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Comment by mikeash | Hacker News Reader

Yes, I'd be paying for your care either way. The difference is, the way you're doing it now, you contribute nothing while I still pay for your care. If I get a million-dollar hospital bill, you don't pay more, but the reverse is true.

If insurance weren't ubiquitous, service would be cheaper, sure. And people would die or be bankrupted by treatable medical conditions like crazy. This is why insurance is so common. People don't like that kind of thing.

Given the system that we're in, you're doing me no favors at all by refraining from obtaining health insurance as a healthy person. You've decided that the risk of bankruptcy is acceptable while externalizing a lot of that risk.

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> If insurance weren't ubiquitous, service would be cheaper, sure.

It would also be cheaper if it were truly ubiquitous and single-payer. The prices European hospitals (even the private ones) charge to the various national health systems are a fraction of the list price for the same procedure at the average American hospital. It's only the current insurance system in America that creates perverse incentives to inflate list prices to the ridiculous levels we're accustomed with.

Your notions of my responsibilities for how and when to protect your financial security are of no concern to me. I will make my own contributions to society as I see fit.

> I will make my own contributions to society as I see fit.

Which is why you will now pay a tax penalty if you don't pay for health insurance coverage. What contributions you make to society is part of a contract, not a unilateral choice.

Your demands to be left alone would be much more convincing if you would sign a forfeiture of your right to participate in the US medical care system above a certain price point, per year. (Assuming we could enforce it)

If, when the care required to save your life cost above, say, $10k in one year, you agreed to die -- then I would consider you to be taking the notion of individual responsibility seriously. As it stands, you are proudly forcing the rest of us to bear your risks.

And people think I'm the heartless one for not wanting the line the coffers of Aetna, et. al.

I'm pretty right-wing generally, but I don't see any alternative between forcing everyone to pay for healthcare somehow, or having hospitals literally throw people out as soon as they are unable to pay. Nobody is willing to vote for throwing injured broke people onto the streets, so we're all going to be paying for it somehow, whether it's through mandatory insurance or taxes.

Hey, none of us like the fact that insurance is so profitable for Aetna et al. We just recognize the cost-benefit tradeoff of paying premiums, and the merit of making urgent medical care undeniable -- i.e. we can't force a hospital not to treat you if you are in dire medical need. So the hypothetical I mentioned above is not, in fact, possible.

Yeah but will you still say the same when the doctors say to you like mine did to me "we are putting you on the kidney transplant list"

That's fine, a highly common and very human attitude. Just don't pretend like you're being somehow noble, or that the rest of us are somehow screwing you over when we try to make you stop pushing risks onto us without contributing.

If I had never gone to college and decided to just work as a burger flipper the rest of my life and spend all my money on cigarettes and sky-diving (see, I can make up low-likelihood hypotheticals, too), then I'd be contributing even less. Are we going to start mandating that people actualize their full economic potential, as well?

No, I'm good with incentivizing that the old-fashioned way, by giving people who fail to do that crappier stuff than those who succeed.

The problem is that you (and the otherwise healthy (under|un)insured) probably wouldn't think twice about getting that cancer treatment, or heart transplant, even if it meant that others in your community would have to pay for you. Therein lies the reasoning why we need something other than optional health insurance.

Except you are implicitly assuming that if you get into a severe car accident and are unconscious and can't prove you can afford surgery, you will still get treatment. This only happens because we mandate treatment and the rest of us bear the costs of it. Congrats on 'contributing "

The problem is that when you don't have insurance your inaction can drive up costs for everyone else (higher prices at the hospital).

Disclaimer: Am Indian, and have no detailed knowledge of US policies. From a summary of the replies to this one: I personally, would be willing to sign a forfeiture to the effect, if i am medically in a bad state and can't afford treatment, would be allowed to die. So it seems, there might be room for allowing people who don't want insurance, and neither penalty to sign a forfeiture.

Personally, my choice is dictated by an attempt to understand my body and live a fuller life and some of those attempts suggest to me that insurance is overrated in light of Bayesian reasoning. -- not to suggest i actually sat down and calculated, just a guess.

It wouldn't be practical.

For example, consider what happens if, as is very likely, you change your mind. The doctor says, "It's cancer, but it's treatable." You say, "Oh, I didn't think this through, please save me."

Very few doctors could say, "Tough, here's some aspirin, GTFO." If they could, they wouldn't have chosen to become doctors.

Or consider the case where you're unconscious and dying. Do they save you, or not? They can't really know what it will ultimately cost, and the certainly can't know how much money you could raise.

I don't think "opt-out" is a good (or sound) idea -- but even if it was -- it'd be pretty hard to enforce: take an auto-accident. You shouldn't be delaying emergency help, just on the off-chance than one of the many victims might be an "opt-out". It would complicate triage for no really good reason.

Then there are things like contagious diseases; you would have to spend money enforcing some kind of quarantine in order to cater to the "opt-outs".

For all other cases, like most types of cancer -- you can opt out -- only you'll have to commit suicide (I don't advocate this either).

The issue with insurance is simple. It is better to have a small, but guaranteed loss that you can survive than a huge, but unlikely loss that you cannot, even if the total cost of the smaller losses are more than the relative cost of the large loss.

That said the insurance system in the US is too broken and needs to be scraped.

I think allowing such things would be a decent idea, but it seems like it would be completely impossible, politically.

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