Philosophy Discussion Forums | A Humans-Only Club for Open-Minded Discussion & Debate

[Ecurb]

Everyone takes risks. Climbing mountains is probably more risky (for me, if not for world class climbers) in terms of the financial liability of others because it will improve my conditioning, and enable me to live a longer and healthier life, which, in the long term, will cost the tax payers more money in Medicare benefits and Social Security. National Health Insurance and private insurance are similar in this way. Those at more risk of expensive treatment drive up the cost for everyone else. But we (and the insurers) don't know who they are or what the behaviors are.

That is patently false. Private insurers are very good at assessing the risks each prospective customer presents. For health insurance, for example, the applicant's occupation, age, various lifestyle factors, and medical history were taken into account when calculating premiums, or deciding whether the applicant was insurable at all. Or they were, before government began demanding those factors be ignored. Insurers insure all kinds of risks, and they have armies of actuaries computing the risks of each. The fact that they remain in business is evidence that they do a pretty good job of it (health insurance in the present government-dictated and subsidized regime excepted).

Private insurers attempt to assess risks, but your notion that their profitability proves that they are good at it is nonsense. I doubt insurance companies ever ask if a potential client climbs mountains. In addition, private companies address the short term risks (because clients can always change insurance). So they may charge smokers more than non-smokers, even if (as I'm guessing) the non-smokers will incur more long-term health care costs. Universal health insurance would avoid these problems. Surely it's reasonable to try to cut health care costs -- which universal health insurance seems to be very good at (since the U.S. still has bad results in terms of health care, but very high costs, compared to other countries).

[LuckyR]

So much misinformation. Firstly, in the current US health insurance market for most folks their employer is the client of the insurance company, not the employees. Thus policies that cost employers less are popular, regardless of their overall cost.
Second, most policies are turned over annually, thus diluting the financial impact of such lifestyle choices like diet, mountain climbing and even smoking in the younger age groups as healthcare costs between non-smokers and otherwise healthy smokers in a single year is negligable, if measurable at all.

[GE Morton]

So much misinformation. Firstly, in the current US health insurance market for most folks their employer is the client of the insurance company, not the employees. Thus policies that cost employers less are popular, regardless of their overall cost.
Second, most policies are turned over annually, thus diluting the financial impact of such lifestyle choices like diet, mountain climbing and even smoking in the younger age groups as healthcare costs between non-smokers and otherwise healthy smokers in a single year is negligable, if measurable at all.

All good points. Comprehensive health insurance per se is largely responsible for the current costs of health care. That is the case for the cost of anything whenever there is a third-party payer involved --- the nexus between supply and demand is broken, and costs spiral out of control. The customer is indifferent to the costs of the product or service because he isn't paying for it. In the case of health insurance he isn't even paying the premiums. So he has no incentive to change habits or lifestyle choices that would have affected the premiums for an individual policy.

Or rather, he doesn't think he is paying for it --- but much of the money his employer is spending on that insurance would have gone into his pocket as higher wages.

The cost spiral for health care in the US began right after WWII. During the war the government imposed wage and price controls, but fringe benefits were exempt. With so many men overseas fighting the war most employers struggled to find workers. Since they couldn't offer higher wages, they began offering generous fringe benefits, especially comprehensive health insurance. Then beginning in the 1960s the government became a new third-party payer, with Medicare and Medicaid. Prices for everything covered by those policies have been increasing at 2 - 3 times the inflation rate ever since.

[GE Morton]

The cost spiral for health care in the US began right after WWII. During the war the government imposed wage and price controls, but fringe benefits were exempt. With so many men overseas fighting the war most employers struggled to find workers. Since they couldn't offer higher wages, they began offering generous fringe benefits, especially comprehensive health insurance. Then beginning in the 1960s the government became a new third-party payer, with Medicare and Medicaid. Prices for everything covered by those policies have been increasing at 2 - 3 times the inflation rate ever since.

Though the graphs begin in 1960, the spiral began about 10 years earlier, as most major employers began offering comprehensive health insurance.

https://pulmonarychronicles.com/index.p ... ew/415/916

[Ecurb]

Good points, Lucky and GE, although far from comprehensive. First, if insurers could really assess risks accurately, nobody would buy insurance. After all, if insurers knew who was going to contract an expensive disease, they would charge them the medical costs plus a premium. Why pay the premium? The only reason for private insurance is that neither the insurer or the insuree can assess risks accurately.

Second, if captialist relations between individual and insurer work so well, why do almost all of the nations with Publicly funded health care get better results than the U.S. at a far lower cost. Hmmm. Maybe capitalism ain't so efficient after all. For one thing, corporate policies are often influenced by short term gains, rather than long term efficiency. That's because the benefits to CEOs and other executives are improved by short term gains. They get bonuses. They keep their jobs. Long term benefits might well benefit someone other than the current executives. Of course the same is true for political office holders, unfortunately.

