I can understand where you are coming from, as we have also chosen a lifestyle that's less demanding of our resources.  We have all the insurances one would consider necessary to be secure, but even that doesn't seem like enough.

For many, financial security has a certain amount of risk that can never truly be eliminated.  We can mitigate damages by being insured, but certain unforeseen acts (tornadoes, hurricanes, war, poltical upheaval, disease, etc.) are always going to catch people unprepared.  Often those with the most money are hit the hardest, as certain conditions can leave money without any true "value."

I say live at whatever level you are truly comfortable with, and don't waste your whole life preparing for the unknown.  It's good to be smart about it, but I'd rather not work my fingers to the bone while missing out on all the joys of life simply so that I can be "fully-prepared" for the unpredicable, and often "inevitable."

Great, thought-provoking post (even though it's way too deep for a Monday) !

Right on! The health insurance issue is the ONLY thing that has kept me on the job for lo, these many years. It will keep me on the job until I'm 65, even though in theory I could have retired long before now.

... to be free NOT to pay for your healthcare when you get sick and decide that "whoops! I still want to stay alive even though I can't afford to pay the doctors to keep me that way."

Seriously, the problem you describe is caused by "compassion" for the poor. The day we decide that hospitals can turn people away to die is the day you'll be free.

Ain't gonna happen.

Someone who makes $100,000 and spends $50,0000 is safer than someone who makes $15,000 and spends $10,000. He is able to absorb $50,000 worth of bad luck in a year while the simple living person can not.

I work in health care and I know we could do better by copying some other countries that have efficient systems.

"That other blog" that we both read would be 100% valid in most countries, but you're taking a big risk if you retire young in the US.

There are so many reasons that Canada is evil that it would take an entire web site and many, many hours to chronicle their savage nature and insidious ways. Suffice it to say with their beady eyes and flapping heads, Canadians are a pox on all that is true and good.

Also, Pamela Anderson. The prosecution rests.

Well, I get your point on that. The funny thing is, until you live outside the good old US of A for extended amounts of time, you don't actually realize how much you're being ripped off on hospital fees. In Ireland, for example, any insurer will sell you full benefits insurance for about 500 euro a year. That's everything excluding dental; and if you're prepared to put in a bit more, you can get day-to-day doctor visits and medications added.

Even when you pay as a tourist it's nowhere near as expensive as any operation in the US (hospital care is free here if you're an eu citizen, and the quality of the public hospitals is almost on par with the best private hospitals).

Perhaps what should really be getting done is more protests on the cost of healthcare - this would surely reduce everyone's burdens.

Dangerman, I am your nemesis. I have lived without medical insurance intentionally for nine years--not one penny spent on thousands of dollars of premiums for which I would have received zero benefit (and I received zero benefit during the previous 14 years that I did pay for medical insurance). I spend that money instead on ways that promote health. As a result, I have not been in a physician's office in 15 years. A side benefit to my healthy living is that I look 10 years younger--truly, I've been told this many times.

As a young investor myself, this is very disconcerning. I am starting to save for my retirement, and I am living frugally. Unfortunately I do realize that there are unexpected expenses that arise. I say unfortunately because it depresses me to find that there are so many expenses involved with just living out your everyday life. I realize that behind the facade of credit, mortgages, and more you still have payments that will need to be repaid. This is why I try to live by the age old philosophy of "don't spend beyond your means." Even with this philosophy I find it hard to just get by let alone save for future expenses.

Anyways sorry about the rant, I it just helps me realize what kind of problems there are with our society and what to look forward to in the future.

"I am American and live in the UK with my British husband. My husband and I pay a combined average $1000 per month for National Insurance."

This would get you coverage in the US to, wouldn't it? (Guess universal health care is neither cheap nor efficient...another illusion crushed)

'Not Free to be Poor' - what an incredibly stupid, even absurd, statement.

Life isn't certain and it certainly not easy. Never has been. You can live the way you want but there are CONSEQUENCES for any action! Your health and the costs associated with keeping it are your business - not mine. You want another bloated, wasteful, unaccountable governmental program destined to grow uncontrolled into the future to take care of you and your family? You want government to be your supermommy? Why should I pay for for someone else's med expense anyway? I work extra hard to pay for my family's health insurance - $7,000 yearly. In addition, I make sure we eat healthy and exercise regularly.

