Hacker News Reader

Comment by pg | Hacker News Reader

I agree it's a bit big brotherish. For a while after we sold Viaweb I didn't have health insurance, because I figured I had enough in effect to be my own insurer. I ended up getting health insurance eventually, because I found the system won't treat you without it; you can't simply offer to pay doctors with a credit card, the way you can with dentists. But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently, or we could end up with a string of Ruby Ridges.

View on HN

Leaving aside whether people like the government to do things for them or not (there are many internet libertarians here who obviously do not), is requiring you to purchase something really that different from just taxing you and purchasing it for you? For instance, I am not happy about having purchased a share of a war in Iraq or numerous other things the government spends my money on.

Also, a point for consideration: you're pretty much required to own car insurance if you want to drive.

> ...(there are many internet libertarians here who obviously do not)...

The labels seem unnecessary here. You could've said "(there are many people here obviously do not)" - there's plenty of smart people who think this bill is going to be bad for the American federal government and American citizens.

The equivalent would be saying something like, "those internet left-wingers who think everyone should be taxed all the time" -> "internet left-wingers" is unnecessary, as is "internet libertarians". The people who oppose this are just people, not internet people, not labels.

Sorry, you're right. Apologies. I think I would have removed that if I'd reread it before wandering off to fix pancakes for breakfast, as it really isn't germane to the point I was trying to make, and with which I'm sure everyone can agree: most of us have things we don't want the government to buy for us, and some of us believe the government should buy very little for us with our own money. I'm just trying to say that between "tax" and "forced to buy" there isn't a large difference, not comment on what I think of the whole thing, which I continue to believe is off topic for this site.

Not looking for comments or to start a thread, but I just now read a commentary that addresses your "between tax and forced to buy there isn't a large difference"

http://www.washingtontimes.com/news/2009/nov/07/obamas-hidde...

If you want to drive, but this would require health insurance simply for being alive, the alternative to which most of us do not consider an acceptable option.

It's also noteworthy that in most states, you can demonstrate an ability to pay for a certain amount of damage in lieu of car insurance.

If you don't consider being dead an acceptable option, then health insurance sounds just right for you!

Seriously, this debate only makes sense in a context where you consider health insurance to be an "optional extra". It's not. Health insurance is as basic as roads and garbage collection, fire departments and a police force. Out of the whole developed world, it's only in America that something as fundamental as health insurance is considered an optional extra.

There are people that compost and bring what little trash they have to the dump themselves. There are people that ride bikes instead of driving cars. There are people that are their own fire department. Why is it so had to imagine that health insurance might be optional foe some people.

Ok. Doctors don't have to get health insurance.

The rest of us, who can't treat ourselves without external assistance (and also those amongst the doctor who expect that they might at some point get ill enough to require assistance from another human being), the rest of us need health insurance.

Pardon the snideness here, but:

As it turns out, doctors are actually human beings, who are able to form relationships and make arrangements with other human beings, whether or not this takes place within the scope of formal public policy or under the aegis of bureaucratic institutions.

People who are not doctors could treat themselves too, if only it were legal.

Health insurance is optional. My parents never had health insurance and were always able to pay for medical expenses, even with six kids. I also don't have health insurance and so far I've also had no problems paying for medical care. I don't know where the idea that health insurance is a necessity comes from, but it's not based on fact.

Had you been less lucky and encountered medical bills that you and your family couldn't afford, everyone else would have to pay higher prices to make up for your failure to pay. If you want to live in a society where no one will be left to die because they can't pay, then you're going to have to chip in to make that happen. That requires insurance for large medical expenses so no one else has to pick up the tab for you.

I know some people who have crossed the road without looking many times, and they're still ok.

I guess looking before you cross the road is also "optional".

It is and there is no tax on people who don't have road crossing insurance. It's a risk that you can choose to take. If you choose to not have medical insurance and you can't pay for medical care then you might die, but it should be up to you choose if the risk is acceptable or not.