[GE Morton]

Good points, Lucky and GE, although far from comprehensive. First, if insurers could really assess risks accurately, nobody would buy insurance. After all, if insurers knew who was going to contract an expensive disease, they would charge them the medical costs plus a premium.

They don't know who will contract a costly disease. You're confusing risks with certain knowledge. What they can calculate is who is more at risk of contracting that disease, based on known risk factors, and set premiums accordingly (a risk is the expected magnitude of the loss X the probability that it will occur).

Second, if captialist relations between individual and insurer work so well, why do almost all of the nations with Publicly funded health care get better results than the U.S. at a far lower cost. Hmmm. Maybe capitalism ain't so efficient after all.

Well, first, the health care economy in the US is in no sense "capitalist," if you mean a free market. It is hagridden with government edicts at every stage and for every product and service involved, from occupational licensing laws, to forced charity demands on hospitals, to the FDA obstacle course through which every new drug or device must pass, to state "certificate of need" laws preventing opening of new health care facilities, to the EMTLA law which forces emergency rooms to treat patients for free, to liability laws which expose health care providers to enormous financial risk, to coverage mandates on insurers and forbidding them to set premiums according to actuarial risk factors.

And the "better results" you cite are not primarily due to differences in health care, but to differences in demographics and lifestyle choices:

"Significant factors in life expectancy include gender, genetics, access to health care, hygiene, diet and nutrition, exercise, lifestyle, and crime rates. Evidence-based studies indicate that longevity is based on two major factors, genetics, and lifestyle choices."

https://www.disabled-world.com/fitness/longevity/

[LuckyR]

Good points, Lucky and GE, although far from comprehensive. First, if insurers could really assess risks accurately, nobody would buy insurance. After all, if insurers knew who was going to contract an expensive disease, they would charge them the medical costs plus a premium.

They don't know who will contract a costly disease. You're confusing risks with certain knowledge. What they can calculate is who is more at risk of contracting that disease, based on known risk factors, and set premiums accordingly (a risk is the expected magnitude of the loss X the probability that it will occur).

Second, if captialist relations between individual and insurer work so well, why do almost all of the nations with Publicly funded health care get better results than the U.S. at a far lower cost. Hmmm. Maybe capitalism ain't so efficient after all.

Well, first, the health care economy in the US is in no sense "capitalist," if you mean a free market. It is hagridden with government edicts at every stage and for every product and service involved, from occupational licensing laws, to forced charity demands on hospitals, to the FDA obstacle course through which every new drug or device must pass, to state "certificate of need" laws preventing opening of new health care facilities, to the EMTLA law which forces emergency rooms to treat patients for free, to liability laws which expose health care providers to enormous financial risk, to coverage mandates on insurers and forbidding them to set premiums according to actuarial risk factors.

And the "better results" you cite are not primarily due to differences in health care, but to differences in demographics and lifestyle choices:

"Significant factors in life expectancy include gender, genetics, access to health care, hygiene, diet and nutrition, exercise, lifestyle, and crime rates. Evidence-based studies indicate that longevity is based on two major factors, genetics, and lifestyle choices."

https://www.disabled-world.com/fitness/longevity/

You are correct that the US health care system is not a free market. Which is not a universally bad state of affairs.

I'm happy that medical licences aren't handed out to anyone who can pay the licence fees. Also that drugs and devices need to show safety and efficacy. Also that hospitals can't create more capacity without demonstrating need, since unlike other services, medicine can create it's own "need" if there is paying capacity.

BTW, EMTLA wasn't created to provide free care, it was made to combat indigent patient "dumping" by for profit facilities.

As to the US health care system compared to the rest of the Industrialized world, the US has a Ferrari, a Lexus, Camries and the bus. Other countries range from Lexuses to Yugos. Your opinion on the US system will depend on what you're driving. All of them will get you to the grocery store. Is it a waste of money to drive a Lexus to get groceries? Opinions vary, but it's true that groceries brought home in a Ferrari are no better than any others

[GE Morton]

I'm happy that medical licences aren't handed out to anyone who can pay the licence fees. Also that drugs and devices need to show safety and efficacy. Also that hospitals can't create more capacity without demonstrating need, since unlike other services, medicine can create it's own "need" if there is paying capacity.

BTW, EMTLA wasn't created to provide free care, it was made to combat indigent patient "dumping" by for profit facilities.

Well, then, you can't complain about the high costs of health care.

Government shouldn't be licensing anyone, for any trade or profession. In a free market private trade associations would certify practitioners who met certain educational or training standards. You can either take your medical problem to a certified doctor with an MD degree from an accredited medical school, to an "alternative" practitioner such as a chiropractor, naturopath, homeopath, witch doctor, or back alley quack. Your choice. You're not a child and the government is not your nanny.

