Wednesday, December 07, 2011

House Over Health = ...Hero?

(HT: Josh Yuter)

A lady named Spike Ward penned an op-ed yesterday in the LA Times discussing how she was formerly against ObamaCare, but now that she has cancer, she has changed her mind. In her words:
The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house. We made a nerve-racking gamble, and we lost.
Now, she has discovered that ObamaCare has a provision which allows her to get insurance, and this may now help save her life.

From the comments on her op-ed and on Facebook, etc., it seems as if many people are hailing this as a proof that ObamaCare is wonderful. While certainly it is wonderful for Mrs. Ward that she can now be treated without going broke, isn't this absurd? Mr. and Mrs. Ward made a conscious decision to choose their house over their health insurance, and contrary to her statement that "We chose to keep our house. We made a nerve-racking gamble, and we lost", they in fact won: They got to keep their house, and their health insurance tab is now being picked up by the rest of the country (somewhat indirectly, as she is paying premiums, but that is not the point).

Contrast that with the decisions made by millions of people each day who consciously choose to keep their health insurance intact and sacrifice in other ways: Nobody is picking up the tab for their foreclosed (or sold at a loss) homes or their cars. They don't get to keep everything they had and then have the rest of the country cover anything they can't afford anymore. It is a horrible testament to this country that someone's irresponsible and selfish "gamble" is being guaranteed by the federal government* and that that burden is being carried by people who made responsible decisions.

* Note that this is no different than the bank bailouts in that sense, except that at least the argument there was (however much I may disagree) that despite their irresponsibility, a bailout was necessary to avoid others being hurt as well. Here, the only beneficiary is Mrs. Ward and her family, who get to keep their house and have her healthcare paid for by everyone else.



  2. So what you're saying is that I'm consistent in railing against government healthcare? Thanks!

  3. [I'm writing this as an Israeli, which has universal healthcare.]

    I am baffled by the utter lack of empathy that Americans have toward each other. Medical care is a basic necessity of life nowadays - similar to having a roof over one's head and bread to eat. Universal health care exists in the vast majority of the western world - with the US being the big exception. Allowing people to die (which is what you are basically advocating) due to not having health care does not jive with modern morals. In order to prevent this from happening, people need to be FORCED into buying insurance, so that in the future they can't have their pie and eat it too.

    Although I am a strong republican, I think Obama did not go nearly far enough in his health plan.

    I value life over politics.

  4. [We have universal healthcare in Australia too]

    I don't think health insurance would be very beneficial if she were living on the street; as far as I'm concerned she made the only choice she could.

    And like Moshe I am also baffled at the lack of compassion and empathy shown by Americans, particularly those who are supposed to be "rachmanim, bayshanim, gomlei chassodim". I mean, how can anyone support a system that says "Hah! You made the wrong choice and you deserve to die for it!"? Come to that, there are undoubtedly people who were never wealthy enough to afford either a home or health insurance. Are they all supposed to die, too?

  5. Moshe, Joe - Nobody is "allowing people to die", and hospitals in the US are required to admit anyone. That's not what we're talking about. More importantly, whatever one's feelings are regarding whether the US should have UHC or not (and I can demonstrate to you that it does not and cannot work here, a country far larger than either of yours), as we currently do NOT have it, what this lady chose to do was immoral. She made a conscious decision not to get healthcare, but instead to get a house - and now, she gets both... and everyone else has to pay for it. Meanwhile, people who made a more responsible, less selfish decision, get screwed.

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  7. I can say it cannot work, because enough of the country is already on something similar, and it's a disaster both financially and clinically - Medicare and Medicaid.

    And I wasn't saying pass the buck to hospitals - I'm merely noting that nobody is truly stuck.

    Why should anyone have to pick up the bill for anyone else? That's immoral.

  8. [Sorry - I deleted my post b/c I misspelled something - I did not realize that you had already replied]

    Hospitals in the US are not required to treat everyone. They are required to treat patients with an emergency. Cancer is a chronic disease, not an emergency.

    In addition, simply passing the ball to the hospitals and the docs who work there is not a solution. Why should the hospital have to foot the bill of this woman (who is obviously no tzadekes)? Why not society at large?

    You cannot demonstrate that UHC *cannot* work in the US - you can only state that in your opinion, it cannot work. Maybe the Israeli or Australian model of health care won't work in the US, but I see no reason not to believe that *something* can work. There are great minds in the US - this is one more pressing problems that needs to be dealt with. To simply say that the problem cannot be solved is heartless and brutal. These are peoples lives we are talking about - not another X-box or Sony playstation.

