Erica Anand

wife, mother, evolving pediatric dentist ,

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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?

  • May 8 2012: To my fearful American friends, I'm an ex pat Brit living in the US this past 25 years. I love the place...but the health care system leaves much to be desired.
    Suffice to say my British friends who are working here now for limited times (say 3 year stints) with young families, ALL without exception tell me that they didn't know just how much they would miss the National Health Service in the UK.
    These are professionals working here with good insurance.
    Health care is a very UNSAVORY subject here. It's actually undignified and vulgar the way it is apportioned.
    Quite unsavory!
    • May 9 2012: It is undignified. Health care, along with all other transactions should be based on voluntary exchange, not forced transactions. Our current system is far too linked to forcible transactions which dramatically skew the market and add multiple levels of unnecessary bureaucracy.
      • May 9 2012: What? are you talking about the system before O'bama care (for which implementation hasn't really begun) or are you talking about the old systtem, in which it was undignified that some 30 to 40% of Americans received less than complete medical care (since they are uninsured) while the American health care system consumed the largest share of GDP in OECD countries? Where is your sense of dignity?
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    May 5 2012: Don't really understand the question- you did say health INSURANCE, didn't you? Insurance is a business based on understanding probability and mitigating risk. It's a numbers game, the mathematical reverse of what happens in a casino. In health insurance, if you win, you're sick. So of course it should be related to risk. Just like car insurance, house insurance etc.
    That doesn't mean the health system ought to be insurance of course. It could be government subsidised insurance (base it on risk, but government subsidises genetic risks so that everyone pays the same), or it could be like the NHS in the UK which is all government expense. But insurance is insurance, so the answer to the question as put must be yes.
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    May 4 2012: No.
    No one is consulted about being born.
    It just happens.
    To all of us.

    No one request their human frailties.
    Or historical period.
    Or economic condition.
    Or family into which they are born.

    Human beings are not created equal.
    Each is unique.

    A civil society cares for it members.
    • May 9 2012: I assume you mean that "a civil society cares for it's members" voluntarily, not by the force of Government. After all, if you have to steal from one neighbor to take care of another neighbor then your society doesn't sound too civil. I also assume that you understand that it's impossible to be compassionate with somebody else's resources. There are no such thing as rights that compel another person to do something for you.
  • May 6 2012: Absolutely, and for the reasons you suggest.

    If someone is demanding a knee replacement and they are substantially overweight why not prorate the coverage? An ounce of prevention is worth a pound of cure.

    What we need is a regulated health care system that retains the proven value of the private market, yet recognizes the benefits of behavior that lowers health care costs as well as imposing penalties on lifestyles which adversely affect these costs.

    It seems only fair. I nominate you to be a member of the think tank.
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    May 5 2012: Erica,

    A great question and pointing to some leading edge discussions and thinking on health care and health insurance.

    Absolutely patients should have primary responsibility for "wellness" and their insurance rates should reflect that in the same way that safe drivers accumulate sfae driver discounts

    Our present system doesn't ecourage, seek or reward wellness. It rewards providers for procedures and services. The more procedures and services, the more income but wellness isn't even in the picture. Medical executives at a recent seminar suggested that it would be wiser to have providers get a fixed fee client in wellness programs focused on prevention and healthy habits. There would be more profit for providers when their group is well . ( moral hazards there obviously but conceptually makes a good point) Other panelists at this same seminar pointed out that the system rewatds procedures and uit sof service..the more x-rays the more profit...the more profitable the xray unit and even more so with over use of MRI's and Cat Scans.

    Insureds who commit to their health..who diet, excercise eat right live responsble lives should definitely be rewarded with significatly lower rates.

    But the whole principal of insurance is risk pooling. It is impossible to have fully individual rated insurace. Any one of us could get cancer, be in a devastating accident no matter how much we commit to wellness so we are co-investing in those risks to which we are all exposed as one component of our insurance but here shuld als be a personal risk factor there that rewards for wellness.
  • May 4 2012: Simply put, a right implies provision of services, whereas a privilege is that which one must pay for. Every developed country recognizes their well being in the world it social/health/economic/ largely dependent on the physical and emotional health of its' citizens. The economic strength of the insurance industry in the USA has precluded appropriate political intervention.
  • May 4 2012: The very notion that the provision of health care as "insurance" defines an economic model, which is improper. One must define health care as either a right or a privilege. The US remains the only developed nation that fails to provide health care for all citizens, despite costs 2x-5x greater than other national health systems that provide better care models and superior outcomes. This is abysmal.
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    May 4 2012: Erica, Please allow me to approach this from a totally different angle. I live outside the box. Insurance and patients are nothing more that product and buyer. For insurance it is strictly lawyer written clauses that will allow for maximum profit and higher yeilds for stockholders. As for the patient they seek a safety net in a world where they are only a pon in the great game. Look at your last medical statement. Charge $500 - allowed $125 - co pay $50 - etc... The medical billing company knows the amount to charge to recieve the amount expected. You are #1234 who recieved a #205 and a #156 lab so T=$500 + L=$200 (B=$700) - A=$125 with CP=$50. Premium rate is $600 per month and #1234 cost us $1200 annually and we receive $7200 in payments equals a net of $6000. That is you to the company. If you really want a scare read the ObamaCare plan. Not what you have heard about it .... read it yourself. There was a national shocker last year when a teenager went on a show stating she was the family wage earner. She stayed pregnant and got money and welfare for 4 kids plus herself. The question was should she be denied further assistance for more illegitimate children? People who do not work do not care because we, the people who do work and buy insurance pay their bills. Look at your state budget. The highest percentage is 1) public health care; 2) education, 3) prisons and public safety. That is where your money goes. So, Erica ... Hospitals, dentists, doctors, labs, etc ... raise their costs to include those that the government makes them treat without payment. The cost of illegal aliens in the US is trillions of dollars a year to the taxpayers but the the federal government refuses to enforce the laws of immigration.

