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Paying the healthcare costs of obesity
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lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours for addressing a given societal problem currently faced. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
Although it's sort of an anachronism, or counterfactual in a sense to point this out, I think it's quite relevant to note that the USA had a bustling collection of privately-funded mutual aid societies that quite handily delivered healthcare to the "unemployable" and those with "preexisting conditions" (they called them just 'sick and needy' back then), at least until government involvement in the healthcare market largely crowded them out, around the mid-1940s and onwards (with the advent of tax-advantaged, employer-provided healthcare insurance, and then Medicare, Medicaid, etc., etc).
Did these mutual aid societies efficiently and in a cost-effective manner, comprehensively "solve" the problem of people needing healthcare? Hardly. Does socialized medicine (or the USA's system of cartelized medicine) do it? Even less so, I would say. The more we slap regulations, subsidies, tax credits, programs, and schemes on top of the healthcare system to fix what's been broken by previous governmental schemes, the worse shape we get in.1 -
Gallowmere1984 wrote: »Gallowmere1984 wrote: »eveandqsmom wrote: »eveandqsmom wrote: »eveandqsmom wrote: »I'm trying to stay away but I just keep trying to wrap my head around the way some people think...you do know that living in a strong, healthy, educated society is better for YOU in a selfish way right?
Yep. And health, strength, and education aren't automatic giveaways. First, individuals must really WANT these things. And to value them when they aren't automatically provided, individuals must WORK for them, which not every individual is willing to do.
You really believe you are on an even playing field, don't you?
What? Re-read my posts. I've had to work harder and suffer more for every morsel of comfort and security I now enjoy at the age of 49. Which is quite minimal compared to the average American.
I've experienced homelessness and have spent many years without health insurance. I had to put off surgery on a benign tumor for years for lack of insurance. Until the thing got so big in my abdomen I looked 9 months pregnant and it weighed 10 pounds after it was excised.
I sent myself to vocational schools in my late 20s and again when I was 39 in order to get skilled in fields I knew had work available and would pay me a living wage. I worked the crappiest jobs, sometimes two at a time, for years to pay the tuition at those vocational schools.
And I have never taken a penny of welfare in my life, in any form. Even when I was uninsured. Even when I was homeless. Even when I would have to go a week eating only beans, rice and apples.
So, please, tell me all about the level playing field I spent my life larking on.
Oh, I see. I suffered so everyone should. That's a different thing.
Personally, through my struggles, I realized that it's better to turn around and help the next person up rather than just turn my back...but that's me.
You're right, it is, and I do what I can. I've let homeless guys shower and crash in my apartment. I've moved jobless friends in with me until they got on their feet. I will buy food for amy hungry person who asks.
That doesn't mean that I am okay with government using force to make everyone be "charitable".
I really think it comes back to my question of whether someone feels treating obesity is a public health concern or a luxury. I don't think everyone agrees that taxes going towards low income subsidies for the health care exchange is "charity."
In the earlier attempt to appeal to greed, one thing got forgotten. If the person receiving said subsidies is giving nothing useful back to society, then it is charity, a donation, a giveaway, whatever. I don't care if it's medical care, food, dance lessons, or a car. It's only a public health concern because we pay for it. If not for that, their being morbidly obese would be of no consequence to anyone else.
As I previously asked (but maybe it wasn't you), what do you do with the morbidly obese who can't pay for care? Even if they die in the street, you still have to pay for disposal teams and facilities.
Correct me if I'm wrong, though, with the following. In most states if you have no income, you wouldn't be on the exchange. You'd either be on medicaid/medicare or SOL. So would you agree that the VAST majority of people getting health care subsidies on the exchange are in fact working and are in fact "useful" to society?
if someone is morbidly obese they more than likely made a choice to become that way, so not sure why the rest of us have to subsidize thirty years of horrible decisions by an individual. What that person should do is cut their intake by 15% and they will lose weight , which will increase their health....
decisions have consequences...
Totally understand the thought. But keep going with it. Who forces them to cut their intake? What incentivises them to do so? Policy? Taxes? Shame billboards? "Mr. Jones at 1213 Main St. Is OBESE" with his drivers license picture?
you obviously don't understand personal responsibility. They should do it so that they do not die or become consistently sick. It is called doing it for oneself. I lost 50 pounds because I wanted to, not because some bureaucrat gave me an incentive me to do it.
You're proposing to base a system of government on "personal responsibility"?
that is what the original intent of the constitution and a federalist form of government was..