  9. This comment has been removed by the author.

  10. [I really need to start proofreading my responses...]


    We now come to stage 2 of health coverage in the modern era:


    People cannot get everything. Until the stupid people will realize that rationing is going on under the table and that it is far more worthwhile to have an open debate about what should and what should not be covered we won't make any headway on this because it is not PC.

    But once again, some people absolutely refuse to listen to reason (I'm referring to specific politicians) and only attack on partisan lines.

    Regarding current medicare plans: Medicare is *not* a clinical failure, only a financial failure.

  11. Under a private system, there's no rationing - if you are willing to pay, you can get it. This is turns leads to greater competition, which leads to better pricing, and most importantly, innovation.

    I don't know what you're talking about Medicare, but I analyze it for a living. It's a failure.

  12. "Why should anyone have to pick up the bill for anyone else? That's immoral."

    I am not advocating for this woman (who truly acted in a stupid way - but that does not mean she deserves to die). I am advocating universal health care - forcing *everyone* to pay into the system - no exceptions. You can tier the payments (as a % of income or some other formula), but everyone has to pay something. Unemployed? You still pay. Just like unemployed people don't get free clothing or free food at McDonalds, so too they need to pay for their healthcare. This is no less moral than any type of unemployment insurance, food stamps, child allowances (in countries that have them), tax credits for children, earned income credits, credits for using "green" technology etc....

    The health coverage should be for basic healthcare. You want more than the basic plans? No problem - pay extra.

  13. That's a completely different subject, though. This post was not about that.

    I'd be happy to have a discussion on the merits of various systems separately, but that's not what we're talking about in this case. Certainly this lady's situation isn't an argument for, but rather against, such a system.

  14. Ezzie:

    You think that private insurance companies don't ration? Baloney. Everything that is "not covered" by the plan is rationing. It is simply left up to the insurance company to decide what to include and what to exclude (except when the govt. steps in to force coverage of some illnesses).

    You also don't have a free market in health insurance in the US. You take what your employer gives you. You don't choose. (I'm not referring to a choice between 2-3 different plans with different co-pays and different deductibles. That is not real competition. Additionally, you can see that the US leads the world in healthcare spending, with lower life expectancy to show for it, even though it has the most "competitive" market.)

    How is medicare a *clinical* failure? Financially - I agree with you. Clinically? Seniors get good and quality care.

  15. Like I said - nothing is rationed so long as you're willing to pay for it. When you make a deal with an insurance company, they're saying they will cover XYZ for you in exchange for X funding. That's a deal you make. (And I would love for gov't to lift restrictions that exist on competing.) It's not left up to the insurance company - it's up to the person buying insurance to choose what they're willing to pay for coverage for. Nobody is required to take from their employer - they can try to negotiate better salaries in exchange for healthcare and get their own if they'd like.

    The US life expectancy is lower partly BECAUSE it has better care. Babies who wouldn't have made it to birth or past childbirth make it because of better care, and they have much lower life expectancy to begin with. That brings down the average, as do many other factors. This is still the premier country to come to when people have any illness, and the best hospitals in the world are almost all here in the US.

    You're wrong about Medicare, sorry: The structure of Medicare rewards moderate care for specific periods of time. Medicare de facto 'rations' services, and would much rather let very sick old people die.

  16. Nobody is required to take from their employer - they can try to negotiate better salaries in exchange for healthcare and get their own if they'd like.

    LOL. Is this a real option for virtually anyone?

  17. If they're truly concerned that their healthcare coverage from work isn't enough, yes. Though I've yet to see anyone who thinks so. Regardless, isn't work paying for it eons ahead of taxpayers doing so?

  18. Ezzie,

    Obamacare forces those who can afford it to by Healthcare coverage or to pay a fee.

  19. I know. That's the wrong approach (and illegal IMO, which is why it will be overturned).

  20. You have no idea what you are talking about. Really, absolutely no idea. I don't frequently say this because even people who are wrong have some idea what they are talking about, but you are not among those people.

    1) Healthcare is too expensive for the vast majority of people to pay for what they need over the course of their lives without insurance.

    2) No INSURANCE system can provide unlimited anything. You don't have to be an actuary to realize why

    3) Because there will be limitations on what can be paid for there will always be rationing in any insurance based system.

