Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
Support MFO
Donate through PayPal
America's Middle Class is no Longer the World's Richest
Not sure that it's possible for any medical insurance plan with semi-universal coverage to exist without a subsidy of some kind, somewhere, visible or hidden. Not taking any particular side on this, but you either believe that there is some obligation (didn't say you had to like it) to your less-fortunate fellow citizen or you don't. The only thing is- if it's every man for himself, in all areas, what's the point of having a country?
Wow, this is a rather more thoughtful discussion that most such online concerning ACA; perhaps cman's presence and stimulus accounts for that, but everyone seems to be being intelligent.
Anyone who doesn't think ACA makes a hugely beneficial difference to many people, not just poor but with various serious conditions, hasn't been googling hard enough. And anyone who has a genuinely negative outcome with it, meaning tested and the numbers run thoroughly and honestly, really should tell the media, not just rightwing media, because no such authentic tales have surfaced yet that I have seen; all such have been totally debunked with the most rudimentary investigation and digging.
Maybe this wise and thoughtful crowd should discuss politics more often -- j/k.
@davidrmoran I've some friends with honest and genuine negative outcomes for individuals (people who didn't want to buy insurance buying it or suffering tax penalties, and many people being forced to get "better" and more expensive plans) Those quotations on better being made. I think its almost always true that the newer plans give more care at a better cost, the question is do people need to get insurance?
To answer my own question I say yes, because when those people do occasionally need medical help they can't pay for, those costs end up being defrayed by others anyway, this just formalizes that. But I think there is an argument that if you don't want insurance its hard to say the ACA makes your life better.
>> there is an argument that if you don't want insurance its hard to say the ACA makes your life better.
Oh, sure, that one. Like the homeowner in front of his burning house waving off the arriving firefighters, No, thanks, I'm a libertarian. Or I don't have kids in school, my property taxes are unfairly high. etc.
I would not include this argument among any of the thoughtful ones I was admiring.
My plan has a pharmacy deductible of $500. That's definitely subsidized as well. This is Northeast Ohio. No co-pay after that.
Then, I don't see how that plan is HSA-compatible. Something isn't right here.
Regarding co-pay vs deductible, a $500 deductible and a $30-$50 copay with no deductible are pretty much equivalent to the insurance company in expected pay outs. Prior to any of these ACA things, you could see that in the almost equivalent premiums between plans that differed in those two. I have been in both types if plans.
The insurance company computes an average expected payout in the pool and prices it so that they get that back averaged over the pool in premiums plus their margin.
In the deductible plan, the people who use little or nothing over the deductible up to the premium cost of the pharmacy benefit (folded into the total premium) subsidize those that need more. So you could land up subsidizing or getting subsidized by others depending on how much you use. That is how insurance works in terms of deductibles and copays.
It is not subsidized in the sense that you are hinting at BECAUSE of the deductible vs copay. Your premiums may be subsidized but that is independent of the plan structure. Total ACA premiums without subsidy are computed to the actuarial tables of the insurance company. They are not under or overpriced as a subsidy or penalty because of ACA. Then depending on the income, you may get a premium subsidy as you have noted.
I am NOT making a case for or against ACA here. Just discussing the economics of insurance. Sometimes, the politically charged nature of this issue hides that.
cman, specifically the plan is from Anthem of Ohio and is plan w/HSA - cbfb. Naturally that w/HSA part means with Health Savings Account. I can read off my card:
Deductible $500/$1000 Co-Insurance 0%
That deductible would be higher if the government were not subsidizing it. Higher for me, that is, not for the insurance company. Somebody's lawyers determined that this plan was legal. I have it. To clear up any misunderstanding, the deductible is $500 for general medical bills (that's within a preferred provider network) and another $500 for pharmacy expenses.
State insurance boards regulate these things differently, don't they? I know that in Ohio insurance companies can't cancel individual policies whose premiums are still being paid, they can only cancel the entire class of policies by not offering them anymore.
That doesn't change anything because insurance companies created buckets after every couple of years for new classes of insurance and stopped writing new policies in the old buckets. This made the premiums go up in the old bucket as people there aged because pricing in each bucket was based on the costs in that bucket according to insurance regulations. People who had no preexisting condition could move to a current bucket and escape those increases which increased the premiums for people stuck there even more until it became completely unaffordable and same as cancelation. All this was legal. Anthem was sued in California for this but the settlement was just to allow a one time transfer not to prevent it.
The idea of reinsurance isn't a new one, Buffet does a lot of that, doesn't he? Dealing with 50 different states makes things next to impossible, but making something like that a rider to all health insurance policies (after all, they aren't insurance if they're cancellable when needed most, and in any event insurance companies will go bankrupt from time to time) would seem logical.
The reinsurance is for insurance companies to cover themselves if the payouts exceeded their expected scenario, not what I was thinking. No insurance company can afford to offer that kind of insurance as I suggested (unless there was a ACA like mandate that everyone had to pay into it) so it is hypothetical. But there must be a value to such insurance that people are willing to pay.
I am just trying to arrive at the true cost of insurance from economics. Without subsidies or ACA or any such complications, there is a value to me of the medical benefits of the insurance, the insurance for keeping the insurance regardless of what happens to me and the insurance so that costs from people who are underinsured or uninsured are not passed on to me (like such insurance in auto insurance). The premiums should reflect that. Otherwiae, somebody is subsidizing somebody regardless of Govt participation.
The true cost of anything can only be arrived at by a bidding process between the producers of the product and its consumers. There is no theoretical way to determine preferences prior to the actions which demonstrate those preferences (which include plenty of non-conscious motivations). Reformers ought to be concerned, in my view, with unblocking those barriers which prevent various offers from being made and accepted or rejected. This goes for everything, including health insurance.
Not sure that it's possible for any medical insurance plan with semi-universal coverage to exist without a subsidy of some kind, somewhere, visible or hidden. Not taking any particular side on this, but you either believe that there is some obligation (didn't say you had to like it) to your less-fortunate fellow citizen or you don't. The only thing is- if it's every man for himself, in all areas, what's the point of having a country?
Not taking any particular sides in this, but if you believe that there is some obligation to your less-fortunate fellow citizen, you should fulfill your obligation. You shouldn't feed your own ego by forcing others to pay for something that ostensibly helps the less-fortunate even if it does so. Rubbing salt in the wound is the fact that most of the money that you're forcing others to pay is actually improving the lots of the not-less-fortunate fellow citizens who are fortunate enough to be administering the programs. That you're also destroying the wealth that could be used to alleviate the lives of the less-fortunate is something of a coup de grace (forgive my poor French).