I am proposing that the person in your example would want to become less obese for themselves...
In the Declaration of Independence it mentions an awful lot about the role of government being organized for the collective safety, by the consent of the governed. So your argument is the morbidly obese person has consented to be a citizen and has consented to being obese. Therefore, no one else should be involved in their health, since it is not a matter of public concern?
if you think that framers of the deceleration of independence and the constitution would approve of the federal government forcing someone to have health care at the threat of taxation by another government agency, you are living on the moon.
Collective safety, in their day, referred to safety from a tyrannical government and not to form some collective Utopian society that would provide for all needs and wants.
My argument is that a morbidly obese person made a conscious decision to eat a lot of food and not move, and that is their right as an individual; however, those decisions have consequences that will have to be faced one day, and that I, as an individual citizen, have no right to have my wages confiscated by the government and then given to someone else to subsidize their choice. If I want to donate to charity or volunteer to obese causes then fine; however, I should not be forced to do so, if I do not want to.
I never once said the framers felt one way or another. I asked how YOU felt. I appreciate your explanation in your final paragraph. It sounds a lot like my summary I asked you whether or not was accurate: "no one else should be involved in their health, since it is not a matter of public concern"0 -
Re the morbidly obese guy, ACA is really off-topic.
Before ACA, it was just as likely that others would share in the cost, either because morbidly obese guy has good employer-based insurance (the head of my first workplace was morbidly obese, for example).
In many cases the harm from being obese gets felt mainly as one gets older. So Medicare.
I'm not taking a position on this one way or another, just saying that if that's supposed to be the reason for the ACA debate, it's off-topic.0 -
lemurcat12 wrote: »Re the morbidly obese guy, ACA is really off-topic.
Before ACA, it was just as likely that others would share in the cost, either because morbidly obese guy has good employer-based insurance (the head of my first workplace was morbidly obese, for example).
In many cases the harm from being obese gets felt mainly as one gets older. So Medicare.
I'm not taking a position on this one way or another, just saying that if that's supposed to be the reason for the ACA debate, it's off-topic.
Good point. What percentage of people being treated for morbid obesity-related illnesses are on Medicare, Medicaid (due to disability), VHA, or private insurance.
Edit to add, it looks like private insurance pays for 50% of the medical costs related to obesity.0 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate. We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.1 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate.
Actually, the popularity and ubiquity of employer-based health insurance is because of two actions of the federal government - one, price controls imposed by the US federal government in the 1940s which prevented employers from offering higher wages in a time of severe labor shortages, and two, the fact that employer-based health insurance was not considered taxable income.We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
You don't seem to actually understand how employer-based health insurance got so popular in the first place.
It was a problem created entirely by government intervention, leading to distortionary economic effects, which led to upward price spirals and further intervention, and etc. - which leads us to today.And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.
I don't think when a homeless person goes to a soup kitchen for a meal they have "convinced the community to pay for their meal." They've benefited from private charity. That's how healthcare for the poor and without means functioned prior to the government stepping in and hyperinflating costs beyond reckoning. There's absolutely no reason to think that such a way of addressing things wouldn't have worked now - the only problem being the extremely difficult problem of reversing the hyperinflationary trends already well cemented into place. I will grant you this - further government meddling is clearly irresistible to most at this point, because once hyperinflation takes off, it typically takes some sort of economic crash or catastrophe to reverse.
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lemurcat12 wrote: »Re the morbidly obese guy, ACA is really off-topic.
Before ACA, it was just as likely that others would share in the cost, either because morbidly obese guy has good employer-based insurance (the head of my first workplace was morbidly obese, for example).
In many cases the harm from being obese gets felt mainly as one gets older. So Medicare.
I'm not taking a position on this one way or another, just saying that if that's supposed to be the reason for the ACA debate, it's off-topic.
Good point. What percentage of people being treated for morbid obesity-related illnesses are on Medicare, Medicaid (due to disability), VHA, or private insurance.
Edit to add, it looks like private insurance pays for 50% of the medical costs related to obesity.
And the government pays the other 50%0 -
Packerjohn wrote: »lemurcat12 wrote: »Re the morbidly obese guy, ACA is really off-topic.
Before ACA, it was just as likely that others would share in the cost, either because morbidly obese guy has good employer-based insurance (the head of my first workplace was morbidly obese, for example).
In many cases the harm from being obese gets felt mainly as one gets older. So Medicare.
I'm not taking a position on this one way or another, just saying that if that's supposed to be the reason for the ACA debate, it's off-topic.
