Map of life expectancy at birth from Global Education Project.

Wednesday, June 12, 2019

A couple of thoughts about fairness and justice

Item One: You don't hear anybody say "Why should I be forced to buy car insurance? I haven't crashed my car or injured anybody with it." And you don't hear people say "Why should I be forced to buy homeowner's insurance? [Which is required if you have a mortgage]. My house isn't on fire."

So why is health insurance any different? It isn't just about whether you have a right to take a chance on not being able to pay for medical care if you do end up needing it. If you're hit by a bus the ambulance will take you to the Emergency Department and they will do whatever they must to save your life. That will cost a lot of money and somebody has to pay for it. Furthermore if you become disabled because of a condition that could have been prevented by appropriate medical care, you will not be able to support your dependents and you will become a ward of society. If you have an untreated or preventable communicable disease, you may infect others.

There are more arguments to be made here but I'll finish with this. You will get older and sicker some day and you will definitely need medical care and decide that it's in your interest to buy insurance, if you can afford it. But if there are a whole lot of people like you who decided not to buy it when they were young and healthy, it will be expensive; and you'll still  be freeloading on those young and healthy people who did buy it. These are among the reasons why every country on earth that can afford it requires that every citizen (and generally speaking non-citizen residents as well) has what amounts to health insurance, and that everybody with an income contributes to paying for it one way or another. For me, the more progressive the payment mechanism the better, and it is always somewhat progressive, but that's a matter of degree and it's arguable.

So the Affordable Care Act, in its original form, had a mandate to buy health insurance if you didn't get it through employment, Medicare or Medicaid. Like required automobile and homeowner's insurance, it also established minimal standards for what had to be covered. Finally, it included subsidies to make it affordable, which means that for most low and middle income people it was a very good deal.

There were problems for people in states that chose not to expand Medicaid, who fell into the resulting gap. That is of course the fault of Republican legislators and governors, along with the Supreme Court. There is one more category of people who felt they were harmed by the ACA, which is people with incomes too high to qualify for subsidies, and who previously had chosen to buy crappy insurance that didn't meet ACA standards. Now their insurance became more expensive. Boo hoo. If you have a behavioral health need, you're covered. And you can afford it. So stop whining.

Item Two: It is baffling to me why some people are offended, or feel that their rights are violated, because rights are extended to other people who -- for wholly irrational reasons -- they don't like. If people of the same sex are allowed to get married, how on earth does it hurt anybody else? You can still marry whoever you want to. People make the bizarre claim that  by opposing same sex marriage, they are defending "traditional marriage." That is idiotic. Traditional marriage is still available. It is completely unaffected.

Likewise, what possible harm can it do to you if transgendered or otherwise non-typically gendered people are protected from discrimination? They exist, okay? Your God made them, Pope Francis. Why do you care if they are in your workplace or your school or your favorite restaurant? That doesn't harm you, and it doesn't prevent you from practicing your religion and thinking they will go to hell. It doesn't stop your preacher from saying that in church, as a matter of fact. You can believe whatever you want, however asinine it may be, and you can pray and preach however you want as well. Why is this even an issue?


John Bachtell said...

Car insurance rates are based upon age, gender, marital status whether you own a home and your past history of claims. You get to choose a lot of options that you may or may not want or need.

Many think that's pretty fair (and just)as opposed to the current ACA laws.

A single man will never need maternity and newborn coverage. Most psychiatric problems are known by middle age so older people might want to opt out of that and also drug rehabilitation coverage unless you're still a crackhead in your sixites.

Also, you seem to be blaming SCOTUS for their ruling on the constitutionality of ACA. That's their job. You should, instead, be blaming congress for overreaching its legislative authority.

Cervantes said...

The idea that men shouldn't have to pay for maternity coverage is sick. In case you didn't know, babies have fathers, and single men have sex. They also have a responsibility to society.

Psychiatric problems can arise at any time in life, including substance use disorders.

The difference between charging more for car insurance if you've had an at-fault crash and charging more for medical insurance if you've needed it in the past is so fucking obvious I am not even going to point it out. The whole pre-existing conditions thing is the reason for the ACA.

The Supreme Court is totally politicized. The philosophy of conservative jurisprudence is to come up with whatever sophistry is necessary to come to a conclusion that conservatives like.