Right now, More than 50% of the U.S. medical expense is already borne by government and mainly through unfunded entitlement programs. These entitlement programs will - without a doubt - bankrupt the nation. This is a fact, a mathmatical certainty, that people refuse to address.

The root cause for the incredible inflation in medical expenses is the lack of personal responsibility. Most medical expense is paid by a 3rd party - either insurance or government. Because the consumer isn't looking at cost, a bureacracy is, price is not the concern it should be. What do you think would happen if people HAD to pay for their medical expenses out of pocket.

Right, prices WOULD HAVE to come down.

Yes, you can decide to live on less than (name an amount) and by doing so not have to endure the stresses of the modern rat race. By doing this you can follow your 'creative' muses - enjoy life and have more fun. Yes, but don't expect society to pay for your play!

I know - I'm p***ing into the wind. Too many expect someone else to take care of them. This is a hugh change even from 30 years ago. Nothing will stop the trend until the whole thing collapses on itself because it's not affordable.

There really is no reason to have private health insurance companies that make a profit. Health insurance is a relatively simple accounting function that is most efficient and fair with the largest pool of people possible (like everyone in the county) so that risk is dispersed. Medicare operates at very high efficiency, with about 3 percent of its budget going to operating costs. Private insurance spends about 15% by comparison. I'd like to see us move to a form of Medicare for all, with a Medicare card issued the day you are born.

It's a political problem, not an economic one.

Kejla asked why she should pay someone else's medical expenses when she works hard to keep her family healthy and other people are careless.

I've often wondered the same thing. My country's government health care covers people who do stupid things -- people who drive drunk, have a poor diet, and smoke (among other things). It's a drain on our system, to be sure.

Yes, I think people need to smarten up and take accountability for their actions, but I don't think that's a good argument for getting rid of (or not having) universal health care. It's good that some people can afford several thousand dollars for their family's insurance, but what about families who aren't as financially advantaged? Are their children worth less than others?

Should a child who is ill suffer and maybe die because they can't afford care? Seems to that shouldn't happen in a developed country. It's in everyone's best interests that the members of a community and country have health care available. It's time to lose the "it's all about me and my family" attitude and see that even people who don't have money deserve care and respect.

Philip,

I do shop for medical care. The incentive is that, with a HSA, I am paying the 1st $5000. I agree with you that at times, shopping isn't an option, but for most things it is.

Two years ago I had to have an operation on my shoulder (that getting-older problem). Now, even though I pay the first $5,000 out of pocket, I'm supposed to pay at the agreed upon Blue Cross Rate. That is, if I go to a doctor or facility on the plan. The doctor assured me the Outpatient Facility he wanted me to go to would accept the same rate.

I hate doctors, hospitals or anything related - at least when it comes to me! The operation, a short one about an hour and half - was a success. I awoke as they wheeled me out to recovery on the gurney. Needless to say, I dressed and wobbled out of the place.

Then the bill arrived. For the less than 3 hours it took, they billed $28,550! I protested. They said, oh that's retail, and took it down. I kicked, screamed and generally made a scene. Finally, the bill was $3000. That's as much as a few day stay at a resort, I said. And, besides, my plan said it would cost much less.

Fine. At least I could apply this $3000 towards my very high yearly deductible of $5000.

No dice, said the insurance company, I had gone to a facility off the plan so nothing would apply to the deductible.

No, no, no!

To shorten this up: I complained to the doc who call the facility and said, hey, what gives. They agreed to accept what my plan would pay for (if they actually paid for it).

Ended up costing me $600. Big drop from that first figure.

I understand most people don't have the drive or determination to see this through. And, granted, the system is far from perfect, but what system isn't.

If you want to see imperfection personified, let the federal government get their hands on health care.

My point is still if you give people more responsibility for their own health, it will inevitably drive costs down.

Everyone wants insurance, no one wants to pay for it.

By the way, there's no insurance against death - the final destination. People should really get over it.

Oh please! I am Turkish and here is a tally of our beloved neighbors: Iraq, Iran, Russia, Syria, Greece, Bulgaria, Armenia and a couple others we tend to like so, consider yourselves very very lucky.

Peace at home, Peace on Earth

T'Pol

I'd like to second what Stacey07 said for those who mentioned that the healthcare is one (or the major reason) keeping them from freelancing.

