A common trope among Obamacare defenders is the oft-asserted claim that the uninsured are “freeloaders.” What makes them freeloaders, so goes the claim, is that when they get sick they go to the ER, then let someone else pick up the tab.
Do those who spout this popular objection bother to think through the logic of the objection?
i) Why assume that when the uninsured get sick, they must go to the ER? If you’re uninsured, you come down with the flu, and you want a prescription, can’t you schedule an appointment at a medical clinic, then pay on the spot?
ii) But suppose you go to the ER? Won’t you be billed? Hospitals are businesses. They charge for their services.
Are Obamacare defenders claiming that the uninsured never pay their medical bills?
iii) Suppose you don’t pay. (a) either you’re able, but unwilling to pay, (b) or else you’re willing, but unable to pay.
In case of (a), how is that different from any other unpaid bill? That’s what collection agencies are for.
If case of (b), if the uninsured are too poor to pay their medical bills, how can they afford mandated health insurance?
And if their mandated health insurance is subsidized, aren’t they “freeloaders”?
Am I missing something?
Spot on. But the argument tacitly passed on to those who are told they are too poor to afford healthcare is that without Obamacare they won't get healthcare since they can't afford it, which is a complete lie.
ReplyDeleteI could not disagree with you less about this.
ReplyDeleteIn that case, perhaps now is a good time for me to retire from blogging. Quit while I'm ahead!
DeleteWhy assume that when the uninsured get sick, they must go to the ER? If you’re uninsured, you come down with the flu, and you want a prescription, can’t you schedule an appointment at a medical clinic, then pay on the spot?
ReplyDeleteI think the freeloading aspect comes up more with more major operations. Cancer, major accidents, etc. A little like how the main reason to get car insurance isn't something minor, like damage from hail. It's for more catastrophic situations - and that's when the bill starts getting extraordinarily high.
Not a perfect comparison, since a major part of that insurance deals with lawsuits and settlements, but still.
But suppose you go to the ER? Won’t you be billed? Hospitals are businesses. They charge for their services.
It's a more complicated situation. Imagine selling a product or service that costs potentially tens of thousands of dollars, or even far more. You cannot pick and choose who you sell to in many cases - if they need it, they're getting it. Assume you can bill them anyway.
Which is one way this differs from any other unpaid bills.
And for the record, I think both the mentality behind and the particulars of Obamacare are a mess. I reject it. I think Roberts was a complete rodent in his ruling. But, I may as well try to be thorough with the evaluation of this law.
DeleteIn which case you're talking about catastrophic care rather than Obamacare.
DeleteSteve,
ReplyDeleteyou ask are you missing something?
Yes you are!
You are missing their logic, ah, no, you are understanding it and that's the problem! :)
So, any rational person, such as you are, should try harder to miss the point then!
For those who can't afford to go to a regular clinic, every city has free or sliding scale medical care if you take the trouble to look for it. Here in the New Orleans area I know of half a dozen clinics subsidized by taxpayers where people can go and pay on a sliding scale. There are also several sliding scale clinics run by Catholic Charities. There's no reason whatsoever to go to the ER for illnesses like the flu.
ReplyDeleteThe problem with freeloaders isn't ordinary care - they can and do probably pay most of those bills. It's major medical problems - major surgeries, cancer, etc. that are the problem. Medical bills are one of the top one or two causes of personal bankruptcy, and I suspect a large number of these people could buy insurance but don't. The bills of the poor are either paid for or written off. It's people with assets/income to protect that declare bankruptcy, not the poor. So collection agencies won't do you much good then. So yes, freeloaders are a problem.
ReplyDeleteIf they're not poor, they can take out loans.
DeleteThat could be a possibility for some, but it's hard to get approved for a loan when one is not generating income due to illness (leukemia, cancer, etc) and one is widowed or single.
DeleteThe other thing is that, for this to be just, there needs to be some uniformity to hospital pricing. Hospitals will charge the uninsured up to four times the price they charge the insured (knowing full well that these bills will not get paid). That's price gouging.
