for a governmental purposes is legitimate) so you want to deny your participation in any tax system. That is, you don't want to be part of society in general. Libertarians like to say all taxes are theft, which you imply. Some more disconcerting vibes arise here where you want to deny the rights of others to exist and to think freely for themselves.

      3) I am not telling you to pay, I am taking part in a society that says we want to raise this money (taxes) to pay for certain societal benefits. This means everyone should pay 'cause everyone benefits--back to our representative system...

      4) I am not arguing that I want to be 'compassionate' with your money. 1) I am willing to pay myself, and 2) my primary motivation is my own self interest and your primary motivation should be your own self-interest (though I don't expect you to be able to understand that concept). That is, I am selfishly interested in paying the taxes necessary for a healthcare system that generally benefits the society I live in. This requires a system that is efficient, open, and transparent-- which of course has not been the case with many systems that call themselves 'socialist'. Take a read of the discourse I've had w/ Krisztián below. Check out how they do it in South Korea, and Singapore -- is that 'socialist' (and therefore bad) or is it a smart way to create the prerequisites for a successful, healthy society--or at least something better than before. Despite all our humans frailtes.
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        May 10 2012: representation is not a basis for theft. try using the following argument: we, here, a company of 5, decide that we take 100 bucks from you per month. in return, you get free lawn mowing, plus you can come over, and you have one vote in every decision we make. there is no opting out, and if you don't comply, we simply take it from you.

        do you think that such a concept would get a pass from any court on the world? obviously not. i can not order you to participate in such a scheme. anyone with a tiniest sense of morality would call that a brutish mob action. but when it comes to the state, we accept that with a wide grin. that "representation" excuse is very very weak.

        basically, anything the state does would cause outrage if done by a person, group or company. everything the state does would be considered either thoroughly stupid, utterly wasteful, ruthlessly immoral or a combination of these, when done by anyone else but the state.

        so i wonder. what is that strange power in the letters S T A T E that makes all these things not only acceptable, but cherished?
        • May 10 2012: Krisztián, you just went off into one of the basic false arguments of libertarians. Your company doesn't exist, it doesn't represent society, and it is not representative of all who live in a society. Therefore, it has nothing to do with the concepts we're talking about.

          Basically, anything the state does (assuming a fairly open, transparent, noncurrupt mechanism -- not what you had in Hungary after wwII) is done at the behest of the individuals in that society. There is nothing thugish about it, and the libertarian argument about the state being similar to the mafia simply misses the reality by a long shot. To the extent that you are not describing reality any longer.
          Now, when you add corruption to the equation--a current problem is many states--you get a widespread reaction to real injustices. But you can't mix up the concepts. Crime is crime--when committed by mafia types, and when commited by the policeman asking for a bribe. But that doesn't make the concept of needing police false--it is simply poorly implemented. That that poor implementation is a problem reflected in our human frailties does make the issue pretty widespread. However, humans can and established systems to avoid these problems. The state is made up of you and me, hate the state and you hate yourself.
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          May 10 2012: If you don't like what the government is doing vote for the other guy.
      • May 10 2012: Deane,

        Regarding "Who is pointing the gun at you?"

        If I don't pay for a socialized program that I don't support I'll get a nasty letter. If I ignore the letter I'll get another. If I continue to ignore the letters men from the Govt with guns will show up at my doorstep. If I ignore them then they will take the guns out and point them at me forcing me to acknowledge their authority. In the end, every law is enforced through the threat of force or direct force. This fact should not be taken lightly. Still missing where that premise is false.

        51% of people have zero moral authority over me regardless of what agreements you may have made with them. The mob may have immoral authority because they are willing to use force to get what they want, but that doesn't make it right. I have not agreed to this contract and would never want to impose such a contract on my neighbors. I strongly prefer voluntary interaction with people.

        3) You use the term "should" pay where the more correct phrase would be "must pay or else you will be put in a cage and/or shot."