I've been independent for over a year now, and I've paid out over $150.00 a month on a private healthcare plan. It was paid for personally, not by my business. As a result, when I did my personal taxes this past April, by entering the total amount I paid into Turbo Tax, it actually took me from having to pay the gov't to getting a refund!

Now, according to my CPA, this is because it's a private plan, not through my business like I mentioned above. But regardless, it was certainly a nice little surprise when I did my taxes!

@Andrea: I think your comments are hilarious! Part of my family is American.

@Kelja, you raise many good points! I agree that people are careless with things when someone else has to take accountability.

But you still can't convince me that providing universal health care is going to make matters worse. There are a lot of people who work very hard and still can't afford health care if they had to pay for it.

I think it's a fallacy of the middle and wealthy classes that no one works as hard as they do, and that people deserve to be poor because they "don't work hard enough."

It's simply not true. There are people who struggle to make a living. Hard work can't always make up for the lack of money or advantages such as a good education. Sometimes a divorce, job loss or death in the family leaves people in financial straights.

Yes, there are people out there who don't want to work and who take advantage of the system. I'd like to see more done to correct that problem than to cut off people who can't afford care and need it.

Again, you ask why you should have to pay for other people's mistakes. I ask why some should have to suffer for those same people's mistakes.

People in disadvantaged communities and countries find a way to share and provide for others. It's sickening that we can't do the same.

People like Kelja make me really sad for this country. The almighty dollar trumps humanity for way too many people. Don't get me wrong. I think there are plenty of people who contribute nothing to society even though they could and people that are so stupid it is amazing they continue to live. But way too many people put this insane obsession with "their money" ahead of every single thing that involves our country or our society. If it doesn't personally benefit them it must be bad.

I'll attempt to bridge the cultural gap here, as it were. I won't even make a Tim Horton's joke.

There is a difference in the US between health insurance and health care. Health care is what you get when you go to the doctor. Health insurance is what helps you pay for it. Anyone can go see a doctor, but not everyone will have insurance to pay for it. Health insurance is often offered by employers (for all employes - called a 'group plan'), but the cost is very high for the employer. Employees might be required to pay a certain amount to have insurance as well (including fees when they go to see the doctor, or buy medicine, and the insurance company doesn't have to cover everything) - it really depends on the health insurance plan and who is providing it. If you are self-employed, you have to buy your own health insurance, and if you are on a private plan, health insurance companies can refuse to cover you (they can't refuse you if you are getting health insurance through a group plan paid for by your employer).

Health insurance is not a right in this country. However, health care IS (to a point - keep reading). I don't think that there are many instances in the US in which someone will NOT get treated at in any emergency room. I'm sure that there are isolated cases in which people are turned away and die as a result, but generally, doctors cannot, by law, refuse service to someone who is in dire need of medical help, regardless of their insurance coverage (or lack thereof). Many people also see their regular doctor without having health insurance - they simply pay out of pocket for their expenses.

There are two main problems with this system. The first is that seeing a doctor is damn expensive, and you pay through the nose if (1) you don't have insurance or (2) you have insurance, but your insurance refuses to cover your trip tothe  doctor. I've had some pretty lousy insurance during my lifetime (especially as a contractor/freelancer). At one point, I went to see an specialist, because my family doc was oddly clueless about diabetes. My insurance refused to pay for the visit to see the specialist, and a one hour consultation with a doctor cost me $300 in office fees and $700 in lab tests.

Now, at the time, I made enough money to cover the cost, albeit grumpily. However, most people without insurance DON'T make enough money to pay for normal checkups ($300 is a lot of money, and that's WITHOUT any tests), so they avoid the doctor until (you guessed it) they end up in the emergency room with a truly horrible complication.

So, as I've mentioned, the ER can't turn someone away if they are terribly sick. If a very ill person has avoided seeing the doctor for heart palpitations, and then ends up having a heart attack and has to go to the ER, the ER will admit him. He can't pay, but they have to admit him and operate on him. Chances are, he will never pay the hospital, and how could he, anyway? If he can't afford to see a cardiologist about his irregular heart beats, how can he afford the $30-50K that his quadruple bypass is going to cost? He'll have to either declare bankruptcy down the line (or possibly give the hospital fake information when he is admitted).