    The answer is when the doctors/companies begin operating at a loss they will pack up. It has little to do with health needs. All the best. Bob
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      May 4 2012: While ur trashing Obamacare we should consider that if the republicans hadn't let the GFC happen your unemployment rate would be 5% like ours is. That takes a lot of the burden off public healthcare.
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      May 4 2012: Robert, you are correct.
      When the lecherous capitalist vultures cannot profit they will seek other fertile fields.
      Damn the rest of humanity.
      Hell of a system.
      Zero sum.
      It's time for a change.
      A change founded in 21st. Century context.
      Not 19th century and earlier.
      Humans imagined, then created the current system.
      Nature did not put it here, a human mind conceived it.
      Human toil brought it into being.
      Humans can re-imagine and recreate a new, inclusive system.
      One that serves the greater good.
      Human kind.
      Win, win.
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        May 4 2012: Manual, While I agree that ours is not the best system it is head and shoulders above what else is offered. The problem I have is letting "government" legislate healthcare. The over 2000 page (mostly unread) current government healthcare document is a nightmare. So much a nightmare that members of Congress and the executives that drafted it and voted for it EXCLUDED themselves and their families and through dhimmitude all muslims. I am also amazed that areas such as death panels passed through our "representatives". We know that socialized medicine does not work ... so as you said it is up to us mortals to devise a better method.
        • May 4 2012: "We know that socialized medicine does not work...."
          sorry robert, do you mean that in sweden they have worse health conditions than in the u.s.? may i know under which point of view? thanks. all the best.
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          May 4 2012: You are mistaken.
          Our system is inferior to other developed nations.
          Including Cuba.
          There are substantial facts supporting this.
          Common knowledge.
          U.S spends more and delivers less.
          Unless of course you are in the .001%
          U.S. focus is on fixing, not prevention.
          It's more profitable.

          Profit centered medicine serves investors (aka profiteers).
          Zero sum.
          Patient centered medicine serves patients.
          Win, win.
    • May 4 2012: as far as i can see it, the problem is exactly that health in u.s.a. is considered just a business.
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        May 4 2012: it is like saying that the problem with designing a bridge is gravity. surely, with no gravity, we could design and build much better bridges. but you can't deny reality.

        we live in a world with scarcity. we don't have all the resources we need. we have less, and we need to optimize how to use them. that is called "economy". you can not consider something not as business, just like you can't disregard gravity. we have limited amount of man hours, especially trained man hours, limited amount of tools, buildings, materials, drugs, etc. the questions in never whether we want to save a man's life or health. the question is whether we want to save his life at the expense of someone else? who we want to save? how many children can have one more hour of education if we do not give a man access to an MRI scan? do we want that scan or the hours of education?

        remember! "do we want that" is always a wrong question. good questions always look like "do we want this or that".
        • May 4 2012: ciao krisztian. thank you for answering. that's it. we need resources to live, and these resources are limited. and what we consider a proper life, it's meaning, the way each of us likes to stay with others (meaning with this organizing a society), priorities in life, “moral values” “ethics” ect., are as important as resources and they’re strictly related. On how resources should be distributed, who deserves to have more and so on we could open a never ending new debate. depends on the idea we have about the topics above. my short answer to robert winner means that I prefer a society where health system is paid by taxes, and so that even lazy non working people (to consider the worst case) can access healthcare, rather than one based only on free-market criteria which isn’t fair either. both have pros and cons, perfection is not an option on planet earth and for what i’ve learnt so far in my life, i keep considering the european welfare state, especially scandinavian welfare state, the best option (by the way in europe generally both education and healthcare are paid by taxes, and if you’re rich you’re always free to choose to pay for a private health insurance and/or private education). I don’t put it in right/wrong terms (right and wrong are always relative and subjective terms that need to contextualized), let’s say that balancing pros and cons I’ve made my choice.
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        May 4 2012: Andrea, Perhaps the business would be better if the government, lawyers, and insurance companies would stay out of it. Being a business is not all bad. It inspires competition and that is often translated into better procedures. I do not have a problem with doctors making money. I do think that there should be limits to charges though. Perhaps patients should be seen in a nursing clinic and then refered to doctors to cut costs. Maybe we can discuss a better way to do business. Thanks for the reply. All the best Bob.
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      May 4 2012: But healthcare should NOT be a matter of profit and loss. Maybe we should be looking at a global solution from which all citizens receive free basic and emergency healthcare and the individual countries pay into the WHO pro-rata to their GDP.
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        May 4 2012: bread making should be? i would say food is more important than health. why food production is subject to profit and loss?

        "profit and loss" became curse words. why? they are synonymous with efficiency. we don't want efficiency in healthcare?
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        May 4 2012: Hi Lesley, Perhaps a better way to do "business" would be to go to a nursing clinic and be refered to doctors as needed. The major problem here in the US is ... my opinion .... the interference into medicine by government, lawyers, and insurence companies. Your right there has to be a better way. I do not know if there is a global solution. I would probally look at the problem on a smaller scale and see where those answers could be applied. Enjoyed your reply. Thanks. All the best. Bob.
  • May 4 2012: Short answer, no.