This man spent a mere 18 days in a hospital for a skull fracture. His bill was almost $250,000. Most people who are at or near the US median income will not get a loan for that.
I'm not an ideologue on this issue. I think there needs to be some tort reform, and I oppose any mandate that requires religious medical centers to perform any procedure or provide a service that conflicts with their religiously-based ethics.
At the same time, it seems not only sensible to require that all people contribute to the health care they will eventually need by purchasing insurance (thereby spreading the risk over a greater number), it's also the humane thing for us to do as a collective nation.
If they could afford insurance, but don't buy it, that's a calculated risk. Either way, insurance is a gamble. On the one hand you may spend a lot of money on insurance premiums for coverage you don't need. That's money you can't spend on other things. If you're young and healthy, that may not be cost effective. If, on the other hand, you lose the bet, then that's what bankruptcy laws are for.
DeleteSome illnesses are related to high-risk behavior. Is there a moral imperative for responsible wage-earners to subsidize the reckless behavior of others?
DeleteJames
Delete"At the same time, it seems not only sensible to require that all people contribute to the health care they will eventually need by purchasing insurance (thereby spreading the risk over a greater number), it's also the humane thing for us to do as a collective nation."
Which is subsidized healthcare. So you still have freeloaders. If their healthcare is subsidized by others, the beneficiaries are freeloaders.
James
Delete"At the same time, it seems not only sensible to require that all people contribute to the health care they will eventually need by purchasing insurance (thereby spreading the risk over a greater number), it's also the humane thing for us to do as a collective nation."
Which authorizes the food Nazis to dictate what people can eat.
"If they're not poor, they can take out loans."
DeleteWho's going to give you a $500,000 loan to cover your cancer treatments? Especially since there's a good chance you might not be able to work? And as I noted the people hit worse by the lack of insurance are the working poor - they don't qualify for Medicaid, and many don't get insurance through their employer.
"If you're young and healthy, that may not be cost effective. If, on the other hand, you lose the bet, then that's what bankruptcy laws are for."
DeleteWhich merely proves the point about uninsured freeloaders. They can bet they won't need insurance, but if they have medical bills they can't afford, they can just declare bankruptcy and everyone else ends up paying for them. And as I noted previously, it's a huge problem with financial problems due to medical bills one of the top reasons for bankruptcy. Aren't you just proving the opposite point from what you were trying to prove?
"Is there a moral imperative for responsible wage-earners to subsidize the reckless behavior of others?"
DeleteThis is hard one for me with people abusing drugs, being grossly overweight, etc. But the man who was traveling the road between Jerusalem and Jericho was engaging in a "high risk behavior", traveling alone on a road known for bandits, when he was attacked and left for dead. Yet the Samaritan bound up his wounds, put him in an inn, and paid for his stay until he healed and was commended by Jesus.
Grifman
Delete"Which merely proves the point about uninsured freeloaders. They can bet they won't need insurance, but if they have medical bills they can't afford, they can just declare bankruptcy and everyone else ends up paying for them. And as I noted previously, it's a huge problem with financial problems due to medical bills one of the top reasons for bankruptcy. Aren't you just proving the opposite point from what you were trying to prove?"
To my knowledge, bankruptcy doesn't mean you get off Scott free. Rather, that's a way of restructuring your debts.
And forcing everyone into the pool simply relocates the "freeloaders." You still have some payers who are subsidizing others who can't afford to pay their medical bills.
Grifman
Delete"This is hard one for me with people abusing drugs, being grossly overweight, etc. But the man who was traveling the road between Jerusalem and Jericho was engaging in a 'high risk behavior', traveling alone on a road known for bandits, when he was attacked and left for dead. Yet the Samaritan bound up his wounds, put him in an inn, and paid for his stay until he healed and was commended by Jesus."