The result is that the hospital eats the cost of the operation, and then passes the 'savings' along to the average customer. That means that, in order to cover costly ER procedures, my lab fees have to go up, or the cost of seeing an specialist will increase.

It's a lousy situation. The plus side to the American system is that we have some really great care (we have some great doctors, because who DOESN'T want to make at least $100 an hour?), and we get most of our treatments very quickly, regardless of the severity of the situation. I have Canadian relatives who come to the US for treatment, especially for things that require a specialized physician's attention, because it takes too damn long in Canada to see a specialist (up to 9 months to see a neurologist). On the flip side, I sometimes go up to Canada to buy medications - even without any insurance, it's much cheaper to buy inhalers in Canada than to pay the copay on my insurance and buy them here.

So, in summary, health care is not exactly a RIGHT in the United States, but it's pretty unlikely that you would not receive treatment if admitted to the ER. The method for paying for the health care, however, is DEFINITELY not a right, and health care is WAY too expensive here for someone without insurance to indulge in.

There's a very good article on this topic on WSJ called "opting out".

DENVER, Pa. -- Jesse Martin, an Old Order Mennonite farmer here, lives much like his 17th-century Dutch ancestors. He shuns electricity and cars. He believes in self-sufficiency, so he opposes insurance and government aid.

But nine of his 11 children suffer from serious diseases. Desperate to save them, he has tapped into 21st-century high-tech medical care. In the process, he is posing tough questions for the U.S. health-care system and for nonprofit hospitals, which are expected to provide charity care in exchange for tax breaks.

http://online.wsj.com/public/article/SB121460367338511945.html?mod=2_156...

@linsey: Sorry for misspelling your name!

Lucille, are you dense or what?

What in any one of my posts gave you any idea I'm obsessed with the almighty dollar?

People like you, Lucile - ignorant in economics - that make me worried for this county.

Hmmm. Joanna's story sounds almost like a mechanic trying to take advantage of a customer who doesn't know anything about cars. When there's a profit to be made at your expense, you have to be informed or you'll get scammed.

I guess the big difference with our "socialized" health care is that dishonest providers are defrauding the government rather than defrauding consumers directly (or through their insurance companies).

In the former case, all tax-paying Canadians bear the brunt of the costs through higher taxes. In the latter case, Americans who are paying for health insurance bear the brunt of higher insurance premiums so the companies can keep making their tidy profits... But they're also getting hit through either higher health care costs because people without insurance can't pay their bills or through taxes as the government fills the gap.

Perhaps I'm missing something, but it sounds like both Americans and Canadians are paying "other people's way". They're just doing it differently.

Interesting... I don't think the American health care system could be "socialized". The fact that it is for-profit would make that very difficult. The costs of setting up the program would be unfathomable, and I don't think providers would be terribly impressed by earning less.

I'm finding myself agreeing with Kelja on the point that people need to be better informed and there needs to be more transparency in the system. It's like any business relationship: You should know enough to make an informed decision and get a fair price.

That being said, I hope the for-profit health care model doesn't ever come into play here in Canada! (That WSJ article sure was an eye-opener!)

One question for Kelja: When you're talking about people being less responsible with money that isn't their own, are you talking about Americans or Canadians (or both?)

The point of price transparency in a for profit system really is a major issue. Most people do not have adequate enough insurance that they can simply ignore the initial price of their health care. Many don't have insurance and most programs find ways to dump a large portion of the financial burden back on the patient.

About 50% of those filing for bankruptcy do so because of medical bills, most of those people had insurance.

People in emergency situations simply can't be debating price and many times are not even able to decline procedures. There are very few situations where you can realistically inquire about prices. Even in those situations it is extremely difficult to obtain that information and it frequently sets up a hostile environment with the provider. Doctors and staff get their noses out of joint when people ask about costs or feel it is detracting from competent care.

There are some providers that have almost all procedures and tests including prices online or otherwise easily available to the public. These providers are very much in the minority.

Now add to this the rampant disease mongering by drug companies and some providers, this increases their profits but mostly add to the financial burden of patients. I heard one this morning that said "if your listening to this your at risk for heart disease" and went on to try to sell expensive cardiovascular testing. There was a news piece yesterday, now the drug companies are trying to convince people that young kids need expensive statin drugs for their cholesterol. This is really a seperate issue compared to how broken our for profit medical system is that bankrupts people daily. But at some point either way the lack of transparency and disease mongering has to stop, it is just adding to the financial burden of all of us.

