Not free to be poor

by Philip Brewer on 7 July 2008 99 comments
Photo: Philip Brewer

Nobody wants to be poor.  It's a dangerous and constrained position to be in.  But there are people out there (me, for instance) who are relatively happy to live at a fairly low standard of living.  Choosing to live at a low standard of living means you don't need to earn as much money--which opens up a huge range of possibilities that ordinary people don't have.  The way society is organized now, though, that's not a safe option.

The classic early retirement strategy is simple to describe:  Earn a good salary, live frugally, save (and invest) the difference.  If you want to retire very early, you need a pretty big gap between what you earn and what you spend.  You also need to know how little you can afford to live on.  To those ends, living frugally is a double-win:  It frees up money to save and invest, plus it also acts as a "proof of concept" for your standard of living in retirement.

(When you're unhappy with your job, it's easy to look at your spending and think to yourself, "You know, if I didn't have to go to work every day, I wouldn't need to spend so much on X" (where X can be just about anything from booze to vacations to video games).  While there's some truth to that, most people are smart enough to know that the thing to do is to cut your budget first.  It would suck to retire early and then discover that you're miserable without your X, whether it's a country club membership or a daily frufru coffee drink.)

As I say, simple to describe.  It's even pretty simple to do, as long as you're willing to live below your means.  The problem, especially for Americans, is that it isn't safe.

Suppose you do this.  Suppose you get a small, cheap apartment that's within walking distance of most of the places you need to go.  You quit driving much, parking (or even selling) your car.  You shop your closet for clothing, let your wardrobe dwindle, and only buy versatile, classic items that are made to last.  You eat a frugal diet with lots of in-season veggies and little or no meat.  You forgo new gadgets and toys, and you seek out cheap entertainment such as free concerts, museums, and libraries.

Suppose, through such means, you get your expenses down to the point that you can fund your lifestyle entirely from your investment return.  (Short of that, maybe your investment return can fund a large enough portion of your living expenses that you can choose any sort of work that appeals to you, even if the pay is very low.)

Are you now free to retire?  No.  At least, not if you live in the United States.  You have too many huge contingent expenses.

A few of these can be dealt with through careful planning.  You can estimate how much you'll need to buy a new car every so often.  You can estimate how much you're going to have to spend to put your kids through college.  You can estimate what you'll need to cover an occasional new roof, furnace, air conditioner, window, door, hot water heater, and so on (generally not an issue if you rent).  But even if you have savings to cover these items, there are some contingent expenses that are simply unknowable.  In particular, you might get sick or injured, and find yourself bankrupted by medical bills.  

Huge contingent expenses are exactly what insurance is for, and it works pretty well for protecting you against the loss of your home in a fire or of your car in a collision.  But, at least in the United States, it doesn't work worth crap for health insurance.

Health insurance in the US is not only expensive, it's also uncertain.  Even if you can afford it, if you've ever been seriously ill, there's a pretty good chance that no one will sell it to you at any price.

There are other contingencies that the potential early retiree needs to worry about--investment losses, for example, or soaring prices for basic necessities like food--but they're relatively straightforward to deal with.  Having more than than the absolute minimum to cover your frugal lifestyle is wise.  A well-diversified investment portfolio that includes some foreign stocks, some bonds, maybe some real estate and precious metals can be expected to hold up pretty well.  A fraction of your retirement income should be in the form of an annuity (such as a pension), and a fraction should be inflation-protected (such as TIPS or I-Bonds).  A willingness to do some sort of paid work (to only semi-retire, as it were) adds to your options as well.

Sadly, none of these really solves the problem of medical insurance.  (Well, bumping your investment portfolio up by a few million dollars would be a partial solution, in the sense that most health insurance has a maximum payout of a few million dollars anyway, so with enough cash, you could just carry that risk yourself.  But that's just a further example of the fundamental problem that there's no ceiling on your potential liability.)

I think everyone suffers as a result of the way we do health care in the United States.  How many people are working at jobs they don't like, or staying married to people they don't love, simply to keep their health insurance?  What if those people were unleashed to follow their bliss?  Everyone would be better off--them, their children, the people they're (unhappily) working for, the people they're (unhappily) married to, the people who could appreciate whatever they might be creating, if they weren't stuck in some job they no longer enjoy.

I'm looking forward to the day when society is organized such that I can pick a standard of living, arrange to earn that much money, and feel confident that ordinary bad luck won't ruin my life.  I want to be free to be poor.

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Andrea Karim's picture

Health insurance is pretty much what keeps me from being self-employed. No one wants to insure diabetics, even healthy ones like myself. It's ALMOST enough to make me want to move to Canada. But then I remember how evil Canadians are.

Guest's picture
Michele

How exactly are Canadians evil? Except for the fact that they hate Americans.

Andrea Karim's picture

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.

Linsey Knerl's picture

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) !

Guest's picture
Alisa

It sounds like this post is advocating a simplier life.

I'm for that!

http://www.ourstockmarketjourney.blogspot.com/

Be well.

Guest's picture

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.

Guest's picture
Dangerman

... 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.

Philip Brewer's picture

@Dangerman:

Oh, I think it probably will happen.

The current scheme, where insurance is generally available to people with good jobs (but not otherwise), is turning into a terrible burden for companies.  Fifteen years ago, they opposed any sort of government health care program for two reasons.  First, they wanted to be in control of what health care services they would offer.  Second, they thought (especially the larger companies) that they could gain a competitive advantage in hiring by offering better insurance coverage.

I think virtually every company has changed its mind by now.  They see the costs of health insurance for their employees as a terrible competitive disadvantage compared to foreign companies (whose employees get free health care from the government).