    Not everyone is capable of making the changes some of us take for granted. Furthermore, once we start to make a list of activities that positively or negatively impact patient health, how many of us would fall into one category or another. This is extremely similar to denying coverage for preexisting conditions, which thanks to President Obama will no longer be allowed.

    For example, there is strong evidence supporting the positive health benefits of moderate consumption of red wine. Could teetotalers be denied coverage for heart conditions that may have been mitigated by drinking wine?

    We all know regular cardio exercise has positive health benefits. Should coverage be denied to anyone who does not meet some exercise requirement? What proof would be required to comply with such a rule?

    Or, what if an unborn child is known to have a birth defect, should the insurance company refuse coverage or charge more if the parents refuse to have an abortion? Until recently some insurance companies did deny coverage to newborns; they were considered to have a preexisting condition prior to being covered by their parents insurance.

    Coverage should be universal and unconditional. The U.S.A. spends twice the money on health care as the number two country spends, we get less for our money, and we are the only developed country without universal coverage. Every time a question like this comes up I feel sick. This is a ridiculous short-sighted question, that really is completely absurd and frightening when one takes any amount of time to consider the ramifications of such a policy.

    Especially in light of the coverage enjoyed by the citizens of, well, every other developed country in the world!

    I have just one question: do you work or lobby FOR THE HEALTH INSURANCE INDUSTRY? Which acts like the mob, and skims billions out of our system, while failing to honor their contractual obligations. These corporations are a major reason health care is so expensive.
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    May 3 2012: Erika, in theory (and in fact as of 30 years ago) "insurance" was the practice of spreading risk among a large pool of insured folks. Under such a theory and practice there were some adjustments for increased risk after you have made a claim. What we have access to now is NOT insurance, it is something else where the so-called insurance company dictates what services are available, what they will pay a provider for those services, and how much profit they will take on all involved transactions.... ie the purchase of the insurance, the services provided (or not) and the fact that they often deny coverage despite a valid claim in the hopes that the covered person will give up on pursuing a claim in utter frustration (or die before they get the claim approved). The primary reason the insurance company SHOULD have to pay is that they as an industry, as a whole, intentionally makes it very difficult for the "covered person" to get any sort of preventative care at all. I do like Peters' idea (below) but I suspect that it would be a political non-starter in the US. I also want to note that the insurance companies all want $550 per MONTH from me (that's more than my mortgage payment) for any sort of medical coverage that's actually useful. (for which I used to pay Kaiser $70 to $90/Month in the 1980s') My actual annual medical costs for the past 10 years have been about $600 per YEAR. Please...explain THAT one to me in a way that actually makes some sense!
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      May 3 2012: In Australia we also have several health insurance companies that are "not for profit" or co-ops surely this is something that should be encouraged. Although it does seem like everything in the US is profit driven.
  • 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.
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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: 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.
  • May 8 2012: Everything has a price, I accept that. But what price a nation that does not highly prize the general health of its populace, you know the people who pay all of the taxes?
    Healthy people make healthy tax payers...surely that's an axiom?
    The American Dream has been compromised by the health care debacle. In the past an entrepreneur (You know those wealth creators who have huge lip service paid to them) could start a business and not worry about health insurance, he could pay the Doctor $100 for his kids illness.
    Now that same entrepreneur can't in good conscious, start a new business unless his spouse works for a large corporation and they get their family health care that route. A Startup businessman finds it VERY difficult to get decent health care insurance for his family at a reasonable price.
    The general economy suffers because of it.
    Having started over 10 companies in the US, I have a little experience of this.
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    May 8 2012: Healthcare should not be funded by insurance.

    That's like saying car insurance should pay for an engine rebuild because you didn't change the oil. The insurance industry was never designed to pay for an oil change so why do we think it should pay for chronic illness care?
    • May 8 2012: But the current healthcare system is funded by insurance. If a person goes in for a surgery the insurance company does cover a portion of the procedure.

      the auto and healthcare industries are different so it is hard to compare them.
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        May 8 2012: Brandon
        No, actually the two insurance industries are the same. It used to be called major medical and was designed for catastrophic illness. It was never designed for chronic illness management. Those newer products arose as changes in consumer health and demand drove them. The underlying fiduciary responsibilities are still based on catastrophic management. Meaning basically the healthcare industry is funded by a for-profit corporate structure where shareholders matter more than stakeholders..
        • May 8 2012: Since the newer products have arose from demand, is the system still the same? If a sick person goes into a hospital they will treat the person regardless of insurance, though a bill is still sent. But if that same person takes their car to a mechanic there is no government legislation that requires work to be done.

          So, just because the underlying systems used to be the same doesn't mean they still are the same because of government intervention to mandate service.

          I do agree that healthcare shouldn't be funded by insurance. I think that if the US is going to take a stance that we will take care of everyone who needs it then I don't see why we shouldn't just all chip in for service before something happens. Heck, our tax money is being spent for medical research already, why shouldn't it be spent for care as well.
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        May 8 2012: I actually agree with your conclusion but I wanted to illustrate how the health insurance and car insurance industries are still the same. What if government mandates required that insurance companies cover not only the oil change, but also the very oil that goes in the car? What if a person was negligent and never changed the oil and the government mandated that the engine rebuild and all the replacement parts were to be provided by the insurance companies, including harvesting parts from non-functioning vehicles? What if the government would mandate that all regular maintenance on a vehicle was to be covered by the insurance companies, battery changes, steering fluid, transmission service? The auto insurance industry might just look exactly like the health insurance industry. They would develop different products for consumers while still protecting their profit margin.