That's not the argument you previously made. You said "it's fine not to have health insurance because I didn't have health insurance and I'm still ok". That's a severe failure of logic. Anecdotal reasoning when looking at something like health insurance is pretty silly.

Unless you're the kind of person whose plan to get rich is to play the lottery, you need health insurance. At some point, in your life, it is quite likely that you will get very sick, or have a serious accident, or have some sort of mishap that suddenly smacks you with a multi-tens-of-thousands-of-dollars-or-more medical bill. At that point, if you don't either a) have health insurance or b) have lots of money, you're basically fucked.

If you pay the insurance all your life and you never actually get to use it, you should count yourself lucky. Health insurance if the kind of thing you pay every month and fervently hope that you never actually need. But if you do need it, having (good, not the american "we'll drop you if you get too expensive" type) health insurance is quite literally a life-saver.

Finally, if you declare bankruptcy because you can't afford your medical bills (and huge medical bills can happen to anyone), society is paying for your treatment anyway, indirectly. Therefore, it is reasonable to mandate that everyone must have health insurance.

_Medical care_ may be in the same category as roads, garbage collection, police department etc. (although one could argue otherwise: the latter are all examples of public infrastructure, but medical care is in most cases a personal service).

However, health insurance is in no way in the same category as any of the above - insurance is a financial tool, used as a means to achieve a desired end in a high-risk situation. Saying that insurance is absolutely essential is like saying that we can't live without zero-coupon municipal bonds. Sure we can, no matter how important the things they're intended to pay for are.

Where I spent most of my childhood, there were no roads for a few miles, no garbage collection, no fire department, and while the area was nominally in the jurisdiction of the Alaska State Troopers, it would have taken at least an hour for an officer to respond. Of course, a total lack of infrastructure would be less than comfortable in a modern city, it's entirely possible to live comfortably without such conveniences.

As for health insurance, the claim that it is necessary is absurd. One could make a much more reasonable claim than health care is necessary, but the question of the specific mechanism by which it is paid for is orthogonal to whether it should be considered a necessity in a modern society.

If you want to drive, but this would require health insurance simply for being alive, the alternative to which most of us do not consider an acceptable option.

There are a lot of areas in the US (most I'd venture to say...) where driving is essentially a necessity once someone has a full time job. Its not like we have a great public transport system. So while you can technically opt out of driving, its not really realistic to do so in most places.

you're pretty much required to own car insurance if you want to drive.

My understanding is that you need to be able to cover any damage you cause someone else, not to cover your own car damages.

This doesn't kill the analogy though. If someone goes into the emergency room and can't pay for their service, the taxpayers pay the bill. So, by the analogy, the requirement should be to cover anything that the doctor must do because the cost could fall to the taxpayer.

If someone goes into the emergency room and can't pay for their service, the taxpayers pay the bill. So, by the analogy, the requirement should be to cover anything that the doctor must do because the cost could fall to the taxpayer.

Part of the argument in defense of the bill is that the mandate will save taxpayer money because the uninsured will now be forced to pay their own way. Yet despite this claim, I don't seen any provision for returning this savings to the taxpayer? Where is this supposed savings going? Either it is mythical or it's just going to be eaten up by the bureaucracy.

And also, if the person cannot afford their emergency room bill, they won't be able to afford the insurance either, and thus will get subsidized insurance. So one way or another, the taxpayer pays.

I see a few possibilities: 1) It reduces the amount of tax money spent on emergency room bills and therefore it gets spent on something of more widespread use. 2) Future taxes would be smaller as a result. Depending on the timing, this could result in a year of double counting for that money. 3) There will be a later provision for returning the money. 4) The bill is gigantic and maybe this issue hasn't made its way into the news (unless you've studied it in detail. I would suspect not because of its length...).

As for your second point, I'm not sure thats true, but I don't have any statistics off hand. It would be interesting to see some comprehensive statistics about how much tax money goes to paying for these things vs. how much money the person makes (adjusted for whatever you want to adjust for).

Yes, it is different. Taxes are taken out of money I make or spend. This is funded by fines I owe whatever I do.