The problem is not an unwillingness to pay for health care; the problem is that the burdens fall so capriciously.  The cost of health care is very reasonable for almost everybody.  But for a few people it's so high as to bankrupt them.  That's a perfect situation for insurance--spread the risk.  The problem is that we let insurance companies cherry-pick the healthy people.  (Health insurance is incredibly profitable, if you only insure healthy people.)

The problem could be easily solved by requiring insurance companies to offer simple rate charts, the way they do for other kinds of insurance.

Beyond that, we could save everyone a lot of money with a single-payer system.  (Americans pay twice as much for their insurance coverage as most European countries, without it making them any healthier or live any longer.)  But that's not necessary.  All that's required to solve my problem is to require insurance companies to offer insurance to sick people on roughly the same terms they offer it to healthy people.  They won't like it--they'll claim that insuring sick people will bankrupt them.  But I don't think the insurance industry has nearly as many friends as it did 15 years ago.

Guest's picture
John Krumm

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.

Guest's picture
Guest

I thought that was what American hospitals did. They have to stabilise you, but after that you're screwed.

Unless you can get to one of the charity-operated ones in time, but I doubt there's enough.

Sometimes, I can't believe that the US, a self-proclaimed great country (and in many other ways it is), doesn't even have a heathcare system available for those who can't pay.

Guest's picture
Dwight

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.

Guest's picture

I can attest to the sublime ease of a frugal life. But then I live in Canada and just graduated (with no debt, health care isn't the only thing cheaper here) so frugal living is relatively easy. I certainly don't envy those who don't have the choice of this kind of lifestyle.

Guest's picture
Looby

Great post- as a Brit currently in Canada (now on the lookout for beady eyes and flapping heads!) health insurance is the only reason we haven't considered moving to the States.
As someone with the misfortune to develop a (potentially severe) chronic medical condition at 21, I'm not even sure I could get coverage there, I'm fairly certain I wouldn't be able to afford it if I could.
As it is I'm pretty hopeful about early retirement through frugal living in either the UK or Canada.

Guest's picture
Don

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.

Guest's picture
Canadian girl

As I glare at all you Americas with my beady eyes and flap my head in your general direction, I can't help but think you're over-simplifying about how cheap it is to live here.

I'm very grateful that basic health care is covered, even if wait times are long and services could use a lot of improvement. However, there is also a lot that isn't covered that can get quite expensive when you're self-employed or your company doesn't have a good benefits plan.

For example, in Ontario dental care and eye care (exams are only free for those under 18 or over 65) are extra costs. Physiotherapy is no longer covered, and no one will pay a cent if you choose to see an alternative health care practitioner. Prescription medications aren't covered either until you are a senior.

Just because our health care is "free", doesn't mean we still aren't tied to our jobs -- many of us need that benefit plan.

I certainly don't hate Americans, but I don't understand why a country as wealthy as the U.S. doesn't take better care of its people.

Oh wait... I know! It wouldn't be profitable!

Philip Brewer's picture

I actually wrote a bit just recently about dental and vision care as things that generally don't need to be insured against.

Still, your greater point is well taken.  You can't just add up your expenses from last year and assume that you'll be able to get by if you can earn that much this year.  You need to do some planning, so that you know you can cover your less-than-annual expenses.  And you need to have a cushion against some small amount of unexpected expenses.

Sometimes, though, the unexpected expenses aren't small--they're huge.  That's when you need insurance. 

Guest's picture
Stacey07

Thanks, Canadian girl! I think a lot of Americans are under the impression that universal health care would solve all of our problems. The problem is that we hear all the good things about Canada's health care system, and none of the negative aspects.

I've been lucky in that I found a decent plan through ehealthinsurance.com. I'm self-employed. It's not "cheap" ($150 per month), but it does save a bit on taxes (premiums are tax deductable) and I strongly feel everyone should have insurance.

For the healthy diabetic - have you looked into a high deductable policy? If you rarely utilize a doctor other than preventative needs, you "may" be able to find a policy that works for you. These plans stress prevention, not curing ailments, and may be a bit more forgiving if you rarly need expensive emergency treatments. I do feel your pain - diabetes runs in my family, and my worst financial nightmare would be to develop a chronic illness this early in life. Best of luck!

Guest's picture
Guest

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.

Guest's picture
InDebtToo

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. I used to resent the amount of my salary that's paid, but actually now I am quite happy with it. I've realised that it reduces one of the huge stresses of life.

We would like to move to the States one day, but given the high cost of medical coverage I'm not sure it's a viable option for us. I'm not sure we would even be able to get coverage. At least here, if there's a problem, we can get it taken care of. Granted, it usually takes a bit longer than things do in the States, but things are prioritized based on medical requirements as much as possible. We do pay for prescriptions and eye exams (you don't if you're either a child or on benefits [welfare]) but these things can be budgeted for. We also pay for the dentist (unless you're a child or on benefits or a pregnant woman) but if you go to an NHS dentist there is a very clear fee structure that is quite reasonable.

One worry I have now as a resident of the UK and NOT an EU citizen is that there is some talk in the government of reducing the medical benefits to non-citizens. Not sure what I'll do then, especially if I am still required to have the National Insurance deducted from my paychecks.

Guest's picture
jerrydill

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.

Guest's picture
Wilson

The retirement plan for the poor is to die. From this perspective the issue of health insurance is moot.

To live cheaply I would suggest retiring abroad. There are a few countries that still have a lower standard of living than US.

I'm still confused about what this post is proposing. Retiring at 40? What do you want to retire for? You couldn't have had children and couldn't travel like the typical idle elderly. I think what you want is to live comfortably without working. Can't do both without slavery.