Good point. What percentage of people being treated for morbid obesity-related illnesses are on Medicare, Medicaid (due to disability), VHA, or private insurance.
Edit to add, it looks like private insurance pays for 50% of the medical costs related to obesity.
And the government pays the other 50%
But anyone with private insurance should be outraged that a large percentage of their premiums are going to pay for illnesses related to obesity, yes?1 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate.
Actually, the popularity and ubiquity of employer-based health insurance is because of two actions of the federal government - one, price controls imposed by the US federal government in the 1940s which prevented employers from offering higher wages in a time of severe labor shortages, and two, the fact that employer-based health insurance was not considered taxable income.We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
You don't seem to actually understand how employer-based health insurance got so popular in the first place.
It was a problem created entirely by government intervention, leading to distortionary economic effects, which led to upward price spirals and further intervention, and etc. - which leads us to today.
I have said repeatedly that it was created by gov't action, so you are obviously not reading what I'm saying.
I'm not in favor of employer-based insurance (except to the extent that we can't find an alternative).And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.
I don't think when a homeless person goes to a soup kitchen for a meal they have "convinced the community to pay for their meal." They've benefited from private charity.[/quote]
Right. And I don't think this replaces SNAP adequately, although I am involved with a couple of food kitchens and pantries.
But the way it worked for health care was someone having a drive at their church (if a member of one) or in their community for funds. Not a good model.That's how healthcare for the poor and without means functioned prior to the government stepping in and hyperinflating costs beyond reckoning.
And it didn't function adequately.
We can go back to the days that charitable hospitals came into being -- still didn't function adequately.
Like I said, also, the main area in which consumers of health care can actually bargain adequately in a free market is when it's not life or death -- routine care. That's nice, but of limited benefit, especially since there's a reason for society to want people to have routine care -- it probably saves costs in the long run (especially things like prenatal AND if we can use it to help bring down obesity, which I would like to focus more on).0 -
Packerjohn wrote: »lemurcat12 wrote: »Re the morbidly obese guy, ACA is really off-topic.
Before ACA, it was just as likely that others would share in the cost, either because morbidly obese guy has good employer-based insurance (the head of my first workplace was morbidly obese, for example).
In many cases the harm from being obese gets felt mainly as one gets older. So Medicare.
I'm not taking a position on this one way or another, just saying that if that's supposed to be the reason for the ACA debate, it's off-topic.
Good point. What percentage of people being treated for morbid obesity-related illnesses are on Medicare, Medicaid (due to disability), VHA, or private insurance.
Edit to add, it looks like private insurance pays for 50% of the medical costs related to obesity.
And the government pays the other 50%
Which has nothing to do with the ACA, as the government likely paid most of those costs pre ACA.0 -
lemurcat12 wrote: »... routine care -- it probably saves costs in the long run (especially things like prenatal AND if we can use it to help bring down obesity, which I would like to focus more on).
So we screen for obesity in the routine care and at the kinds of things like school visit things like when they checked my hearing at school... required to join sports... job entrance requirements... etc. And then...? Ok, now we know WHO is obese. What do we do? Give them a pamphlet? Put them in special fat camps? Fines/taxes (for them or their parents) if they don't lose 5% of their weight by date x? FORCED STOMACH STAPLINGS?0 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate. We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.
but its OK to force people through the tax code to subsidize others care???????
the simple solution to the cost problem is to allow companies to compete across state lines. In Florida, I have two choices - Blue Cross Blue Shield or United...if I could shop my business health care policy around like I do other services, then I am sure that I could bring down the cost on my own without government involvement.2 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate. We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.
but its OK to force people through the tax code to subsidize others care???????
the simple solution to the cost problem is to allow companies to compete across state lines. In Florida, I have two choices - Blue Cross Blue Shield or United...if I could shop my business health care policy around like I do other services, then I am sure that I could bring down the cost on my own without government involvement.
I could support that. I wonder who'd be against that, though.0 -
lemurcat12 wrote: »... routine care -- it probably saves costs in the long run (especially things like prenatal AND if we can use it to help bring down obesity, which I would like to focus more on).
So we screen for obesity in the routine care and at the kinds of things like school visit things like when they checked my hearing at school... required to join sports... job entrance requirements... etc. And then...? Ok, now we know WHO is obese. What do we do? Give them a pamphlet? Put them in special fat camps? Fines/taxes (for them or their parents) if they don't lose 5% of their weight by date x? FORCED STOMACH STAPLINGS?