        Can you even imagine what that would do to the rates?

        Underneath it all they are the same beast. The difference is that not everyone owns a car, but everyone has health to maintain.
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    May 8 2012: Don't confound insurance with charity -- and don't mistake State forced transfers for charity .

    As Edmond Hui said , "Insurance is a business based on understanding probability and mitigating risk. "

    Before the government started aggressively communizing medical care and charity in the 1960s - when all were more affordable , a family calculated what a catastrophic cost would be for them , and insured against that . The absurdity of creating the paperwork to have a third party pay for discretionary , predictable , or minor expenses , eg , contraception , was obvious . But , of course , paperwork and bureaucracy are the State's rice bowl .

    And forced transfers as opposed to voluntary ( market ) charity sends , as discussed here , sends all the wrong signals . In the market of charities , one can chose which are cost effective , and which triage the deserving from the undeserving .

    In a socialized system , the providers become the slaves whose remuneration is set the politicians . That's why you see country wide strikes ( slave rebellions ) such as currently in Nigeria , and recently Israel . Why anybody with ability would go into medicine in the US given its current direction , I don't understand .

    And people don't go to socialized countries like Cuba for the surging business in medical tourism . They go to places with relatively free markets like India , or even ( still ) the US from Canada .

    Insurance should be insurance ; charity should be charity ; and State Force should be retained for those purposes so presciently outlined in the constitution federating the American states .

    & BTW , mandated car insurance is not analogous . It is purely liability insurance attempting to ensure financial responsibility for injury to others , not oneself .
    • May 9 2012: Thank you. After reading through these comments I was beginning to think that the whole (TED) world seems to think that health care just appears magically if only we would vote for it. Socialized anything is a highly violent proposition akin to enslavement of some for the benefit of others. It's certainly not compassionate, fair, noble, or ethical.
      • May 9 2012: There's that word 'enslavement' in relation to human beings making the world around themselves a better place to live--for their themselves (selfish interests) and for others (use whatever positively conotative term you want). Your arguement is FALSE in every sense, from humanistic to logical.

        Socialized medical care (as practiced in Sweden, where I live or in England where two of my sons live) is entirely fair, and ethical, as well as being a highly practical solution to a difficult issue -- which is good enough for me. It is also compassionate and noble, if you need it to be. Your libertarian view is based on several false premises -- like most things libertarian. You therefore make a false conclusion. Read up and learn more...
        • May 9 2012: Are the systems you speak of voluntary or do you have to use force to keep libertarians "in the system"?

          My premise is to not support the use of force to push my social agenda. Socialized medical care, whether practical or not, is medicine at the point of a gun for people who disagree with it. It's the old argument that the mafia Don (sp?) keeps the neighborhood safe so we should support him. I believe that's an irrational, short-sighted thought process but I understand why folks like all the "free" services . . . one less thing to worry about in a complicated life.
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    May 8 2012: I agree people should be more encouraged to take responsibility for their health, but I don't think a penalty based insurance is the right way to do it.
    Lifestyle habits aren't the only factor for certain disease, so where do you draw the line? How healthy do you have to live for the insurance to cover your costs? With this policy insurance companies will look for any reason not to pay for the costs. How do patients prove that they have done their part in improving their health, and how do insurance companies prove that they did not?

    I think education is a better way to achieve a sense of responsibility. From a young age and a different kind of education than is given now. Maybe one that doesn't emphasize on making people feel guilty about bad habits, but letting them feel a sense of reward for taking care of their health.
    • May 9 2012: On the issue of people taking responsibility for their own health -- here's how it works in Sweden. Example -- motorbikes a legal, with laws requiring helmets and other protective gear. The idea? If you want us to pay for your medical care when you crash, we want you to take reasonable precautions. People still die riding their bikes, but the state has also encouraged the majority of bikers to take some own responsibility. Same applies to, say, smoking, obesity, and what not. With, as you say, regular high profile campaigns to educate the masses. And guess what, most people listen!
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    May 8 2012: As far as the actual question is concerned, everyone should pay the same base rate unless you can demonstrate that you have made a conscious effort to maintain your health. You don't penalise some one if they are over weight but you reward some one for not being over weight. You get rebates based on the amount of effort you are demonstrating regarding maintainence of your health
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    May 7 2012: The cold war is over! The communists aren't going to invade because you have publicly funded healthcare. It works in every other western nation. I'm scared to go on holiday to the US because I might have an accident that requires hospitalisation. I could jump a plane to Cuba I suppose. Or Canada. Or Mexico. They all have publicly funded healthcare.
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      May 8 2012: smart idea. so communism failed, and now you are calling for repeating their mistakes.

      if you are party leader, cuba is really good. if you are an average fella, better stay in the US. in canada, the word "patient" is a double entendre.
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        May 8 2012: Maybe I should have ended with a ;-) . The Australian system is much like Canada with regard to the double entendre but waiting, even long time is preferable to having no access at all like many US citizens. 4o million don't have access to affordable health care according to the WHO
        • May 9 2012: Who doesn't have access to health care? I'm not sure where you're getting your info but I've lived all over the U.S. and I've never met a person without access to health care.
  • May 7 2012: What do people do if they don't have any insurance?
    Who pays when they get sick?
    Nobody really wants to get sick... do they?