Guest's picture
Wilson

"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)

Philip Brewer's picture

@Wilson:

If you've never been seriously ill, $1000 a month will buy you great health insurance in the US.  If, however, you have any sort of health problem--if you've ever had heart disease, cancer, stroke, diabetes, or a dozen other illnesses or conditions--then you simply can't buy insurance at all.  (Sometimes, depending on the state you live in, you can buy insurance, but it doesn't cover anything--no coverage for heart attacks or strokes or cancer, for example.)

Guest's picture
L

@ Post 17 (and 20), I'd just like to point out that the National Insurance contributions you make cover not only health care but disability allowance, state pensions, bereavement and maternity allowances etc.
Also it's not linked to how much you have contributed, so if you were to become a stay at home spouse, your family's combined contribution total would drop but you be entitled to the same treatment- pretty much the point of socialised care.

Guest's picture
Kelja

'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.

Philip Brewer's picture

@Kelja:

Have you ever tried to shop around for medical care? My wife and I have had health savings account-style insurance for awhile now--the sort with the high deductible that's supposed to encourage people to shop around for their medical care. Our experience is that it doesn't work.

For the most common stuff--getting a throat culture, perhaps, or a course of antibiotics--it's kind of possible. But for anything even slightly less ordinary, it really isn't.

There are plenty of places around here with an MRI machine, but your doctor isn't going to want you to go to another one--and not just because profits from his MRI place help pay his salary. He wants you go to to his MRI place because he knows the radiologist there and trusts him (and knows his weak spots and how to allow for them). He wants you to go to his MRI place because he knows what equipment they've got; he's seen the pictures it produces, and he knows that it's good enough for his needs. (And, if it isn't, he knows which research hospital has a better machine and will send you there.)

And that's assuming that you're basically healthy (although, if you are, it's not clear why you need an MRI). If you're sick--if you've got a brain tumor or you've had a stroke, or were in a bad accident--then how are you supposed to shop around? Going to wake up from your coma and quick hire an ambulance to take you across town to the cheap MRI place?

If you've ever actually tried to shop around for medical care, you'll have run into this again and again.

It's true that part of the reason that medical care in the US is so expensive is that most patients don't care how much something costs. But it's false that they can "shop around" for cheaper care. Even if you're paying for the care out of your own pocket, it's simply not practical, once you're beyond the sort of care that you can get at a doc-in-the-box.

Guest's picture
Joanna

Phillip:

I see your point here and it's valid. However, I have two things to say. First, I'd argue that shopping around is more possible than you describe. In some cases, doctors may have medical reasons for selecting a particular facility, but many times it's simply a matter of routine and convenience. Although I completely agree that quality of care is currently opaque the only way it will become more transparent is if consumers (a.k.a. patients) insist upon it.

And, apart from price comparison, there are other ways in which you can be a consumer rather than just an impotent patient receiving what doctors & hospitals choose to give him.

Case in point: Last year, my then boyfriend went to he ER after 6 days of fever, body chills and generally feeling bad followed up by a spiked fever on Sunday night that responded to neither tylenol nor an ice bath. In triage, the young woman who was attending us received a phone call while doing so. Over the phone, she described what she was currently doing and stated that it was "probably a case of pneumonia". By the time we left the hospital, he'd had bloodwork, a chest x-ray and, strangely, an MRI. Why the MRI when it was "probably pneumonia"? He was having headaches. However, at that time, headaches were totally normal for him due to the fact that he gets migraines when stressed. Had we been consulted about the MRI, explained what it did and why it was recommended, we would not have had it. Instead, a nurse simply came to the room and cheerfully informed us that he was going for an MRI. Not knowing any better, went for the MRI.

While at the hospital, he asked at least 3 times how the "payment situation" worked and was blown off every time, being told, "don't worry, you have insurance". Yes, but not all insurances are alike and his was high deductible a fact of which I was unaware at the time. The doctors did not wait for blood work / chest x-ray to come back and confirm that he did have the most likely cause of his symptoms, pneumonia. Instead, they threw everything they had at it all at once even though it was not a life-threatening emergency. I guarantee you this is due to the "no worries, you have insurance" mentality.

A month and over $3k later, we learned a very costly lesson and one that we will continue paying even after we are married. (1) Know what procedures are being performed and why they are recommended. Insist on being informed. (2) YOU decide what procedures are performed, not the doctor. (3) Find out how much things cost before they are done. You wouldn't have your car fixed without an estimate and health care should be no different (with the obvious exception of a life threatening emergency). (4) Don't sign a piece of paper that gives the hospital the right to do whatever they please and charge you for it later. This is what they'll use to justify their rash decisions.

For me, this was an extremely eye-opening experience and one that has made me a much more active consumer of my medical care. In my opinion, that is the solution we need, not socialized health care. I just don't trust our government to do it better than I. But that's just me.

Guest's picture

I think the main problem is that health care is treated as a commodity nowadays, much like college degrees. People are so used to buying things that they expect that health (and education) can be bought too when those things actually comes down to particular behavioral problems and all they're buying is a doctor visit or a "degree". A doctor can fix a broken bone but he can't fix most problems which aside from the unlucky cases of poor genetics basically comes down to crappy lifestyle choices of poor diet, poor exercise routines, bad sleep patterns, etc.

When there is increasingly less connection between price and results, that is, between cost of benefits and actual "benefits"=health, the price can be whatever people are willing to pay. And some people are willing to pay a lot merely because they have a lot of money.

Already I notice that people are increasing their medical tourism, though. Our desire to spend money is driving up global prices, but for now foreign doctors are inexpensive.

Philip Brewer's picture

@Early Retirement Extreme:

I don't think that's it. At any rate, I don't have any problem with the level of care I get, on those rare occasions that I actually need to see a doctor. (I'm really quite healthy.) My problem is the very small risk that simple bad luck will bankrupt me.

