• This Salon essay explains why I don’t advise friends to “opt-out”

    If you haven’t come across it already, Brian Beutler had a really terrific piece up at Salon yesterday making the case for why young adults ought to buy health insurance. You see, he was shot in 2008. That wasn’t a planned health expense.

    My medical bills totaled about $200,000, mostly attributable to major surgery and a 10-day hospital stay. My deductible more than cleared out my bank account, but in the end, my insurer paid almost every other penny, and saved me from bankruptcy or a lifetime of debt. For $200,000 you can buy an Ivy League education, a home, a law degree, a secure retirement or a splenectomy. But there’s no equity, dividend or residual value in a splenectomy.

    Go read the whole thing. Seriously.

    I’m a twenty-something whose delight in health policy is inanely obvious to anyone who so much as adds me on Facebook (they’re all immensely good sports about it). This means I routinely field questions about insurance from friends and classmates.

    If they’re under 26, I urge them to talk to their parents about taking advantage of extended dependent coverage. I explain the way the subsidies work, and that they should probably expect premiums in the vicinity of $100-150 per month—unless they’re unemployed or a student in 2014; then they might qualify for Medicaid. I tell people if they aren’t going to be eligible for subsidies, they should compare plans—particularly catastrophic plans—on and off the exchange. I describe the wrinkle of limited open enrollment. And yes, I highlight the penalty, its weak bite in 2014, and the lax construction of its enforcement mechanism.

    But I never advise them not to buy insurance, and Beutler’s essay articulates why better than I ever could.

    Adrianna (@onceuponA)

    Share
    Comments closed
     
    • There’s also a misconception regarding the requirement that hospitals treat patients who present in the ER: yes, hospitals must provide care, but not for free. And hospitals, not for profit hospitals in particular, employ aggressive debt collection practices, worse than banks, credit card companies, or even some pay day lenders. And for the uninsured, the hospital’s charges are much higher than for the insured.

      • Hospital charges for the uninsured are a disgrace. Yesterday I wrote about a med student who had insurance but the insurer declined to cover a particular test. His price: $2,000. Insurer price (he later found, when the insurer reversed course and agreed to pay): $375. Full story here: http://theselfpaypatient.com/2013/09/23/hospital-bills-student-2000-for-lab-test-insurer-pays-375/

        It’s the natural result of a system in which prices don’t have to transparent or real, because everybody has some third-party payer picking up the tab. Except for the uninsured, of course.

        I also don’t recommend people ‘opt out’ if by that you mean having NO coverage at all. But I’m a big fan of alternate types of insurance and coverage, such as health sharing ministries, fixed benefit policies, critical illness policies, etc. Beutler’s story should be a caution to everyone considering going completely bare (I do wonder whether the $200,000 figure is real though – not that I think he’s making it up or exaggerating, but that might be the ‘chargemaster’ amount, which his insurer paid only a fraction of.

        • “do wonder whether the $200,000 figure is real though – not that I think he’s making it up or exaggerating, but that might be the ‘chargemaster’ amount, which his insurer paid only a fraction of.”

          Well, when the first step is not just an ER, but a trauma center, with lots of emergency surgeries just to survive until morning, …

        • In 2000, in Richmond, VA, I had an apparent TIA. The total actual payout (in 2000 dollars) was over $23,000. That was for a battery of tests that was completed in a single day, a CAT scan upon arrival, and 2 nights in the hospital. That’s what the insurance company paid out,

          So $200,000 2013 dollars for a serious gun shot would doesn’t really seem outlandish.

          • Oh, it’s plausible, but anyone familiar with how hospitals price things should know to be suspect of any number attached to a medical bill and referred to as the ‘cost’ of treatment.

          • I’ll go a bit further than Sean. It is plausible that an uninsured individual might be billed over $23,000 for an uncomplicated TIA. I have even seen some people pay such a ridiculous bill, but I doubt an experienced insurer would pay such an amount for an uncomplicated TIA, especially one that is Canadian.

            I have had experience with Canadian insurers and looked at the statements provided to the insured. Sometimes they can be a bit confusing and though the patient thinks the provider was reimbursed the total amount they were in error. I sincerely doubt your insurer paid over $23,000 for an uncomplicated TIA which might not even require hospitalization. Odds are that the insurer paid a lot less and you didn’t realize it.

            If you can find your statement of benefits and wish to post them perhaps the list managers permit it. If they paid that type of claim then they are probably out of business today or your premiums for travel insurance would have to be tremendous.

    • Here is another reason to buy insurance. As bad as being shot is it is a a relatively short recovery time. Even if one needs physical therapy their recovery time and hospital visits will cease (unless the unfortunate circumstance of paralysis of occurs). Last year at the age of 32 I was diagnosed with brain cancer. Luckily I had an employer based plan. I can’t remember what the biopsy, Neuro ICU room, etc cost, but it was an absurd amount. Then a week later I returned to the hospital due to seizures. This was another 3 day hospital stay. At the beginning I had MRIs every 3 months, but now it’s every 6 months. Each time I go in the total cost is about $19,000. The cancer is incurable so I will be doing this for the rest of my life. I’m pretty sure no one wants to pay that much as their debt rises til the day they die. The $300 penalty now that will increase to $600 dollar and still not have coverage seems pretty silly when looked at in this light.

    • No, totally wrong! Insurance is a religion. As an investment it returns less than 80 cents on the dollar. Roulette pays 95% or so.

      Obamacare is particularly stupid, especially for a young person who goes sailing or backpacking around the world. He is liable for paying Obamacare premiums or penalty, but there is neither Obamacare nor Medicare available to an American traveling outside the country.

      The Salon article was written by a journalist–a person evidently ignorant of math or principles of economics.

      You need to calculate how much poorer you will be at age 65 because of lifelong FICA taxes and insurance premiums, money that could have been invested in the S&P growing at 6% annually. The value of those funds at retirement exceeds $5,000,000. So a lifelong payback of a $200,000 hit would be a breeze for someone not impoverished by FICA and insurance premiums.

      It’s presenting a false dichotomy to speak of needing to choose between Obamacare and death or lifelong debt payments. There are the options of gradual payback, as a rational person does with school debt or a mortgage and, furthermore, medical tourism, where the costs are far less for the person going “bare.” Don ‘t forget, many of those who declare bankruptcy were insured! They are the suckers of the Religion of Insurance. Funny that the Amish are exempted from Social Security, Medicare and Obamacare.

        • Stella,

          If you had Excel and an understanding of economics, you could figure out for yourself what a screw-job SS, Medicare and Obamacare represent. I dare you, using Excel and the S&P500 growth stats, to put your annual FICA payments into an S&P500 index fund investment, starting, say 45 years ago. You will find that those socialist programs have cost you over $2M dollars in lost investments!

          You do realize, don’t you, that the disabled, spouses, ex-spouses, widows and children of “beneficiaries,” even though indolent, collect from those socialist programs? How the hell can a worker carry all that freight and do better than putting his FICA contributions into an investment fund? If you are incapable of doing the math, I will gladly send you the spreadsheet that proves my point.