@Lucille:

“People in emergency situations simply can't be debating price and many times are not even able to decline procedures.”

So what about non-emergency situations? And who is it that is unable to decline procedures? Are you specifically referring to situations in which the patient is incapacitated and loved ones have not arrived or do you believe there are other situations in which patients are incapable of making their own care decisions?

“…it is extremely difficult to obtain that information and it frequently sets up a hostile environment with the provider. Doctors and staff get their noses out of joint when people ask about costs or feel it is detracting from competent care.”

Perhaps I’m insensitive here, but optimizing my physical and financial wellbeing far outweighs a doctor’s personal upset over a cost inquiry. Doctors are human beings too, often with financial problems of their own (btw, how is it that malpractice insurance has escaped us completely in this debate?), who surely are capable of being reasonable about a patient’s financial concerns. I’m not sure I’d stick with a doctor who made me feel uncomfortable with such an inquiry.

“There are some providers that have almost all procedures and tests including prices online or otherwise easily available to the public. These providers are very much in the minority.”

I’ve got to say, this is fantastic news to me. I didn’t realize that there were any providers like that, but I would love to consider one as an option. The fact that they even exist is a positive for me, an indication that we’re moving toward price transparency.

And, while I agree with your treatment on drug company ads (and wonder to myself how they can possibly sell drugs given their outrageous potential side effects), I can’t blame them completely because their “for profit” nature has resulted in some fantastic benefits to our levels of health care. We must defend the little guy without blaming it all on the big guy just because it’s easy.

It seems to me that most of us agree that price transparency needs to increase. I’m curious, though, to hear from those who believe in socialized health insurance. How, in your view, will price transparency increase? I just don’t see that happening with the government in charge. Don’t forget, that just because the government becomes the insurer does not necessarily mean that the drug companies or various PACs go away. In fact, I’d bet they’d increase their efforts to ensure that their constituents’ needs are addressed. Goodness knows Uncle Sam is not the greatest at transparency and efficiency.

In my view two very bad things could come out of socialized health care. Either (a) we have a total lack of price transparency leading to increased usage by people who aren’t personally paying and are therefore more likely to use it or (b) we end up waiting 9 months for an MRI and the rich leave the US to go where they can get the MRI. Seems to me that the poor, who cannot afford to travel for healthcare, are still stuck out in that situation.

Kelja, I think you're making some very broad generalizations about how Canadians view health care. I get the impression you think everything is handed to us for free and we take it for granted. Let me tell you a little more about what our health care is like.

Resources aren't exactly plentiful up here. There's a significant portion of the population who can't find a family doctor at all, and it really does take 6 - 9 months to get in to see a specialist. Wait times for non-emergency services are ridiculous as well. If you have a family doctor, sometimes it can be weeks before you can get in to see him or her. Emergency room wait times are getting better, but they still aren't ideal. It can take a while to even get booked for a test because of high demand. Private hospital rooms aren't free either.

You're wrong when you say that we're wasteful or careless or don't take personal responsibility because our health care is "free". As you argue, people may be careless with resources they don't take ownership for, but you're forgetting that people are MORE careful with resources that are limited.

In addition, I think people who pay more for something have an inflated sense of what they are entitled to. The whole "I worked hard for it, therefore I deserve" it attitude is part of what got the US into its current financial crisis in the first place.

Maybe what we need to do is think about piecewise solutions.

1) Everyone should be able to afford basic preventive services--it would be great if more people "took advantage" of the system to get their kids immunized, teeth cleaned regularly, etc.

2) Everyone should be able to join negotiation guilds to work out prices for the usual illnesses and so forth.

3) Everyone should be able to spread out the risk of catastrophic illnesses or accidents.

4) We should encourage drug innovation (including basics like immunizations and antibiotics) without putting appropriate pharmacology out of the reach of patients.

To my mind, (1) is a perfect candidate for government universal coverage. I think the uninsured often don't "take advantage" of the system as avoid the system as long as they can; this would be more efficient and save paperwork.