You can buy insurance against most of other kinds of bad luck that might bankrupt you. (You can even buy insurance against a market downturn that might wipe out your portfolio, in the form of an annuity.)

I just want to be able to buy health insurance on similar terms. Right now, you can't. (Or rather, you can--unless you've ever been sick.)

There are plenty of people who have lifestyles that lead to illness, but there are plenty of other people--more than you seem to think--who fall into the bad genes/bad luck category.

Guest's picture
Kelja

John Krumm,

Perhaps 3% of Medicare's budget goes to administrative costs, but it wouldn't matter if it was .05%. The trend is clear, the growth of Medicare is outstriping incoming revenue.

Don't you realize, eventually entitlement programs will make up more than 100% of the budget? Simple Math.

UNSUSTAINABLE.

Guest's picture
John Krumm

Kelja, The costs of medicare that appear to make it unsustainable are political problems. It's the same with social security. Drug company profits have to come way down to reasonable levels and that will help hugely. We have a certain amount of health care pie to divide up. It really comes down to wanting to do this fairly, or wanting to let some groups with huge hands and strong arms (private companies like pharmaceutical corps) grab it all first and then sell it back to us for mega-profits. Other counties spend much less and provide care to everyone, with better overall results.

Guest's picture
Joanna

John:

Two things. First, I'm confused by your post because you state first that "Drug company profits have to come way down to reasonable levels and that will help hugely." Then later you say "It really comes down to wanting to do this fairly, or wanting to let some groups with huge hands and strong arms (private companies like pharmaceutical corps) grab it all first and then sell it back to us for mega-profits." Aren't drug companies and pharmaceutical corps the same ones? So are their profits reasonable at this point in time or not?

Could you also direct me to where you get this info?

My second thing is that I'm very interesting in this topic and would love to research it further, including other countries' systems. Could you tell me to which countries you're referring? And if you have any links to where you get your info, I'd love to check them out.

Thanks in advance,

Joanna

Guest's picture
John Krumm

Hi Joanna,

Yes, pharmaceutical companies and drug companies are the same, and yes, I do think their profits are unreasonable. The same drugs they sell to us they also sell in other countries for far less money. Basically they have convinced our politicians (and us!) through lobbying and other means that these high prices are reasonable, so the new Medicare drug coverage, for instance, while being a good thing for seniors, is also a big government give-away to these companies.

As for where to look for more information, there is lots out there, but I'll give you one link to Physicians for a National Health Plan, who advocate expanding Medicare to all. They have some good articles and statistics, and since they are doctors, they obviously aren't so worried about being underpaid by Medicare (that's a frequent argument against it, that it underpays doctors).

http://www.pnhp.org/

Guest's picture
Canadian girl

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.

Guest's picture
Kelja

As long as someone's there for you when you fail, most people won't take personal responsibility.

I should clear something up. I have a HSA (health savings account) which means that I pay the 1st $5000 medical expenses out of pocket , then I pay $7000 a year for catastrophic insurance coverage for anything over that - with co-pays, naturally. I have to work extra hard to pay for that coverage, but I'm concerned about my family's health.

Canadagirl: you say, what about the families not financially advantaged? What about those who don't work hard enough to provide the coverage for their families. Or, what about those who'd rather spend their money on other things than insurance. If a person decides they want to live a 'frugal' existence, let's say they manage to live on less than $15,000 a year, I say fine. That's great. But why do I have to pay for what they won't work hard enough to pay for?

It's really basic. Some are for wealth redistribution. I'm not.

Guest's picture
Guest

Kelja, you sound very bitter. Wouldn't you be better off if you didn't have to work "EXTRA" hard for yoru healthcare? You would have extra time for yoru family and hobbies, essentially a better life. I am sorry that you must work so hard to live.

Also, hard work and wealth does not equate to healthcare. Many work very hard, but their companies do not provide coverage. BTW/How do you feel about paying for the healthcare of your wealthy elected representitives?

Guest's picture
Phamacyninja

What about the many people who work very hard (some working three jobs) and STILL have no health care coverage? And don't say "Because they didn't get an education". Many people I work with have masters degrees and still must work two full time jobs to make ends meet and have no money left over for even dental care.

It seems that you are for the typical right wing health plan: live healthy, pay your fees, die quickly and quietly.

Andrea Karim's picture

I love it when people chime in from all over! (For future reference, the reason I pick on Canadians is that my family is entirely Canadian, and I like getting a rise out of them when they read my blog).

I'm glad that the point about health care not being totally "cheap" in Canada was raised - because taxes are very high there, and jobs, frankly, don't pay as well as they do here. I occasionally consider using my citizenship to move up to BC and work as a tech writer, but the pay is much lower than it is in Seattle - I don't know if I could afford to buy a home in Canada.

There are many reasons why healthcare costs so much in the US, and I don't think that irresponsible people are the main cause. I think doctors make too much money and drug companies spend too much on advertising (and pass the costs along to consumers). Are these the main problems with the system? No. Would changing them drastically reduce the cost of healthcare? I believe so.

Guest's picture
Kelja

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.

Guest's picture
Guest

"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?

Guest's picture
Kevin

@Kelja:

When I hear "shop for insurance" I think of something very different: surveying a field of products from competing vendors and making a rational decision about which product to buy. An example would be automobile insurance. Consumers can decide on their deductible, whether to get windshield coverage, and so on. If your car is damaged you can get estimates from several repair shops, understand their interaction with your policy, and decide where to get the repairs done if at all. This all leads to a competitive market with generally rational agents, with all the checks and balances that go along with that.

My experience with health care has been that usually there are no options, and when there are it is impossible to get the cost information I need to make a rational choice. So the whole thing fails to function as a market and accountability goes out the window.