          • Which 45 year time period did you use? As the article I linked explained, that is a critical question. Firecalc.com* has data going back more than 100 years which will allow you to see the effect of various time series on a given investment strategy.

            The fact that FICA also covers disability and life insurance doesn’t bother me. The fact that I never got “my money’s worth” from those two components is a big win for me, IMHO. I’m also happy to report that it’s been 25 years since I benefitted from my auto insurance policy payments and 29 years of “wasted” homeowners insurance payments. Also wins for me. As Brian pointed out already today, your analogies to healthcare as an investment are stupid. Ditto FICA.

            You are right that I’m not much of a mathematician. The memory, of Stochastic Processes II still makes my skin crawl and I think that it led to dropping our of the doctoral program. As someone with both gray hair and (retired) ovaries, you are not the first person to make the accusation. I will refrain from speculating about libertarians, mom’s basement, action figures and Ayn Rand novels.

            * firecalc.com is a nifty tool for retirment planning for those of you who are interested.

    • Granted, having full insurance is great once you get shot or are attacked by cancer. But for every person who gets shot in DC, there are hundreds in Peoria, where nothing ever happens, who spend a fortune on insurance premiums with never a return.

      The web is saturated with the formulaic:

      “I was so glad I had insurance when I suffered _________, because it would have cost me $___________ out of pocket otherwise.”

      What you–no statistician or actuary-will never figure out, or hear or read in the drive-by media, is:

      “Now, at 65, I’m $5,000,000 richer for having gone “bare” my entire life, having paid for my own drugs and healthcare treatment in Mexico and invested the savings in the S&P.”

      OR

      “Fox News reports that nothing happened in Peoria this year, which means that the 115,000 people of Peoria have lost $1,115,000,000 in health insurance premiums that would be growing at a rate of 6% if instead it had been invested in the S&P.”

      • Insurance is not an investment, so it’s incorrect to say that it pays only $0.80 in benefits per dollar of premiums and therefore, it’s not worth buying it. Your cellphone data plan pays you zero and costs you money every month. Your car pays you zero, and it is in fact a depreciating asset. But both those things are pretty useful. Perhaps even vital.

        When you buy health insurance, you are in fact buying two things:

        1. If you meet a catastrophe, you’re more or less covered. That counts for something, because the financial loss in a catastrophe would be very, very large.

        2. You’re buying the insurance company’s ability to negotiate favorable prices for drugs, medical services, etc, on your behalf. That makes it cheaper than it would have to manage your own health by buying your own services out of pocket.*

        Insurance is insurance. It is not an investment.* Your comparison assumes that it is such, and therefore I think is a misleading comparison. After all, while the chance of you getting shot in any one year is very low, the cumulative chance that some major medical event that would have impoverished you without insurance will happen you by the time you are 65 is not low. The chance that you will have such a medical event from age 65 until you die is very, very high.

        * OK, full life insurance blends insurance with an investment function. But this is not how health insurance is structured, and it has never been presented as a financial investment.

        • I generally concur that health insurance isn’t an investment. But the more I learn, the more I am skeptical that in buying insurance you’re really getting much value in return for ‘negotiated’ rates with hospitals, providers, etc. Consider cash-only doctors, who generally cost less than those who participate in insurance. To dramatically simplify things, I can pay:

          $X to the doctor for treatment (self pay)

          or,

          $Y to the insurer to handle claims processing/administrative overhead + $Z to the insurer to pay the doctor for treatment + $A to the doctor in the form of a co-pay (where $Z = $B for treatment + $C for the doctor’s claim’s processing/administrative overhead).

          It is not self-evident to me that the latter is superior to the former in terms of cost to the patient. In fact, numerous doctors are able to offer pretty low fees, even lower than co-payments in some cases, once they opt out of insurance, see: http://theselfpaypatient.com/2013/09/11/for-less-than-many-insurance-co-pays-this-doctor-in-austin-texas-will-see-you/

          Scale back third party payment, even for expensive stuff such as through reference pricing, and the need for insurers to add costs to the system shrinks dramatically, I think. We don’t need insurers to get real prices in health care, we just need a functioning market.

    • Managing (i.e., sharing) risk is what finance is all about. Indeed, in the perfect world all risks (health, fire and casualty, economic (such as unemployment), pestilence, etc.) would be shared so that the per capita cost would be nominal. Sharing risk facilitates investment, which promotes employment, economic growth, and well-being and maximizes wealth. When those in finance refer to “financial innovation”, what they mean is improving the means of managing (i.e., sharing) risk. It’s the confluence of the free market and the common good. And managing risks includes health care risks. Those who choose not to participate hurt not only themselves (if the risk befalls them) but everybody else who shares in the risk.

      • per capita health care costs alone are not nominal. That is why there is such a huge fight on how to pay for it.

    • Paying insurance premiums (subsidized or not) for catastrophic care, if there is no cap on payout, enables you to walk away with the Max OOP in debt and not absolutely have to file for bankruptcy.

      Since most young people do not have assets, the bankruptcy option remains open. But, since the bankruptcy will be for Max OOP in the thousands not hundreds of thousands, the potential to get family members to pay (you are alive after all) or to “work your way out of debt” to not have to file for bankruptcy becomes more palatable. So on top of your massive student debt, you now have debt to family or debt for healthcare to keep you waiting tables.

      All of this is under the condition that the care is indeed covered and not challenged post fact by the insurer in some way, and

      That you are able to continue making the premiums and continue to qualify for the “bucket” of coverage you are currently in.

      If you fall out of the bucket or fail to make the premiums, you will be shuffled off to Medicaid in short course.

      This wouldn’t be seen as problematic if Medicaid was not a stigmatized program and it was uniformly practiced. But alas, it is not.

      The marketing campaign “to do the right thing” will be fierce because the penalty is not realistically enforceable for young people with little income, catastrophic care will still be available, and bankruptcy is still an option.

      It is sad, because preventative care ( lifestyle modification to prevent obesity, diabetes, smoking, sexually transmitted diseases, women’s health, and on and on) is most important in young adults PRIOR to the onset of the conditions. Discouraging healthcare for sake of encouraging health insurance is a sad state of affairs.

    • Most of y’all haven’t a clue about statistics, actuarial science or economic analysis.

      It makes no difference whether insurance is called a religion, an investment or whatever. What matters is the cost/benefit analysis. A car increases your pleasure or your income. Playing roulette gives you pleasure for a slight loss. Insurance costs you bigtime and gives negative pleasure every time you deal with them.

      After all, sickness insurance is called “health insurance,” just as death insurance is called “life insurance.” I suppose flood insurance should be called “sunshine insurance.” People with limited understanding are religious, fully insured, and believe in global warning. Everyone has the right to be stupid, even those who are $200,000 in debt for having gained an English major. I only object when I’m forced to join in paying for their stupidiies as represented by public prayer, public parks, public mis-education, star-spangled banners, Hail Marys, pledges of allegiance, SS, Medicare and Obamacare.

