[stvswn]

It's was pretty easy to predict: allowing enrollment after a diagnosis was politically popular but a terrible economic disincentive to not buy insurance (because at that point, it isn't insurance -- it's a subscription plan for your treatments).

The young and healthy needed to enroll for the economics to work, but the individual mandate was delayed for years -- because coercion isn't popular politically, and there was a reelection to win in 2012. Without the coercion, why would a 20-something buy insurance?

So begins the death spiral. The only thing that can save it is very high penalties for failing to get insurance on the individual marketplace. This would be politically disastrous -- "we know the plans are expensive, but it will be even more expensive to not get one!" isn't a great selling point.

It's not only that you have to pay up so that others may wait until they're sick -- you have to buy a plan that covers things you don't need. I have to pay for all sorts of treatments I'll never use -- addiction counseling, prenatal care (I'm a man), etc. -- because it was considered unfair that I should pay less for consuming less (why this argument doesn't transfer to auto insurance, where men pay higher rates, I don't know).

I know liberals are going to argue "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be. I'd end up paying even more for everyone else who isn't paying.

But, politically, that's dead on arrival. Democrats just voted to abolish the cadillac tax. Everyone knows the ACA is an albatross on the Democrats' neck. The sorts of anecdotes in this thread are all over the place. "We just didn't go far enough, try single payer" is not going to win the day anytime soon.

If a Republican wins the presidency, we'll see a full repeal of the entire thing (Dems will not filibuster if they know what's good for them). If a Democrat wins, we'll see gradual repeal, marketed as tweaks and improvements.

Personally, I'm fine with a strong subsidized public option for the truly indigent (oh wait, I just invented Medicare). After that, let the market bring costs down by removing regulations. It's no coincidence that laser eye surgery, teeth whitening, cosmetic surgery is all generally affordable -- markets and competition have formed.

A good market would be one where you paid your doctor out of pocket for recurring, predictable costs and then bought insurance from a private company in order to guard against unforeseen catastrophes -- kind of like how your auto insurance policy doesn't pay for oil changes and car washes.

And what if someone is irresponsible and didn't qualify for Medicare but also didn't buy insurance? What happens if they get cancer? I hope they have family and friends to bail them out. It would be great for charities to lend a hand. I don't think the role of government is to take care of you, because it isn't the government taking care of you. It's the government coercing others to take care of you, against their will. It is not charitable to hold a doctor at gunpoint and force him to perform a surgery. So for everyone who believes that healthcare is a "right," I expect that you're freely giving away your excess time and money away? Or do you just expect others to?

I'm already paying someone else's medical bills -- I can calculate how much I give to Medicare each year, it's more than enough for someone else in this country to see a doctor for the entire year. I'm also paying way more than I should for my family's insurance plan because I'm indirectly subsidizing others. I wonder how many people are getting free healthcare on my dime, and what excuses they have for not being able to afford it on their own. I'm a little tired of being told how great it would be if I just paid a little more and others paid a little less.

[jonnathanson]

"It's no coincidence that laser eye surgery, teeth whitening, cosmetic surgery is all generally affordable -- markets and competition have formed."

This isn't the best example to have chosen. All of these procedures are discretionary and nonessential. If I find the cost of an elective nose job too pricey, I can take my time and shop around. Or I can just go without a nose job altogether and be totally fine. The only thing that will suffer will be my vanity, and, well, it's suffered before. :)

On the other hand, let's imagine my kidney is catastrophically failing, and I need it removed or replaced. I'm probably not going to shop around at that point; I'm going to accept my doctor's recommendation that I be hustled into the nearest ER as soon as humanly possible, and I'll be stuck with the bill after the fact. I have neither the time, nor the expertise, nor the inclination to wait and comparison shop. For another thing, nobody is generally in a "market" for emergency kidney surgery. It's not something you anticipate. It's not something you expect to have done, much less seek out and shop around for. And there are no economic substitutes for the surgery. It doesn't lend itself to a market-based system in the same way that elective goods and services do.

[rlanday]

Most medicine doesn’t happen on an emergency basis. E.g. if you’re diagnosed with cancer, or find out you should get a heart bypass, you have time to shop around for doctors.

[Jeema101]

No you don't, because hospitals intentionally obfuscate their pricing, and in many cases it's impossible for them to even tell you what your final bill would be for a procedure.

This is the source of the problem. There is no 'market' to speak of. There needs to be laws requiring hospitals to provide prices up front and honor them after the fact.

[stickfigure]

And even in the case of emergency care, there's at least the potential that you could prepare in advance by familiarizing yourself with the market. But hospitals won't tell you what anything costs ahead of time, which is practically an invitation to gouge ("just leave your wallet and bank account passwords with the front desk...").

Even auto mechanics are required by law to give you a written estimate.