    I live in Norway, when I get sick, I go to the doctor. It doesn't cost anything.

    Although I'm almost never sick, it's a good feeling to know that I don't have to worry about having enough money to pay for the doctor bill.

    You can say what you like about socialized medicine but it sounds to me like the insurance companies in the US have got you by the throat .... squeezing harder and harder...
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      May 7 2012: I tried make it clear that the question really doesn't focus about people who get sick, but for people who have lifestyle habits that affect their overall health.

      Why should an insurance company pay for medication for someone who is severely overweight, who then gets diagnosed with Type II Diabetes, when they didn't need the medication 1-2 years earlier if they changed their lifestyle? Or a smoker who refuses to quit....not one who tries and tries relentlessly by going to smoking cessation therapy?

      Many cardiovascular problems begin with the patient not taking good care of themselves, although this is not to say someone who is diagnosed with a congenital problem or develops a heart condition shouldn't be treated.

      I think that if a method was in place that based insurance on certain risk factors, patients would have an incentive to care for themselves better, because otherwise they would be paying out of pocket.
      • May 7 2012: Ever heard of Dale Oen?

        Norwegian olympic swimmer. Trained himself to death last week. Died in the shower of a heart attack. Age 26.

        I think in 20 years time there will be an epidemic of different unforseen health problems from people who train too hard. Maybe the olympics should be banned... could be dangerous to your health...

        Seriously, I do get your point and understand your question.

        Of course, your car insurance doesn't cover the damages if have an accident when you are driving too fast or are breaking the law...
        Your house insurance wouldn't cover it if you were grilling inside and burned down the house...

        Its a grey area indeed. Who is at fault. Where does one draw the line of being irresponsible where health matters are concerned.

        But the scary thing is, we might one day be looking at some kind of genetic testing before we can get health insurance at all.... and where would that put us...?
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        May 8 2012: The argument about risk versus costs isn't realistic. If someone gets sick because that person didn't quit smoking the costs are on average similar to someone that didn't smoke and lived much longer to deteriarate on other issues. The most important thing to stay healthy is to keep your body fit by daily exercise. A non smoker that never walks has more health risks than a modest smoker that walks 10 mile a day.

        Here in Holland at first all costs were covered by the insurance but over the last years more and more of it is left to the patient. Dental costs is secured up till the age of 18 and after that you have to pay more for the insurance or take the risk yourself.

        Health insurance has to be for everyone without discrimination on the base of lifestyle for nobody can know what is good or bad for any individual. This surely counts with the mental influences someone has on physical health.

        If you do discriminate the next step will be on genetics were strong genes pay less than the weak ones or the income as rich people tend to be less ill than the poor.
    • May 9 2012: I wish people would stop implying that the US medical system is a "free market" system. Our system is well over halfway socialized with Medicare, Medicaid, the FDA, AMA, BCBS, etc. A free market implies voluntary transactions among consenting adults. The US healthcare system is well on it's way to becoming a socialized system which is largely why it's collapsing (as socialized systems tend to do).
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        May 9 2012: Name one socialised healthcare system in a first world country that has collapsed.
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        May 10 2012: The healthcare system failed in the USSR along with everything else, what about a country where the health system failed because of the health system? I can name 20 nationalised healthcare systems that haven't failed. Just read the top twenty from the WHO list of the best performing healthcare systems.
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    May 3 2012: They should have to pay because they can. I've never understood the insurance industry, becuase they post profits that rival the oil and gas industry (and we all know what kind of fat bucks they make!) and yet claim insolvency with every single natural disaster. Insurance companies don't even produce a good or a service, they are a bookie. They are betting that you will never get sick, and when you do, suddenly the house shuts the betting booth and hangs up the out to lunch sign.

    Also, let's look again at ourselves: we will inevitably come to the question of trying to decide why that 700 lb person never stopped eating long enough not to be so mordibly diseased, which frankly steers our attention away from the fact that for every one of those, there are ten more people who could have had prosthetic arms, voice boxes, and even asthma medication, but were denied because some insurance company determined them unworthy, either because of cost or pre-existing condition.

    Yes, Iwould be all on board with the standard "personal responsibility" angle, if it wasn't a smoke screen used used place the blame on the socially defenseless, more than an industry that has increased its profits to the detriment of the American worker as well as industry.
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      May 4 2012: The American system does beggar belief. In Australia basic healthcare is pid for by the taxpayer but you can get private insurance if you want fancy stuff like a private room. The majority of our private insurers are "not for profit". There are some things that big business should be kept out of. I'm sure I'll be labelled a socialist now which is ironic because in Australia I'm considered a bit of a righty.
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        May 4 2012: The problem in America is that health care is seen as a commodity, and if you can't pay for it you don't really deserve it. Only when health care is seen as a civil right such as police or fire protection, or public education, will there ever be any real positive change.
  • May 3 2012: I do not understand why we cannot model the health insurance plans on the auto insurance models: safe drivers, lower premiums. Prior to the Health Care Reform Acct, private insurers took every pre-condition into consideration before even granting policies. Why not have the self-determined behaviors that involve risk (e.g. smoking) influence premiums? I would extend this idea to that proposed by Ms. Ravin-Anand about discontinuing coverage if diagnostic procedures are not followed.
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    May 3 2012: I don't know if it works like this in the US but in Australia you get rebates on your car insurance based on things like how long you have gone without making a claim, whether you keep your car in a garage, whether you have an alarm fitted etc. The health insurance equivalent would be attend and pass your yearly physical and dental exam 5%rebate require no medical treatment in the last year 5%rebate require no medical treatment in the last 2years 10%rebate, maintain body fat% below 25% get %5 rebate, maintain body fat below 20% get 10% rebate. It works with cars
  • May 3 2012: Hello Erica,
    This question could easily extrapolate. Why should anyone paying insurance premiums subsidize those who refuse to improve themselves----subsidy as you describe above? I have a strong suspicion there will come strong financial incentive for people to improve or else! This incentive likely will be pressure from insurance companies to deny coverage to the most costly persons. This denial just might be a result of pressure from those persons and companies who will balk at high premiums. Already we have seen companies and municipalities go to employees and ask them to pay more of premiums, sometimes for less coverage.