To put it concretely, I really do contribute money to the Salvation Army. I think it would be a good thing if others did as well, but if I had the power to force them to do so then, well, what's the point of living in such a country?
"The true cost of anything can only be arrived at by a bidding process between the producers of the product and its consumers."
There was a time when I was born that the consumer dealt directly with the hospitals and doctors. No insurance to drive up prices. My folks made arrangements with the hospital and made monthly payments for my childbirth. That would be closer to the true cost of medical care than what we have now. I believe insurance has caused the inflation in prices for healthcare. Some might argue that the doctors or the hospitals have driven up the costs but then again which came first? The chicken or the egg?
"The true cost of anything can only be arrived at by a bidding process between the producers of the product and its consumers."
My error. I had forgotten that the medical services community is a competitive market with transparent pricing and lots of competition, so that you can make your choice of necessary services well in advance of the time when you'll actually need them.
In cases of trauma you are correct but more and more the consumer had been more selective on certain services. That ended with ACA.
On a side note, I worked in healthcare for 35 years. There was no gratitude on the behalf of patients using DSHS/Welfare for the "free" care they received. Only demands. They wanted their prescriptions filled ahead of others because their ride was waiting. They were upset when they didn't get what they wanted ( brand name pain killers). They expected everything to be handed to them. If they had to pay even a small amount, there would be a big scene. It was true entitlement behavior.
Was there waste in healthcare? Most definitely. The stories have been told over and over of un-needed tests and procedures that cost $$$. The organization I worked for took a proactive approach to cut costs and streamline the process.
I don't have a answer to this whole thing. I understand that most people cannot afford healthcare when something major happens. I would have liked to seen a system of insurance for major medical and leaving minor costs to the patient. Most people complain of paying $60-100 to the doctor for a visit but spend that amount on various things that are not necessary. It's all about priorities.
My plan has a pharmacy deductible of $500. That's definitely subsidized as well. This is Northeast Ohio. No co-pay after that.
Then, I don't see how that plan is HSA-compatible. Something isn't right here.
cman, specifically the plan is from Anthem of Ohio and is plan w/HSA - cbfb. Naturally that w/HSA part means with Health Savings Account. I can read off my card:
Deductible $500/$1000 Co-Insurance 0%
I think I understand what is going on here. This is with a different subsidy under ACA for cost sharing that lowers the deductibles, in addition to the premium subsidy. The plan deductible itself should be $2000+ and the income level not more than 1.5 times poverty level. The HSA benefit is based on the unsubsidized level.
Yes, you indeed have the most ideal case for benefitting under the ACA and does point to the problem of making ACA subsidies income tested vs means/wealth tested. The latter would have been my preference for the law.
But this is exacerbated by the bigger problem I have been pointing out for treatment of return from capital vs treatment of returns from labor. The former allows a lot of that income to be hidden from what is considered as income for benefits like this. This is a problem different from health policy and not as easily solved.
Piketty does indeed point out the growtg of a new type of rentiers in his book - those who live by return on capital alone. He is referring to people like us. In some ways we are both exploiting the favored treatment of capital in different ways while the rules are written with return on labor in mind. I don't see either party willing to address this.
Hard to eliminate the middle man especially when they control the profitable purse strings.
Years ago my dad would take crates of fruit as payment for setting a broken bone. These settlements (barter) between medical provider and patient were very common. Somewhere along in his career doctors collectively decided to form "member owned insurance groups" (he had owner shares in Blue Cross...later gobble up by Wellpoint).
Much like many community owned banks being swallowed up by Big Finance, Big Med has gobbled up and stepped inbetween producer (provider) and consumer (patient). They have created their own version of how Health Care is provided and paid for.
Hard to get the genie back in the bottle especially when it is wealthy and politically powerful.
The true cost of anything can only be arrived at by a bidding process between the producers of the product and its consumers. There is no theoretical way to determine preferences prior to the actions which demonstrate those preferences (which include plenty of non-conscious motivations). Reformers ought to be concerned, in my view, with unblocking those barriers which prevent various offers from being made and accepted or rejected. This goes for everything, including health insurance.
In theory, yes. In practice, no if the service we need is not able to be provided by any business model. Defense (not to be confused with products used by defense) is one such benefit.
No insurance underwriter can afford to underwrite a non-cancelable policy for any condition unless the pool was big enough with a mandate (from state or federal). So there is no practical way to bring that price discovery about just as we cannot bring about a privatized military for the country.
We had a hidden subsidy before - we all subsidized people who lost their insurance or could not afford insurance when their costs were the highest.
Any discussion of the cost increase in ACA must include that in the baseline to be compared against. That is my point. With something like ACA, you are getting those three components I identified in the open rather than hidden. This is an economic argument, not a political one. Unfortunately, this economic reality is lost in the ideological bluster.
Admitting that I know very little about the insurance industry, and hoping that someone will correct me if I'm wrong...
But isn't the 800 pound gorilla that ALL insurance is a redistributive subsidy? It takes money from a large pool of people and spends that pool on a hopefully very small group who ends up needing it. Good drivers subsidize bad. Fortunate homeowners subsidize the unlucky and those who insist on living in areas with a higher probability of flood or wind or landslide. The young and healthy subsidize the older and unhealthy. People pay more or less in premiums because of circumstance, but those never cover the cost of a true catastrophe. Insurance exists because of what philosopher Bernard Williams called moral luck. You hope you won't have to rely on using it, because if you are using it you are relying on others. But if something does go wrong, the general cost to others is high enough that the pain of premiums going to others is worth it. You have insurance, as Chris Rock says, "in case sh!t."
We implicitly accept that with most forms of insurance. No one questions the need for car or homeowners insurance because we can see that if something goes wrong, others will bear a cost and we won't be able to pay it. Health insurance works a little differently because most people use theirs in every day life. You go to the doctor or get prescriptions. But that isn't the largest expense for insurance. If I recall, the top 5% of those who receive health benefits account for something like 50% of all insurance expenses. You don't think about car insurance because you rarely (hopefully) have bad accidents. You do think about health insurance because you want cheap medications. But the lion's share of payouts isn't going for your monthly drugs. It's going for terminal and very chronically ill patients.
As @cman alluded, we agreed in America long ago that everyone deserved some basic level of health care, and that emergency rooms had to provide it and wouldn't have to bear the entire cost. Seems to me like the ACA boils down to a simple equation: is the cost of increasing some premiums less than or greater than the cost borne by all taxpayers when the 15+% of Americans who are uninsured (and who use more unpaid services) receive subsidized insurance? If the answer is less than, then the ACA is a good thing and is actually saving American taxpayers money. You might not like it when you open your insurance bill, but that's only because it appears immediately like you are paying more because the costs of the uninsured were hidden before.