And yes, I'm required to get car insurance if I want to drive. Driving is optional. Living is not.

Taxes are taken out of money I make or spend. This is funded by fines I owe whatever I do.

Sorry, I'm not sure I see the difference. At the worst, this is an increase of 2.5% in your taxes unless you do something (buy insurance) to avoid it. They might well call it a fine but in both cases its just paying a percentage of what you make. You might not like this increase, but thats a separate point.

Let me know if I'm missing something though...

Edit: I think they are calling it a fine so that people will avoid it as much as possible in an effort to make sure people purchase health insurance.

Just to clarify-- the percentage increase in your taxes is much higher than 2.5%-- a 2.5% new tax rate is probably a 5 or 7% increase depending on your existing tax burden.

That doesn't clarify anything, it took me about 30 seconds to figure out what it was you are trying to say. It's pretty simple to understand the penalty is 2.5% of your income, most people don't think in terms of their existing effective tax rate.

I got the impression that the penalty for not having health insurance comes in the form of a tax (up to 2.5% of income). Am I misunderstanding?

It's going to be difficult for them not to enforce it, if something like this actually goes into effect. Getting those who think they can go without insurance to pay into the system is one of the major ways it is going to get paid for.

(It is, objectively, a wealth transfer from young people to old people. I find myself wondering if youth support for the bill would drop somewhat if youth realized what was being done to them. I'm not "old" but I'm past the age where I feel I can go without now, so I guess I'm out of this "youth", but I still don't like it. I am young enough that I don't foresee a single penny of this ever being around when I'm actually old enough to need it, since there's just no way in hell either the current system or this new one if it passes will hold up until 2045.)

One interesting scenario I saw (don't recall where, sorry) pointed out that the entire idea of forcing purchase of coverage like this is very Constitutionally dubious. (Where "dubious" means that I actually can't even come up with an argument I disagree with that the Federal government can do this based on the Constitution.) So it is possible this provision could be struck down, but leave the rest of the bill intact, committing to massive outlays with no way to pay for it.

>I find myself wondering if youth support for the bill would drop somewhat if youth realized what was being done to them.

Probably not since:

a) The youth are the least likely to have insurance.

b) The least likely to be able to afford it (they usually have jobs that make less money).

c) Since they meet both a & b, they'll likely be eligible for the credit/handout that they can use to buy the insurance (if that's still in the plan, hard to keep track of and I don't feel like reading through 80 different versions of a 2000 page bill).

Thus it's more a transfer of wealth into the insurance companies. Even with a public option (which I believe in the last rev of the bill, states could opt out of), most people will probably just end up with private insurance.

> So it is possible this provision could be struck down, but leave the rest of the bill intact, committing to massive outlays with no way to pay for it.

This is probably where this will be in 3-4 years. Which will give lots of opportunity then for the opposition to be able to point out how expensive this all is. sigh Not a really helpful attitude towards engineering a solution, but the GOP hasn't been on top of this issue at all in the last 30 years while every other industrialized country on Earth has at least given it a good go.

It's not that hard for even a youth to get a job that gets you past the subsidy provisions... well, at least in a normal economy... but I hear what you're saying. Part of what I'm saying though is it is not just an instantaneous transfer; as "youth" move up into their 30s and 40s, they'll be transferring wealth up the chain, and in their 30s and 40s probably still not needing a lot of medical services on average. It's not just today, it's the next 30 years of your life that you'll be experiencing a high marginal tax rate. Which as we all know, under Democratic theories of economics, nobody ever considers the question of marginal tax rates when making decisions about their jobs, of course.

"Not a really helpful attitude towards engineering a solution, but the GOP hasn't been on top of this issue at all in the last 30 years while every other industrialized country on Earth has at least given it a good go."