There weren't a lot of roads to choose from back then. Maybe he was on a business trip. Maybe he was visiting relatives. Maybe he was fulfilling a religious duty by attending one of the Jewish holidays in Jerusalem. A certain amount of travel was necessary.
That's hardly equivalent to chain-smoking, porking yourself into diabetes, marinating your liver in alcoholism, &c.
"To my knowledge, bankruptcy doesn't mean you get off Scott free. Rather, that's a way of restructuring your debts."
DeleteThere are two types/chapters, 7, which is liquidation of assets, and 13, which is reorganization. However, 96 percent are Chapter 7 with no assets, meaning there is nothing to seize/liquidate, and the debt is written off. So, no, in most cases it is not restructuring of debt, but debt relief.
But you were talking about people who do have assets. They are simply in over their head. Are you saying bankruptcy can't involve consolidating debt and/or negotiating a different payment schedule with different interest rates?
Delete"But the argument tacitly passed on to those who are told they are too poor to afford healthcare is that without Obamacare they won't get healthcare since they can't afford it, which is a complete lie."
ReplyDeleteUh, wouldn't they know if they are getting health care or not? They wouldn't need Obamacare to tell them that, right?
As fpr getting health care, that's sort of true. But the question is what kind of care? If you are poor and go to an ER they are required to "stabilize your condition" (I'm not sure of the exact words) but the point is that they not required to treat the real underlying cause that drove you to the hospital. So, yeah, you get emergency care, but you don't really get your health problem addressed, which is what you and I would have done because we have insurance.
That's the difference in care. The problem isn't so much the "dirt poor" but the working poor, those that make more than the Medicaid minimums but can't afford insurance.
"Which is subsidized healthcare. So you still have freeloaders. If their healthcare is subsidized by others, the beneficiaries are freeloaders."
ReplyDeleteI think the term "free loaders" or "free riders" is generally use of those that could afford insurance but choose not to buy it. Forcing those people into the system is usually the point of contention.
The label is also used in conjunction with "paying their fair share." However, if some pay in more than they receive in medical services, while others receive more than they pay in, they the latter aren't paying "their fair share." They are free riders. Although they pay something, it's not comparable to the benefits.
DeleteIf two people take out auto insurance at the same time. Person A has an accident a few months later, Person B does not. Since the payout to Person A is greater than the amount of premiums - he is a free rider, right?
DeleteWrong. The systems works because my premiums will help pay for your loss while I have none and vice versa, but it only works if everyone buys into the system. That is what Obamacare tries, though not perfectly, to accomplish. Get as many people as possible into the system, thus spreading the risk over a larger base.
In my opinion, though, single payer healthcare is the only real solution to the current predicament.
i) Obamacare is not analogous to car insurance. Rather, Obamacare is analogous to making people buy cars, then insure them.
Deleteii) You're also doing nothing to solve the problem of why healthcare is so costly. Obamacare is just a financial shellgame where everyone is borrowing money from everyone else. That doesn't make it affordable.
iii) Insurance doesn't require everyone to buy into the system. Flood insurance doesn't require everyone living outside the flood zone to buy insurance. Rather, insurance simply requires a certain number of people to pool their resources.
I think the analogy is apt. Everyone has a physical body (the cars in this scenario) that will likely need medical care at some point in their lives.
DeleteA financial shell game. Uh, yea - that's sorta what insurance is. The more people buying into the system, the less the cost to everyone involved when a claim is filed - as you point out in your third point.
To say everyone needs medical care doesn't mean everyone needs insurance.
DeleteThe more people you throw into the system, the more sick people you throw into the system. So that's not a just of more folks contributing to the pool; that's also a case of more folks draining the pool.
DeleteAs long as we don't throw people to the dogs and allow them to get medical care that they aren't paying for, this will be a problem. Insurance is the only organized way of handling this and I don't see anything wrong with some people benefiting more and others less. I assume you have at least some insurance in your own life, whether it is medical, auto, life, etc. so I'm not sure what your issue is?
ReplyDelete