        Finally, you never answered my basic Q . . . is socialist health care voluntary? If it's not, you can list the benefits all day long, but I want no part of it. Let me know the best voluntary option and I'll have your back. Don't underestimate the violence of using the Govt. to get your way.
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          May 10 2012: Spencer please see the obove comment to Krisztian.
        • May 11 2012: Spencer, you have a tendancy to ignore the arguments presented to you, and you have a tendancy to not consider the entire conversation as it arises here. I have answered you question, mostly in other comments--you simply have to read them and try to understand.

          Your 'IF' argument is really off base-- it puts you squarely within the ideological framework of the Branch Davidians who preferred to kill themselves rather than live in society. Your ideology boils down to 'kill or be killed'. There is a basic fallacy there that indicates you have an inability to deal with other people and with reality.
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        May 11 2012: "anything the state does [...] is done at the behest of the individuals in that society"

        i said that what states does is silly, ineffective and morally wrong. and now you defend it by pointing out that people elected them? why would that be any better? silly, wrong and immoral things don't become suddenly rational and moral if people vote for it. rather, it should be the opposite, people should vote for things that are rational and moral. as of now, they don't.

        so that's why we argue about it. we try to explain why the state is immoral and wrong. and it is not a counterargument that "but we like it, and we are more".
  • May 10 2012: You certainly have not experienced the chaos of services provided in the US, then. Sure my argument is simplistic -- it is only one sentence! The US experience is a very good example of a nation fumbling away its technological prowess and advantage in the name of bad market regulation and bad governmental regulation of those markets. Things work fine here in Sweden, and have been progressing well throughout Europe on this. South Korea, Taiwan, and Singapore seem to function relatively well.

    As for libertarianism, I am certainly for both a governmental presence (requiring good and transparent governance) and for limiting that presence to the extent it is not needed. I can understand that you (and others with similar historical issues) are wary of the first part--but I would suggest that your history of governmental presence pretty much lacked entirely the 'good' and the 'transparent' parts, and much else, too. Such an experience would certainly leave a bad taste in just about any reasonable person. American libertarians seem to me to be filled with rabid anti-types that hate too much.
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      May 10 2012: i still believe that there is nothing wrong with the cellphone service in the US, and i will believe that until you show me what is the problem with it, and how could it be done better
      • May 10 2012: Well, your inability to take me at my word is a worrying sign. In general, I have read articles at my technical level (low) that describe the technical problems involved in the US markets -- the sum of which is that the US cell phone service is not a system, but rather several systems that conflict and cause excess costs and other technical problems. You will have to find your own sources to read up on that.
        But my opinion is based on disussions with family over there, where a natural topic of conversation is how much does your cell phone service cost and what do you get for it. In comparing, my US relatives are surprised the services I get in 'high' priced Sweden are more comprehensive in coverage and competitive in pricing. Then they describe the problems they have with coverage--in their homes in suburbia, and whenever they need to travel anywhere. Describing it as a chance-taking at all times. Sometimes it works well--like when we went to Disneyland, and sometimes they have no coverage with the 'national' service they have selected. Then my cousin, a high-powered business type (not your typical 'socialist') with extensive business travel experience in Asia just shakes his head and confirms that things are better elsewhere. I can accept that as confirmation that something is wrong there. You may not.
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          May 10 2012: i tried, but 5 minutes googleing didn't result in anything. a solution can be complex. being complex not necessarily bad. for example the chocolate market is very complex, and before you try, you don't know what to expect. the banking or insurance sector also known to be complex. what's wrong with being complex?

          also note that US has a very low population per square km. coverage is a huge problem, so it is natural that a more localized, more diverse solution appears.

          solutions tried on the market. if users demand more coverage, a company can offer better coverage at a higher price. if users are willing to subscribe to that service, the company makes profit. what is interesting here is that it didn't happen. so we can conclude that providing better coverage would require so high prices, nobody is willing to pay that.