Politically I can see making two points for the ACA. Liberals will claim that it is a part of a broader social contract, that you support those in need even if it costs you in the short term, and conservatives could actually claim that this is personal responsibility, that if something goes wrong for you, others shouldn't bear that cost. I can't conceive of a reason people should be allowed to be uninsured.
"The true cost of anything can only be arrived at by a bidding process between the producers of the product and its consumers."
My error. I had forgotten that the medical services community is a competitive market with transparent pricing and lots of competition, so that you can make your choice of necessary services well in advance of the time when you'll actually need them.
Your error, I should say errors, are in not noticing that this is a response to cman's saying, "I am just trying to arrive at the true cost of insurance from economics"; that the statement is explicitly general and not specifically about the insurance market or the entire "medical services community" which you mysteriously transformed it to; and that my very next statement shows that I believe the insurance market (and I'll add here the entire medical services community) is not competitive and therefore is in need of reform.
My plan has a pharmacy deductible of $500. That's definitely subsidized as well. This is Northeast Ohio. No co-pay after that.
Then, I don't see how that plan is HSA-compatible. Something isn't right here.
cman, specifically the plan is from Anthem of Ohio and is plan w/HSA - cbfb. Naturally that w/HSA part means with Health Savings Account. I can read off my card:
Deductible $500/$1000 Co-Insurance 0%
I think I understand what is going on here. This is with a different subsidy under ACA for cost sharing that lowers the deductibles, in addition to the premium subsidy. The plan deductible itself should be $2000+ and the income level not more than 1.5 times poverty level. The HSA benefit is based on the unsubsidized level.
Yes, you indeed have the most ideal case for benefitting under the ACA and does point to the problem of making ACA subsidies income tested vs means/wealth tested. The latter would have been my preference for the law.
But this is exacerbated by the bigger problem I have been pointing out for treatment of return from capital vs treatment of returns from labor. The former allows a lot of that income to be hidden from what is considered as income for benefits like this. This is a problem different from health policy and not as easily solved.
Piketty does indeed point out the growtg of a new type of rentiers in his book - those who live by return on capital alone. He is referring to people like us. In some ways we are both exploiting the favored treatment of capital in different ways while the rules are written with return on labor in mind. I don't see either party willing to address this.
Back to the original question. Approximately 85% of my capital is the fruit of the savings from my labor, which as it happens was done almost entirely by working in a hospital (University Hospital of Cleveland). The other 15% or so was the fruit of my parents acquired by their labor (as it happens, from my father's working in a factory). He directed his savings to a bank account, which is about the only thing he really knew and trusted to do with it (Depression adolescent), and at least for his last 3 decades an honest return was available there. In those days, mostly the local banks invested it into home loans and small business loans.
Having a certain interest in economics, I invested my savings in stocks and bonds (mostly mutual funds). In doing so, of course, both my father and I directed parts of our labor which we had saved rather than consumed in certain economic directions. I mentioned where my father's went; I'll just call myself a value investor whose main successes have come from not panicking during the '87 Crash, not losing my head during the Internet Bubble (directing my own funds away from that destruction of capital and towards things that were for that moment starved for them, e.g., REITS), and not just riding a financial bubble through in 2008 (avoided banks then, and less profitably so since).
It should be mentioned that nearly all of labor's income derives from the capital invested in the laborer. That's why my labor at that hospital made me so much wealthier than the much greater labor of peasant farmers centuries ago. It sure wasn't my own efforts. The neat separation of capital from labor in any but conceptual terms is absurd, taxation of the one is also taxation of the other, and the destruction of capital would also be the annihilation of labor's living standards.
Of course, in the dreams of some, capital cannot be destroyed because it somehow automatically replenishes itself. This is so nonsensical that I can no longer accept it as a mere intellectual error. These, from Marx on (and before that), are elaborate rationalizations meant to ease the way to complete control over society by those who are charitable enough to 'direct' the reallocation of wealth ostensibly towards the oppressed laborers but in reality to themselves.
To be clear, this is NOT to say that all capital, or income inequality, is justified in the world as it is. Where it isn't, which is to say where it is acquired by physical force rather than by peaceful exchange, then we have a problem. As I said way back when, if income inequality is the result of solving problems then it is no problem; if it's the result of creating problems, then it is a problem in the sense that a fever is an indication of a problem that must be attended to for the sake of health.
Admitting that I know very little about the insurance industry, and hoping that someone will correct me if I'm wrong...
But isn't the 800 pound gorilla that ALL insurance is a redistributive subsidy? It takes money from a large pool of people and spends that pool on a hopefully very small group who ends up needing it. Good drivers subsidize bad. Fortunate homeowners subsidize the unlucky and those who insist on living in areas with a higher probability of flood or wind or landslide. The young and healthy subsidize the older and unhealthy. People pay more or less in premiums because of circumstance, but those never cover the cost of a true catastrophe. Insurance exists because of what philosopher Bernard Williams called moral luck. You hope you won't have to rely on using it, because if you are using it you are relying on others. But if something does go wrong, the general cost to others is high enough that the pain of premiums going to others is worth it. You have insurance, as Chris Rock says, "in case sh!t."
We implicitly accept that with most forms of insurance. No one questions the need for car or homeowners insurance because we can see that if something goes wrong, others will bear a cost and we won't be able to pay it. Health insurance works a little differently because most people use theirs in every day life. You go to the doctor or get prescriptions. But that isn't the largest expense for insurance. If I recall, the top 5% of those who receive health benefits account for something like 50% of all insurance expenses. You don't think about car insurance because you rarely (hopefully) have bad accidents. You do think about health insurance because you want cheap medications. But the lion's share of payouts isn't going for your monthly drugs. It's going for terminal and very chronically ill patients.
As @cman alluded, we agreed in America long ago that everyone deserved some basic level of health care, and that emergency rooms had to provide it and wouldn't have to bear the entire cost. Seems to me like the ACA boils down to a simple equation: is the cost of increasing some premiums less than or greater than the cost borne by all taxpayers when the 15+% of Americans who are uninsured (and who use more unpaid services) receive subsidized insurance? If the answer is less than, then the ACA is a good thing and is actually saving American taxpayers money. You might not like it when you open your insurance bill, but that's only because it appears immediately like you are paying more because the costs of the uninsured were hidden before.
