Not to completely absolve personal choice, but the food industry is complicit in this. Ditto the average restaurants with their ginormous portions.
Nesrie
6283
Not everyone has family they can reach out to. In fact, there are several people out there who are better off not associating with their family at all. This only works in the nice neat little family bubble that the GOP likes to sell but doesn’t exist for large portions of the population.
At some point you have to look at the probablities. It is certainly true that people can smoke for decades and have no troubles and others can get cancer through no fault of their own. That’s the point of the catastrophic insurance, society at large picks up the tab. If you are being healthy and taken advantage of the incentives to save money in HSA, its not even a financial catastrophe. Even if you haven’t save with any luck the family helps you out.
But you can’t ignore the huge cost that people add to the healthcare cost due to bad choices. I’m involved with a start up company that provides medical monitoring technology. There big success story was winning a contract for HSMA (Blue Cross provider) of Hilo, HI (population 43,000). 23 patient had run up 300-600K hospitalization bill each, more than 30% of the total amount spend by HSMA for the whole city. By monitoring and changing the life style (which include diet, exercise, making sure they took their medicine) they slashed cost 40%.
So while your right it isn’t always as simple as putting down the donuts, to pretend that in many cases it pretty much is that simple is even more wrong.
What percentage of Americans don’t have any family?
What percentage are estranged?
And more importantly what’s your solution to driving down the costs caused by lifestyle?
Scuzz
6286
So is child birth considered “catastrophic”? What about appendix, gall bladder or tonsils?
I think a system that expects it’s users to cough up huge amounts of money every few years is bound to fail. And as people age those “catastrophies” are going to pile up.
I am far from being the most left leaning person on this board but when it comes to health care I keep finding myself leaning farther and farther in that direction. The American Health care system is broken for most of it’s citizens, and if ever there was something that the government should do for it’s people it would be to insure that all people had available health care.
It’s easy to take a moral high ground when no costs is involved.
I have a number of cases in a Philippines village where kids are dying due to water issues and other diseases. Someone donated a simple water purifier that helped when we shared bout it, 1 time cost of around 100 SGD and after that 20 SGD to replace the filter every year. Some other cases where the poor child requires about 40-100 USD per month of medicine.
For the cost of a game or 2 every month, it saves lives. But very surprisingly, not many people are willing to make such a sacrifice when asked.
Compared to people who are educated about the “lifestyle risks” and yet take them regardless, these people born into environments where they basically don’t stand a chance. How would a person allocate his or her limited resources?
“Only evil scum” is a bit extreme to describe people advocating not paying for the consequences of certain lifestyle choices by relatively educated people, don’t you think?
E.g. Would one pay for a smoker who develop lung cancer despite decades of education on the risks involved? Is it as clear cut as being an “evil scum”?
Oghier
6288
It isn’t “fat people should be left to die.”
Education is the primary tool. The most dangerous thing you can do to your body is smoke. Smoking has drastically reduced by teaching people that it kills. Obesity and its associated diseases is a much tougher nut to crack, given that 1/3 of the US population qualifies as obese, despite widespread education. But the answer can’t be to let those folks suffer.
Also, keep in mind that most people you know over 50 are very likely to have some kind of pre-existing condition. At some point, it’s just a consequence of aging, even for those who make reasonable lifestyle choices. Are you ready to tell them, “Good luck living to 65, when you can pick up medicare?” I’m sure that’s how Ayn Rand would have it, as well as those who view this solely in economic terms. That’s pretty cold-blooded.
Our health insurance system was designed when almost everyone worked for large or mid-size companies, and they were likely to stay there for decades. That’s not what the labor market looks like today, and it’s absolutely not the direction that market is headed. Without the ACA, a large and growing of people would be shut out of health insurance altogether.
Timex
6289
E.g. Would one pay for a smoker who develop lung cancer despite decades of education on the risks involved? Is it as clear cut as being an “evil scum”?
To make it even more clear:
You only have the resources to treat one of two patients. One is suffering from the effects of an illness that stems from their own choices, and the other suffers from an illness that they had no control over.
Is it really fair to use the resources to treat the first person, and let the second die?
Often, people never consider the harsh realities of these things. Sure, in a magical land where resources are infinite and everyone can do whatever they like, then it’s not an issue. But that’s not the world we live in.
Whatever choices we make, some will die.
Tim_N
6290
I am not too familiar with the US health system, so excuse any ignorance, but I thought Miramon’s rage was directed at the idea of refusing people with preexisting conditions any insurance plan. It is indeed immoral to say “you are more likely to get cancer because of X, therefore we won’t insure you and you can either go bankrupt paying medical bills out of pocket or die somewhere.” Can’t you legislate that they must be eligible for insurance, but also let insurance companies charge a higher price?
Not to change the subject or anything, but there’s this:
Fourteen more people have been charged in connection with a high-profile 2014 standoff over cattle grazing rights between armed protesters and federal agents at the Nevada ranch of Cliven Bundy, federal prosecutors said on Thursday.
One of the newly-charged defendants, New Hampshire resident and former U.S. Marine Jerry DeLemus, has headed a veterans’ group formed by the presidential campaign of Republican Donald Trump.