      There are many folks out there who are not risk-averse, who climb Everest and jump out of perfectly good airplanes, or have sex, which has killed far more people than lead or mercury.

      I’d like to know how you superstitions folks explain the health and happiness of the Amish, Brethren, Mennonites, as well as acupuncture alternative medicine and yoga victims who don’t want things like your insurance, SS, contraceptives, abortions, Western medicine, meat or electricity.

      “Sharing” is a crock! Sure, the young male “shares” in paying for the illnesses of the old and the breeding of women he’s never met. His share amounts to most of the pie, especially since women consume 187% of the healthcare a man does, and old folks 500% of what the young adult male does.

      • @Jimbino

        You don’t have a clue about investments. Hedges are valuable and always cost something. Health insurance is a hedge against all your assets being wiped out in a medical catastrophe.

        Medical bills are the cause of over 60% of all bankruptcies in the US.

      • “breeding of women”

        Women are not farm animals. This phrase of yours speaks volumes.

        Also, women likely receive 187% more care because they live longer than men on average.

        There couldn’t be health insurance for the old unless young (healthier) people are paying into the pool, insurance is about risk sharing after all. I hope I never get my monies worth from health insurance as that would mean something terrible has happened to me. Which is statistically likely over a lifetime.

    • “They also enter a social contract that promises to provide them affordable coverage when they’re older and no longer healthy,”

      Except that under the ACA, they do not have to pay when they are young in order to buy insurance later when they are older. The two are unrelated.

      The problem with the ACA for healthy young people is that the policies are intentionally overpriced in order to support an intergenerational subsidy. If the price insurance for a young healthy man was based on the likely costs of covering young healthy men, then it would be a good deal. The young men would get protection from the costs of the illnesses they were likely to get, and there would be no need to make moral arguments about why they should buy overpriced insurance. But the ACA prevents insurance companies from pricing based on likely costs, so young healthy people, as a group, MUST pay too much.

      It is absolutely not true that everyone pays too much for their insurance. For older people, it can be obvious that their care will cost more than they pay in premiums. So they are getting a great investment.

      I have no idea how many young healthy people will buy insurance under ACA, but if they do, they will clearly be paying too much.

    • Yes, quite right dbh.

      Gummint loves to choose the winners and losers in life. It used to be that men won, women lost, whites won, blacks lost, protestants won, catholics lost.

      We’ve now moved way beyond those simple disgusting discriminations, thank Darwin. But under Obamacare:

      religious and superstitious win, atheists lose
      women win, men lose
      elders win, youth lose
      married win, singles lose
      breeders win, child-free lose
      risk-averse win, risk-friendly lose
      couch potatoes win, world-travelers lose
      smokers win, abstainers lose
      hypochondriacs win, circumspect lose

      I am the loser in all but one of those categories, which is why I won’t be participating in Obamacare.

      • Perhaps the most important one:

        insurance companies win; people – it depends

        Wouldn’t Medicare for all be so much easier/cheaper/fairer etc.?

    • What is $200,000 amortized over 40 years, he still might be better off over a life time without insurance, he has not yet exceeded the average lifetime healthcare spending. Some people play the state lotteries, not getting health insurance is a much better bet than that. Never the less I think that $50,000 deductible would be best for someone like him but who am I to force that on him?

      • You’re not allowed to amortize that over a lifetime.

        Unless you do it with this wacky new product called: insurance.

        Insurance premiums = amortizing your health care costs over your lifetime

    • Jimbino: “Most of y’all haven’t a clue about statistics, actuarial science or economic analysis.”

      Wrong blog for that!

      • There is no “wrong blog” for pointing out the superstition as well as STEM and Econ ignorance of the commentators and the host..

        • The problem is when something happens to you and you can’t pay, one of two things must occur: one, you die or suffer for your short-fall. Two, you get treatment, don’t pay, and WE all pay for your treatment. Which is fair to you? And which is fair to us?

          The thing is very few, if any, people choose to die/suffer when they can’t pay. Moreover, society has said it will treat you when you show up to the ER and grant you relief in court if you can’t pay. The only way your system works is if society says that when you show up for treatment if you have no insurance and/or you cannot pay, you suffer and/or die. At some level you must know that.

          • Elboku, one has to consider that many that are insured never pay their deductibles or co pays or the insurer refuses to reimburse the expected amounts or even pay at all.

            Those so called insured persons also cause a drain on society while many of the uninsured pay multiples of what the insured pays making up in part for those that refuse to pay their bills. The actual amount left unpaid by the uninsured is really not of significant impact on society (though annoying) when one considers the fact that many of those that do not pay would have had to have had their premiums supported or paid for by government.

    • I’ll bet that $200,000 bill makes any patient feel good about their insurance, but as others have already stated that was likely the bill charged not the actual money the hospital would receive from an insurance company.

      Thus all this is a giant game at the expense of the individual. Seeing such high bills promotes the purchase of insurance and perhaps too much of it. If the uninsured were charged the average amount paid and looked at how much money out of pocket the insured were frequently forced to pay they would take note of the scam and demand appropriate types of insurance that would be high deductible and limited in scope.

      By the way bankruptcy is not a big threat to one that doesn’t have assets. That is why hospitals frequently settle for prices that approach the normal amounts of money seen instead of forcing the patient into bankruptcy.

      Also, by the way, the last price a hospital charged for a procedure needed by a family member as an outpatient was $8,000. The insurance carrier allowed only $400. 20:1 which at least in the recent past was not unheard of. Had I been unaware of how much the costs of insurance were and how the charges were created I would have thought I was getting a great deal, but the premium wasn’t worth the $400 actually saved.

    • I have never heard such absurd arguments against healthcare reform. The analogies that healthcare is an investment is demeaning since the return would be sustaining life. No individual claims that they want insurance because they will get something more out of it. Families get insurance to protect their children and wife/husband. Their is a moral and security component. They get insurance so they don’t have to worry about going bankrupt if they get sick. Insurance costs less than the full price without insurance and we don’t know when or how we get sick. If you want to gamble your childrens’ or loved ones life, then go ahead. But us normal people don’t want to even think about the consequence.

      You are actually making a case that no one ought to have insurance because the money we may save is more than what we pay in insurance. Again, go ahead and just pay the penalty. But normal people don’t want to gamble with their life or the child’s life. That is what the social contract is. To look beyond our own interest. You talk about religion, but it seems like you created a libertarian utopia that most people reject. People look beyond just individual economic interests and see how education affects others. How paying for roads to good even though I don’t drive on them. How paying for firehouses, police stations, hospitals, etc even if I don’t need them. You have created spreadsheets based on a misguided analogy, but you lack a moral and philosophical foundation for living in a society.