I'd call your story an example of holding a bureaucracy to its obligations, which is commendable, but I wouldn't call it "shopping". I have had similar experiences myself, when I've tried to follow all the rules and ended up with an outrageous bill that's taken hours to clear up. Billing and customer service seem to be completely broken. I'm not sure whether it's a matter of impossible complexity or simple negligence; but in either case it tells me that the current system is a failure and needs to be overhauled or replaced.

Guest's picture
T'Pol

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

Philip Brewer's picture

@Kelja:

Getting a billing error corrected isn't the same as shopping around.

Shopping around would have been contacting several different surgery centers and getting bids on your shoulder surgery, then picking the ideal trade-off between the best surgeon versus the best price.

I've actually tried to do that--entirely without success. Nobody knows (or cares) who does the cheapest surgery. The information is unavailable (and what little there is, is incomprehensible).

Now, a certain amount of shopping around did happen--it was done by your insurance company, when it arranged negotiated rates. But that's just another way that people who can't get insurance end up being screwed: If you can't get insurance, you can't get in on the negotiated rates. And, of course, you can't negotiate your own rate, because you're just getting one shoulder surged--the insurance company can bring in dozens of shoulders a year.

We need to make insurance available to everybody. Even sick people.

Guest's picture

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!

Guest's picture
Marcie

Maybe we should just all consider living the Amish lifestyle...

Guest's picture
Canadian girl

@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.

Guest's picture
traveler

I plan to make my 1st million by using the deserted DIY bldg. for DIY Medical Center. With a few computers (with slots for credit cards),
disposeable thermometers
auto read BP Cuffs that take pulse.
respirometer and pulse oximeter (to check lung function)
some culture sticks (anyone can swab their own throat) etc.
stool specimen collection equip (see above)
and a few other pieces of simple diagnostic equip.
Enter your symptoms, and then utilize the computer prescribed diagnostic equipment.
Then, once computer has diagnosed and prescribed treatment (there are already "doc websites" that help with the diagnosis and prescribing);
go to treatment dispensing zone.
Insert that credit card.
Take your treatment.
Use your savings to go to the gym or on a cruise--whatever.

(Actually, I heard years ago from Phillipine doctor friend that some of this was in practice in Phillipines 1980s.)

Guest's picture
Lucille

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.

Guest's picture
Elizabeth

I'm a bit confused... I'm Canadian too, and I think I can see how Selja and Canadian Girl aren't seeing eye to eye.

You have to understand that up here we're all entitled to basic care (quality is another story!) In most cases, it's not a "have" versus "have-not" situation. It's usually not a "I'm paying more, therefore I should get more" scenario. It's like our roadways and our emergency services... It's covered by our taxes, and the fact that these services are there and are "free" doesn't make us more or less careless with our lives and health than Americans.

But I get the impression that health care/health insurance in the States is an entirely different philosophy? It's something that can be bought (for those who can afford it) rather than something that's a basic right? That only people who work hard really deserve it while others are basically freeloaders?

Please correct me if I'm wrong. That's just the impression I'm getting. I want to know more.

Andrea Karim's picture

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.

Xin Lu's picture
Xin Lu

I'm not sure if you guys have seen this show called 30 days by the guy that did Super Size Me.  He went to the hospital without insurance and they charged something like $200 for a bandaid.  I think some kind of cap/price regulation needs to be set by the government.  If they promoted more competition between hospitals and set price limits then it wouldn't be as expensive for people without insurance.  I have gone to checkups that cost $600 before.  A 45 minute checkup without any blood tests!  I had insurance so it was paid for but I still thought that price was ridiculous.  If there is some kind of open price information like Philip said then it would be much more helpful to the consumer and insurance companies. 

Guest's picture
Joanna

@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.

Philip Brewer's picture

@Joanna:

Have you ever gone to the doctor when you were really sick or after having been seriously injured?  There's no way that somebody, even with something minor like a dislocated finger, is going to say, "No, no--don't reduce that fracture until I call around and see if you're giving me a good price."  If you're suffering, and a doctor you trust to provide good care is there offering it, you're going to take it.  (And, frankly, it seems kind of bizarre to trust the doctor provide good care while not trusting him or her to charge a fair price.)

That's not to say that the issue you bring up is invalid--it is. And being a little proactive is not just good financial sense; it's also good for your health.  An unnecessary MRI is mostly just an expense, but an unnecessary CAT scan exposes you to a bunch of radiation and an unnecessary biopsy to all the hazards of surgery.  Well worth avoiding that.

The time to shop around, though, is not when you're bleeding or infected.  The time to shop around is up-front, when you're deciding who to get health care from.  And that's exactly what the insurance companies do when they negotiate rates from health care providers.  But, as I've said before, if you can't get insurance, you can't get in on the negotiated rates--you're doubly screwed.

Xin Lu's picture
Xin Lu

@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.  

Guest's picture
Mark

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...

Philip Brewer's picture

@Mark:

Thanks for the WSJ link--fascinating article, right on topic.

Guest's picture
!wanda

@lindsey: Everybody dies at some point. If you wait until you're old, that point and the short while leading up to that point is usually quite expensive. The thing is, you won't know if it will be simply expensive or catastrophically expensive. When I get old, which is a while away, I figure the US will either have universal health care or provide very broken healthcare to seniors. The thought of dying years sooner than I want to because I don't have the money is terrifying.

Guest's picture
!wanda

@linsey: Sorry for misspelling your name!

Guest's picture
Elizabeth

Andrea, thanks for the explanation! That was great. Very helpful.

And no Tim's jokes? Come on! :)

Guest's picture
Kelja

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.

Guest's picture
Lucille

I am fully aware of the situation in the country. The problem is too many people like you who think everything is about you and your money.