I wonder if this will help or hurt Trump. I wonder what Trump will say about it. I think I can guess.
Oghier
6292
Smoking may be a singular exception, as it’s tremendously unhealthy and entirely behavioral.
But how about a non-obese, non-smoking 40 year-old who has a heart attack while mowing the lawn? That’s one heck of a pre-existing condition. Or how about an otherwise-healthy 60 year-old who develops prostate cancer? A non-smoking, non-obese woman in her 50’s with uterine cancer? These are not hypotheticals for me – I know these people (they’re all fine now).
If you think about pre-existing conditions as the morbidly obese who chow down 5k calories of McDonalds and two packs of cigarettes a day, it’s perhaps tempting to think “it’s just the consequence of their choices.” But that’s not nearly the whole story.
Should the rage be directed at the insurance actuaries, the profit driven insurance company heads or the consumers who complain about rising insurance costs?
As a tangent, going in the direction which the insurance industry seems to be headed, where they seem to indicate the preference for taking into account genetic pre-disposition etc etc… and costing everything based on that. Adding hefty administration costs on top of it. What advantage is there for people to buy insurance as compared to just saving up money for the proverbial rainy day? Basically the insurance industry is driving itself out of a business case for it’s existence.
By the way… has Trump won yet?
Timex
6294
I think that goes without saying, and no one suggested that all illness is somehow self inflicted.
But SOME is. And it’s silly for us to refuse to even acknowledge any notion of personal responsibility.
Oghier
6295
Your zero-sum thought experiment is pretty disconnected from how healthcare actually works. If it’s an organ transplant, you have a truly scarce resource, and the choices a patient has made may impact your assessment of whether they are likely to maximize use of that organ. But in the other 99.99% of situations, the impact of treating person A isn’t to let person B go untreated – it shows up in the accounting ledgers of the healthcare providers, insurance companies and other consumers. Healthcare spending does have limits, of course, but it’s not a simple tale of morality and relative utility, as your example suggests.
Or what about the guy who looks healthy who has a stroke at 45 and he gets kicked off a plan because he worked 60 hours a week at his job and was under a lot of stress. He should have made a better choice and not worked so hard? He may have been working towards early retirement or a vacation home or saving money for college for his kids. But he doesn’t get to stay on a plan because he chose a stressful lifestyle and that contributed to his stroke?
People get sick, and if you want to look at lifestyle decisions as leading to the illness, you’re going to exclude a lot of people. Hey, you stayed up until quarter to three playing games and became chronically sleep deprived. No insurance for you!
I probably could have avoided becoming type 2 diabetic for a few years longer if I had taken better care of myself, but I actually did exercise and eat reasonably well. My father, his two brothers, and his mother were all type 2 diabetic, so I suspect it was going to happen to me sooner or later. There’s a strong element of genetics here.
Agreed it’s definitely not the whole picture. Taking extremes tend to lead to outrageous outcomes. A non-obese, non-smoking 40 year-old who has a heart attack while moving lawn begs the questions “Did he drink too much alcohol the night before?”
It’s unfair to cast people who disagree as “evil scum” without finding more about their real objections. I mean, just look at how the people are behaving in the nomination cycle. People calling each other names. Not addressing the issues brought up.
“I disagree because I am not willing to pay for consequences of lifestyle choices people make.”
“Evil scum!”
How does that even make for a rational conversation? Challenge Strollen on the meaning of lifestyle choices.
Oghier
6298
Yeah - so what? Let’s acknowledge it. Let’s ACKNOWLEDGE THE HELL OUT OF IT. What are the policy implications? Are you suggesting that this agreement now means we should head right back to the “sick people in some states can’t get insurance” days? Because some fat people smoke? Or what?
Oghier
6299
No, he doesn’t drink. But keep trying to find some way that my brother was actually at fault for his heart attack.
Bad shit happens to the human body. Trying to plug it all into a rational economic model of incentives, costs and eliminating externalities and free-rides glosses over the fact that those statistical anomalies are people.
Tim_N
6300
I think people like to fantasise that their future health is largely due to their own decisions, as it’s nice to feel that you have control over your life and your future, and you don’t have to worry about the slim chance of a catastrophic illness taking your life away. I also think that’s why people, after hearing reports of someone being shot, urgently want to hear that it was drug violence or due to some preexisting argument. Noone wants to think about random shootings that they have no ability to prevent, which I think is why terrorism often scares people more than the drug trade or hate crimes.
Timex
6301
We’ll, technically the implications from a policy perspective would be that in order for you to get certain types of support, you should have to meet certain requirements.
Otherwise you are removing the natural forces which would normally improve the system.
It’s not so much about caring for people with pre existing conditions, as much as its about having the government impose restrictions on your rights in exchange for taking on your responsibilities.
As an example, for instance, if the government is to subsidize your Healthcare, then perhaps you should not be allowed to smoke.
The reality is that Americans make many bad choices about such things. We have an epidemic with obesity, and it’s not just natural. It’s behavioral. We didn’t used to be so fat. And now we are. And it has direct implications on our health.
When people are paying for themselves, so be it. Do whatever you like.
But if you are going to start having the government pay for stuff, then you are also going to start losing the right to make some of those decisions.