          lamenting is one thing. paying for it is another.
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        May 10 2012: Its a matter of needless complexity. In Australia my cell phone company has a network that covers the entire country. I can drive my car 2000km and my cell phone doesn't have to interface with other networks. I can also access one of the fastest mobile internet services in the world over the same nationwide system. Of the other two networks one provides a similar level of national coverage and the other is a city centred network aimed at business people that only covers major population centres. I beleive at last count there are around 180 different providers in the US
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          May 11 2012: if you know a better way to do this, why don't you do? why nobody does? there is a jackpot there that nobody wants to collect? everyone is stupid in the US?
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        May 14 2012: Unfortunatly the better way is to put the cell phone network under government control, which niether you nor the US are likely to accept.
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          May 14 2012: not at all. the state proved many times that there is no rock bottom. there always is a worse level of service, and a higher level of waste.
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        May 15 2012: The Australian system that I described above is state controlled and works, probably because it is privately owned but state regulated.
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          May 15 2012: i would claim, without having good data at hand, that a state solution costs 5 to 20 times as much as a similar level of free market solution. i also claim that state solutions used to be convoluted and rigid. you are the first person i've ever met being satisfied with state public healthcare.

          hybrid solutions are always better. but the question is, what is the correct mixture of good and bad? in my book, it is 100% good.
  • May 10 2012: Any system that relies on forced transactions is undignified or unethical or immoral or all of the above. If you think that I should pay for someone else's services then persuade me to do so voluntarily. Don't point a gun at me, tell me to pay and then tell me how you're being compassionate.

    Regarding your Qs, I'm talking about both before and after Obamacare. Our system has relied on forced transactions since at least the 60's and it's getting worse every year.
    • May 10 2012: Any argument that relies on false premises based on absolute, and incorrect definitions of the reality we live in is indeed undignified, and unethical, and immoral. Your arguments fall into that category fully.

      You will not be persuadable until you start really seeing the world. Your gun obsession indicates you have serious difficulty in taking a well-adjusted, reasonable view on this or any matter. I know there are many using this kind of argument in the States, but numbers doesn't make it more reasonable. I can add other observations about your statements but will refrain.
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    May 9 2012: As someone who has grown up with government run health care I find it impossible to see the distinction between my government forcing me to pay a 2% medicare levy to fimance healthcare and the same government forcing me to pay 30% income tax to cover the running of other government departments. If libertarians are so against being forced to be part of socialised healthcare why are you happy to be part of socialised road networks, socialised armed forces, socialised police, etc. You should refuse to pay any income tax and turn to the private sector for these things. Then they might run as well as the US cell phone network.
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      May 10 2012: why are we happy with that? we are NOT!! in pure libertarian principle, there IS NO government at all
      • May 10 2012: Ahh Krisztián, you have never experienced the chaos that is the US cell phone network!! A very good argument against the libertarian foolishness of NO gov't.
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          May 10 2012: that is probably the most simplistic argument ever made by a human. as far as i know, cellphone service in the US works. whether it can be done better, and a better service would find its demand is debatable. but since nobody so far proposed a better system at a marketable price, probably it is the best solution.
      • May 11 2012: Kristian -- there is not 'pure libertarian principle' that exists in reality, not now, not every in human history. Your are arguing your dream of perfection while ignoring the reality of your human imperfection. This is one of the basic falacies of libertarian thought. In other words it just doesn't accept us humans as human beings. Hitler had that kiind of philosophy too.
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          May 11 2012: principles don't exist in reality. principles are concepts, mental structures. so what is your point? in 1500, there was no capitalism, no socialism, no democracy, no equal rights for women ... you would say back then that "we don't have democracy, so we don't need"? the nature of things to improve. we discover new things, and advance forward. your world view is a relic of the past. or, more precisely, it should be. we are working on that.

          that remark about hitler is the lowest of the lowest.
  • May 9 2012: There are several kinds of system that would suit both you and me at the same time, I believe. Sweden's current system has been modified signficantly in the last 5 10 years (Starting with the old-time 'socialists', but last 6 years with the 'conservative centre-right'), so that it is much closer to what you describe.