It always amazes me that people assume health care is somehow exempt from the laws of economics.

[Ecurb]

They don't know who will contract a costly disease. You're confusing risks with certain knowledge. What they can calculate is who is more at risk of contracting that disease, based on known risk factors, and set premiums accordingly (a risk is the expected magnitude of the loss X the probability that it will occur).

Of course. My point was abstract and hypothetical. The more accurate we get at assessing the risk of disease, the less effective insurance will be. Obviously (as I pointed out) if we were 100% accurate, nobody would buy insurance, and the poor saps who were fated to contract some million dollar disease would be out of luck in the Capitalist system. The point of National Health Care (and to some extent of current insurance systems) is to defray costs, so that everyone chips in for those who need huge expenditures. What's the alternative? Death and suffering?

Well, first, the health care economy in the US is in no sense "capitalist," if you mean a free market. It is hagridden with government edicts at every stage and for every product and service involved, from occupational licensing laws, to forced charity demands on hospitals, to the FDA obstacle course through which every new drug or device must pass, to state "certificate of need" laws preventing opening of new health care facilities, to the EMTLA law which forces emergency rooms to treat patients for free, to liability laws which expose health care providers to enormous financial risk, to coverage mandates on insurers and forbidding them to set premiums according to actuarial risk factors.

And the "better results" you cite are not primarily due to differences in health care, but to differences in demographics and lifestyle choices:

"Significant factors in life expectancy include gender, genetics, access to health care, hygiene, diet and nutrition, exercise, lifestyle, and crime rates. Evidence-based studies indicate that longevity is based on two major factors, genetics, and lifestyle choices."

Even if the law did not mandate free care for Emergency Room patients, the hippocratic oath and common decency would. The problem is that indigent patients go to the emergency room instead of far less expensive urgent care -- which tries to charge them. This problem would be solved with a decent National Health Program.

Neither you, I, or those who wrote your article (which advertised "How to fight Critical Race Theory") know what factors affect life expectancy and other measures of health. But it seems likely that a decent National Health Care program would help.

[GE Morton]

Of course. My point was abstract and hypothetical. The more accurate we get at assessing the risk of disease, the less effective insurance will be. Obviously (as I pointed out) if we were 100% accurate, nobody would buy insurance, and the poor saps who were fated to contract some million dollar disease would be out of luck in the Capitalist system.

Spending a million dollars to save anyone's life is asinine. Especially when you're not even saving it, but merely postponing death by a few years (or months). Few would ask their kids to sell their houses, hand over their own kids' college funds, raid their IRAs to raise that million. And if they were asked most of them would refuse. People will only spend that kind of money when someone else can be forced to pay it.

And, of course, in a free market unencumbered by government edicts and mandates no treatment regimen would cost anywhere near $1 million.

The point of National Health Care (and to some extent of current insurance systems) is to defray costs, so that everyone chips in for those who need huge expenditures. What's the alternative? Death and suffering?

Oh, stop with the euphemisms. Everyone only "chips in" because they're forced to so do. In a free market people would buy insurance tailored to their own risks, after conducting some sort of cost-benefit analysis. The alternative for those who can't afford insurance, and for others sympathetic to them, is charity, to which each sympathizer can contribute whatever amount he thinks appropriate. No person has any a priori duty to meet any other person's needs, medical or otherwise.

Even if the law did not mandate free care for Emergency Room patients, the hippocratic oath and common decency would.

That claim is false prima facie --- if that notion of "decency" were truly common, no force would be needed to provide care for the indigent; people would freely donate to charities to meet that need. The Hippocratic Oath, BTW, does not require a physician to treat anyone for free.

Speaking of "decency" and force in the same breath is oxymoronic (and grating).

[Ecurb]

Oh, stop with the euphemisms. Everyone only "chips in" because they're forced to so do. In a free market people would buy insurance tailored to their own risks, after conducting some sort of cost-benefit analysis. The alternative for those who can't afford insurance, and for others sympathetic to them, is charity, to which each sympathizer can contribute whatever amount he thinks appropriate. No person has any a priori duty to meet any other person's needs, medical or otherwise.

This is nonsense. People "chip in" because they want to chip in and help their neighbors. That's why they vote for representatives who pass the tax laws and Presidents and Governors who sign them. True: some people are so selfish they don't want to help their neighbors. They vote for other representatives and are forced to chip in when their side loses elections Waaaah! My heart bleeds for them! Is it really fair for the klndly 60% majority to chip in while the selfish, greedy minority refuses to do so? I don't think so.

Also, I would be ashamed to name myself among the greedy minority who wants to let children die instead of chipping in for their health care. I suppose some people are without shame, though. How about you, GE?