I don't know. But medical intervention and help, referral to a dietitian, so on, seems better than just reducing medical care (the alternative I was arguing against).
I am frustrated in these policy discussions because I have yet to come across anything on a societal level that I think will work. On the personal level, I know what to do. But it IS a societal problem.1 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate. We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.
but its OK to force people through the tax code to subsidize others care???????
the simple solution to the cost problem is to allow companies to compete across state lines. In Florida, I have two choices - Blue Cross Blue Shield or United...if I could shop my business health care policy around like I do other services, then I am sure that I could bring down the cost on my own without government involvement.
I could support that. I wonder who'd be against that, though.
This was part of the McCain proposal I posted (which honestly is worth discussion).
The typical reason people are against allowing insurance companies to compete across state lines is that they are governed by the state in which they are located. So if Illinois has certain requirements for insurance companies, I can be sure when I (as an Illinois resident) buy insurance that I get the benefits of those, as they have to comply to do business in the state. If they sell across state laws they can all choose to locate where regulations are the lowest and operate under those requirements -- something the consumer may not understand so well. Arguably, it also creates a race to the bottom in regulations so as to attract insurance companies to headquarter in your state.0 -
lemurcat12 wrote: »lemurcat12 wrote: »... routine care -- it probably saves costs in the long run (especially things like prenatal AND if we can use it to help bring down obesity, which I would like to focus more on).
So we screen for obesity in the routine care and at the kinds of things like school visit things like when they checked my hearing at school... required to join sports... job entrance requirements... etc. And then...? Ok, now we know WHO is obese. What do we do? Give them a pamphlet? Put them in special fat camps? Fines/taxes (for them or their parents) if they don't lose 5% of their weight by date x? FORCED STOMACH STAPLINGS?
I don't know. But medical intervention and help, referral to a dietitian, so on, seems better than just reducing medical care (the alternative I was arguing against).
I am frustrated in these policy discussions because I have yet to come across anything on a societal level that I think will work. On the personal level, I know what to do. But it IS a societal problem.
I 100% agree. An individual's weight is their problem, but when we're talking about 35% of adults meeting the definition of obese by the BMI charts, I feel like it's gone beyond one person.2 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate. We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.
but its OK to force people through the tax code to subsidize others care???????
I think it is okay (through the tax code or otherwise, I don't like the current model) to force people to subsidize a basic level of care, yes, with people free to add on if they like through purchasing services or insurance. In fact, I think basic health care is a human right (and we pay for a lot of it anyway as hospitals are required to provide emergency care paid or not).1 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »How about we try the free market? When in comes to information technology, which comparatively has been subject to far less regulation in the USA, consumers have for the past several decades reaped the benefits of a blistering pace of innovation combined with steadily decreasing costs.
I don't think free market works because it doesn't solve problems like pre-existing conditions and people being unemployable and I do want to share risk across society in some way (we do this to a significant extent with Medicare, but that doesn't help younger people). Also, unfortunately, the area in which health care is probably most price responsive to market pressures is routine care, and that's what we probably want people to take advanage of, as it saves costs in the long run (and in theory is one avenue for addressing obesity).
I did post above about McCain's proposal which I think can serve as a springboard for an interesting policy discussion.
I don't think any of us should be seriously viewed as offering approaches that "solve" anything, just approaches that address problems better than other approaches.
"Solve" may not be the right work, but an approach that does nothing to address the issues I mentioned is a non starter, IMO.
You talked about sharing costs, dealing with pre-existing conditions, and dealing with the unemployable, then assume that free market approaches don't address these issues. I don't think that's correct, at all.
I don't think they do, no. Left to the free market, insurance companies aren't going to cover pre existence conditions, period.
Insurance companies don't insure buildings for fire damage after they've caught fire. Imagine the premiums on insuring fire damage if that was the case?
Totally agree. That's why the insurance model for health care doesn't work well. We are trying to share risk, but also to cover/spread existing costs, as I understand it (or as I would have it).It just means free. Allow people to voluntarily cooperate to find solutions that suit them the best, free of force or coercion. That includes charity, mutual aid societies, creative crowdsourcing, technological solutions, a whole universe of approaches that haven't even been attempted or imagined yet.
So I see nothing here that suggests that it would address the problems I mentioned.
That's kind of the main rhetorical advantage of pro-government solutions over free-market proponents. Relying on the spontaneous order of the free market means by definition I don't have a wonkish policy proposal that I can trot out to argue is better than yours. You can insist that people are simply incapable of helping the sick and needy if government is out of the picture. I disagree.