    • The problem is not insurance, it is being coerced to buy overpriced insurance to subsidize someone else. If it were priced properly there would be no anxiety about whether young men would participate. There would be no profit to distribute to others, so the success of the system would not depend on them joiningnin

    • Yes, dbh, Brian’s last post is illiterate to the point of being incoherent, though I forgive him if he’s not a native English speaker.

      Forced subscription to insurance is dumb. Although it represents a loss to the public at large, certain individuals will gain and others will lose, as I spelled out in an earlier comment.

      Participation in insurance, as in religion, is based on ignorance. I have a good idea–but do you?–what the returns on title insurance, NFIP flood insurance, auto liability insurance and health insurance are?

      Now I admit that some folks will stupidly pay for religious and superstitious pursuits other than Obamacare, but the difference is that they don’t force me to participate in their superstitions, but Obama is trying to force me to participate in the religion of health insurance.

      Force will ultimately be met with force.

      You speak glibly of “properly priced” health insurance. How in the hell do you define or determine “properly priced”? Yes, of course, anything is worth purchasing if “properly priced,” but that is what is called “begging the question.” Properly priced insurance is insurance that seriously discriminates male/female, young/old, sick/well and so on and that returns at least $1 for every $1 spent in premiums. You consider $1 spent on roulette, a car or food to be well worth it if you get more than $1 worth of satisfaction. That’s something insurance in general, and Obamacare in particular, cannot promise. Indeed, insurance companies have already been penalized for paying out less than $0.80 per premium-dollar!

    • Jimbino,

      You have convinced yourself that you are an intelligent person that you fail to consider your own stupidly. However, suppose that my post was incoherent. I have a terminal brain tumor which I mentioned in my first post and you now mock. You proved my point that you lack any moral character. You also showed that you are willing to gamble your child’s life and others ought to do so also. A great person you are.

      Your analogies are still ridiculous and have no applicability to the situation at hand. First, I am an atheist and I truly hate it when people make absurd analogies regarding religion. Religion deals with faith in the unknown that can’t be objectively measured. Thus, if you can’t objectively measure how Obamacare will help, then you can’t objectively measure how it won’t help (according to your silly logic). Secondly, I worked at a casino. Your gambling analogy is just as silly. If insurance is like gambling people are either gambling with money that they can afford or can’t afford. If the former, it is usually a form of entertainment. If the latter they will lose material possessions. Either way, people don’t look at insurance this way. You don’t gamble to prevent something from happening and you don’t pay for insurance to gain more than you already have. You need to be more consistent with your analogy instead of plucking them out of thin air.

      Health insurance is not a gamble or an investment. You have failed to prove that they are. You are (forgive me for stealing your analogy) clinging on to a religious theme without questioning it. Nobody who receives healthcare sees it as an investment. That is just stupid. You need to live in the real world. If nobody got sick, then, obviously, nobody would need insurance. Since not everybody gets terminally ill insurance costs needs to balance out. Thus, people who don’t get sick will always (yes, always) will pay more than they what you would ridiculously call a return.

      I started receiving healthcare a few years ago. Let’s say I pay $100 a month. In four years that would be $4800. Was that a waste of money since I never went to the doctors? Then I needed a brain biopsy. After my surgery I already got a “return”. Now let’s look at a 30 year period. The payments in 30 years would be $36,000. I still got a “return” from my surgery alone (not including $18,000 each time for my MRIs and appointments 3-4 times a year). Will all people meet their payments right away like me? No. But will people take that risk? So to say that you expect more out of what they spend in health insurance as a monetary value is stupid beyond words. People view insurance as a precautionary measure and to prevent him/herself, their child, wife/husband from dying you idiot. Quit trying to present yourself as a scientist/objective thinker (especially with your ridiculous analogy with religion) when you can’t even understand how people cognitively approach the problem of insurance. They see it as saving a life and not going broke if they get sick. What is a bigger risk (again, forgive me for stealing your stupid analogy) paying a few hundred bucks that you can afford to be prevent a catastrophic event or going broke and not being able to get treated? Furthermore, Obamacare covers preventive care when people can be treated and detect illnesses before they will be serious enough that increases costs.

      Seriously, presenting yourself as an objective thinker on the Internet isn’t fooling anyone since your premises are based on flawed analogies. Again, forgive me for stealing your stupid analogy, but your arguments are like believing the Earth is resting on the back of a turtle. That is to say, you create an idea just so you are able to comprehend the subject despite the fact that your creation has nothing to do with the subject matter. So keep living in you I fantasy world that people see insurance as an investment instead of a precautionary measure to protect themselves. The same thing with bodyguards. You may not need one, but you feel at ease to do everyday living. It astounds me how you have taken the time to create an analogy that has nothing to do with the subject matter. Talk about investing time without an adequate return.

      I am done reading your drivel since my life is too short to waste on the stupid. Go live on your libertarian island that rests on the back of a turtle and created more inane analogies that have no relevance to real life.. The rest of us will enjoy our insurance knowing that our family is protected

      • “Nobody who receives healthcare sees it as an investment.”

        Brian, traditional insurance is very much an investment decision though not an investment that is expected to provide increased revenues. Think of the shipping industry of almost 4,000 years ago (check out the Code of Hammurabi).

        Health insurance has an additional reason for its existence. To pool funds so that treatments that are unaffordable to individuals in the pool are paid for by the pool. In order for that to work what is being insured should be an unexpected event that is rare enough that the pool can afford to cover the occurrence.

        What many are trying to do is to provide pre paid health care which is a distortion of what insurance is. For insurance to function as an efficient mechanism to prevent losses that cannot be effectively managed by the individual or to pool money for care it needs to be voluntary and an agreement made voluntarily by both the buyer and the seller.

        • Emily,

          As I said in the quote that you provided nobody SEES it as an investment. Maybe I shouldn’t have said ‘nobody’ since you and a few others on here see it as such, but the reasons that most people give for insurance is not an investment, but rather as a means of prevention and a precautionary measure. But remember, I was responding to Jimbino who did in fact say that he wanted a return. He claims to be a scientific thinker, but then denies global warming. If I would’ve seen his denial first I would’ve ignored his rants in entirety since climate change is irrefutable.

          Anyway, my point is this: insurance has a cognitive reasoning which is, as I said, a sense of security. I agree with your assessment for the underlying reasons of insurance (pooling). However, an event doesn’t have to be rare. Preventative care, minor emergencies, etc are covered. However, if you mean the majority of the costs come from rare illnesses I agree. That is what I meant that the costs need to be balanced out by those who are not yet sick and those who are sick. Both pay the same monthly fee, but the sick will pay more in deductibles and out-of-pocket expenses until the limits are reached.

          I don’t really get your last point. It seems like your premise is that a consumer must agree to purchase the insurance. But this doesn’t need to be the case to reach your conclusion (to pool money). It doesn’t matter if you pool money through penalty fees, voluntary payments, etc. As long as you get to the required amount necessary, then the insurance can be given. I see no difference between this and paying for roads that I don’t use. To have a road built a given sum of money is needed. Tax dollars are collected that go to building those roads.