    Suggest you look at how Singapore does it -- still national, national insurance, but, much private provision and funding --very much mixed. They seem to have gotten something right -- considering their internaitnal health rankings and cost of provision--especially coming from where they started 50 years ago. But then again, some don't consider them a 'democracy'...
  • May 9 2012: @ Krisztián below ... I seriously doubt your statement about those examples.
    My examples are of people living in democracies who actually vote, with their rights and pocketbooks, in signficant majorities to keep the kind of healtcare system I describe, and most do it for selfish reason, which doesnt fit with any considered definition of socialism. Do you want to call modern Germany 'socialist', or, say the UK? What about Singapore or South Korea? Then you'd mock the word by calling, say, North Korea 'socialist'. Though all have some kind of national health care system. Though in Germany, UK, Sweden, and South Korea, I know the system is not fully 'nationalized'--as in there is a thriving system of private provision (though different in each).

    I think of both Hitler and Stalin calling themselves 'socialist' and then the new French president calling himself 'socialist'-- I note the wide gulf that exists between the first two and the latter. What I define as socialism, then, is basically an irrelevant and useless exercise. What I want to see is results, practical results. And I see the Swedish healthcare (both publically and privately owned) providing among the best services in the world (though certainly not perfect)--for almost all citizens at a cost that is 1/2 to 1/3 less (in terms of GDP) than the healthcare US citizens get, including when only, say, 60 to 70% of everyone in the States can access this more expensive healthcare.

    This difference is striking. Calling it 'socialism' does it a great disservice and ignores too much of the efficiency and other gains a society gets with a system that works. It ignores the many private providers contributing to making that system work, as well. Like I said before, we live in a different world than even 20 years ago.
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      May 9 2012: i don't know what statement and examples you are talking about. either reply to the comment, or quote relevant parts.

      i gave you my definition of socialism. you are debating it or not? if you are, present your counterarguments.

      germany and UK are half-socialist countries. approx 50% of all the goods people produce is taken and redistributed by the government. schooling and healthcare is publicly funded.

      calling it socialism is simply true. why would i call it anything else, if it matches my definition? actually you are the one that needs to ask yourself: how it is possible to cherish an idea, but refuse to call it on its name? why do we redefine our words every decade? what is that doublethink that socialism is not good, but public finance according to needs from tax money is good. it is like saying that carbohydrates are bad, but wheat is good.

      interestingly, i don't think that being a socialist is wrong, as morally wrong. i just think it is a wrong idea. if you are socialist, it is perfectly okay for me, but i think you got it wrong. so i want to change your opinion in a debate. on the other hand, you treat socialism like something shameful. i can't wrap my head around that.
  • May 9 2012: @S.Stang below -- I see socialized medicine as entirely voluntary, and the smartest, most efficient way to deal with the messy business of all our human frailties. I include your frailties, and mine. I include my neighbor ( a high powered business executive) who's first daughter has autism, epilepsy and a few other issues to deal with. He willingly pays his high taxes while voting for the Swedish center-right (nonsocialist) current government to finance the national healthcare system.

    Will quote my conversation above --
    The issue should be whether health care is available to all citizens or not. I don't see this as a 'socialist'/socializing issue. It is a practical issue of making the world/society that I (or you) live in a better place to live--that is, I it is in my own (and everyone's) selfish interest to have a nationalized healthcare system. In this system (which is pretty much, though not perfectly, applied in Sweden where I live now) the healthcare system looks to the needs of both the individual and society, which speaks for more preventative measures all around. This benefits the individual so they can live a healthier, fuller life. And it benefits society since a) you have happier, healthier people around, and b) since preventative healthcare is rather much cheaper to finance. In other circles this is called a win-win situation.
    This also defies all those that see social healthcare as a zero-sum game -- where the benefit to the individual is only a cost to society. The way it works practically is that everybody gains. I have examples -- personal and friends to support this for anyone interested.