For (2), maybe more like the current system, except set up options that do not rely on being employed by a big company. Make it just like joining Costco or something. Make your coverage as portable as your cell phone number, not just the limited time that COBRA allows. Middle class people can budget and price shop and whatever; the poor are on medicaid anyway. It is my understanding that with a lot of welfare programs it's more expensive to track down a few "abusers" than to just let them draw the check; I would imagine that it would be just as true here, especially since people don't go to the doctor to make money. (Well, unless they're drug reps....)

For (3), the private sector might be able to handle this if they were absolutely forced to cover people for the same price except for maybe smoker/non-smoker and maternity differentials. Even better, to my mind, would be a sliding scale, but that won't happen. The point is to actually pool the risk; it's not much of a pool if you slice it so fine that each pool is just a droplet.

I'm not sure what we can do about (4), but it's worth thinking about how to promote scientific research in general.

I must be getting tired. Joanna, I was answering your question and I put in the wrong name (and spelled doctor wrong too! ha!)

Got to hand it to Philip... I've never paid this much attention to an article and it's comments before. I'm learning so much that I keep coming back!

@Xin Lu: I agree it's absolutely ridiculous to pay $200 for a band-aid, but do we really need another law to fix this problem for us? I have a different idea. Let's start a grass roots revolution. Every time you go to the hospital or the doctor, demand to see the prices prior to receiving treatment. When they give you one pill of your antibiotic and charge 3 times the copay for the remaining 2 weeks'pills, give it right back to them and stop by the pharmacy on your way home. Also, do you have any examples of government intervention increasing competition? My view is that it would definitely decrease it, but perhaps I'm wrong.

Well, I would like the government to mandate some kind of transparency into hospital bills.  Right now they charge crazy prices for things like cough syrup just because they can.  And yes, government intervention does increase competition in some cases.  For example, monopolies are illegal and companies are prevented from getting too big.  Big corporations also get broken  up to spur on competition.  If there is transparency into what the heck we are paying for then there would be more competition.  

"All humans are more likely to waste any resource they don't see as their own. This is why government programs always grow to gargantuan size and are massively wasteful - there is no personal ownership. This is especially true since the majority of voters do not pay income tax."

I'm confused... Is that an exaggeration? How does that work?

I don't know how the income tax system works in the US. Here in Canada, most of us have to pay income tax (the amount depends on how much we earn). I do know we pay more on a whole than people in the U.S, though.

Seems like a lot of the discussion is centered on the topic of health care costs in the US, while the original post--I believe--was raising the issue of access to insurance coverage.

The high cost of medical care is an tricky economic problem that may or may not be amenable to some interventions such as transparency of costs, malpractice reform, or making consumers have more "skin in the game."

But given the current high-price situation...here's my question: If we agree that human beings have a "right" to medical care (at least in critical situations), do we extend that to agree that human beings have a right to receive that medical care without bankrupting themselves and without becoming exposed to risk of financial ruin for the rest of their lives?

I think we should.

The system most developed countries have devised for dealing with this issue is insurance. In some countries the insurance is mandated, national in scope, and financed by taxes. But in the US, insurance is a private, for-profit system, and it is NOT a right.

In the US, the costs for treating catastrophic injury or illness are too high for all but the richest people to pay from their assets. This makes medical insurance a necessity if one wants financial security. In the US, once someone become ill, the current private, for-profit insurance scheme does not have any obligation to include that person in an insurance pool, leaving them open to the risk of financial ruin the next time they are afflicted by accident or illness.

What's needed is a system whereby all residents of our country are able to join some kind of insurance pool. This could be accomplished by providing a government sponsored insurance pool, or by some amount of regulation that requires insurance companies to find a way to include all comers. Or some combination. That's the task I'd like to see our legistlators take on.
The current system, where insurance is only available to the healthy (or the employed of certain firms), leaves too many open to bankruptcy at the next accident.

Yes, some people would end up paying more to help cover the expenses of other people. THAT'S THE WAY INSURANCE POOLS WORK. Everyone chips in some to cover the costs of those who are struck by calamity. It spreads the risk. If I never get sick or injured, money spent on health insurance was NOT wasted...it was spent to give me the peace of mind knowing that I would not be financially ruined if that bad luck had happened to me instead.