Well, I've actually liked the GOP proposals that I've read. Yes, the ones that do in fact exist. (Claims that the GOP have offered no solutions are one of the most blatant lies of the entire process; it's simply objectively false. You may not like them but they exist. Another example of our media being either incredibly biased or totally unwilling to follow up on the statements of politicians.... reader's choice.) It's not particularly relevant because if they had to craft a bill that might actually pass in the real world it would get bogged down in all kinds of crap, but there's so much low hanging fruit in the system that the current bill still manages to fail to address in 2000 pages, such as tort reform.

>Well, I've actually liked the GOP proposals that I've read. Yes, the ones that do in fact exist. (Claims that the GOP have offered no solutions are one of the most blatant lies of the entire process; it's simply objectively false. You may not like them but they exist...

It's funny, during these last few months of the debate, this topic has come up a large number of times among my social group (largely in a community and neighborhood messageboard startd as an alternative to my HOA board and in proper startup fashion now has advertisements).

There certainly are many examples of work done by the GOP in this area in the last administration (mostly around medication pricing), but as to this particular case the GOP has been very late to the party and has brought substantially no ideas to the table until very recently -- generally running and obstructive tactic vs. an alternative tactic.

I believe the alternative bill they presented a week or so ago was political theater mostly. There was no chance on it getting debated, voted on, or really seriously considered (particularly this late in the game), and the party knew that. That's why the opening portions of the bill didn't contain policy, but rather a stream of consciousness of party talking points. They simply wanted to be able to point to it and say "see? our ideas aren't even being considered!" knowing full well that most people won't have tracked the submission date of the bill. David Gergen offered a different but similarly minded analysis today.

What I thought was interesting is that, when I asked people, and threw out ideas almost a year ago now, the right leaning members of my community generally came up with some very good, feasible plans that addressed the bulk of this particular issues (no recision, no denial of coverage, must accept people for coverage even with preexisting conditions, balanced by an open market place, all insurance is moved nationally, breeding open competition etc.). But these weren't offered up by the Party (capital P) until many months later. Instead the Party chose to run a scare campaign that had very little to do with the actual contents of any of the proposed bills (including doing a Godwin and interjecting Nazis, which was clearly the point knew they had no appropriate counter argument in the wings anymore). It was wholly disappointing.

"I believe the alternative bill they presented a week or so ago was political theater mostly."

Consider http://thomas.loc.gov/cgi-bin/query/z?c111:S.1099: . Note the date. It may not run to 2000 pages, but I consider that a feature, not a bug.

Again, the idea that Republicans did nothing but run an obstructionist campaign is pretty much objectively a lie. What is true is that only their obstructionism was reported in the press. That said, it's not like anything they wrote had a chance of getting passed, I am aware of that, and frankly at this point I'm not a fan of either party on this point as it's pretty clearly a choice between dumb and dumber (reader's choice as to which is which), but the putative "coverage" of Republicans has been blindingly biased. Not that the press has done much more than sit there and twitch feebly every once in a while.

(Further, I'd point out that as a minority, "obstructionism" is pretty much their job. The idea that this is evil rather suspiciously dates to January of this year, for mysterious reasons.)

Nice use of Thomas. I had forgotten about this bill, most likely due to the news media showing me some shiny new thing in a different direction while they hid this one under the rug. But if I'm not mistaken (which I'm more than happy to admit I may be in this case), many of the ideas in this bill were eventually moved into the current Senate bill and the just passed House bill.

But to be honest, the legal documentation is so voluminous and it's a moving target such that I can't keep track of all this. So I may be mis-remembering. The size is certainly a bug.

I would say that it's also bad thinking to think that none of the Republican proposals didn't find their way into the present legislation. I think that there were some good ideas put up by the Party that the Democrats also latched onto pretty fiercely. They claimed it was for bi-partisanship, but I think it's more to appear that they owned all the ideas in this debate.

>(Further, I'd point out that as a minority, "obstructionism" is pretty much their job. The idea that this is evil rather suspiciously dates to January of this year, for mysterious reasons.)

I pretty much agree with you on everything you wrote here except for this and that the obstructionist agenda was purely of the media's making.