People with that mindset think that way until something bad happens to them and reality hits them right in the face. Then they are the loudest ones demanding they be given theirs by everyone else because they earned it in some regard.

When we put money ahead of the well being of other people and our country we take another step away from being human.

Guest's picture
Canadian Girl

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.

Guest's picture
Kelja

I agree my example was a poor example of 'shopping around'. But I maintain it's possible, albeit difficult. I've done it with doctors and dentists both. Funny thing is, I usually went with the pricier ones because they were just plain better.

It is difficult to shop because of the complexity of the system now in place which results in a lack of price transparency. If people had some incentive to shop for their medical care, I'm sure you'd agree, that transparency would be demanded.

In the old days, before insurance coverage, people did pay for their medicines and medical care. Granted, the technology 100 years ago doesn't compare with todays in any way, but medical care was both affordable and personal. Think of family doctor making home visits.

With the rise of corporate insurance plans, people took less interest in the prices paid for medical plans. As a result, slowly but surely, prices rose.

I'm not advocating going back to the old days. All I'm saying is that their should be some individual responsibility built into the health system. It would act as a governor on price. People are much more cautious about spending their own money vs what they perceive as someone else's.

I don't get people who want more government involvement in this area.

Name one governmental program that's efficient and effective??????????

By the way, Philip, a healthy discussion!

Philip Brewer's picture

@Kelja:

I'm sure you're right to an extent--part of the high cost of medicine is that people don't care if they get the expensive option or the cheap one, because it doesn't come out of their pocket.  I don't think that's the biggest factor, though. 

I think the biggest factor in the general rise of health care costs is that the care is much, much better than it was, let's say, 50 years ago.  Things like drugs for high blood pressure, statins, bypass surgery, stents, and angioplasty have added years to millions of people's lives--often years of high-quality, active life.  Some cancers can be virtually cured now.  Many other conditions that used to kill people can be cured--and other conditions that merely made them miserable can at least be treated.

I think the much better care is worth paying for.  Maybe not quite as much as it costs in the US, but a lot.  I'm willing to budget for that care.  I'm just bugged that it's so hard to get insurance to protect me from the small risk that I'll be the one who ends up needing care costing tens or hundreds of thousands of dollars (unless I want to work full-time at a good job).

Guest's picture
Elizabeth

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?)

Guest's picture
Kelja

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.

It's a let-the-other guy pay or bear the burden mentality.

No skin in the game.

Americans and Canadians are very much alike in this respect.

Guest's picture
Michelle

The Kaiser Family Foundation found that among those with coverage provided through employers, the average premium was $4500/year, and the average "family plan" premium was $12000. The amount paid by the employee was on average $700/year, or $3300 for a family, with the employer paying the balance.

Note that these are averages, and do not count co-pays, etc.... Those who follow the tradition of self-employment, of course, pay the entire premium, and often don't get the premium discounts and completeness of coverage that other-employed individuals do.

Guest's picture
Lucille

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.

Andrea Karim's picture

"And, frankly, it seems kind of bizarre to trust the doctor provide good care while not trusting him or her to charge a fair price."

Might seem bizarre, but if you think it about it, it's not the doctor who generally charges you - it's the institution that he or she works for. So doctors frequently have no idea what a procedure is going to cost - that's handled by an entirely different department. And anyway, even if a doctor did know the prices, he or she would be more apt to worry about providing good care than charging you correctly - they can get sued for malpractice if they mess up your operation, but whoever heard of a doctor getting sued for charging more than they should for a suture?

I think that whoever said that we're both pushing the cost along to someone else is correct. Someone always ends up paying. Both systems have serious sets of flaws.

I think the main thing that would prevent the American system from socializing is the American Medical Association - they have a powerul lobbying system that tried to sabotage Canada's socialization so many decades ago. They may have failed up north, but I'm sure they'd do well by appealing to the American sense of individualism.

Also, our fear of high taxes.

Philip Brewer's picture

I think the doctors are no longer much resisting moves toward "socialized" medicine.

They used to, because they didn't want some government official telling them what care to provide and what care to withhold, based on price.

But now the guy is there anyway.  He's not a government official--he works for the insurance company--but he's there, and he's telling the doctors what they can and can't do.  And the doctors have to listen--to do otherwise would be to bankrupt their institution (if they didn't get fired first).

So, I think the doctors are on board.  (The hypothetical guy from the government is not going to be worse than the guy they've already got from the insurance company.)

The only people left in opposition are the insurance companies.  They're the ones whose profit is on the line.  Under a single-payer system, they'd be cut out completely.  Under a system where they had to write insurance for everyone (including sick people), their profits would be squoze (although not necessarily badly, as long as the rules applied to all the other insurance companies, too).

You're right, by the way, that it makes perfect sense to trust the doctor to provide good care without knowing that you can trust his institution to charge fair prices--although I still think that's a symptom that needs other fixes than simply encouraging individual consumers to be more price aware.  At the point where they need to make a decision on care, they're simply not in a position to shop around.  The shopping around needs to come earlier in the process.  (In the choice of institution, the choice of insurance company, and by the insurance company when they negotiate rates.)

Andrea Karim's picture

I think doctors will be resistant to the change, too. I doubt a doctor in Canada makes $300K-500K a year like some physicians do here, unless they are a surgeon specializing in very expensive procedures. Even THEN, I don't think doctors make that much.

Not that the money is the only reason doctors become doctors, understand. But I imagine it might play a role in the fight for or against socialization.

I agree completely, btw, on the idea that consumers need a more transparent system so customers can make choices. It's obviously only a part of the solution, but it would be helpful.