Politically I can see making two points for the ACA. Liberals will claim that it is a part of a broader social contract, that you support those in need even if it costs you in the short term, and conservatives could actually claim that this is personal responsibility, that if something goes wrong for you, others shouldn't bear that cost. I can't conceive of a reason people should be allowed to be uninsured.
No, all insurance is not a redistributive subsidy. It's neither redistributive nor a subsidy. It's a voluntary arrangement in which a group of people voluntarily pool their resources for protection against certain unpredictable individual disasters (which are predictable as a class). The paying off of any legitimate claims from that pool doesn't redistribute anything, it distributes some part of the pool in the previously agreed upon manner. It's no different from my paying $20 for a meal in a restaurant. This is no redistribution of anything.
Redistribution takes place when some third party seizes the pool and starts distributing it according to the third party's will. Naturally, most of this redistribution will go to the third party, though it's likely the third party will justify themselves by way of some fictitious 'Social Contract' or something which mysteriously will always amount to whatever the third party desires and never to something that some other party desires.
As to the costs you want to compare, no it's not nearly so simple as that. For example, and practically unmentioned here (only by me, I fear), ACA is massively increasing the Medicaid program. This is know to lead to INCREASED, not decreased, use of emergency rooms for treatments. This is because of a shortage of doctors who will see Medicaid patients. What ACA will do for the availability for doctors generally can't be judged until it's actually fully in effect (of course, it's open-ended so it will never be 'fully' in effect). It will almost certainly lead to the use of nurses to do jobs now done by doctors. Will that be good or bad? Personally I can see that much of it will be good, but it will have some costs. Will the costs be worth it? Who knows? In any event, you certainly don't need ACA to do this.
And if cost programs associated with ACA drive doctors into early retirement they would presumably be replaced with foreign doctors from third world countries. Would these doctors be as good? Maybe they would be better. How about the cost to those third world countries of being drained of their doctors? I'm pretty sure that doesn't enter into the equation. But who knows if this will happen or not?
One can also go into what it means for the implementation of new medical drugs and devices, but again, who can say? I sure can't. Really no one can because it will depend upon what happens once the system is in full effect. But as I said way back in the beginning, the idea that all we need do is add up the cost in increased premiums to those poor pathetic middle class workers and see if the benefits to those receiving the premiums, AND THOSE SEIZING CONTROL OF THE ENTIRE MEDICAL SYSTEM, are greater is way too simple.
Vert- Thanks for participating. Civil discussions with contrasting viewpoints are a great way to examine issues, and can very possibly modify one's position according to those contrasting viewpoints. It's much more interesting to hear intelligent opposing or contrasting opinions rather than to always hear folks who are in agreement.
No, all insurance is not a redistributive subsidy. It's neither redistributive nor a subsidy. It's a voluntary arrangement in which a group of people voluntarily pool their resources for protection against certain unpredictable individual disasters (which are predictable as a class). The paying off of any legitimate claims from that pool doesn't redistribute anything, it distributes some part of the pool in the previously agreed upon manner. It's no different from my paying $20 for a meal in a restaurant. This is no redistribution of anything.
Redistribution takes place when some third party seizes the pool and starts distributing it according to the third party's will. Naturally, most of this redistribution will go to the third party, though it's likely the third party will justify themselves by way of some fictitious 'Social Contract' or something which mysteriously will always amount to whatever the third party desires and never to something that some other party desires.
We have very different definitions of the word redistribution. If I give another party money and they give that money to a third party, to me that is a redistribution of money. In the case of health insurance, where a small group of unhealthy individuals are claiming a majority of all payouts, that seems very much like a redistribution to me.
We agree that insurance is based on protection against unpredictable disasters. If I am lucky, someone unlucky ends up with my money. If I am unlucky, the payouts flow to me. Premiums don't seem like paying for a service, but instead like income taxation or social security. I choose to go out to dinner when I can. I don't choose when I need my insurance because bad things in life just happen. In any case, money is flowing from one party to another through an intermediary.
And if there are unlucky people who aren't insured, there is also a cost to others. And that is a problem. Even leaving moral hazard out of the equation.
I was not trying to be ideological, but I will admit our differences are ideological at their root. That probably makes us intransigent. I appreciate everyone taking the time to discuss this nicely. I especially appreciate some of the specific concerns you raise regarding outcomes in healthcare and will go away now and consider them.
Part of your passage brings to mind a concept called "dispursed costs and concentrated benefits". A stealth method of wealth redistribution achieved in small increments and then pooled for some other specific purpose.
Look at one of your utility bills some time for these dispursed costs. City and State do this all the time collecting what seem like small fees (taxes) that concentrate the benefit into their hands.
When the multitude of small costs are looked in aggregate you begin to realize how outsized the burden really is.
mrdarcey- I was intrigued by your comments above...
"But isn't the 800 pound gorilla that ALL insurance is a redistributive subsidy? It takes money from a large pool of people and spends that pool on a hopefully very small group who ends up needing it. Good drivers subsidize bad. Fortunate homeowners subsidize the unlucky and those who insist on living in areas with a higher probability of flood or wind or landslide. The young and healthy subsidize the older and unhealthy. People pay more or less in premiums because of circumstance, but those never cover the cost of a true catastrophe."
... because I as I was mulling this whole thing over last night I wondered the very same thing. Additionally, as you also mention the intrusion of luck into the equation, I was also mentally comparing the insurance redistribution/premium issues to that which sort of goes on in a gambling casino. Now, I don't frequent those so can't speak with any degree of expertise, but I've certainly been in one or two in my lifetime, and observed what seems to me to be two essentially different classes of gambling:
1) No skills required, pure mathematical odds: games such as keno, and of course the slots. There is a pool of players providing the premiums, the house takes it's cut, and the reward has no relationship to the premiums paid or any expertise on the part of the player.
2) Games influenced by skill: blackjack, poker, and many others. Here the payout odds are influenced by the player to some degree.
In both cases though, the reward consists of a redistribution of assets from the participants.
With respect to healthcare, because of the complexities involved it is possible to influence the payout odds, balanced against the premiums paid, by skillful manipulation of the system as has been discussed here.
And then you have the other aspect, where the keno and slot players are maybe assigned to Medicaid or one of the less advantageous pools.
In any case, casino or insurance, no money comes from the house: it's purely a redistribution of premiums paid by the participants.
Not sure that this analogy makes any sense, but it's something to mull over.
>> If I give another party money and they give that money to a third party,
When you buy a car that money goes to all sorts of people via the dealer, and I bet you do not think of that as redistributive. Perhaps you can think of insurance product like a car but only when needed?