          Furthermore, I think there claim that people don’t want insurance is highly exaggerated. I didn’t pay for insurance out of college because it was too expensive from my employer compared to my income. When I switched employers and made more money I could afford it so I bought it. If young people are offered affordable healthcare I believe they will buy it. And remember, the ACA applies to individuals who don’t have insurance now. And these people will receive subsidies where some won’t pay anything and others will pay very little. The bronze plans will most likely, depending on the state one lives in, pay under $100. No one is forced into the marketplace. If you can buy it from your employer, then you can. Again, I highly doubt people will reject all of the plans that are affordable. Since I have cancer and I will opt for the platinum plan mine will be around $200, which will be less than what I’ll will be paying on Jan 1st if the ACA wasn’t implemented. Right now I’m paying $100, but I’ll be kicked off my insurance plan on Dec 31st since I was fired for being on disability for over a year, which is legal. I won’t be charged more for having a preexisting condition. And this is what makes me so angry. You have Jimbino who can’t and won’t understand what it is like to be denied insurance for having a preexisting condition. I was denied a supplemental plan. It is a sickening feeling.

          One final note. You argue that the ACA isn’t how insurance actually works. Exactly! It is attempting to redefine how insurance works to help those who can’t afford it and who now can’t be denied insurance. It is empowering the consumer.

          • Brian, I was merely pointing out that the ACA wasn’t really insurance in the traditional sense. I believe it unfortunate that we call it insurance because that implies things that do not really pertain to the ACA.

            I am not sure of what Jimbino meant. A “return” on investment could mean certain benefits which I believe are a myth with regard to the ACA. Understand I do not disagree with the intent of the ACA, rather I believe the ACA causes more harm than good while at the same time I recognize that others might hold the opposite position. That difference of opinion is what needs to be debated, but instead we debate personalities and among other things calling those opposed to the ACA uncaring folks. That type of thinking lacks the intellectual ability to appreciate other points of view.

            If insurance were voluntary Jimbino wouldn’t be forced to buy into the concept of mandatory pooled financing and would probably be happy to let you make your own decision of what is best for you, but are you permitting Jimbino the same right to make his own decision?

            “Preventative care, minor emergencies, etc are covered.”

            Why? Why cover things that are easily paid for? We should be more concerned with the expensive less elastic problems and if we were costs would fall. Additionally preventative care with the exception of vaccination have proven to be of little benefit financially. One other thing. When you use the term emergency it means different things to different people and you might feel that some of those emergencies should not be paid for while others will disagree. That causes costs to rise (moral hazard).

            “. It doesn’t matter if you pool money through penalty fees…”

            You missed the point about efficiency. One can always use force, but take note of the totalitarian countries and how poor the efficiency is when the work product is not voluntary. Take a look at the history of the Soviet Union that had the resources of a powerful and intelligent entity. Eventually the lack of efficiency killed it and among other things that is because they used involuntary means for production.

            “I see no difference between this and paying for roads that I don’t use. ”

            Think about the economic definition of a public good.

            “If young people are offered affordable healthcare I believe they will buy it.”

            That is a place where the ACA fails. If we want universal insurance we have to look at the long term. We want the young to learn to carry insurance. By making their premiums higher than the value they receive we failed in that regard.

            “having a preexisting condition. ”

            The one thing that needed to be managed was to make sure a person didn’t lose insurance simply because they became ill. At a cost of trillions of dollars we supposedly solved that problem with the ACA, but did we? I believe this was one of the first provisions to be offered and I believe only a trifle over 100,000 persons were helped to the disadvantage of tens or hundreds of millions. There are much simpler and less expensive ways of managing this problem.

            As a last note, the ACA is not empowering the consumer, rather it is empowering government and all those rent seeking persons that live off of the taxpayers dime.

            • I’ll make my point very brief since it seems that we are talking past one another. I’m not really sure what you mean by the idea that the ACA isn’t insurance in the traditional sense because insurance was defined by certain acts at a specific time in history. That would be like saying capitalism wasn’t a real economic theory in the traditional sense since mercantilism was the prevalent theory or that representative government wasn’t a real political theory because it wasn’t in place before it occurred. These definitions are elastic and are merely functions of society. Even definitions in the hard sciences change over time (look at how the idea of gravity and time have changed throughout time).

              I truly don’t know where you got the idea that preventative care is not financially effective. Preventative care includes MRIs, which are very expensive. Mammograms are also expensive. It seems like you are just making stuff up. Remember, you are talking to a cancer patient who is going through (more or less) preventative care until my cancer spreads. I know first hand how effective preventative works and how much it costs.

              I think it is unfortunate that you used the term ‘totalitarian government’ and that people are simply living off of taxpayers’ dime. You called the other Brian’s comment was pejorative, which I view your comment to be. I’m not sure where you got your number that only a 100,000 people are helped by the the preexisting mandate, but a lot more people have cancer or some other illness that will now not lose their insurance. Furthermore, to call This bill was debated. It was passed by an elected representative government. We had a presidential election where one person ran on the promise to repeal it. I respect the idea to replace it with an alternative, but the system that was in place was already letting people die. It was failing us as a people and society. No one presented a better alternative (at least in the debates in Congress).

              You asked me to think about the definition of the public good and that is what I have in mind when I think about the ACA. As I stated above I always respected the right for people to offer an alternative, but I saw none from others during the debate for the ACA that was viable. I have reached the end of my rope because I and many others are dying due to the failures of our current system. The free market has failed in this respect. I have stopped talking to friends to support repealing the ACA without making sure that people in my situation are covered. Do I see these people as uncaring? Yes. Why? People they support the current system that discriminates those with cancer and that the poor can’t afford it. To live or die shouldn’t be based on how much money you have or predetermined genetics. This is why the so-called traditional definition of insurance is absurd and needs redefining. To hold onto the previous definition just because of politics is astounding. All governments use force in some way. Taxation is forced. You can’t claim that the economic system this country used made this country great and be against force. Hamilton forced manufacturing in this country. He destroyed the whiskey trade by poor traders here in PA. He used insider trading to establish the first bank. The robber barons used political clout in the mid to late 1800s. I could go on.

              But to claim that insurance is the same as other markets is dangerous. I view insurance the same as other scientific measures. Medical advances succeed under federal grants. Some do use private contributions, but they lobby mostly for federal money.

              I’m sorry, but it seems like your quibbles are purely political. You call certain things ‘force’, ‘totalitarian’, etc. You make up numbers to support your conclusion and you created a generous history of the way you want this country to be founded on. You can’t claim that you want people to play nice and, at the same time, make things up. In all of this you have failed to mention how the current system has failed. And through your made up numbers you are denying people who are dying the opportunity to receive healthcare because you don’t want to be forced to pay a tax. No one is forcing you to buy insurance. Take the penalty, which is essentially a tax. But don’t misconstrue the idea that certain groups were never forced to be taxed for the public good. The whiskey rebels were forced to help fund the war bonds’ the first bank, and a manufacturing class, which took place after the constitution was created. Right or wrong, but this was viewed as the public good by the majority that set the precedent for how capitalism flourished in this country. You can’t ignore the means, but accept the end.