[Vendan]

"I don't think the role of government is to take care of you, because it isn't the government taking care of you. It's the government coercing others to take care of you, against their will."

The government does a lot of coercing people to do things against their will. That's why we have police, court systems, jails, and so on. Heck, we've had drafts! That's literally coercing young men to march headfirst into combat to protect the country!

[nickff]

And many people believe the draft is morally equivalent to slavery (which they do not support either).[1]

[1] http://gregmankiw.blogspot.ca/2006/11/rangel-and-friedman-on...

[Vendan]

That's fine, I personally don't support the draft, but still. What about the legal system? Don't you see there is a problem with forcibly locking a portion of our population away behind bars? After all, that's what the government does, "for your own safety". Do you really feel safe in a country where the government can decide that murder is a "crime" for which you should be inhumanely LOCKED AWAY FOR LIFE?

P.S. Extreme sarcasm above...

[donatj]

The only justifiable coercion is against coercion. Someone injures you physically or financialy. Forcing someone to do something they don't want to including dieing or giving you their things is coercion. Coercion is always unjust and only fit as a reciprocation for coercion.

[ubernostrum]

So you're prepared to invalidate close to 100% of all employment contracts in the US?

[donatj]

Quite the contrary. Those are entered into willfully and not coercively.

[nbb]

Cite?

[donatj]

*The Golden Rule. "Treat others as you would like to be treated"

[nickff]

I have recently revised my views in light of Michael Huemer's latest book, which I found convincing (, despite my initial reluctance to accept many of his findings).[1] It takes at least a book to explain his reasoning (which rightfully separates political legitimacy and political obligation from each other and independent moral obligations), and I won't bore you with poor paraphrasing here.

[1] http://www.palgrave.com/page/detail/the-problem-of-political...

[Lawtonfogle]

You admit to sarcasm, but say the murder victim was an 3rd trimester fetus... now you have yourself a modern day political issue.

[mgkimsal]

Was going to post something like this - you beat me to it.

"I don't think the role of government is to protect our country, because it isn't the government protecting our country. It's the government coercing others to protect our country, against their will."

Obviously, we have a volunteer force, but haven't always had that - conscription, as you brought up. It's fine to have a volunteer force, until we need more. Then force is brought in.

[nickff]

If you can't convince others to defend your country through rhetoric and compensation, perhaps the country isn't worth defending; your comment implicitly assumes every state is worth sacrificing young lives for.

[mgkimsal]

> your comment implicitly assumes every state is worth sacrificing young lives for.

no, it assumes those in control of the state believe it is worth sacrificing young lives for.

[nickff]

Apologies if I misread your comment, but I read the following quote to imply that coercion was acceptable once the volunteer army was not enough:

>It's fine to have a volunteer force, until we need more. Then force is brought in.

[mgkimsal]

I don't believe it is acceptable, but the people in power probably (often?) do believe that it's acceptable, generally because it's not their own lives at risk.

[zeckalpha]

"... to secure these rights, Governments are instituted ..."

[Vendan]

it's almost like our government is supposed to "establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare", right?

[gnaritas]

> "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer.

No, it's a consistent argument for those who think beyond themselves; it's good for society as a whole. One doesn't have to believe one personally benefits, that's now how liberals work.

> A good market would be one where you paid your doctor

A good market for healthcare is one where it isn't a market, but a social good provided to everyone, like other civilized countries do. The market is not the correct answer to every question of how to distribute goods and services.

[novalis78]

other "socialist" civilized countries, you know, like the ones that regularly innovate and push the boundaries of science and attract millions of people each year because of a higher standard of living and less taxes. oh, wait... The "market" is just a synonym for individuals co-operating together for their mutual benefit. The "public" option is one where a faceless bureaucracy with a monopoly on power steps in and dictates terms. Disclaimer: I have lived decades with a single payer system and left in part because of it.

[gnaritas]

> like the ones that regularly innovate and push the boundaries of science and attract millions of people each year because of a higher standard of living and less taxes. oh, wait...

Propaganda Americans seem always believe, as if the rest of the world were a third world country. The Nordic countries top the world standard of living, America, not so much. Quality of life, the U.S. doesn't even break the top 10. The U.S. isn't a shining city on a hill, it's a waning rotten empire slowly sinking back into 3rd world status for its average citizen.

> The "market" is just a synonym for individuals co-operating together for their mutual benefit.

That's a nice theory, it's just not true in the real world.

> I have lived decades with a single payer system and left in part because of it.

And which country would that be?

[popmystack]

>I have lived decades with a single payer system and left in part because of it.

No you didn't.

[sageikosa]

No, but it is the only answer to how much those services cost, which is a necessary question to answer if you intend to apply accounting to resource allocation and consumption.

[gnaritas]

> but it is the only answer to how much those services cost

No it isn't; and that which can be asserted without evidence, can be refuted without it as well.