>> In the case of health insurance, where a small group of unhealthy individuals are claiming a majority of all payouts,
Oh, Lord, seriously? I take it you are not going to get old, or sick, nor have children. Now *this* is unsophisticated thinking.
It should be mentioned that nearly all of labor's income derives from the capital invested in the laborer. That's why my labor at that hospital made me so much wealthier than the much greater labor of peasant farmers centuries ago. It sure wasn't my own efforts. The neat separation of capital from labor in any but conceptual terms is absurd, taxation of the one is also taxation of the other, and the destruction of capital would also be the annihilation of labor's living standards.
This is indeed the crux of the narrative that has led to the ascent of capital over labor in an asymmetric fashion with the observed consequences. There are two inadequacies in arriving at that narrative - one, not quantifying the risk and investment aspects of labor just like capital and two, the generalization of fungible capital as to what it invests in. I will take each one separately.
The lack of symmetry between capital and labor is the problem to be looked at. From an economic perspective both capital and labor are inputs into a production, consumption cycle. Both are needed and one cannot thrive without the other. So, it is not an either or situation. I will ignore arguments that pit them as such because destruction of either is bad for the other. The question is how to balance the rewards between the two.
The problem is inherent in your own acceptance of the risks and investments you had. What is missing in this equation is the investment and risk that labor takes to provide that labor.
Labor is assuming a lot of costs and risks. Costs include education costs, skill acquisition costs, opportunity costs in focusing on a particular specialty, etc. The risks it assumes for this are considerable but not quantified in this discussion. The risks include uncertainties in getting a reward in the future for that investment, lack of liquidity in moving from one industry to another, market and environmental conditions that can cause a loss of returns, physical and mental damage risks in certain types of labor, etc.
One should see the rewards for labor as the returns for that investment and costs. When this is quantified in terms of capital, it becomes more evident. Arguments that capital returns must be favored for the risks they take ignore this reality.
Of course, the labor returns should be commensurate with the costs and risks just as it is for capital. But here is one problem in taxation. The return on labor is taxed very differently than return on capital. The rationalization is that the capital has already been taxed because it arrives from some labor that has already been taxed.
In a fiat currency, this is a false assumption. Money can be just created to put into circulation. And in this virtuous cycle of conversion between labor and capital, it is false to arbitrarily claim the origin at some labor.
If I invest capital that has already been taxed in my education and get rewards from it and the risks I take in providing that labor, why should the RETURNS be taxed again (let alone highly) as my wages? And yet, this is exactly the rationalization for favored return on ALL capital as some kind of double taxation. Because people with capital write the rules. So, one has to create a reset for that taxation at every such deployment, not artificially at one conversion only, there is no logical reason to do so.
Even in this lopsided treatment, it used to be that labor could have a satisfactory life from the savings of that labor without having to take further risks. But these days, not only do you take the labor risks but also market risks in further deploying the returns to be able to retire. On the other hand, people who start with capital only (by borrowing or windfall) take the latter but get much more favored treatment from it because of that faulty generalization.
And people have bought into this one-sided narrative without looking at the quantification that has made the investment in labor a bad investment. This upsets the balance between labor and capital over time and the returns from capital get diminished as labor diminishes, in the same way returns for labor gets diminished if capital is diminished. These two are sides of the same coin. They cannot be separated as you have said but they also cannot be treated separately as one being more virtuous than the other.
Unfortunately, rather than look at it with the economic quantification as above, the narrative gets mixed up with the political ideologues of capitalism and socialism. This favors the people that write the narrative for capital and get people like you believing that without that asymmetry, everything will collapse. There is no economic or intellectual rationalization for the asymmetry, only an ideological one.
The second false narrative is that all capital creates labor. This is no more true than all labor creates capital. In fact, I can say with certainty that my gains over the last year in capital markets had very little to do with creating or rewarding labor and had everything to do with gaming other deployments of capital partially and an asset bubble for the rest. My capital deployment in equity markets had very little to do with even reaching the industries that it was invested in. And yet we cling on to that old model of investing in a company which takes that capital and deploys it to create jobs and products to justify most of the gains coming from game theory between investors.
The justification is true only in a tiny fraction of capital deployment - venture capital, IPOs, companies raising money for expansion, etc. This is not why most people in this forum made 20% last year. Most of us are free-riding on that sliver of justification.
Then there is the false narrative that market forces make all this natural and fair and correct. This is true only in a theoretical framework where the markets are extremely efficient with similar barriers or lack of for both labor and capital. This is where the reality is completely tilted in favor of capital because it is so fungible with very little barrier to movement even across borders these days. Labor isn't.
This is not an argument for destruction of capital which is another red herring. It is an argument that it is easy to game this existing system with capital at the expense of labor and all of us here are doing this at the expense of labor to varying extent. We just happened to be lucky or diligent enough to move into the winners column from the losers column. But that is not a sustainable solution, only as long as losers agree to remain so!
At the least, let us not delude ourselves that somehow this is a fair or sustainable system and that capital gaming is necessarily leading to a better outcome.
It seems that prior transformations in the economy took time to manifest themselves. The blacksmith did not disappear right away as automobiles took over the streets. Those blacksmiths probably got jobs at the local assembly line. Today though it seems everything is sped up. Change is happening at a rate that is unprecedented. This prompts increased spending for education. Most jobs require some kind of post high school education. A housekeeper working in a hospital is required in most locales to take a course in tech/community college. I guess mopping floors is not the same.
Added costs onto the middle class for college must have some impact here.
Well, Mona, just a brief question related to an incidence that happened to me. I was crippled by a driver who crossed a highway and hit me head on. He had partied for 48hours and fallen asleep at the wheel. He was employed at the time of the accident but decided to quit that day. His insurance was so minimal as to almost be a joke. My insurance, especially my health insurance stepped in and paid the bill (along with my having to do the copays and deductibles).
Should my insurance have just said - let the leg rot off in gangrene and die if you must because paying the bill, which should have been party at fault's responsibility, is simply not virtuous and might have the moral hazard of your expecting help every time you need it whether we think you deserve it or not?
Or rather I should ask a simpler question - why didn't the good Samaritan come out of the dark shoulders of that road and offer to cover my costs because of the greater virtue of his offer? There is no way greater virtue would have come from the irresponsible guy who sleeps while driving.
Ah, I see the difference. If you have to say thank you and acknowledge the superior standing with God of your benefactor, all is OK.
Obama would look mighty good on a white horse. When I was growing up there was something considered to be good about men on white horses, especially if they wore white hats too. Chuckle.