This discussion is certainly lively and interesting. I think it's sad that there was probably more discussion in this forum about health insurance and whether it's a "right" or a privelege for the wealthy only, then there has been in Congress since Hillary Clinton was first lady. The reason is that the people who set the laws do not have to live with the same constraints as the average US worker.

I propose that all elected officials should be given the same level of medical coverage as the average Walmart employee rather then their exisiting rather generous medical coverage. That might start some discussion about whether the system needs to be "fixed". And, this wasn't a slam at Walmart, you could probably substitute the name for any large employer in the US.

First off, let me state that I am thoroughly enjoying this debate/conversation and, as someone (maybe Andrea?) stated earlier, am learning a lot. I particularly appreciate the Canadian perspective. It had been months since I’d been to Wisebread, but I’m so glad I stumbled back. Thank you, Philip! And now to what I missed last night when my computer crashed at home…

@Canada girl:

“As you argue, people may be careless with resources they don't take ownership for, but you're forgetting that people are MORE careful with resources that are limited.”

Excellent point here, and one I had not considered. I’m not sure it makes the case for socialized health care given the lack of resources, but people would value those resources more if they were less plentiful.

“In addition, I think people who pay more for something have an inflated sense of what they are entitled to. The whole "I worked hard for it, therefore I deserve" it attitude is part of what got the US into its current financial crisis in the first place.”

Here, I have to disagree with you, not about the mentality, which I agree is rampant in the US, but about the cause. My best friend is a Legal Aid attorney, whose clients do not pay for their services, and let me tell you, it ain't the paying for it that makes people feel entitled. Her clients are often extremely demanding and resentful of any efforts they must personally make to further their own case, despite the fact that they're receiving a free service (and one with many other clients). I’d actually argue that it is entitlement programs (social security, welfare, etc.) that give people that mentality. Although perhaps we’re both off the mark and it’s a simple matter of plentitude or scarcity of supply. Nothing would humble you like waiting 9 months for a dr.'s appointment.

@Xin Lu:

I agree with you wrt the need for price transparency, but not with the government mandates. As a culture, IMO, we need to look less to the government for our solutions and more to ourselves. Transparency would also be made available if demanded by enough people. Perhaps a not-for-profit advocacy group is in order.

You do make a good point re: monopolies, but socialized health care is exactly that, a monopoly. I guess I should have said government-run programs rather than just government intervention.

@Edgar A.:

“The statement by somebody that "the majority of voters do not pay income tax" seems unlikely. It's probably true that somewhere between 30% and 40% of the potentially tax-paying residents of the U.S. pay zero income tax. But these are mostly poor and young, two categories that are among the least likely to vote. So, without documentation, we should regard the statement as right-wing hyperbole (to put it as gently as possible).”

I absolutely agree that documentation would be needed to support this statement (obviously a moot point now as Velja has backed up her previous statement), however, Velja expressed a mind-set that is not unique to her. Is the correct response an immediate write-off as “right-wing hyperbole”? Or would that be as bad as refusing to listen to a “flaming liberal”?

Perhaps the right response to a statement we initially find overly dramatic or even morally repugnant, is to consider the statement and look for the grain of truth within it, or at a minimum the circumstances and beliefs that have created the mentality, then consider it before we discard it. Believe me, I understand how difficult this is; it’s something I am working on personally. However, I really believe that that’s where we’d have to get to truly get out of “partisan politics”.

Just my two cents,

Jo

Alas, none of the believers that government should play more of a role in healthcare will answer my simple question:

Name one government program (agency) that is both effective and efficient?

I shake my head in disbelief at the people who think big government is smart and will save us all.

I, for one, would rather live free.

Yay Kevin! You were thinking many of the same things I was :) I've seen many successful programs in my community as well. And no, I'm not going to name them, Kelja. You made the claim that no programs were effective and efficient, the burden of proof is on you. Besides, I live here and you don't.

I think we're all agreed that no one's health care system (or insurance) is perfect :)

Rural electrification and the NIH are two examples of government programs that address private market failures. They were both created because private enterprise wasn't doing the job and companies freely admitted that they never would. And even neoclassic economists now admit that utilities and other natural monopolies should be at most semi-private. Every time I hear someone tell me that private enterprise always does a better job than government I remember back a few years to when California decided to deregulate its energy markets, because that was so fabulous that it led to widespread national demand to deregulate and denationalize hundreds of other services... oh wait, no it didn't.