We started the employer-based insurance system, plus the various add ons, because the free market solution was not adequate. We "reformed" it because of problems that even those did not solve, such as the ones I mentioned. If someone says we should go back to free market, I think they need to explain why the problems that originally existed leading to the change away from the free market are (a) no longer a problem, or (b) shouldn't matter to us, or (c) would actually be addressed by the free market in some way.
And no, I don't think an acceptable alternative is saying that people with urgent or expensive health care needs need to convince the community to pay for their chemo.
but its OK to force people through the tax code to subsidize others care???????
the simple solution to the cost problem is to allow companies to compete across state lines. In Florida, I have two choices - Blue Cross Blue Shield or United...if I could shop my business health care policy around like I do other services, then I am sure that I could bring down the cost on my own without government involvement.
I could support that. I wonder who'd be against that, though.
This was part of the McCain proposal I posted (which honestly is worth discussion).
The typical reason people are against allowing insurance companies to compete across state lines is that they are governed by the state in which they are located. So if Illinois has certain requirements for insurance companies, I can be sure when I (as an Illinois resident) buy insurance that I get the benefits of those, as they have to comply to do business in the state. If they sell across state laws they can all choose to locate where regulations are the lowest and operate under those requirements -- something the consumer may not understand so well. Arguably, it also creates a race to the bottom in regulations so as to attract insurance companies to headquarter in your state.
So it's the insurance companies who want to take choice away from consumers?1 -
I know this is a slippery slope, and I've been avoiding getting into this conversation due to its high controversy index and MFP's discouragement of discussion of divisive political topics on the open forums. So I'll have to limit my reply to this: Unless we, the citizens of the U.S., make out-of-wedlock births socially unacceptable and difficult to navigate after the fact - the illegitimacy rates, and all the social consequences that go with them, which are documented and irrefutable - will continue to rise.
Yikes. May my daughters never see this day. May they never have to drop out of school if they get pregnant, or have neighbors shun them. May they never have to go to a back alley abortionist, or give their babies away. May they always have access to good contraception, while we are at it.
I have two high achieving daughters, now women, who were both born out of wed-lock, and two more who bid fair to follow their sisters' path. It was the birth of the first two that spurred me to go to college and get a better job, to set an example for them and to make more money for us all. I cannot imagine my life, or theirs, would have been better if I'd been forced to marry their dad, or if they had been bullied for being "*kitten*". It certainly wouldn't have been better if I couldn't get the pell grants and short term welfare we used for a couple of months, that started us on our slow upward climb.
I would NEVER want to go backwards on this. My mom, too, says it was a nightmare time for women, when the out of wedlock pregnancy was seen as unutterably shameful.
On the original question - yes I think that, like smoking, obese people should pay a premium on their healthcare, and that it should be treated like disease, covered like other diseases. I think that reasonable lifestyle discounts or premiums on health insurance are better than most rating criteria because they are based on things you do and choose, not things you are. Insurance is kind of a racket anyway, a game you can only win by losing. Health insurance is bad enough, don't get me started on homeowner's. I literally paid MORE in homeowner's insurance than it would cost to buy my house over the 20 years we had the house and mortgage. It was a bigger part of the monthly payment than the loan, interest, or taxes, and as big as any two of those combined. Hate those companies, they gouge until it's unsustainable then walk away, cancelling whole neighborhoods.5 -
lemurcat12 wrote: »Packerjohn wrote: »lemurcat12 wrote: »Re the morbidly obese guy, ACA is really off-topic.
Before ACA, it was just as likely that others would share in the cost, either because morbidly obese guy has good employer-based insurance (the head of my first workplace was morbidly obese, for example).
In many cases the harm from being obese gets felt mainly as one gets older. So Medicare.
I'm not taking a position on this one way or another, just saying that if that's supposed to be the reason for the ACA debate, it's off-topic.
Good point. What percentage of people being treated for morbid obesity-related illnesses are on Medicare, Medicaid (due to disability), VHA, or private insurance.
Edit to add, it looks like private insurance pays for 50% of the medical costs related to obesity.
And the government pays the other 50%
Which has nothing to do with the ACA, as the government likely paid most of those costs pre ACA.
Without a doubt. It has been 50/50 for a while. With subsidies from the ACA the percent Paid by the government will go up
I should clarify. 50% is paid for by government, the other 50% by a combination of private insurance, policy owner out of pocket costs and anyone that just self insures. The insurers are paying the biggest part of this half.0
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