Yea, I know holes can be made in my story above. It actually is true albeit simplified. But if I hadn't been little miss priss with a high wage good job with benefits, who would have needed to step in to put my foot back on my leg and otherwise glue the remaining bones together again? Or should I just die if the Samaritan doesn't show. Using the ER when there is not payer is also compulsory. No?
As an after thought, you may want to read one of many good pieces written by Charles Krauthammer, as relates to the ACA. Unfortunately, Dr. Krauthammer, as 22 year old, was not as fortunate as you, do to his accident back in 1972, when he was a freshman at Harvard.
Comments
Anyone who doesn't think ACA makes a hugely beneficial difference to many people, not just poor but with various serious conditions, hasn't been googling hard enough. And anyone who has a genuinely negative outcome with it, meaning tested and the numbers run thoroughly and honestly, really should tell the media, not just rightwing media, because no such authentic tales have surfaced yet that I have seen; all such have been totally debunked with the most rudimentary investigation and digging.
Maybe this wise and thoughtful crowd should discuss politics more often -- j/k.
To answer my own question I say yes, because when those people do occasionally need medical help they can't pay for, those costs end up being defrayed by others anyway, this just formalizes that. But I think there is an argument that if you don't want insurance its hard to say the ACA makes your life better.
Oh, sure, that one. Like the homeowner in front of his burning house waving off the arriving firefighters, No, thanks, I'm a libertarian.
Or I don't have kids in school, my property taxes are unfairly high. etc.
I would not include this argument among any of the thoughtful ones I was admiring.
Deductible $500/$1000
Co-Insurance 0%
That deductible would be higher if the government were not subsidizing it. Higher for me, that is, not for the insurance company. Somebody's lawyers determined that this plan was legal. I have it. To clear up any misunderstanding, the deductible is $500 for general medical bills (that's within a preferred provider network) and another $500 for pharmacy expenses.
To put it concretely, I really do contribute money to the Salvation Army. I think it would be a good thing if others did as well, but if I had the power to force them to do so then, well, what's the point of living in such a country?
There was a time when I was born that the consumer dealt directly with the hospitals and doctors. No insurance to drive up prices. My folks made arrangements with the hospital and made monthly payments for my childbirth. That would be closer to the true cost of medical care than what we have now. I believe insurance has caused the inflation in prices for healthcare. Some might argue that the doctors or the hospitals have driven up the costs but then again which came first? The chicken or the egg?
On a side note, I worked in healthcare for 35 years. There was no gratitude on the behalf of patients using DSHS/Welfare for the "free" care they received. Only demands. They wanted their prescriptions filled ahead of others because their ride was waiting. They were upset when they didn't get what they wanted ( brand name pain killers). They expected everything to be handed to them. If they had to pay even a small amount, there would be a big scene. It was true entitlement behavior.
Was there waste in healthcare? Most definitely. The stories have been told over and over of un-needed tests and procedures that cost $$$. The organization I worked for took a proactive approach to cut costs and streamline the process.
I don't have a answer to this whole thing. I understand that most people cannot afford healthcare when something major happens. I would have liked to seen a system of insurance for major medical and leaving minor costs to the patient. Most people complain of paying $60-100 to the doctor for a visit but spend that amount on various things that are not necessary. It's all about priorities.
Apologies for the rant. It's bedtime here.
Yes, you indeed have the most ideal case for benefitting under the ACA and does point to the problem of making ACA subsidies income tested vs means/wealth tested. The latter would have been my preference for the law.
But this is exacerbated by the bigger problem I have been pointing out for treatment of return from capital vs treatment of returns from labor. The former allows a lot of that income to be hidden from what is considered as income for benefits like this. This is a problem different from health policy and not as easily solved.
Piketty does indeed point out the growtg of a new type of rentiers in his book - those who live by return on capital alone. He is referring to people like us. In some ways we are both exploiting the favored treatment of capital in different ways while the rules are written with return on labor in mind. I don't see either party willing to address this.
Years ago my dad would take crates of fruit as payment for setting a broken bone. These settlements (barter) between medical provider and patient were very common. Somewhere along in his career doctors collectively decided to form "member owned insurance groups" (he had owner shares in Blue Cross...later gobble up by Wellpoint).
Much like many community owned banks being swallowed up by Big Finance, Big Med has gobbled up and stepped inbetween producer (provider) and consumer (patient). They have created their own version of how Health Care is provided and paid for.
Hard to get the genie back in the bottle especially when it is wealthy and politically powerful.
No insurance underwriter can afford to underwrite a non-cancelable policy for any condition unless the pool was big enough with a mandate (from state or federal). So there is no practical way to bring that price discovery about just as we cannot bring about a privatized military for the country.
We had a hidden subsidy before - we all subsidized people who lost their insurance or could not afford insurance when their costs were the highest.
Any discussion of the cost increase in ACA must include that in the baseline to be compared against. That is my point. With something like ACA, you are getting those three components I identified in the open rather than hidden. This is an economic argument, not a political one. Unfortunately, this economic reality is lost in the ideological bluster.
But isn't the 800 pound gorilla that ALL insurance is a redistributive subsidy? It takes money from a large pool of people and spends that pool on a hopefully very small group who ends up needing it. Good drivers subsidize bad. Fortunate homeowners subsidize the unlucky and those who insist on living in areas with a higher probability of flood or wind or landslide. The young and healthy subsidize the older and unhealthy. People pay more or less in premiums because of circumstance, but those never cover the cost of a true catastrophe. Insurance exists because of what philosopher Bernard Williams called moral luck. You hope you won't have to rely on using it, because if you are using it you are relying on others. But if something does go wrong, the general cost to others is high enough that the pain of premiums going to others is worth it. You have insurance, as Chris Rock says, "in case sh!t."
We implicitly accept that with most forms of insurance. No one questions the need for car or homeowners insurance because we can see that if something goes wrong, others will bear a cost and we won't be able to pay it. Health insurance works a little differently because most people use theirs in every day life. You go to the doctor or get prescriptions. But that isn't the largest expense for insurance. If I recall, the top 5% of those who receive health benefits account for something like 50% of all insurance expenses. You don't think about car insurance because you rarely (hopefully) have bad accidents. You do think about health insurance because you want cheap medications. But the lion's share of payouts isn't going for your monthly drugs. It's going for terminal and very chronically ill patients.
As @cman alluded, we agreed in America long ago that everyone deserved some basic level of health care, and that emergency rooms had to provide it and wouldn't have to bear the entire cost. Seems to me like the ACA boils down to a simple equation: is the cost of increasing some premiums less than or greater than the cost borne by all taxpayers when the 15+% of Americans who are uninsured (and who use more unpaid services) receive subsidized insurance? If the answer is less than, then the ACA is a good thing and is actually saving American taxpayers money. You might not like it when you open your insurance bill, but that's only because it appears immediately like you are paying more because the costs of the uninsured were hidden before.