    "medicine at the point of a gun" -- this is a typical screwed up view of the entire issue and the world. It indicates to me that you have some pychological issues in your relations to your fellow human being. If everything in your world boils down to 'whatever you want' then there is no reason to live with other human beings. Is that were you want to go?
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      May 9 2012: ah, that is good. if it is voluntary, we have no disagreement. count me out.

      alas, it does not work like that in hungary. i can't opt out.
      • May 9 2012: Why do you want to opt out? If it doesn't work, then fix it -- don't trash it. Otherwise you'll end with a lot of trash...
        But I can understand there are historical issues still playing into peoples' attitudes and ideas. The thing is you have to work on is making the future better, at least, for everyone. Not always an easy thing.
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          May 9 2012: simply i have different views how healthcare should be done.

          in my system, there are private service providers, and there are insurance companies. i would like to have some insurance that covers only expensive stuff. i don't want free blood tests and free visits to my GP and free x-rays.

          then i want to help out my family members, friends if they get in trouble.

          third, if there is a fund that helps poor people to get service, and their policies are to my liking, i will be regular donor to that fund. i think it is efficient, and moral.

          so thank you, but i'd rather opt out from your service. can i?
  • May 9 2012: Beg to question your question! ;-) The issue should be whether health care is available to all citizens or not. I don't see this as a 'socialist'/socializing issue. It is a practical issue of making the world/society that I (or you) live in a better place to live--that is, it is in my own (and everyone's) selfish interest to have a nationalized healthcare system. In this system (which is pretty much, though not perfectly, applied in Sweden where I live now) the healthcare system looks to the needs of both the individual and society, which speaks for more preventative measures all around. This benefits the individual so they can live a healthier, fuller life. And it benefits society since a) you have happier, healthier people around, and b) since preventative healthcare is rather much cheaper to finance. In other circles this is called a win-win situation.
    This also defies all those that see social healthcare as a zero-sum game -- where the benefit to the individual is only a cost to society. The way it works practically is that everybody gains. I have examples -- personal and friends to support this for anyone interested.
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      May 9 2012: it is a good thing that we arrived to an era in which socialists deny that they are socialists. at least you can't sell that idea on face value any more. that's a progress.

      however, we still have many many socialists, and socialism is not dead at all. it is just disguised, dishonest. that's bad.

      what is socialism? socialism means that the state provides a service, not the free market. people get it according to their needs, and not according to the money they pay. we get pizza on payment. a pizza is $5 for everyone, at a certain restaurant, regardless of income. this is the free market capitalist solution.

      what are the characteristics of nationalized healthcare? payment proportional to income, service proportional to need. that is, by its very definition, socialism.
      • May 9 2012: I don't accept your 'name-calling' on this issue. Besides, I can beat you at that game. I think your definition of 'socialism' is entirely out-dated. which says to me your living in a fantasy world that no longer exists. Or perhaps you have to deal with people who call themselves 'socialist' as a way to argue the 'correctness' or 'rightousness' of their views -- say in the former eastern bloc.

        But don't count me in that group, thank you. I am a conservative in the best sense of the term, but, well, the term lives a rather corrupted life in today's USA. Just as you have a rather cock-eyed definition in your response.
        Like I said, I can give you real examples of real people who enjoy their lives while still paying taxes for a well functioning healthcare system.
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          May 9 2012: and i can give you examples of people who enjoy their lives in poverty, illness or dictatorship. it does not make those things good or even acceptable.

          what is your definition of socialism?
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    May 9 2012: Absolutely not, first of all this presupposes that medical science has all the facts about disease progression, it does not, and that health risk is solely related to behaviour, it is not, genetic makeup which is something an individual does not control will influence both risk of acquisition of a disease and also how a disease may progress. Environmental risk factors are also outside of the control of many people, as are risk factors than an individual may have been exposed to in utero or during childhood which they can hardly control. Allowing health insurance companies to decide on this issue is loaded with moral hazards when the bottom line is profit.
  • May 9 2012: Absolutely not!