    The time is coming when many people will turn their mercy elsewhere, away from those who refuse to help themselves with personal improvement and who refuse to quit smoking or to abandon any other harmful habits. If a person refuses to help himself, there likely will come trials of choice.

    This topic could open up to many other aspects of human life. In the long run, life must improve or else humanity must suffer. Why should those who make a sincere effort to help self and others be punished with extra costs and delayed progress by those who might be lazy? What is best for all seems better than everyone selfishly grabbing and being insensitive to others.

    Maybe others would agree: some have said you have to love yourself to see love and give love to others. Self respect is not selfish and love of self is self respect when one realizes he is valued! If this is absent, its hard to see any possibilities for self improvement----adjusting life and habits for great satisfaction and enjoyment.

    Insurance pressure might be needed to drive some people to wanting improvement.

    Possibilities here?
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      May 3 2012: I agree - and I do not mean to be insensitive to those who desperately need aid because of congenital issues, medical disorders, cancer, etc. But, there are certain conditions and smoking is one that lies within a person's own self control. Harmful habits like alcoholism, smoking, and drugs can lead to terrible medical conditions, but ultimately it was the patient's decision to begin those horrible habits.

      Obesity is probably a major reason that insurance pressure may drive people to improve their lifestyles. It simply leads to too many conditions that require expensive treatment.

      It is unfortunate that it all comes down to money....but maybe that is what is needed to change people's lifestyles and change insurance coverage, especially for those who are unable to afford it.
      • May 3 2012: Yes, I agree it is unfortunate money must be a major driving force. I prefer attraction to be the major drive to improvement. The reality is many ignore efforts and promotions for health improvements. It is nice to dream for a strong humanity, free of disease and full of desire for strong character and vitality. If spiritual values and realities do not attract people to self respect and self improvement, then as I said, ultimately it will be other forces.

        Bravery and courage are worth considering. Just how brave and forthright each of us chooses for improvement is a personal decision. What I want to know is what causes people to exercise regularly and to eat balanced, healthy meals? From where comes the discipline?

        People talk about rights. A person's concept of what his rights are for all of life could be a factor for doing or not doing! This could be another topic that could involve weeks of discussion.

        Thanks for this topic.
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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?

  • 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 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.
  • 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.
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  • May 8 2012: If a person is given a path of success after being diagnosed with the possibility of future health problems and they do not follow it then I think there should be a level of monetary responsibility. But that is hard to track and who is to say that they are in a place to make those changes.

    To keep my opinion simple....if a person is given an attainable path to a healthy lifestyle then yes I think they should be responsible for their decisions, even if it does mean paying more for insurance.
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    May 7 2012: I know for some people the idea of health insurance based on a patient's risk is impossible and detrimental to the overall health of a person if they cannot be treated. But, for the commenters who agreed, I think you understand it is really about giving people responsibility of their own health and since most people are motivated by money, this type of insurance would encourage those who participate in habits like smoking, etc. to re-think their choices if they were the ones who would be paying for it.
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      May 7 2012: You are right about the opportunity for risk based premiums to influence behaviour, but that's a red herring. You can't influence people out of their genetics, yet genetics are a major contribution to risk. The problem most people have with this question is that it appears unfair when you have to pay more than the next guy, as if a loaf of bread costs you more. But the health insurance for each person costs the insurance company a different, definable amount to provide. It's not the same loaf of bread. If you are truly talking about insurance, then the premium has to be risk-based. Some other thing might be good for society, but if you have that, it wouldn't be 'insurance'.

      When I bet on a horse, I don't complain that if I bet on the favourite I get less if it wins than if I bet on an outsider and that wins. That's precisely the same problem faced by the insurance companies. A chain smoker who doesn't brush his teeth costs is simply more expensive for the insurance company to cover than a non-smoking spouse of a dentist. So their premiums should reflect that difference.
    • May 9 2012: Bad eating habits are recognized by most as food addictions, which are very difficult to treat. If you consider the number of kids and teens who are overweight and may have developed medical problems as a result, then you would penalize their parents for their lack of control. Often, a single parent is involved and control is very difficult, given their schedules and resources. I agree that some benefit should accrue for people making an effort at improving their lifestyle, something on the order of discounts for taking seminars, workshops, lectures that focus on teaching ways to improve lifestyle choices.
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    May 5 2012: Insurance rates are predetermined based on many risk factors such as age, location and prior medical history. The approval of an insurance policy means the insurance company is willing to assume the risk. Good insurance companies like Humana reduce that risk by bombarding the insured with literature and programs that guide the insured to a healthier life style. If the insurance company and its medical providers fail in improving the health life style of the insured, then the insurance company is stuck with the increase cost of health care. If they are successful, the insurance company and the insured are the winners. In all cases the insurance company is, and should be, contracturally stuck with the costs. It is how the market place works.
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    May 5 2012: I know the question is a bit too vague, so it can be interpreted in many ways. I would never suggest that insurance not pay for congenital conditions or medical conditions not in a patient's control. However, it is habits like smoking, poor diet, poor oral hygiene, alcoholism, drug use, lack of exercise that lead to so many cardiovascular and other serious medical issues.