[sageikosa]

You assertion assumes ignorance as a starting point.

Be enlightened: http://wiki.mises.org/wiki/Price

[gnaritas]

The Austrian school, no thanks, that school of thought hasn't been mainstream since the 30's, for good reason; it's wrong. Here, you be enlightened and catch up to the modern world: https://en.wikipedia.org/wiki/Mainstream_economics

[rdtsc]

> It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be.

There is no need to believe or not believe. We are not talking about alternate realities, other modern, successful countries with better healthcare, longevity and quality of life have a single payer option.

> After that, let the market bring costs down by removing regulations.

Right. Point to any country where removing of regulations for healthcare has resulted in higher quality care.

[vidarh]

> After that, let the market bring costs down by removing regulations.

This is hilarious, given that the US has the most expensive healthcare system in the world, outpacing far more regulated countries by vast amounts....

You might be right that you're hampered by bad regulation, but heavy regulation of the healthcare system have beaten the US consistently on cost for most of the developed world.

[vezzy-fnord]

The United States' healthcare system undoubtedly is heavily regulated. It just so happens that it's simultaneously stupidly regulated: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730786/

[nommm-nommm]

>I have to pay for all sorts of treatments I'll never use -- addiction counseling, prenatal care (I'm a man), etc. --

Yeah, I know! Outrageous! Next thing you know they'll be asking me to pay to educate other peoples children!! Oh wait....

Having a society full of healthy babies (remember those babies are going to grow up to be adults someday) and people without substance dependency is beneficial to you.

Are you also upset that the people who live across town from you have roads that you never use?

The whole idea of "insurance" is to pool risk anyways. Do you also go on a rant like this every year you don't get into a car accident?

>because it was considered unfair that I should pay less for consuming less (why this argument doesn't transfer to auto insurance, where men pay higher rates, I don't know).

There are some countries (and Montana) where gender discrimination in auto insurance is illegal.

[gozur88]

>A good market would be one where you paid your doctor out of pocket for recurring, predictable costs and then bought insurance from a private company in order to guard against unforeseen catastrophes -- kind of like how your auto insurance policy doesn't pay for oil changes and car washes.

That works great if everyone is basically healthy. And it falls apart completely for people with ongoing medical conditions who either don't make a lot or are too sick to hold down a job.

[mgkimsal]

> you have to buy a plan that covers things you don't need.

Well... isn't that sort of the point of insurance all together? There's always going to be someone in an insurance plan getting some treatment that I'll never need, no?

[PKop]

Can never need under any circumstances (prenatal care, for example).

[hueving]

No, it's not that the insurance money is going into a pool to pay for someone else getting that. It's that they are forcing you to buy coverage for something that you can't possibly use (e.g. child dental care for someone with no children).

[CamperBob2]

I'd end up paying even more for everyone else who isn't paying.

You're neglecting the fact that unless you get hit by the proverbial bus, you will eventually have one or more very expensive medical conditions, just like those freeloaders you're being forced to pay for now.

The whole idea of selling "insurance" in a market where you know that everyone is eventually going to file expensive claims is just stupid. No other insurance market works that way, nor could it.

[humanrebar]

> This would be politically disastrous -- "we know the plans are expensive, but it will be even more expensive to not get one!" isn't a great selling point.

IANAL but it's my understanding that the individual mandate only passed Constitutional muster because it was not punitive. If it were a penalty or crime instead of a tax, the legal interpretation might change. Then again, the Supreme Court had been all over the place lately.

[nickff]

It passed constitutional muster because the Supreme Court (specifically the Chief Justice) is unwilling to wade into this particular political morass. This was not the first decision which has been made by post-hoc rationalization because of magnitude, political significance, side effects, and judges' policy preferences, but it is one of the most notable.

[DanBC]

> I know liberals are going to argue "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be. I'd end up paying even more for everyone else who isn't paying.

US government currently pays more per capita than eg UK NHS, and you still get stuck with insurance, co-pay, and bills for your very expensive health care.

[cmurf]

You're unfamiliar with how the American political system works. Presidents can't repeal laws, only Congress can do that.

[digler999]

If the government has billions of dollars in funds to blow up people, they have a few billion to heal people.

[angersock]

There's no guarantee that a single-payer would cost any more to you out-of-pocket than your insurance premiums. In fact, being able to draw against bonds and general taxes suggests to me that it'd do better.

In fact, giving the sheer amount of bloat the entire billing apparatus of hospitals, the machinations of health insurers, the weird regulatory captures, and whatnot of the current system, I don't think it's unreasonable at all to at least give it it's day in court.

Your writeup to me basically reads as a "Fuck you got mine" libtertarian approach to healthcare, and one that frankly falls flat on its face if you acknowledge even the slightest personal responsibility to one's civilization or even to one's older, more enfeebled self.