Guest's picture
Joanna

Andrea / Canada Girl:

I have heard, although this is admittedly only anecdotal, that some Canadian med school graduates actually move to the U.S. for that very reason. It simply isn't profitable (or as profitable) to work in Canada.

Is that the case in your opinions?

Guest's picture
Joanna

@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.

Guest's picture
Canadian girl

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.

Andrea Karim's picture

I'm a little torn on the issue of malpractice insurance. There are definately instances in which doctors are forced to pay WAY too much for coverage, but isn't the average cost for a doctor around $25K per year? High, but not insurmountable. I think OB/Gyns pay the highest rate, and at the worst, it's a quarter million per year. Unless I'm getting the figures wrong.

It's true that there are many doctors in the US who went to school in Canada - my father is one of them. He didn't move here for the money, although it's a nice living. He happened to meet my mother when doing his internship in Los Angeles, and they decided to raise us here. Mind you, there are doctors from all over the world practicing here in the United States - it's probably a combination of wanting to make a really good salary and wanting to work with some of the best research facilities and with some very good technology.

Guest's picture
Michelle

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.

Guest's picture
Canadian girl

Andrea,

Doctors do very well here in Canada, but not as well as they do in the States. And yes, quite a few move to the States simply to earn more money. My uncle was one of them.

It happens with a lot of other careers too. We call it the "brain drain." Or at least we did a decade or so ago when it was in the news.

Given that we have a shortage of doctors here, and how expensive it is to train them, it would be nice if doctors who trained in Canada actually stayed in Canada.

Guest's picture
Canadian girl

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!

Andrea Karim's picture

I was just thinking about treatments for things like cancer (crucial and long-term, but not usually associated with an ER visit), and I just realized that I don't know how uninsured people in the US manage to pay for things like that. I know that there are a number of organizations that help people afford treatment, but I wonder how many people simply die from it rather than to have to pay for chemotherapy?

Yeah, my dad (and mum) actually worked in Canada for a while. My mother just missed the US, I think, and didn't want her kids to be grow up playing ice hockey and drinking Canadian beer... zing!

Philip Brewer's picture

As was explained above, the poor do get treatment.  Oh, a few get turned away--sent to cheaper hospitals, usually--but almost all of them get treated.  In fact, it's a lot less trouble to treat someone who's really poor, because you don't have to worry about what his insurance will and won't cover.

The people who suffer are the middle-class and working-class folks who either don't have insurance, or have insurance that doesn't provide adequate coverage.  They get treated too, mostly, but then they lose everything--all their savings, their house, their car.  Some just declare bankruptcy right away.  Others try to negotiate the uncovered expenses down to something that they can afford.  Sometimes the hospitals write off the costs that can't be paid.  Other times they don't.  But in either case, they take everything the patient's got first.

But the patient does get first-rate care, before being financially ruined. Almost always.

Guest's picture
Elizabeth

"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.

Guest's picture
Edgar A.

@Elizabeth

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).

Guest's picture
kathryn

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.

Guest's picture
Kelja

@Edgar A

Yea, should have amended my statement to say approximately 32% don't pay income tax. Or, perhaps this would be more to your liking - 50% pay very, very little income tax. This, by the way Edgar, isn't hyperbole, right-wing or otherwise. I wish you'd keep your obvious prejudices to yourself since you have no idea of my philosophical leanings.

See: http://www.taxfoundation.org/research/show/542.html

Since you seem (I could be wrong here) to be a believer in big government, answer the question I posed here earlier.

Name one government program that is both efficient and effective? Hard one, eh?

It's really common sense, someone who has 'skin' in the game, is much more interested in the outcome than someone who does't. Human Nature. The people who get entitlements from government and pay nothing in, vote to increase entitlements with little regard what it does to the taxpayer. Why is this hard to understand?

I'm a believer that individuals can rise up challenges no matter what. Big Government, in my opinion, stands in the way of creative, smart and motivated people.

Guest's picture
Guest

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.

Guest's picture
Joanna

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

Guest's picture
Kelja

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.

Philip Brewer's picture

@Kelja:

I wouldn't really call myself a believer in "big government," but I'll take a stab at your challenge.

Let's begin by agreeing that you can only talk about effectiveness and efficiency at some particular goal.  With that in mind, if you'll let me define the goal as "provide universal delivery of letters at a uniform price," I'll nominate the Post Office as an effective, efficient government program. 

I know that it's held up as an example of the opposite, and it's true that it's been partially privitized, but I think it may qualify.

It's effective--I send letters all over the country, and I've never had a verified instance of the letter not reaching its destination, usually within just a few days.

It's efficient--it costs only 42 cents to send a letter.

It's also very versatile.  My DVDs from NetFlix are routinely delivered, unbroken, in one business day.  (Not something that was envisioned when postal systems were created.)

Courier services are barred from competing directly--but I've never seen one that even wanted to compete, in the sense of providing universal service at a uniform price.  The closest equivalent service that they do provide costs several dollars.

Fifteen years ago, the rallying cry of the forces opposing the Clinton health care plan was "Do you want a health care system with all the efficiency and compassion of the Post Office?"  At the time, that was a statement that gave me pause.  Since then, though, both the coverage and the service of the health insurance my former employer offered got worse and worse.  (Although still pretty good, especially if you're not sick.)  At this point, I'd say that the efficiency and compassion of the Post Office would be a step up.

Guest's picture
Kevin

@Kelja

I for one have resisted answering your challenge because "efficient" and "effective" are both ill defined terms that are defined relative to an individual world view. I suspect that we have different operational definitions of those two terms, so suggesting examples will lead us down a distracting sidebar debate.

That being said, I have been impressed with the effectiveness of DARPA, NSF, NOAA, my county parks department, community college programs, and the Coast Guard, relative to the size of their budgets. You may not agree, and that's fine, but I don't think debating these programs will be productive.