              But this will be my last post. Again, I’m at the end of my rope probably because I’m approaching this as someone who needs this insurance. Plus, I can’t have an honest debate with someone when someone makes up facts (I’m still astounded by the claim that preventative care can easily be paid for and have little benefit financially. And I certainly can’t discuss an issue with someone who claims that this bill is totalitarian and like the Soviet Union. These rightwing scare tactics are old and over used, which is why the right lost the last two presidential elections. People aren’t buying it anymore because they are seeing the bullshit that the right is selling. But I won’t reply to anymore of this because I’m tired of the same old bullshit myself. It is just tiring hearing it over and over again with made up history and numbers. And after people give these “facts” they complain about how others aren’t having an honest debate and resort to name calling. This is why. People are more concerned with ideology rather than making sure the government and social institutions work for them. Jefferson was libertarian in some ways, but he also wanted taxpayer dollars to go to individuals so they can buy 50 acres of land (look up his draft of the VA constitution). People have created a myth of this country to support their own ideology and use that myth to claim that already passed bills are illegitimate and are contrary to this country’s values. I’m just tired of this rightwing bullshit. That is all it is. Just bullshit.

            • Brian, it is difficult to discuss concepts and ideas when there is no agreement over the definition of crucial words. I think you mix up pre paid health care with health insurance. The same is true with your use of preventative care. MRI’s are not preventative. They represent procedures that lead to early diagnosis, etc. MRI’s prevent nothing (flu vaccinations may prevent the flu).

              The literature is clear with regard to preventive medicine and even early diagnosis. With the possible exception of vaccinations most other modalities lead to higher not lower costs. They may, however, lead to great benefit for the individual patient though frequently these tests lead to less benefit than believed. The changing definition of gravity has to do more with an increased knowledge base than an actual change in definition.

              Mammograms are inexpensive. MRI’s are expensive in your terms, but may be a lot less expensive than you seem to believe. The prices for these types of tests do not reflect real costs because prices are being set by other entities than the buyer and the seller.

              “I think it is unfortunate that you used the term ‘totalitarian government’ and that people are simply living off of taxpayers’ dime. ”

              One cannot help but use those terms when that is the truth. When a government forces its citizen to do something and the citizen has no choice that is a road to totalitarianism. When you mandate shared costs you are using other people’s money for your own desires. You seem to believe that a pure democracy is a good form of government. It isn’t. Pure democracy can mean that 51% of the population can enslave the other 49%. The founders of the US Constitution recognized that and I think you should as well.

              You also seem to believe that the ACA will save lives. It won’t (in total, over time) and will likely degrade care in the US along with taking money from a more productive segment of the economy while throwing money into a hole where all the concepts are defined to make the ACA look good, but in actuality lead to a disaster. The reasons why I believe this to be true and others disagree is where the discussion should be engaged, but you are falling into the trap of discussing feelings instead of true concepts and statistics.

              I don’t want to make this an even more lengthy post so I will ask you to tell me the definition of a public good and how the ACA fits that definition. It is unfortunate that anyone including yourself is ill and I hope that things change in a positive fashion, but your illness was not caused by any health care system. It was caused by cancer something you are being treated for. That we wish to help those in need is not something we need to debate as we both agree, only disagreeing with how to go about accomplishing that desire. There are many ideas out there to do such a task, but those ideas cannot be seen by those that refuse to look.

              You seem to have a religious attachment to the ACA so I don’t think any amount of discussion will change your mind. Where religion is concerned faith seems to trump logic and science. That might be appropriate or not and is something for the individual to decide.

              I will leave the rest of your posting untouched. I wish you well.

            • Emily,

              I’m sorry, but what you wrote is simply ridiculous. I won’t go into it all because I believe that your ideology is clouding your mind to what is actually science and what is made up. And I truly believe that your definition of science is not what the definition that scientists actually use, given the fact that you don’t use ‘preventive care’ as they do, as I will sure below. And, quite frankly, most of what you wrote isn’t elucidated to really make sense of. You just throw out talking point terms that only make sense in your particular ideology and claim that it is true without backing anything up. It reminds me of watching Bill O’Reilly where he claims his ideas are true simply because he says they are true and if you doubt him he says that you are wrong without documentation. When you call him out on lacking citations he just, once again, says you are wrong and that he has personally looked up the info without sharing the info. That is the role of a demagogue and someone who is truly religious in their thinking because they are unable to backup any of their claims. They just keep saying it is true. You keep claiming numbers are clear, but I don’t see any citations. Scientists cite everything, including well established ideas.

              I agree, however, that MRIs can cost a lot less, but it has nothing to do with Obamacare. You claim that it is the government getting in the way, but it is odd to me that countries that provide socialized medicine have lower costs for MRIs and healthcare costs (http://www.washingtonpost.com/blogs/wonkblog/post/why-an-mri-costs-1080-in-america-and-280-in-france/2011/08/25/gIQAVHztoR_blog.html).

              True, MRIs are screenings, but they are early preventative screenings. They can detect tumors in early stages before they spread. I hate to break it to you, but doctors use the term as I do. It is part of preventive care procedures or preventative screenings ). Healthy eating and exercise is also considered ‘preventative care’.

              I think it is funny that you claim that you know more about a process than me who is going through it and guided by a medical team. But it is easy to claim that you are right and that you have read the literature without curating the literature. It reminds me of the “prophet” Joseph Smith and Mormonism. We should just trust you that you have read such documents and, furthermore, we should blindly accept your unknown source. Perhaps the literature exists, but the author is not acclaimed. Michael Behe in the Intelligent Design community is a biologist at a university, but his writings are a laughing stock in the science community because he uses his religion to guide his “scientific” work, which it seems like that is what you are doing. Again, you keep saying something is true as if we should blindly accept it. It is very ironic that you call others religious in their thinking, but that is exactly what you are doing.

              But here is a quote from a doctor dealing with MRIs, “Will the future of MRI also involve preventive care? FORSTING: There are a number of diseases where preventive care makes absolute sense. A good example is colon cancer because this type of cancer develops very slowly. For this, MRI would be an excellent choice. So yes, if we want medical imaging for preventive care, it certainly should be MRI. I also think that in a few years, MR mammography will play an important role in preventive care. However, the speed and depth of penetration certainly depends on the financing available.” ).

              I know you truly want to believe what you do, but, as I said, you have a blind ideology that is structured around any idea of taxation is totalitarian. As I claimed, the whiskey rebels believed Washington was another King George, yet today he worship him. He created taxes that singled out groups. Ben Franklin’s grandson (Benjamin Franklin Bache). Read ‘American Aurora’ by Rosenfeld and you will see how hated Washington was during his days. Not everybody thinks that they are being forced to purchase insurance. I do not follow pure democracy. However, I do believe in our election procedures. It seems to me that you are upset about the outcome of the election and the passing of the ACA that you just whine ‘totalitarianism’ because you didn’t get your way.