I think it's a matter of semantics. "Obstructionism" can be one of a number of things. It can be pure stonewalling and obfuscation, or it can be a presentation of alternatives.

The Republicans in this case were relatively transparent, on my plane trip today I saw no less than 20 Republican backed advertisements against "Health Care Reform" -- unqualified. Some of the advertisements asked questions that made absolutely no sense "will it guarantee I can keep my provider?". Well, lady-acting-like-a-concerned-citizen, I've got news for you, you have no guarantee of that now! And several other examples.

Now the GOP may have been taking a two pronged approach, addressing both senses of "obstructionism", but considering that the agenda I heard came from the GOP itself via paid advertisements and spokespeople/heads of the party like Steele, there really wasn't much made of the alternatives. I would say it was an 80/20 effort.

"One interesting scenario I saw pointed out that the entire idea of forcing purchase of coverage like this is very Constitutionally dubious."

There is no direct way for it to be lawful. It has to be done indirectly using an actual authority of Congress. For instance, they could say "A person shall not engage in interstate commerce unless they buy a policy or pay the fine." I predict this is what they will do; those Congressmen really love that Commerce Clause.

But note that the nondiscrimination amendment requires them to treat all persons equally, regardless of place of residence or incorporation. This means foreigners! If a guy in Cincinnati can't call California without buying insurance, then neither can a Chinaman.

If enforced, this will instantly detonate the entire global economy.

If not enforced, then foreigners will be explicitly elevated over citizens. This is not a recipe for political tranquillity, to put it mildly.

What happens now if you don't have insurance and you need medical treatment? For example what happens if you're in a car accident, do they first ask you whether you have insurance? What do they do if you don't have health insurance & don't have enough money to pay for the treatment?

1) You die? 2) They take you to the hospital and treat you

If it's (2), who pays for you? If the answer is the taxpayers then that's a reason for making not having insurance illegal.

It's the same reason why car insurance isn't optional.

But a 2.5% penalty for someone who makes $150,000 is a great deal for emergency care. Obviously family and kids change the decision-making process, but if I were single and making $150k, I'd rather pay a $3750 penalty and get free emergency room care (as anyone can today) than pay an insurance company $600/month.

In the end, passing a law that create more demand for private insurance services has little chance of driving the price down.

I don't know. We have this kind of health care bill in the Netherlands and I'm paying ~70 euros per month (not sure exactly).

Edit: that also includes liability insurance etc.

"It's the same reason why car insurance isn't optional."

You can choose not to drive.

I live in a country with universal health care (Romania). Being forced to pay insurance is annoying, in theory. What happens in practice is if you don't pay it and need insured medical care you have to pay for the last 6 years, with penalty (about double, in the worst case). That would be the "fine". Not being employed I was able to delay paying for about a year, without penalty and being insured in the meantime.

What you get for it is the knowledge that you'll never have to budget for medical expenses. I did have to pay occasionally, like when I wanted a better yearly checkup, but it's never been an amount I couldn't just take out of my pocket.

Anyways, I always felt that if there's something worth paying for it's a healthy society. At least as much as all the other givens: police, military or emergency services.

There's also the option of the way the UK does it. You pay insurance. It's even called that - National Insurance. There is no alternative. Not having a National Insurance number is like not having a SSN. If you are in specific situations (student, low income, self-employed below a certain threshold etc) you become exempt from stamp, but it's still insurance.

It's so well-entrenched and forgettable (comes out along with tax and student loan repayments - but I shouldn't stir that hornets' nest!) that hardly anyone realises what it is, or its origins as, quite descriptively, a nationalised form of healthcare and unemployment insurance.

It's the same thing here. I was describing this from a freelancer's point of view, who has to actually take out the money, but if you're in the system in any way (employed, unemployed, student) you don't even know you pay it.

Romania's society isn't especially healthy (life expectancy is lower than the U.S.). Neither is its economy, with a per capita GDP of less than $12,000 a year.

Don't buy the myths of government-run health care. It increases corruption and political control of our lives, the new taxes hurt entrepreneurs, and it will reduce overall health care innovation.