There are certainly some ineffective and wasteful government programs, but the same can be said of corporations and individuals. You can't prove by example.

Guest's picture
Kelja

Wow, holding up the USPO as the paragon of effeciency!

We have vastly different experiences. As part of a business, I have sent out hundreds of thousands of piece of mail through the U.S. mails. A good of percentage of mail that was either destroyed or never received by recipients was sadly expected. It was, after all the post office.

Maybe your local post office is different, but I've enjoyed lines that would be the envy anywhere in Eastern Europe during the old Soviet era. Haven't you had the experience where one or more of the clerks has simply taken a break when there's a long line of customers?

Inefficiency has always been part of the Post Office. If not, alternative delivery services wouldn't have been born and prospered - UPS, FedEX, etc.

My dad got a job at the post office in the 1940's when he was a teenager. Too many of the men were off fighting the war. First day he delivered the mail, he was too quick. He finished his route early and came back to the post office to find out what else he could do. The supervisor's eyes got real wide and he yelled, 'what are you doing back here so soon?'. When my dad told him he finished delivering the mail, the supervisor told him to go hide somewhere - a poolhall, a friend's house, anywhere, but not to show back at the post office until the end of the day.

Do you think the USPO has changed that much?

And, Kevin ------------ you have to be kidding!

Wasteful, Inefficient companies in the real world get punished by the market and go bankrupt. Anyone who's run a company is acutely aware of that fact! Government programs, no matter how wasteful and stupid, don't ever go away.

You mention the Coast Guard, a branch of the military I have a high regard for. It might do a good job at what they do, but like the rest of the military, it's laughable how wasteful they are.

Anything a federal agency can do, private enterprise could do better.

Philip Brewer's picture

I did have crappy experiences with long lines and surly service at the post office back in the 1980s when I lived in Ft. Lauderdale, Salt Lake City and Los Angeles.  It may be that the difference these past 20 years has more to do with moving to the Midwest than with any change in the Post Office.

On the other hand, at the Post Office there actually is someone there at the counter when I go in.  At my (soon to be former) health insurance provider there was not even an "in" to go to.  Routine claims were processed well enough, but anything out of the ordinary landed you in a nightmare of calling and speaking to someone for whom English was a second language, working from a script, the purpose of which was to find some way to deny your claim.

I'll take the Post Office any day.

Guest's picture
Kevin

"Wasteful, Inefficient companies in the real world get punished by the market and go bankrupt."

Halliburton, Exxon, and AT&T are all wasteful yet successful companies.

"Government programs, no matter how wasteful and stupid, don't ever go away."

The Civilian Conservation Corps is the first disbanded government agency that comes to mind. There are others.

"Anything a federal agency can do, private enterprise could do better."

That's one heck of a broad claim and I really doubt it could be defended against every real or hypothetical service. Why were private firefighting services abandoned for municipal ones?

In most cases it's an apples-to-oranges comparison anyway because companies can select their clients while government agencies are beholden to service everyone. FedEx can close unprofitable branches, but USPS is beholden to service practically everywhere. Getting back on topic, Medicare has to cover everyone over a certain age yet private insurers can choose to avoid expensive individuals.

Guest's picture
Canadian girl

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 :)

Philip Brewer's picture

Thanks, everyone, for this great discussion.  I'm pleased to have played a part in kicking it off.

Guest's picture
Guest

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.

Guest's picture
Cooley

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.

Guest's picture
Common Sense Will Not Kill You

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.

Guest's picture
dj

I love your site! I know what you mean, but the phrase, "low standard of living" has negative connotations. When did living w/in ones means, living simply, or being poor, become crime-like. Ho hum. I just don't want to fill my life with junk and I care about people and our lovely planet. I had the opportunity to travel to New Zealand, and stayed in hostels. The transportation and accommodations there were terrific!! Unlike any I've seen in the US. I meant a lot of people from Asian and European countries, and what I noticed, and it stuck with me, was how free they were. They didn't seem to worry about money like the US, and they didn't have to worry about healthcare, and they seemed liberated/free. When my mom was losing her battle w/cancer (She had her own HInsurance problem when my father's company dropped retirees and told them a month later. Try getting affordable supplemental insurance w/pre-existing conditions.), she made pre-arrangements. When she passed and we went to the funeral home, they were trying to sell us all kinds of things for thousands of dollars. We kept saying no. They didn't understand, it wasn't that we couldn't pay, it was, we didn't WANT it.   HInsurance is a joke. I quit my job (when to contracting) to help and be with my mom/hospice.  When I left,  I spoke w/contractors and they said pay out of pocket. I had terrible experiences w/Cobra, catastrophic, and other HInsurance. It was stange being drilled by a salesperson about personal health issues and they weren't happy when there weren't any they could write about. It was a real game to them.  My HInsurance is exercise, eating "right", hopefully keeping my environment safe, and prayers. I just didn't want to participate in what I saw was a losing, corrupt business. A friend, who only had HS diploma, actually had a job approving claims, overriding doctors. I wanted to downsize my home from 1600 sq ft to something smaller because I wanted to - less upkeep, insurance, property taxes. I didn't need much and didn't want much - quality vs quantity. The real estate agents turned their heads, and some subdivisions actually had size limits, large was okay, but not small.  It takes great strength of character in our society - we are inundated with pressures to consume and misinformation -  to simply live and live simply.

Guest's picture

In this generation where technology has surpassed the living environment, it's certainly very hard to adopt the frugal living. But having a deep sense of responsibility may be the driving force to attain a living that is beyond our means. Making current adjustments and dealing with quality resolutions of our living attachments makes us prepared for a valuable future.