Bob Owen said...

For your readers who disagree on what should be covered and what's not, there is an exception built into the ACA for religion-based medical expense sharing organizations and there are quite a few.
Usually about half the cost.

Cervantes said...

Well yeah. They're cheap because they're a scam.

"In effect – with health sharing ministries and AHP’s, even though you’d be paying for membership or coverage, you would be getting zero-to-few of the benefits of legitimate health insurance – while taking on a huge amount of increased risk. That’s a bad deal. These are deceptive and hollow offerings that extract your cash while guaranteeing nothing in return and simultaneously taking a massive dump on the future of the Affordable Care Act and the consumer protections that it offers to every American. There is an illusion of safety, but no real safety with these programs.

The thing about health insurance is that you don’t know when you need legit insurance until it’s too late. The same goes for home insurance, life insurance, and auto liability insurance. If you don’t have these, you are rolling the dice. If you lose in this game of chance, it could cause complete financial ruin for you and your family. That is the short-term, red-alert reason why you need legitimate health insurance – and it is more than enough reason for you to avoid AHP’s and health care share ministry programs. They are not legit alternatives.

As noted in the above legal disclaimer of one of the largest health sharing ministries – there is one thing you should take their advice on: “This program should never be considered as a substitute for an insurance policy”.

But there’s a longer-term reason why you should avoid these programs as well. These programs were created and expanded, in large part, to subvert the ACA by driving up the costs for participants in the ACA. Every young, healthy person that has a temporary sense of invincibility that leaves an ACA plan for one of these programs (or no plan, with the repeal of the individual mandate) is one less young, healthy person within the risk pool for the ACA. And if enough people do this, the end result is extremely high costs for those remaining in the ACA. Or worse, no ACA at all, and back to the days of insurance companies denying essential benefits, imposing lifetime caps, and denying coverage to those with pre-existing conditions.

Almost everyone, at multiple points in their lives, is going to wish that they had a legitimate health insurance plan with manageable costs. The way to keep costs down and more manageable over time, for everyone, is for the young and healthy people to stay within the ACA plans.

Just say “no” to AHP’s (if self-employed or your employer wants to move to one) and health care sharing ministries. Over the long run, you will likely be much better off."

Bob Owen said...

Don't know much about AHP's but have experience with Medishare, the largest Christian medical sharing (non-profit)organization. It's not "insurance" because it's not a contract and they have no legal liability to pay. That's the reason it was exempted from ACA.

It is what it is. It isn't insuance. You have to trust them.

That being said, Medishare has been in operation since 1993, has successfully paid in excess of 2.6 billion in bills for it's 350,000+ members and has had few complaints that were not resolved according to the BBB website. (Insurance companies NEVER have complaints, of course).

It's a private non-profit club for Christians. Members write the rules. If you don't want to live a healthy Christian lifestyle (smoking, drinking, drugs, etc.) don't join. If you get in an accident drunk, they won't pay. If you get AIDS through drug use or homosexual contact, they won't pay.

It's not for everybody and I don't think they try to be.

It's just another choice.

Dr Porkenheimer said...

I'd like to remind you that Democrats wrote and passed ACA with 1 (one) Republican vote in the house and NO Republican votes in the Senate.

They were running the show. They didn't need any input and accepted little if any from the other party.

It's really difficult to see how you blame anyone but the party in charge for carve-outs for these organizations.

Cervantes said...

Wrong as usual. This is because of amendments to the ACA passed by the Republican congress and signed by Donald J. Trump.

Cervantes said...

As for BO, it's not just another choice. You have ignored the basic points I have made repeatedly about the concept of insurance and the reasons for universal health insurance. I'll just make one point, rather than write a lengthy essay. If you make this choice, and you are injured for some reason that they won't pay for, your wife and kids are screwed. And if you haven't noticed that a large percentage of sanctimonious Bible thumpers in fact engage in behaviors that they condemn, you have your head up your ass.

Cervantes said...

DP -- see my footnote on latest post. Sorry about that. However, this obviously was an example of accepting input from the other party, probably an artifact of the failed attempt by the "Gang of Six." Yeah, it shouldn't have gotten in.