Politically I can see making two points for the ACA. Liberals will claim that it is a part of a broader social contract, that you support those in need even if it costs you in the short term, and conservatives could actually claim that this is personal responsibility, that if something goes wrong for you, others shouldn't bear that cost. I can't conceive of a reason people should be allowed to be uninsured.
Having a certain interest in economics, I invested my savings in stocks and bonds (mostly mutual funds). In doing so, of course, both my father and I directed parts of our labor which we had saved rather than consumed in certain economic directions. I mentioned where my father's went; I'll just call myself a value investor whose main successes have come from not panicking during the '87 Crash, not losing my head during the Internet Bubble (directing my own funds away from that destruction of capital and towards things that were for that moment starved for them, e.g., REITS), and not just riding a financial bubble through in 2008 (avoided banks then, and less profitably so since).
It should be mentioned that nearly all of labor's income derives from the capital invested in the laborer. That's why my labor at that hospital made me so much wealthier than the much greater labor of peasant farmers centuries ago. It sure wasn't my own efforts. The neat separation of capital from labor in any but conceptual terms is absurd, taxation of the one is also taxation of the other, and the destruction of capital would also be the annihilation of labor's living standards.
Of course, in the dreams of some, capital cannot be destroyed because it somehow automatically replenishes itself. This is so nonsensical that I can no longer accept it as a mere intellectual error. These, from Marx on (and before that), are elaborate rationalizations meant to ease the way to complete control over society by those who are charitable enough to 'direct' the reallocation of wealth ostensibly towards the oppressed laborers but in reality to themselves.
To be clear, this is NOT to say that all capital, or income inequality, is justified in the world as it is. Where it isn't, which is to say where it is acquired by physical force rather than by peaceful exchange, then we have a problem. As I said way back when, if income inequality is the result of solving problems then it is no problem; if it's the result of creating problems, then it is a problem in the sense that a fever is an indication of a problem that must be attended to for the sake of health.
Redistribution takes place when some third party seizes the pool and starts distributing it according to the third party's will. Naturally, most of this redistribution will go to the third party, though it's likely the third party will justify themselves by way of some fictitious 'Social Contract' or something which mysteriously will always amount to whatever the third party desires and never to something that some other party desires.
As to the costs you want to compare, no it's not nearly so simple as that. For example, and practically unmentioned here (only by me, I fear), ACA is massively increasing the Medicaid program. This is know to lead to INCREASED, not decreased, use of emergency rooms for treatments. This is because of a shortage of doctors who will see Medicaid patients. What ACA will do for the availability for doctors generally can't be judged until it's actually fully in effect (of course, it's open-ended so it will never be 'fully' in effect). It will almost certainly lead to the use of nurses to do jobs now done by doctors. Will that be good or bad? Personally I can see that much of it will be good, but it will have some costs. Will the costs be worth it? Who knows? In any event, you certainly don't need ACA to do this.
And if cost programs associated with ACA drive doctors into early retirement they would presumably be replaced with foreign doctors from third world countries. Would these doctors be as good? Maybe they would be better. How about the cost to those third world countries of being drained of their doctors? I'm pretty sure that doesn't enter into the equation. But who knows if this will happen or not?
One can also go into what it means for the implementation of new medical drugs and devices, but again, who can say? I sure can't. Really no one can because it will depend upon what happens once the system is in full effect. But as I said way back in the beginning, the idea that all we need do is add up the cost in increased premiums to those poor pathetic middle class workers and see if the benefits to those receiving the premiums, AND THOSE SEIZING CONTROL OF THE ENTIRE MEDICAL SYSTEM, are greater is way too simple.
We agree that insurance is based on protection against unpredictable disasters. If I am lucky, someone unlucky ends up with my money. If I am unlucky, the payouts flow to me. Premiums don't seem like paying for a service, but instead like income taxation or social security. I choose to go out to dinner when I can. I don't choose when I need my insurance because bad things in life just happen. In any case, money is flowing from one party to another through an intermediary.
And if there are unlucky people who aren't insured, there is also a cost to others. And that is a problem. Even leaving moral hazard out of the equation.
I was not trying to be ideological, but I will admit our differences are ideological at their root. That probably makes us intransigent. I appreciate everyone taking the time to discuss this nicely. I especially appreciate some of the specific concerns you raise regarding outcomes in healthcare and will go away now and consider them.
Part of your passage brings to mind a concept called "dispursed costs and concentrated benefits". A stealth method of wealth redistribution achieved in small increments and then pooled for some other specific purpose.
Look at one of your utility bills some time for these dispursed costs. City and State do this all the time collecting what seem like small fees (taxes) that concentrate the benefit into their hands.
When the multitude of small costs are looked in aggregate you begin to realize how outsized the burden really is.
"But isn't the 800 pound gorilla that ALL insurance is a redistributive subsidy? It takes money from a large pool of people and spends that pool on a hopefully very small group who ends up needing it. Good drivers subsidize bad. Fortunate homeowners subsidize the unlucky and those who insist on living in areas with a higher probability of flood or wind or landslide. The young and healthy subsidize the older and unhealthy. People pay more or less in premiums because of circumstance, but those never cover the cost of a true catastrophe."
... because I as I was mulling this whole thing over last night I wondered the very same thing. Additionally, as you also mention the intrusion of luck into the equation, I was also mentally comparing the insurance redistribution/premium issues to that which sort of goes on in a gambling casino. Now, I don't frequent those so can't speak with any degree of expertise, but I've certainly been in one or two in my lifetime, and observed what seems to me to be two essentially different classes of gambling:
1) No skills required, pure mathematical odds: games such as keno, and of course the slots. There is a pool of players providing the premiums, the house takes it's cut, and the reward has no relationship to the premiums paid or any expertise on the part of the player.
2) Games influenced by skill: blackjack, poker, and many others. Here the payout odds are influenced by the player to some degree.
In both cases though, the reward consists of a redistribution of assets from the participants.
With respect to healthcare, because of the complexities involved it is possible to influence the payout odds, balanced against the premiums paid, by skillful manipulation of the system as has been discussed here.
And then you have the other aspect, where the keno and slot players are maybe assigned to Medicaid or one of the less advantageous pools.
In any case, casino or insurance, no money comes from the house: it's purely a redistribution of premiums paid by the participants.
Not sure that this analogy makes any sense, but it's something to mull over.