              Let me give you a philosophy lesson on language since this is what my degree is in. Language is divided in two aspects – descriptive and social. Descriptive language deals with observable data like physics, biology, etc. Social languages are our dealings with individuals, society, economics, etc. ‘Totalitarianism’ can mean different things to different people. The same is true with democracy. Our democracy isn’t the same as what occurred during our founding. They tarred and feathered political leaders. They burned effigies in public. They had physical fights in Congress.

              I know that I said I would not reply, but I simply couldn’t let you get away with claiming what you said is true without any documentation and at the same time claim that I am religious in my thinking. It is clear that you fail to understand what the medical community calls preventative care and you fail in your historical knowledge just to hold onto your ideology. You also fail, due to your ideology, to understand that costs are lower in countries with socialized medicine, which contradicts your claim that having the government in the way increases costs. To prove my point that you are dishonest. Compare the list of countries that are the healthiest according to Bloomberg and those countries who have universal healthcare. If universal healthcare is so bad it would be rejected by the people AND the people would be dying! (http://mobile.bloomberg.com/slideshow/2012-08-13/world-s-healthiest-countries.html).

              (http://www.health.ny.gov/regulations/hcra/univ_hlth_care.htm)

              Thank you for your well wishes, but your dishonest claims about what the medical field actually says is what makes passing good healthcare legislation difficult. As you can see, the healthiest countries have socialized medicine. So I’m sorry, but given this evidence I have to doubt that you are concerned about the health of individuals more than your narrow ideology. So I will implement your logic: I can state the above claim because it is true. The only difference is that I provided some evidence. Now I am done since I can’t deal with someone who claims they are right and refuses to provide sources, but rather states they are correct like a a prophet. But yet states that science is the true religion. If you want an example of this look at Coulter’s book ‘Godless’.

              Take care.

            • One last thing. I wanted to make sure that I wasn’t mistaken about my claim with preventative care so I looked it up again. And it reminded me of this statement of yours, “There are many ideas out there to do such a task, but those ideas cannot be seen by those that refuse to look.”. It is obvious that you haven’t looked because here is another claim by doctors that MRI scans are preventive care:
              http://blog.oregonlive.com/business-watch/2010/10/first_low_cost_mri_imaging_in_the_northwest.html

              This pamphlet by the National Brain Tumor Society shows how important preventive care is for people who already have been treated:

              So, as you can see it is clear that MRIs and other screenings are considered preventive. All you had to do was look.

              Here is how early detection corresponds to survival rate an PD this is how the medical field determines preventive care:
              http://ww5.komen.org/Diagnosis/ChancesForSurvivalBasedOnCancerStage.html

              Although this example is a first-person account and not a peer reviewed study, it is still helpful. Massachusetts (and now the ACA) consider mammograms preventive care. Again, you may not like it, but it is a shift in definition. You need to study up on philosophy of language and how language develops in social settings because you have no idea what you are talking about. It seems like you would argue that the term ‘apple’ exists in the real world and not as a cognitive process that was a random event in our society.
              http://healthcaresavvy.wbur.org/2011/08/are-mammograms-preventive-care/

              And by the way, yes the definition of ‘gravity’ changed due to increased knowledge. So you you admit that there is a difference between observable data and social terms. You can’t say that observable data is less rigid than social terms since social terms change as society changes. The definition of ‘gravity’ is dependent on what is observed whereas insurance is dependent upon how our society defines it. You have it completely backwards. You are basically saying that currency has meaning outside of our social existence. Gravity has meaning no matter if we exist or not. Insurance is a human invention that derives its meaning through our accepted definition as a society. Thus, when you claim that I am not accepting your definition of ‘insurance’ and ‘preventive care’ you are forgetting that, one, you are using them incorrectly according to the medical field. And, two, they are not rigid terms because they are methodologies in a social setting. Yet, you accuse me for not accepting your definition that only exists in your ideological world without giving evidence that those definitions exist in the medical field. Unbelievable.

              OK, now I’m done. I just had to make it clear that you can’t just make stuff up in order to justify you ideology. You also can’t claim, like Jimbino, that you base your false claims in science even though you fail to present one piece of evidence (but rather say it is true and we just have to believe you despite the fact that is the opposite of how science works) and that scientific practices claim the opposite of what you are. I guess I should have mentioned that my degree is in cognitive science where I have conducted research in my studies before I was diagnosed. So I do have a background in science and have participated in scientific procedures. So you can claim all that you want that I am unscientific, but it is clear that you have failed in understanding the scientific process. Furthermore, since my field isn’t in medical research I have been in touch with my doctors every step of the way where even they state that MRIs are preventive care. But it was important to show articles that you can read and not just take my word for it.

              I think that I have made my point where I won’t be back on this site since I can’t waste anymore time on those who pretend to know a subject without researching it. Instead, they base their claims on silly ideologies and then claim it is scientific fact without providing evidence just to make themselves more confident.

            • Sorry, I forgot one last thing. Scientific methodologies change all the time without their being a specific reason except for simplicity. This occurs with theoretical terms like ‘gene’ before it was discovered or how to physically measure an object. This is why they create standards where standards are purely conceptual and not empirical. This is what is called anti-realist philosophy of science. The theoretical term isn’t considered by the scientist to be real, but rather a conceptual framework to guide the scientist through the scientific process. Hence, preventive care is one such methodology. Insurance doesn’t fit into this since it is a social framework that can (but not necessarily) adopt scientific standards (ie. preventive care and psychological measures, but not alternative medicine). However, as a society we can define it how we want. It is confusing to claim that insurance only has one definition, but yet other societies define it in a socialistic framework. You have a strange American exceptualism going on here that is cult like and, if it was a scientific process would be victim of experimenter bias. This is why they have double blind experiments so the experimenter’s bias don’t infiltrate the experiment just like your bias has done in your so-called argument that failed in presenting one study to support your weak claims. http://psychology.about.com/od/dindex/g/naturalobserv.htm

              Now I’m done haha. But you need to know how science really works and not have a strange (as the other Brian said) voodoo understanding of science that no scientist would accept.

            • Brian, I think it is pointless for us to further discuss these issues. Your citations do not prove your point nor disprove mine. I think you are arguing with a shadow because your arguments are not relevant to what I have said. It appears that you have created new arguments and mangled mine.

              Let me just make a few things clear. I broke what you and some others might call preventative medicine into its true components. (1)Preventative care is care that is thought to prevent disease from occurring. The flu vaccine prevents the flu or decreases the flu’s risks. (2) Early diagnosis. An MRI can provide an earlier diagnosis of a disease, but it doesn’t prevent the disease from occurring or spreading. I didn’t do this to prove one party wrong and another party right. I did it to demonstrate how the definitions of words make discussion impossible unless the parties are using the same definitions. Preventative care and early diagnosis were benign examples, not an attack.