The US system needs reform but the bill passed last night does nothing to address the drivers of higher costs. Instead it forces more people and resources into the current system.

Romania's society isn't especially healthy (life expectancy is lower than the U.S.). Neither is its economy, with a per capita GDP of less than $12,000 a year.

Two possible reasons spring to mind:

  1) this is the fault of public healthcare
  2) this is because Romania was basically a Soviet
     principality for fifty years

Perhaps you should try looking at, say, Canada if you don't want an comparison that was rigged from the beginning.

Like gloob said below, a lot of Romania's population is old, poor and lives in rural areas. This particular segment probably drags down the average a hefty amount.

I do agree with the corruption being rampant, though. But I'd blame this on particulars of the Romanian society - there's hardly any aspect of it that's not touched by corruption.

Strange enough the system encouraged a lot of private medical practice which is both good and corruption free. Their income is both public insurance and direct pay.

Wait wait wait wait wait wait.

You had 7-8 figures in your brokerage account, and that was when you decided you didn't need health insurance?

Sure. Insurance is just a way of pooling risk. If you have enough money you don't need it. If you're an average risk, you save both the insurance company's profit and the tax you'd have to pay on the money you'd have to make to pay them.

A normal person has maybe ~$70k to lose if they get seriously ill or injured without insurance.

You have millions to lose.

I'm not making a moral judgement. It just seems crazy that you'd risk losing so much money just to avoid an expense that had to have been a rounding error to you at the time.

I found the system won't treat you without it

Now there is something that could use some reform. I have a hard time picturing a good solution coming from a government though; something that looks like more like a union than an insurance company might be effective.

I really think they need to look at the input costs to health care and take a serious look at tort reform. For a look at how bad hysteria and court run amok can be look at the history of asbestos cases.

I found the system won't treat you without it

I find this assertion strange... my wife and I lived for several years on a cash-only basis with little trouble. Granted, there were no catastrophic expenses, but we never had any trouble paying cash for ordinary doctor's visits and the occasional minor emergency.

...But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently...

I'm still trying to wrap my head around that sentence.

Are you saying it's bad for government to take away all those freedoms? Or are you saying that it's a little bad for government to come strip you of your property, but hopefully they won't do it too much?

It sounds like you are equivocating. Either it's more bad than good or not. Right? And -- assuming you reply -- if it's just a little bad, where is the line where you know the government is overstepping where it should go? If your party does a little bad this year, and the other guy's party does a little bad next year, after 100 years we're not going to be in such a good spot, are we? (Made even worse by having nobody to actually blame for our predicament) But hopefully nobody will enforce all those laws too much? (scratches head)

Luckily it likely won't get to that: http://news.google.com/nwshp?hl=en&tab=wn

the reason behind this is simple. A basic task of the state (a framework for society) is to insure[sic] that its people can live (even at the eventual price of others' lives, albeit in other states). This is why the state would (normally :) not kill you, and to the contrary, has to do everything to keep you alive (think euthanasia controversy, obesity, tobacco and alcohol price in healthcare). Therefore, when you fall ill, in most normal[!] societies, people would have to help you -- even before validating your PIN code, or even if you are not holder of a visa or mastercard (are there any other credit cards left?). Like the neighboring lady looking after the kids you were alluding to once. And this inevitably has monetary costs to the society: this is why the compulsory health insurance.

The downside is, that it is wide open to abuse by those who only wish to profit themselves from society. Many countries in Europe introduced universal healthcare after the World Wars, because they learned the hard way, that health and lives and peace are the most important in [to] the world (and ie. not getting rich from online pr0n trade). A great wealth has been amassed, and it has become too tempting to chip off bits and pieces (as always with any huge value) hoping it will go unnoticed. This has happened in most countries (.de, .uk) along with the pension funds (think Enron: the millions who lost their pension savings). Currently there are little safeguards against these white collar crimes (no coincidence either, the politicians don't really make laws against their own interests).

Reply on news.ycombinator.com