And then there are public research universities, most of which manage to provide graduate education of equal or better quality than that of private research universities at a fraction of the cost. For undergraduates, public teaching colleges look pretty good next to private teaching colleges as well, although there aren't many public ones. I could think of examples if I wanted to spend time on the question but I've had these discussions before with ideologues, and evidence is never really what's being debated.

Ever stop and think about how private health insurance works? Successful businesses must make a profit. That profit, for any insurance company, can only be made in a few general ways: increase your ratio of profitable to unprofitable customers, charge more money for the same services, or cut costs. Also consider that a private market economy demands not just profit, but a growing profit... otherwise a company will see dwindiling investment, less available credit/capital, and a shrinking market share.
The ratio of profitable to unprofitable customers remains fairly constant between new and existing customers as long as legal and economic regulation don't change, so that's the industry's base minimum bar for growth. That only leaves two other options: charge more, or cut costs. Charging more shrinks your customer base and hurts your ratio...not a company's first choice. Then, there's cost cutting: reduce overhead or reduce service. There's a point where overhead simply can't be reduced further and the only remaining way to increse profits is to reduce services by denying claims, reducing coverage, etc... More for less becomes the name of the game.
Consider also, anyone in the United States can walk into an emergency room and be guaranteed treatment for serious injuries. You don't have to: have insurance, prove you can pay, or even be a citizen. It is illegal to deny you treatment. For those that don't pay (any reason) the cost is absorbed by the hospital. Hospitals (even public ones) are still bound to economic pressures to break even...or better yet, to turn a profit. So, the losses sustained by providing guaranteed treatment down in the E.R. get spread amongst all the other services in an attempt to stay in the black. The most profitable services provided are those paid for by insurance companies and various governmental institutions.
So far: the under- or un- insured are a loss for hospitals due to laws guaranteeing treatment, that cost is then passed to either the insurance companies or the government by charging more for paid services, and the insurance companies pass it back by charging more for less, or the government passes it back by increasing taxes.
That means anyone that either pays taxes or has health insurance is already paying for a low-grade form of universal healthcare. The differences between this present form of universal healthcare and a social program are: the quality and availability of services, who manages the system, and the fact that profit earning is a factor. The few are still paying for the many, and getting a raw deal to boot.
There are really only two solutions to this problem: change the laws and deny medical treatment to anyone incappable of paying for it, or eliminate profit earning for the equation. Eliminating profit can come in two forms: regulating the industry into non-profit status and watch all things good about free market economics disapear, or create a governmental program providing true universal healthcare.
Wouldn't you rather get a better deal, have an immense weight taken off your shoulders, and help countless people live a happier and healthier life? Do you enjoy providing outrageous salaries to industrial healthcare executives, or would you rather see that money in the smile of your friends and neighbors? Ask yourself this: If every day you were to hear personal accounts of the tragedies this system is responsible for: people affraid to seak treatment for fear of the costs- dispite having debilitating and painful conditions, families reduced to poverty or bankruptcy because their insurance company denied coverage and they chose to save their loved one's life, those that are scarred- crippled- or dead because they avoided treatment until they had no choice and were forced into the E.R. to recieve the bare minimum of care... could you sleep at night?
Remeber that for all, frugality is not a choice but a necessity. Impoverishment is not often a choice, and is seldom able to be laid as blame at the feet of the poor. Living modestly is no sin...it is, in fact, a virtue.

"My point is still if you give people more responsibility for their own health, it will inevitably drive costs down."

Then why are our costs the highest compared to nations with single-payer system?

Kelja, you are absolutely priceless:

#1: Let's all bargain down our bills from $28,550 to $600. That's change we can believe in.

#2. People without health insurance or those underinsured are simply making a lifestyle choice. It's feature of our system, not a bug. Microsoft has job waiting for you.

#3. It won't work because it's the gub'ment. After all, name us one gub'ment program that does work. Oh, you mentioned a whole bunch. Time for this troll to go back into hiding or to research more cut-and-paste talking points.

#4. You don't know my political leanings, says the troll. Yeah, right, we couldn't figure it out because everyone knows all lefties lack triple-digit IQs.

We await more of your anecdotes, right after you get back from the "14 year-olds that wank off to Ayn Rand" meeting.