    I am in the dental field, not medical, so when I see a patient over a course of a year not improve his/her oral hygiene condition after prophylaxis and oral hygiene instruction, it not only gets frustrating but makes one think, why should dental insurance continue to pay for these treatments when the patient is not interested in improving? It is a waste of money. It is a waste of time when someone neglects their own body.

    Obviously, if insurance premiums were ever linked to a patient's risk, there would have to be so many conditions and limitations as the system can not neglect patients who need medical care.

    Someone posted the quotation: "One must define health care as either a right or a privilege."This is a really controversial topic. It should be a right, but when people take advantage of the system, then I think at times it should be a privilege.

    There really is no right or wrong answer to this question - when it comes to the best care of a patient, he/she should be treated. No questions. But, when it comes down to dollars and cents, the health care system may disagree.
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    May 5 2012: The issues and discussions bring out the difficulty of a one size fits all model . and that's the difficulty. The models of health care should encompass a basic level which is the responsibility of us all. and through the state, I buy into the value of compassion and care for all people who can't speak for themselves.
    At the same time I think it's right to search for a system that says I have a responsibility (if I'm capable ) to care for myself.
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    May 5 2012: No, It would mean those born sick through no fault of their own could not pay and would not be covered. A medical system cannot totally repair the damage from bad habits. Those fools pay as it is. Companies could and would game a fault system. It would be a great waste. Obama is close. Everyone pays. The sick get care.
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    May 4 2012: I had occaision to work for an insurance company doing systems and compliance .. sollutions for actuaries and such.
    IT is known that the first insurance policies (as we know them today) started out as a confidence trick "life insurance" which was later "tamed" by regulation to ensure claims payout.
    The form and structure of this model is still present in most private insurance.
    However, there is a big distinction between personal and social insurance.

    With personal insurance, one gains the capacity to take greater risk. It is a kind of gambling, because if the risk "falls-in" then it is at the expense of other contributors to the policy account. Actuaries work hard to apply risk premiums according to the contributors risk profile - ensure that the account does not collapse and that there is no perception of favor amongst the contributors. THe winners are the policy claimers and the company - all else lose. So it is win/lose.

    With social insurance (such as healthcare) the objective is to spread teh community risk across the entire community. This is to prevent single individuals from bearing the risk entirely alone. The payoff to the society is that those who have to draw on the policy do not inflict further collapse of risk through the community.
    For example, a person facing a huge hospital bill might consider unethical means of getting the cash - selling drugs maybe, or robbery. Or, that the entire cost of care falls on a single family, who in turn, can contribute less to the community. In such a risk-spreading exercise, the actuarial risk calculation is on the entire community, not the individual - there is a margin of win/win over all.

    THese 2 forms of insurance have to be kept separate for your analysis.

    Hope this helps!
  • May 4 2012: Hi Erica

    Health insurance must not be related to the patient's risk because it is unfair to the losers and underdogs who are unable to change their situation, and above all to their children.
    There are alternatives to save money.
    1. Free choice of the level of own risk. For decades I had a reduction of 60% of the insurance fee in exchange of an own risk to the level of 70% of the insurance fee. We had healthy habits, took care, payed rarely more on risk than 20% of the fee and never reached the 70%.
    2. Keep better track of the mental state and medical knowledge of medical personnel. A specialist, apparently affected by Alzheimer, disabled my wife and as result she needs regularly rather expensive operations for the rest of her live.
    3. Organize schooling via internet to keep the knowledge of medical personnel on an acceptable level. One day I had a heart problem and several medics failed to make a proper diagnosis. "No, your heart is normal for your age, but you have moisture in your left lung.". Since when is moisture in the left lung not a symptom of serious heart failure?
    4. Organize auditing of the costs of medical treatment. Why are there price differences up to 40% depending on the specialist or hospital?

