Question: if the problem is freeriders, why not tougher penalties for people who ignore their bills? And if the problem is that we just don't feel right doing that to people for medical care, why not tougher penalties along with straight, tax-based federal assistance? There's a disconnect here in the description of the problem and the application of the solution. There's a point at which supporters of Obamacare describe the problem, but then use that problem as if it justified this all-encompassing attempt at a solution. But the problem is much, much narrower in scope than the solution.
The problem with this analysis is that there are actually two problems, which are of great importance in this debate. First is the issue of access, second is the issue of cost. Conservatives seem to agree with the issue of cost but seem to gloss over the issue of access. In order to ensure that both of these problems are successfully dealt with, we need to do a lot more than just punish free-riders. We actually do need to radically change the healthcare system. The conservative proposals on the table will not get everyone, or virtually everyone, covered. Obama's healthcare reform, it's important to point out, doesn't do that, either, which is why many feel as if single-payer healthcare is the only solution that addresses both of these very important problems. However, Obama's healthcare reform, if implemented as intended, will get much closer to universal coverage than anything we've had before, and is a much more significant step towards the realization of both goals than anything the Republicans have offered.
Precisely. Which means it's a question of cost, not of rights. It's not a fundamental right that we simply must have to have a free nation and a free people, it's a luxury that some people think we can now afford. Which completely changes the angle of the conversation. It turns into a technical discussion about costs and benefits, not a civil rights struggle. Which, frankly, is better, because once you lump health care in with freedom of speech, what point is there in arguing? It's not like I can show you data that would convince you to deny someone a basic right. To say it's a right is to effectively end the conversation.
I do think healthcare is and should be a fundamental right, so we disagree on this point, but I am open to different ideas about how best to grant these rights and provide people healthcare.
Originally Posted by AKA23
An expansion of Medicaid would only cover the poor, not the many young and healthy people who merely choose not to purchase insurance and then end up incurring huge costs when they get involved in a car accident and it costs $200,000 to keep them alive.
Well, this is the worst-case scenario, sure, but how likely is it? Nobody denies that it happens; the question is how often it has to happen to make the decision not to have insurance an inarguably unreasonable one.
Since healthcare costs are the number one reason for bankruptcy in the US, I think this happens often enough to be seen as a legitimate problem and something that our government should be working to combat. This "worst-case scenario," as you call it, is actually a lot more prevalent than you seem willing to acknowledge. Not only this, even if the numbers are small, the devastation for those who fall victim to this scenario is huge.
Originally Posted by AKA23
That's what Romney did in Massachusetts, and it worked. 98% of Massachusetts residents have health insurance.
But it cost twice what was predicted! There's a circular argument here, in that people say these things "work" because they actually do make sure people have health insurance. But people don't just object to them because they think they won't cover people, they dispute that it'll lead to better overall care and higher overall standards of living. It could cost us trillions of dollars and still "work" by the very narrow definition of "does this get people insurance?" But that's not the only question. It's not a worthwhile goal at absolutely any cost, and even if it were, at certain cost levels it would be doomed, anyway.
We spend trillions of dollars on the military budget. We fight wars we can't win, then when things aren't going as rosy as we naively predicted, we pretend we've achieved "victory" and abandon the effort, leaving millions of people to pick up the pieces of their broken country as a result of the devastation our policies created. For a case study on this, see Iraq. We spend billions of dollars building more weapons systems that accomplish no useful purpose, and encourage the very arms race that our policies ostensibly seek to prevent in other countries. I haven't heard many Republicans do a cost/benefit analysis on any of this. I've never heard a broad consensus of mainstream Republicans say that the military budget needs to be dramatically reduced. Republicans are fine with spending whatever it takes to build more weapons systems and engage in wars that we can't win, or give tax cuts to the wealthy, but balk when having to spend money to ensure that there is healthcare for every American. Using your theory, which is arguably a legitimate one, Republicans should be willing to cut everything, dramatically, but they are only willing to cut services for the poor and the disadvantaged. This is a glowing example of misplaced priorities, and a completely inconsistent application of conservative principles.
Also, the kind of system you're describing, again, doesn't sound similar to the actual law. The actual law calls for the IPAB, a board that decides what things are and are not cost effective. These are what you've probably heard referred to as "death panels," and whether you agree with that incendiary label or not, they will definitely be making choices that decide who lives and dies.
The "death panels" that you refer to referred mostly to the government paying for people who are ill to get free end-of-life counseling. The idea that providing people information about their options with respect to treatment and their likelihood of success, and their options for planning an orderly transition from life to death, is a death panel, is ludicrous. The idea that a board that will use evidence-based approaches to determine what treatments are actually effective and which are not, is going to lead healthy people to die in droves from "rationing" is a caricature, not an actual description of the policy. These were politically motivated attacks, not based on reality. Every study that has looked at this issue has shown that people who have a plan for their death are far more comfortable with their death process, have a much more orderly, and dignified, transition, and end up spending a whole lot less on expensive, and often completely futile, end of life treatments.
As for rationing, rationing will occur, but rationing has to occur. Any time you have a finite resource, rationing has to happen. We don't have an unlimited amount of funds, or resources, to treat everyone with every conceivable treatment, no matter how unlikely it will be to succeed, and no matter what the cost. The notion that this can continue, or that it is desirable to continue, does not square with reality. In Europe, 70 year old Dick Cheney would not be given a heart transplant. "Rationing" would occur. Someone with 3 decades of heart disease who has lived a full and good life would likely die in his condition, but that's the reality of life. None of us can live forever. The fact that we waste resources on people in Cheney's condition instead of using those resources to save people who could more effectively use the finite resources we have is a damning commentary on our healthcare system. This lunacy doesn't speak to the greatness of our American healthcare system, it merely highlights the degree to which it is divorced from reality and is completely unsustainable.
I don't think the real problem is that some people can't get care. The real problem is whatever stops them from doing so. And I don't think it's just that health care is expensive. I think it's that we keep trying to split the difference. We have some market elements in health care, but not many. We have complicated regulations and many layers of abstraction. You can't buy health insurance across state lines. Few people have much idea about what things cost. Healthcare is inexplicably tied to employment because employer-based health care receives tax benefits that independently purchased care doesn't, which is insane. These are huge market distortions. People talk about the necessity of some form of socialized care and imply that the market has simply failed here, but we don't have anything approaching an open market. Not even close.
I fully support allowing the purchase of insurance across state lines. As for your other point, the notion that some people should only be able to get services that they use and shouldn't have to pay for anything more sounds good in theory, but in reality, a large part of health insurance is that the young and healthy help to defer some of the costs for the elderly and the sick. If we start opting out large and expensive services that a lot of people use and need, we'll have a wide disparity in health insurance premiums that could become cost prohibitive. That isn't sustainable in the long term. Yes, I am not going to get pregnant and have a child, so I in theory shouldn't have to pay for that as part of my health insurance, but there are other services that other people will pay for, that I will use, and that they will not, that will be expensive, so in the end, there is more balance to the system than you acknowledge. Not only this, your market oriented idea sounds good, again, in theory, but pragmatically, this isn't how our society functions. I can't even choose what channels I want for my TV subscription. I end up paying for all sorts of channels I never watch. This isn't even done with non-essential, trivial services, like TV, that don't have the cost burdens of something like healthcare. The idea that you want to bring these exclusively market-based principles to an essential service like healthcare when we don't even do this for things as simple as TV subscriptions seems naive to me, and shows a lack of a full appreciation of the complexity of the healthcare system.
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