Regards- OJ
When you buy a car that money goes to all sorts of people via the dealer, and I bet you do not think of that as redistributive. Perhaps you can think of insurance product like a car but only when needed?
>> In the case of health insurance, where a small group of unhealthy individuals are claiming a majority of all payouts,
Oh, Lord, seriously? I take it you are not going to get old, or sick, nor have children. Now *this* is unsophisticated thinking.
The lack of symmetry between capital and labor is the problem to be looked at. From an economic perspective both capital and labor are inputs into a production, consumption cycle. Both are needed and one cannot thrive without the other. So, it is not an either or situation. I will ignore arguments that pit them as such because destruction of either is bad for the other. The question is how to balance the rewards between the two.
The problem is inherent in your own acceptance of the risks and investments you had. What is missing in this equation is the investment and risk that labor takes to provide that labor.
Labor is assuming a lot of costs and risks. Costs include education costs, skill acquisition costs, opportunity costs in focusing on a particular specialty, etc. The risks it assumes for this are considerable but not quantified in this discussion. The risks include uncertainties in getting a reward in the future for that investment, lack of liquidity in moving from one industry to another, market and environmental conditions that can cause a loss of returns, physical and mental damage risks in certain types of labor, etc.
One should see the rewards for labor as the returns for that investment and costs. When this is quantified in terms of capital, it becomes more evident. Arguments that capital returns must be favored for the risks they take ignore this reality.
Of course, the labor returns should be commensurate with the costs and risks just as it is for capital. But here is one problem in taxation. The return on labor is taxed very differently than return on capital. The rationalization is that the capital has already been taxed because it arrives from some labor that has already been taxed.
In a fiat currency, this is a false assumption. Money can be just created to put into circulation. And in this virtuous cycle of conversion between labor and capital, it is false to arbitrarily claim the origin at some labor.
If I invest capital that has already been taxed in my education and get rewards from it and the risks I take in providing that labor, why should the RETURNS be taxed again (let alone highly) as my wages? And yet, this is exactly the rationalization for favored return on ALL capital as some kind of double taxation. Because people with capital write the rules. So, one has to create a reset for that taxation at every such deployment, not artificially at one conversion only, there is no logical reason to do so.
Even in this lopsided treatment, it used to be that labor could have a satisfactory life from the savings of that labor without having to take further risks. But these days, not only do you take the labor risks but also market risks in further deploying the returns to be able to retire. On the other hand, people who start with capital only (by borrowing or windfall) take the latter but get much more favored treatment from it because of that faulty generalization.
And people have bought into this one-sided narrative without looking at the quantification that has made the investment in labor a bad investment. This upsets the balance between labor and capital over time and the returns from capital get diminished as labor diminishes, in the same way returns for labor gets diminished if capital is diminished. These two are sides of the same coin. They cannot be separated as you have said but they also cannot be treated separately as one being more virtuous than the other.
Unfortunately, rather than look at it with the economic quantification as above, the narrative gets mixed up with the political ideologues of capitalism and socialism. This favors the people that write the narrative for capital and get people like you believing that without that asymmetry, everything will collapse. There is no economic or intellectual rationalization for the asymmetry, only an ideological one.
The second false narrative is that all capital creates labor. This is no more true than all labor creates capital. In fact, I can say with certainty that my gains over the last year in capital markets had very little to do with creating or rewarding labor and had everything to do with gaming other deployments of capital partially and an asset bubble for the rest. My capital deployment in equity markets had very little to do with even reaching the industries that it was invested in. And yet we cling on to that old model of investing in a company which takes that capital and deploys it to create jobs and products to justify most of the gains coming from game theory between investors.
The justification is true only in a tiny fraction of capital deployment - venture capital, IPOs, companies raising money for expansion, etc. This is not why most people in this forum made 20% last year. Most of us are free-riding on that sliver of justification.
Then there is the false narrative that market forces make all this natural and fair and correct. This is true only in a theoretical framework where the markets are extremely efficient with similar barriers or lack of for both labor and capital. This is where the reality is completely tilted in favor of capital because it is so fungible with very little barrier to movement even across borders these days. Labor isn't.
This is not an argument for destruction of capital which is another red herring. It is an argument that it is easy to game this existing system with capital at the expense of labor and all of us here are doing this at the expense of labor to varying extent. We just happened to be lucky or diligent enough to move into the winners column from the losers column. But that is not a sustainable solution, only as long as losers agree to remain so!
At the least, let us not delude ourselves that somehow this is a fair or sustainable system and that capital gaming is necessarily leading to a better outcome.
It seems that prior transformations in the economy took time to manifest themselves. The blacksmith did not disappear right away as automobiles took over the streets. Those blacksmiths probably got jobs at the local assembly line. Today though it seems everything is sped up. Change is happening at a rate that is unprecedented. This prompts increased spending for education. Most jobs require some kind of post high school education. A housekeeper working in a hospital is required in most locales to take a course in tech/community college. I guess mopping floors is not the same.
Added costs onto the middle class for college must have some impact here.
Should my insurance have just said - let the leg rot off in gangrene and die if you must because paying the bill, which should have been party at fault's responsibility, is simply not virtuous and might have the moral hazard of your expecting help every time you need it whether we think you deserve it or not?
Or rather I should ask a simpler question - why didn't the good Samaritan come out of the dark shoulders of that road and offer to cover my costs because of the greater virtue of his offer? There is no way greater virtue would have come from the irresponsible guy who sleeps while driving.
Ah, I see the difference. If you have to say thank you and acknowledge the superior standing with God of your benefactor, all is OK.
Obama would look mighty good on a white horse. When I was growing up there was something considered to be good about men on white horses, especially if they wore white hats too. Chuckle.
Yea, I know holes can be made in my story above. It actually is true albeit simplified. But if I hadn't been little miss priss with a high wage good job with benefits, who would have needed to step in to put my foot back on my leg and otherwise glue the remaining bones together again? Or should I just die if the Samaritan doesn't show. Using the ER when there is not payer is also compulsory. No?
I'm happy to read that your leg is fine and that you did not die.
Regarding the remainder of your post, would you like me to get you Dinesh D'Souza's address so you can write him?
Mona
As an after thought, you may want to read one of many good pieces written by Charles Krauthammer, as relates to the ACA. Unfortunately, Dr. Krauthammer, as 22 year old, was not as fortunate as you, do to his accident back in 1972, when he was a freshman at Harvard.
http://www.washingtonpost.com/opinions/charles-krauthammer-obamacare-laid-bare/2013/10/31/d229515a-4254-11e3-a624-41d661b0bb78_story.html
Mona