    There is another important aspect that does not get the attention it deserves, namely the costs of medical failures.
  • May 4 2012: a physician in the USA who has practiced medicine and held senior level medical management positions..and a dual citizen of the USA and Canada, forget the concept of "policies"...that's marketplace speak, and for me, health care should NOT be a "market driven" commodity. That said, given that health care costs real money, the "privilege" issue should be the ability for any taxpayer to have the vested interest in directing how health care is rendered...not stockholders nor insurers who care only in the MLR..."medical loss ratio", which means that percentage of premium insurers must spend to provide care (with the balance being profit). In Canada, and in the rest of the developed world where health care is provided for all, the onus of responsibility falls on all participants, as occurs with your Medicare, such that health care may be extended to all.
  • May 4 2012: I do agree with ken Richmond on the basis of separating privilege and right. However, my personal opinion on the matter, is that I do believe that even though everyone has a right to have an insurance policy, especially affordable policies, I think that policies should be a privilege as well. The reason being that, although we do pay certain amounts to save on inflated prices of health care, the reason being that we do not take care of ourselves close to as well as we should, and therefore, medical costs are exponentially higher especially in the USA. I firmly believe that individuals, even as a society or populace, we all need to emphasize the importance of our individual and communal health to inspire reduced costs, a healthier state, and reduced purchasing of harmful foods and toxins. As a Canadian, yes I have Medicare, and am very grateful for the health care system we have here, requiring me to not have to invest in. Many other insurances when costs are already subsiidized,however, again, when it comes to private clinics, blood tests, MRI, PET scans, CT SCANS ETC., prices are high and/or wait is drastically long. If a policy that were to require said individuals to get regular medical checkups and validate the maintenance or optimization of ones health, for the benefit and/or privilege to have a reduced insurance policy, then I am for such a policy, inclining a greater reason to maintain ones health and save money simultaneously. I do also think though, that behavioral economics/psychology does disagree on this basis, that select or majority of groups/individuals will spend above their means to pay for medical visits, ut not invest in annual insurance policies and vital health maintenance. In respect to the epidemic of obesity and it's rather drastic increase in health costs, this can somewhat validate my point.
    I do hope this though process has stimulated other thoughts or was at least able to respond accordingly to the initial debate.
  • May 4 2012: Why is dental insurance even a separate thing? Last time I checked dentists were just specialists.
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    May 3 2012: If a person pays their premium and has honestly disclosed all the info required by the insurance company then of course the insurance company should pay. It's up to them if they load the premium due to addictions, pre-existing conditions etc. Where the responsibility rests with a state health service, I would say that emergency treatment should be given free of charge to everyone but treatment for chronic illness should be refused (or maybe charged for) if the person refuses to follow the advice of the doctor.
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    May 3 2012: What I know (it can be dead wrong) is insurance companies already have huge influence on treatment decisions in many healthcare system not being even expert of the field they just can over-rid the decision of doctor just due to financial reason......moreover in many instances they find loop hole not to cover something they committed while selling the policy (may be sales over promised or did not know the product but to close the sales promised what was needed to close sale of the policy) this can be another golden opportunity for them to maximize profit.

    That being said , I am in favour making people responsible also for their own this case before doing that lot of health education is needed.....who is going to do that ?
  • May 3 2012: your question clearly shows your point of view on the topic. i'm of your opinion but i would add some more considerations to extend the context. i think it's fair enough to give a sense of responsibility to any person, we can make a difference with our behavior, in italy for instance (where, like in many european countries there is a national health system payed through taxes) if you don't use a seatbelt and have a car accident which can lead to serious injuries you get the whole health treatment for free (payed by all taxpayers), this includes hospital care and even the salary while you're injured if you're an employee, not to mention the lifelong disability pension for the worst cases. a lot of money that could have been saved with some commonsense. Is it right to pay all this money? I don't think so. When it's widely known that something is really dangerous for health you should feel obliged to behave in order to limit risks. Alcohol, fat food, drugs and cigarettes are part of the same issue. But if cigarettes and alcohol are so dangerous, why can you get them so easily (they are even advertised)? here we could open a very long and wide discussion about prohibition (i'm not prohibitionist). about obesity, is it true that it affects more people with low income (junk food is cheap) and therefore, doesn't it look almost like a form of discrimination to let them pay more for health insurance, also considered that usually they are less educated and less informed? As you can see these kind of problems involve many aspects of living with no simple solution. We must find a balance between our individual freedom and the necessity to avoid that my wrong choices may affect others negatively. I think that increasing the insurance premium for people misbehaving by ignoring commonsense, may be, broadly speaking, educational (and of course to award a prize to those who are particularly careful in living healthy), also insisting with effective information campaigns is needed
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      May 3 2012: The "junk food is cheap" isn't entirely true. Junk food is cheap compared to other prepared food but you can cook your own healthy food much cheaper. The problem is junk food is easy.
      • May 4 2012: thanks peter. yes, i guess you've been more accurate. junk food is cheap, easy and (perceived by many people) tasty.
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    May 3 2012: i would like to call everyone's attention to the strangeness of the question, which is not apparent.

    let me ask: should a chocolate contain peanuts? should it be small or large? should cars have air conditioning?

    what's wrong with these questions? these are kinda silly. but they look very similar. it does not work like that, we say, some firms offer this kind of product, others that. some people prefer this, others that.

    why should health insurance be any different? provides should be able to offer different schemes, and people should be able to choose according to their taste. a model is either successful or not. why should "we", whatever that means, decide what is a "right" service? and even if we do, should that limit service providers? should that limit customers?
    • May 3 2012: hi krisztian. in the end i don't see her question contrasting with your point of view. i don't know if i'm interpreting it wrongly but as i see it she's just saying: i'm of the opinion that people who deliberately choose to risk their health shouldn't get the health treatment payed by insurance companies, what do you think about? thus she'll choose an insurance company that takes this issue into account, and another person who thinks differently will choose another.
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        May 3 2012: she never mentions that there would be a free choice. she says "Should health insurance be" and "should it be the responsibility of the insurance company". these are policy questions. general questions about health financing in general.

        my position is that we should not discuss what is the right thing, and then make it happen for all.

        suppose a health insurance provider says that they accept obese people, and no extra fee is charged. it is because they "respect the human rights" or whatever nice slogan they can come up with. of course they will be a little more expensive, but if people buy that argument, and they agree to pay more to cover the increased risk of their overweight comrades, what's wrong with that? it might redistribute some more wealth from healthy people to obese people, but if it is voluntary, that's okay.

        similarly, i don't want to declare that wearing seatbelts is good, and it should lower insurance cost. i personally believe that driver side seatbelts don't increase safety, so i would not like to be forced to do so just because some people believe it is good.