    4) Medicare and Medicaid are not actually insurance systems. Insurance = distributed risk over time. Medicare is an uncapped federal entitlement program, Medicaid is a more limited state and federal entitlement program.

    5)The US has the highest infant mortality rate of any comparable country and the lowest average lifespan for those who reach adolescence of any comparable country.

    6) The US spends by far a greater percentage of its GDP (about 17% and rising) on health care. That's why it is the premiere country to come to for care. Foreigners who can afford it get to come here and take advantage of the fact that we spend an absurd amount of money on hi-tech medicine that overall does little to increase the rates of mortality and morbidity in this country.

    7)"Medicare de facto 'rations' services, and would much rather let very sick old people die."

    Where do you get this? do you know what percentage of its annual outlays medicare spends on the last six months of life? Look it up.

    8)Buying healthcare on a private market where one is free to buy or not buy insurance is prohibitively expensive as it is mostly heavy utilizes who use these markets. People are locked into employer administered and subsidized plans primarily because that is there only option for group-based coverage which is far less expensive.

    9) Increased competition does little to to nothing to control the cost of healthcare. Healthcare is no a regular commodity and healthcare markets do not follow the patterns of commodity markets. There is not even a serious debate among healthcare economists on this.

    10) If you think that what this woman did is immoral, how do you feel about the frum organization that relocates sick people who have no insurance and do not qualify for subsidies to states, like new york, where they can much more easily qualify for medicaid or other state-subsidized programs, so that NY taxpayers can pay for most of the cost of their care? That seems much more problematic yet I've never heard so much as a peep from people about how immoral that is.

    You can be as libertarian as you want, rail against the nanny state etc. But don't pretend that the free market is a solution to the problems in the US. There is a reason why every other developed country, and some much less developed countries like Costa Rica, have something like universal coverage. Every other option either costs a lot more or makes people's lives nastier, more brutish, and significantly shorter.

  21. DC - Normally I wouldn't respond to people who start off as jerks, but...

    1) Yes/no. If that's true, by definition we're all screwed anyway, so let's give up now. Certainly if we then went government-run, we'd quickly bankrupt ourselves.

    2) Again, yes/no. No insurance is likely to do this, but some will cover all expenses if you pay enough in premiums, based on the same ideas as normal: If enough people pay enough, and only X% cost us above that, we'll still do all right.

    3) Agreed, but that choice should be made by people, not government.

    4) But in reality, they function in conjunction with or essentially as insurance.

    5) The high infant mortality rate is in large part due to a very successful approach to handling pregnancies.

    6) Investments in hi-tech care have and continue to pay off in the long run, even if in the short-term that means shifting expenses to low-return care. More importantly, most of this comes from either wealthy individuals or top insurance plans which pay out a lot of money for services that don't do as much per dollar, but these lead to progress. Again, this is why people end up coming here for care: We CAN do more than any other country.

    7) I work in the field, and one of my jobs is calculating how Medicare pays out. It's clear if you understand what it pays for and what it won't, and where it caps what.

    8) Allowing for greater competition will help bring these down, as will a greater ability to pool into larger groups.

    9) Not quite true. As more competition would come into play, and it's easier to compare costs across companies, it will bring these numbers down. There are more sites popping up that are almost like Mint.coms for healthcare, and I would venture that the more insurance companies are allowed to compete, the more valuable such sites will become, which in turn will bring prices down.

    10) I have no familiarity with such programs, and I don't think I'd like them. Not sure why that's relevant.

    11) That's not true, again - the US has been a leader in extending lifespans across the globe, and almost all innovations the past century have come from the US, with its free market approach. I've yet to see any such innovations from almost anywhere outside the US in places which have UHC, except perhaps Israel.

  22. You're ridiculously dogmatic about this. It's simply untrue that the alternative to UHC is not to let people die. As Moshe points out, if you have cancer and no insurance, you can't just walk into a hospital and get chemo. (There are some organizations stepping up to help, but not enough for everybody. This is a perfect example of how the right's idea that charity can do everything is wrong.)

    Your opinion that UHC cannot be done in the US is similarly untrue, as virtually every other Western democracy demonstrates.

    Finally, the rationing is a red herring. Rich people can get extra coverage under UHC the same way as they can with private insurance -- they just pay for it. If UHC doesn't cover as much as they want, then they are free to have rich-guy supplemental insurance.

    This example is perfect for why we need UHC. Even if by some inhuman right-wing morality, this woman deserves to not get cancer treatment without losing her house, we as a people (except the right-wing minority) aren't prepared to force her to live with those consequences, because we aren't monsters.