              With the exception of vaccinations I cannot think of any other medical procedure whether called preventative care or early diagnosis that saves money in the long term for society. I also stated that preventative care and early diagnosis while not saving money for society may be good for the individual so I cannot see what your point is except if it is to vent your frustrations while creating enemies out of others that are seeking the same goals.

              ” I do not follow pure democracy. However, I do believe in our election procedures. ”

              I believe in the Constitution and the fact that the market place has been a successful way to allocate goods and services. I don’t deny that in some areas there is a place for government assistance.

              I leave the rest of your post untouched as it strays from the subject and most of what you say is opinion, frequently IMO errant opinion, not fact.

              Don’t get so upset. We each are entitled to our own beliefs and we should accept our differences on a friendly basis since all of us are trying to do the right thing.

            • Emily,

              I agree that it is pointless to continue, but not for the reasons that you state. The sources that I provided from medical professionals certainly do state that screenings are considered as preventive care. You can deny that fact all you want and define it as you feel fit, but this redefining doesn’t make it a fact that the medical officials agree with your position. That is your decision to accept to methodology though. It seems as if you believe that your own opinion ought to be considered as fact just because you say so, not what is actually stated in the medical field. That is fine, but you can’t claim what you state is what most people consider as ‘fact’. You still failed to cite anything to back up your assertions so it is safe to say that your claims are baseless opinions and are structured by your rigid ideology. Perhaps the medical officials that I cited are wrong. I don’t have a problem with you claiming that they are. However, I do have a problem with you saying that they are wrong and claiming the medical field doesn’t define preventive care as I and the sources that I provided do (even though the sources come from medical officials) and fail to back up your assertions. It is a strange type of logic. It seems that you are wrapped up in your ideology that you refuse to research this subject area. You simply make a claim and state that it is fact. I guess that it is OK to do on the internet since you don’t have any responsibility and your reputation won’t be diminished like in a peer-reviewed setting, but when you make false claims that your individual ill-informed vote would impact people’s lives I feel that your false claims ought to be exposed.

              I did forget to mention that the reason most founders disliked pure democracy is because they distrusted the people. They only trusted the people to select the elite, but not be involved in politics. This is what created the push for the Constitution. They dislike the monetary policies of state legislatures where they were breaking contracts. Only part of their dislike of democracy was the 51% enslaving the 49%.

              Anyway, the point is. You can define ‘preventive care’ however you like, but it is clear that the medical field doesn’t constrain the phrase to simply stopping a disease from arising. They include in it early diagnosis to prevent worsening of the disease. Thank goodness that you do no have any political power because your claims are baseless, lack any objective credentials, and are simply irresponsible since they are dishonest and they would affect millions of people’s lives. You ought to consider buy a guide that will train you the proper way on how to conduct research and not simply make a claim, say it is fact, and since it sounds good (to you) experts must feel the same way. Children can’t get away with that methodology in middle school. But, as I said, you can get away with it on the internet when you are anonymous and their isn’t any real consequences.

            • Brian, you have had your say and I have had mine so I don’t wish to rehash this conversation over and over again.

              Many use preventative care as a term that includes both preventative care such as flu shots and early diagnosis such as a colonoscopy. That doesn’t make it right though for the lay person it might be easier for them to talk about the two items as one group. A vaccine might help prevent cancer from developing (cervical cancer) or the flu from occurring, but an MRI today prevents nothing, but does lead to early diagnosis which can be good for the patient. It is all relatively unimportant. What is important is the question that was addressed, does any of this care save money for society as a whole? Maybe flu shots do, but I cannot think of another medical procedure that fits into that category when we are discussing preventative care and early diagnosis.

              Can you?

              Democracy: Of course the founders distrusted the people and were afraid of what the 51% could do to the 49% and they even had their own personal motivations.

              You really should’t try to be so insulting to another. It makes you look foolish to one that is knowledgeable, is not agenda driven, or one that has read my prior postings.

            • Emily,

              You haven’t proven yourself knowledge by simply claiming that scientific literature supports your claims, which it doesn’t. And you have failed to cite that it does. As was stated MRIs do save money by early diagnosis since one can avoid later procedures.

              I only insult those who pretend to be helping those in need, but are only protecting their own ideological agendas. You have failed to prove that your claims and numbers are accurate. You have had sufficient time to do so and your failure shows that you are simply making up statements that align with your agenda. Due to this fact, it shows that you don’t have the best interest of the people’s health in mind. Rather, you only care that your radical agenda is implemented. Until you can support your claims your accusations are meaningless. I have provided sources in the medical field that support my conclusions and you have not. Pure and simple. Sorry if you don’t like it, but facts are facts despite your odd definition of ‘fact’.

            • Furthermore, the only only one who looks foolish is one who refuses to backup their claims, but rather says the phantom ‘literature’ backs them up. Also, when they say absurd things repeatedly to a person that deals with a medical team that provides information about this very subject one must wonder who is ideologically driven. So I have first hand experience and cite my assertions. Who do you think is more knowledgeable? I doubt it is a person who claims that they “believe only a trifle over 100,000 persons were helped to the disadvantage of tens or hundreds of millions”. That statement alone shows your ignorance and moral ineptitude. Take care and read a few moral philosophers to learn how to be moral since your libertarian/conservative leanings lack knowledge and moral certitude of the subject area. Simply claiming a vague literature doesn’t prove your points.

            • Pure and simple you put ideology over people’s lives. Your dishonest claims make the situation much more disgusting.

          • Brian, Emily, I’m no longer approving comments for you to continue your argument on this post. It’s beyond the point of productive discussion. Future comments won’t make it past the moderation queue.

        • I’m not the same as the above Brian, just want to make that clear. Anyway, you say:

          “Brian, traditional insurance is very much an investment decision though not an investment that is expected to provide increased revenues.”

          That makes it a hedge, which is a type of investment – yes, but clearly not the kind of investment we are talking about.

          I don’t see any functional difference between forced participation and voluntary participation in risk pools (other than the obvious adverse selection issues). In fact, I don’t see how voluntary participation can ever be more effective than forced participation. Any distinctions thereof are largely political.

          Insurance isn’t there to minimize YOUR loss. It’s there to minimize SOCIETAL loss.

          I’m a mid-20’s guy that is largely well off. I am a “bro” as they say. As others have noted, PPACA isn’t perfect but it’s a far sight better than what we have today. I frankly find what you and Jimbino advocate is total voodoo.

          • Brian(2), ” I frankly find what you and Jimbino advocate is total voodoo.”

            Think what you wish but the voodoo I advocate is precisely what made the USA into the great nation it is. Go back in history and look at the economic advancements that were made and then note the jump in the standard of living that occurred when the market place was permitted to thrive.

            I doubt you even know what I advocate and that is probably why you used the word voodoo as a pejorative instead of actually discussing the different points of view.