    Regardless of lifestyle health insurance should be a right and costs of premiums, care and drugs should be fixed and regulated by the government. Healthcare should not be part of the capitalistic free market, people lives are not commodities and surgeons should not make as much as they do today.

    However there should be premium discounts for people who take care of their health (normal weight, non smoker, non drinkers, exercise, have regular physicals) but some jobs are tough on people's health and you can't judge that. For example most truck drivers are grossly obese because all they do is sit all day long, eat junk food at truck stops and smoke because they are bored. Oil rigs workers are at high risk of being injured on the job, and you can't judge that either.

    Anyway, insurances cannot differentiate lifestyles from plain poor health, they do not have enough information about us and should never have access to it. If we allow them to attach a risk to a patient, they will and they are now denying cancer patients and so on or making the premiums so expensive that people can't afford it and this is totally unacceptable.
  • May 9 2012: No, not entirely. If the medical issue can be prevented and proper action is not taken, then Yes. If the pre-existing condition can not be prevented or maintained at a healthy level then no, the insurance should not be related to risk.

    To require someone to pay more because they can not change their biology is like saying their life is not as valuable as someone who has perfect health. It is inhumane.

    I feel as though many Americans forget that living in this country is a blessing and not a right, and with these privileges we should be willing to do our part in being responsible for ourselves by living healthy and treating our body and mind well. IF you make the choice to eat poorly or be a couch potato, that is your chosen liberty, and should be forced to deal with the consequences of choosing so. Being pre-diagnosed with any number of diseases is unfortunately not a choice, and sometimes can be debilitating to the point that living well is difficult. With the rapid advances of technology in the medical field we should be able to pick up on these issues before they become overwhelming, and in attempting to prevent further complications we should educate and teach proper lifestyles that benefit each individual case. By doing so, you are informing each patient of the consequences and risks he/she is making by choosing a lifestyle which does not suit their biological needs (which of course is their liberty as a citizen, but liberty is not cheap)
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    May 9 2012: Yes.
    Please clarify your statement "It's impossible to be compassionate with somebody else's resources."
    Thank you.
  • May 9 2012: The price of health care should be be set at whatever level the buyer and seller agrees upon. If I were selling healthcare insurance, I would surely give people who were likely to use less care better rates than people who were likely to use more care. To be honest, I find the need to discuss this Q to be a bit scary in the sense that free people should see the answer as being obvious . . . kind of like saying, "Should I have to pay more for a gallon of milk than a quart of milk?" The fact that there is such a discussion on this topic makes me realize that many people don't value freedom to the degree that I wish they would.
  • May 9 2012: To answer your question simply, only after a baseline determination. After that it's based on behavior.

    We need a three pronged approach to solving the crisis - massive educational outreach - making unhealthy food more expensive through penalty (taxes) and shift existing subsidies to healthy food production - and increased health care costs for bad behavior. In any case, since money always talks we have to shift the conversation and listen to other voices.
  • May 8 2012: If the insurance is picking up the tab for someone's poor lifestyle, it is enabling unhealthy behavior. Why should a person who maintains a healthy lifestyle be forced to subsidize someone elses bad lifestyle. Insurance companies do not pay anything, it is the customers of the insurance company that pay. Healthcare is not a right, it is a responsibility. We need to move away from the comunitarian insurance model toward one where the individual saves to provide his or her healthcare - much like we save for retirement or housing, recognizing that this is easier said than done.
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