    It's just like that recent case where a fire department stood around and let a house burn down because the owner hadn't paid the $75 fee. Right-wingers say good, that's what they deserved. People with hearts say, whoa, this is clearly a horrible outcome for everybody and we can easily and obviously fix it with universal coverage the way 99% of fire departments work. Ditto health care.

  23. People with hearts or a shred of common sense, that is. You don't have to actually care to see that universal fire or health care coverage is simply the utilitarian choice for any society.

  24. I don't think there are enough details on this woman's lifestyle to decide whether or not she's doing the right thing. However, about healthcare:

    ObamaCare has helped me in allowing me to get back onto my father's health insurance, by raising the age that insurance can kick me off. This enabled me to get off of Medicaid.

    HOWEVER, if our UHC will be run anything like the Medicaid system is run, we're in trouble!

    Obviously, I only have knowledge about how Medicaid works in relation to mental health, as this is all that I have researched. But the following holds true for mental health across the States:

    1. States are not required to pay for therapy. They will only pay for a limited amount, if at all. (Using PTSD as an example, as this is the issue I deal with, this means that I can only have my treatment payed for if I limit it to approximately once a month. Read any medical research, this is not enough to put someone in remission from severe PTSD).

    2. While most states will pay for psychiatric medications, they are not required to do so.

    3. Medicaid is not required to pay for care out of state. Therefore, again taking PTSD as an example, if your state does not have a treatment facility, you have to pay privately. (PTSD inpatient treatment runs at approximately $1,300/day. Due to the nature of PTSD, many of those who suffer from this condition cannot afford to pay their own health insurance--despite desperately wanting to--let alone pay that much per day of treatment!) According to my most recent search there are only 12 inpatient PTSD treatment programs in the US, only some of those will deal with you for more than the very short term, and only some deal with non-combat related PTSD. The 12 treatment programs are not in 12 different states, and at least one is private pay only. In other words, there are only 11 options on insurance, and only if it's in your own state.

    Let's hope that if UHC becomes a reality, it's run a little differently!

    (This post does not really express all that I wanted to say on the topic. Try me again after the intensive PTSD treatment that I will get under my father's private health insurance that neither of us can pay for.)

  25. Not getting into the issue of whether American should or should not have UHC, I have two things to say.

    1) Ezzie's point, is that this woman's has money, (her house), but would rather have other people, indirectly pay for it. Meaning, she would win. Yes, life is unfair. She wants her house and treatment. I don't see how she entitled to both. But that is my opinion

    2) Since we are all adults here, and realize to everything in life there are pluses and minuses, what do the people that are pro UHC think are the minuses, or unintended consequences to having UHC

    To Moshe and Joe, please keep your moral indignation to yourself (or not). There is some gall by others claiming Americans don't have sympathy or empathy towards others, while so nicely patting themselves on their backs. I think Americans have been quite empathetic and sympathetic the plights of people.

    Not every system is perfect. From the American POV, or lets say, from those that are against a UHC, the belief is for a nation like this, with a historically value of a limited, and less powerful centralized government, a private based system is the better of both options. That way, a man is able to keep more of the fruits of his own labor and to make his own decisions. Perhaps its a bit too Calvinistic in talking about the virtue of self sufficiency, but in the long run, it may be for the best of the whole society, in my opinion. Will it save every single person out there? No, but no system functions based on 100% results.

    There is something to be said with people have pre conditions. But there is quite another to say about those that simply opt out of paying for it because they don't WANT it since now they are healthy and don't see a need. Now that's irresponsible.

  26. >aren't prepared to force her to live with those consequences, because we aren't monsters.

    Why I love leftists.

  27. btw, just as a curiosity, why are people against the health insurance companies instead of the hospitals, doctors and administration?? They are the ones charging in the first place.

    It sort of reminds of stupid students who are in general, protesting banks for their debts rather than their universities who are charging in the first place.

  28. >There is a reason why every other developed country, and some much less developed countries like Costa Rica, have something like universal coverage.

    Yes, there is a reason. Putting aside Bismarck for a second, I think man just naturally yearns for security and protection. To be taken care of. Now, plug in Bismarck and the tradition welfare state, and you have the answer to your question.

  29. BTW Ezzie, Mazal Tov on the new baby girl. Perhaps, as JA says, she won't grow up to be a monster like the rest of us.