By the way, I know what you think each person's "duty" is. I (and every kind, empathetic person) disagree. Merely restating what you (incorrectly) think constitutes a person's duty is not an argument. It's not even conversation.

[GE Morton]

This is nonsense. People "chip in" because they want to chip in and help their neighbors. That's why they vote for representatives who pass the tax laws and Presidents and Governors who sign them.

Well, no. They vote for those representatives, not because they want to "chip in" --- which they could always do without voting for anyone --- but because they want to force others to provide the bulk of the funding for their favorite charities, while their own contributions are negligible. They are "humanitarians by proxy" ("I'm all for helping the poor --- as long as I can do it with someone else's money").

True: some people are so selfish they don't want to help their neighbors.

That's true. Others would prefer to support animal welfare charities, or environmental causes, or artistic endeavors, or scientific or technological research. There is nothing immoral about preferring any of those choices, or with selfishness. The belief that there is, is an archaic dogma derived from the organic fallacy and promoted in the West by the dominant religion.

The moral question is, What rational moral principle permits Alfie to force Bruno to support Alfie's favorite charity, or any charity?

Also, I would be ashamed to name myself among the greedy minority who wants to let children die instead of chipping in for their health care. I suppose some people are without shame, though. How about you, GE?

Well, then, you should be ashamed. Children die for numerous reasons every day, all over the world. What percentage of your income do you devote to preventing that? If you're an "average American" it will be about 2% --- a long way from meeting the obligation set forth by Peter Singer, among others:

"I begin with the assumption that suffering and death from lack of food, shelter, and medical care are bad . . . My next point is this: if it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable moral importance, we ought, morally, to do it. By "without sacrificing anything of comparable moral importance" I mean without causing anything else comparably bad to happen, or doing something that is wrong in itself, or failing to promote some moral good, comparable in significance to the bad thing that we can prevent."

https://personal.lse.ac.uk/robert49/tea ... Famine.pdf

Give that some thought, then answer: Do you satisfy that test?

By the way, I know what you think each person's "duty" is. I (and every kind, empathetic person) disagree. Merely restating what you (incorrectly) think constitutes a person's duty is not an argument. It's not even conversation.

Oh, I've given the argument, which you have yet to refute. What are not arguments are emotional responses. It is true that not everyone is kind, empathetic, etc. What arguments can you offer for imposing your (hypocritical) sentiments on those people by force?

[Ecurb]

If people want to participate in the regulated economy, they must pay taxes, and elected representatives decide how to spend the money. Nobody is FORCED to participate, as I have unsuccessfully tried to explain. Paying taxes is a condition of employment, contractually agreed to by the employer and employee. Of course contractual obligations are enforced by law.

[GE Morton]

If people want to participate in the regulated economy, they must pay taxes, and elected representatives decide how to spend the money. Nobody is FORCED to participate, as I have unsuccessfully tried to explain. Paying taxes is a condition of employment, contractually agreed to by the employer and employee. Of course contractual obligations are enforced by law.

Huh? They're not forced? Threats of fines or imprisonment are not force? Since when are "contractual agreements" entered into under duress --- threats of fines or imprisonment --- valid and binding on anyone?

And of course, no one needs anyone else's permission, or is obliged to satisfy any conditions dictated by third parties, to participate in an economy. You have an economy wherever you have 2 or more people willing to exchange goods or services. The only permission anyone needs is that of the person with whom you propose to trade.

You're ignoring the arguments above and grasping at ephemeral straws.

[LuckyR]

I'm happy that medical licences aren't handed out to anyone who can pay the licence fees. Also that drugs and devices need to show safety and efficacy. Also that hospitals can't create more capacity without demonstrating need, since unlike other services, medicine can create it's own "need" if there is paying capacity.

BTW, EMTLA wasn't created to provide free care, it was made to combat indigent patient "dumping" by for profit facilities.

Well, then, you can't complain about the high costs of health care.

Government shouldn't be licensing anyone, for any trade or profession. In a free market private trade associations would certify practitioners who met certain educational or training standards. You can either take your medical problem to a certified doctor with an MD degree from an accredited medical school, to an "alternative" practitioner such as a chiropractor, naturopath, homeopath, witch doctor, or back alley quack. Your choice. You're not a child and the government is not your nanny.

It always amazes me that people assume health care is somehow exempt from the laws of economics.

I'm not complaining about the general cost of the system, though specific cases do warrant criticism.

I definitely have not stipulated that the health care system is a free market, in fact it is better that it is not a free market.

Medical practice is regulated by both governmental and private "trade" organizations. Nothing wrong with that.

Medical practice follows the "laws" of economics, such as they are (they aren't Laws, in the traditional meaning of the word.)