More DNA Day Fun: To Test, Or Not to Test?

Katherine Mangu-Ward | April 25, 2008

In honor of DNA day: 

Congress reached an agreement clearing the way for a bill to prohibit discrimination by employers and health insurers on the basis of genetic tests...

[The bill] would make it illegal for health insurers to raise premiums or deny coverage based on genetic information, and would prohibit employers from using such information for decisions on hiring, firing, promotions or job assignments.

Everybody's favorite fillibusterin' Republican Tom Coburn of Oklahoma has been delaying the bill, but it looks like it's about to shake loose. Coburn says he was worried about a new lawsuit boom as people with genetic conditions sued employers, insurers, or any body who looked at them cross-eyed. Some additional legal protections for employers have been added to the bill in the form of a "firewall" between insurer and employer sections of the bill, so it will mostly affect people looking to get individual health insurance plans.

We're bound to see more debate in this area as the science improves and the price of genetic testing comes down--this particular legislation took 13 years to make it through Congress. On one hand, people are afraid to do (potentially lifesaving) genetic tests right now because they're worried about future insurabiity--surely a suboptimal state of affairs. On the other hand, employers will discriminate on certain conditions, no matter what the law says, and in many cases, they ought to be able to. Why should we demand, for example, that a company invest in training an employee that it knows will likely to be out of commission due to illness in the near future? 

And then there's this slippery slope:

[The bill] does not prohibit discrimination once someone already has a disease, and some experts said such protection would have to be the next step.

“You don’t want to be denied health insurance when you are at risk for breast cancer,” said Sonia M. Suter, an associate professor at George Washington University Law School. “But it seems to me you really don’t want to be denied health insurance when you have breast cancer.”

Our insurance system is pretty broken at this point, but layering on legislation requiring insurers and employers to ignore the information made available by quickly evolving science and medicine doesn't seem likely to help much. 

Comments

|4.25.08 @ 12:29PM|#

KMW,

This is a little OT, so apologies in advance:

Is mandating health care coverage for everyone that terrible of an idea? I know some people will use as a model Canada's health care system, however, from what I have seen of Japan's system the Japanese use far more technology far more often than we do yet everyone is covered. Of course apparently the Japanese government is intimately involved in how various products and services are priced in the arena of healthcare and this means that doctors and hospitals are compensated far less than is the case in the U.S.; all of which many might object to. However, I don't think universal health coverage based on some sort of government and private mix is necessarily a terrible idea.

T|4.25.08 @ 12:38PM|#

Strange. I had this exact conversation with my doctor about the possibility of testing for a degenerative disease that is at least partially hereditary which I may be prone to. His point was threefold. 1) The test only determines susceptibility, not whether I'll get it, 2) No cure or effective treatment exists yet, so if I get it I'm screwed no matter what and 3) Kiss my chances of future insurance coverage goodbye if it comes back positive. His recommendation was avoid the test and deal with it if it arises. There's literally no benefit and some downsides to the test.

Guy Montag|4.25.08 @ 12:42PM|#

So, if they apply this to automobile insurance, they could not deny me coverage and I could pay the regular premium after I damage my vehicle or someone else's property?

Sounds like insurance is not a field to enter.

|4.25.08 @ 12:45PM|#

Someone could introduce a bill requiring all Members of Congress, and their staff, to have their DNA tested and entered into the National DNA Database. It's only fair, right? I bet Congress would change their tune on a lot of legislative initiatives.

Elemenope|4.25.08 @ 12:47PM|#

Methinks all concerned should (re)view the uneven but excellent Gattaca, which illustrated both the promise and danger of genetic screening, as well as noting the absolute impossibility of successfully legislating ignorance of potentially very profitable and/or important information.

OT: Tom Coburn's wacky antics reminds me of a recent story that is sure to blow a giant hole in McCain's head come election time. Like Coburn, McCain also raised the spectre of an increase in litigation as a reason to not pass another piece of legislation: the equal pay for women legislation. Like it or not, good or not, this is quite possibly the stupidest reason to oppose legislation ("If we pass an act, people might use it! That would be horrible!")

If Obama is the opposing candidate, this will double whammy McCain by losing him all the chick votes he might have had a shot at if Hillary is not the opponent. McCain cannot survive losing both black people and women.

Episiarch|4.25.08 @ 12:48PM|#

However, I don't think universal health coverage based on some sort of government and private mix is necessarily a terrible idea.

That's what they have in Britain and it's atrocious.

Since there is a large possibility that universal health care may get rammed down our throats whether we want it or not, I wonder whether a way to defuse total socialized medicine is to attempt a compromise where the government supplies catastrophic coverage only, and everything else is private.

Other Matt|4.25.08 @ 12:53PM|#

So, if they apply this to automobile insurance, they could not deny me coverage and I could pay the regular premium after I damage my vehicle or someone else's property?

Sounds like insurance is not a field to enter.

It's actually pretty easy to solve the US health care issues, just make it so insurance companies can't deny coverage and have to charge based on the average risk presented in the US. Some people will pay more than they would if they could be in a place where you could base your profitability by excluding people, some would pay less. I'd venture to say that those who pay more might see a reduction in overall cost to counter the possible increase in relative cost due to increased coverage levels and a lesser focus on breakdown maintenance as practiced by those who go to the E Room exclusively.

On the plus side, however, you'd immediately sever the health insurance from the job requirement, which screws up our system dramatically and has no logical basis to exist. It would foster competition based on reduction of OH, as you couldn't charge more for a segment of people or deny coverage for people as a means to cut costs. As opposed to socialized medicine, you'd at least have SOME measure of competition. Further, in theory, those who currently have no insurance at least could be able to get it, which would take care of those who want it but can't actually get insurance because they're unemployed due to circumstance or choice.

Other Matt|4.25.08 @ 12:55PM|#

Dropped the last part:

Finally, the negative aspects of DNA testing as mentioned by T would disappear, because the insurance co's couldn't exclude people or charge more based on them, and you could identify potentials for certain diseases and try to take evasive actions sooner.

tarran|4.25.08 @ 1:00PM|#

The simple solution is to have government end its practice of severely limiting the number of doctors who are allowed to practice medicine in the U.S.

If we treated the plumbing industry the way we treat the medical industry, 50% of the population would be using outhouses, and presidential candidates would be promising to have government provided plumbing services at a cost of $100 billion per year.

|4.25.08 @ 1:05PM|#

"But it seems to me you really don't want to be denied health insurance when you have breast cancer."

Well, in that case it's no longer "insurance", is it?

Many, many years ago, while working for an HMO provider, I wrote a software routine to calculate payment rates for the physicians associated with the HMO. It was a simple program, really, that calculated a monthly payment fee, per doctor, based on the HMO members for whom they were the primary care physician. The rates came from an actuarial table that included average monthly medical costs and were calculated based on the age, gender, and relative health of the subscriber.

If we (the government through universal health care, or the insurers through legislative fiat) are going to pay for all medical costs no matter what, then mandating that all have health coverage and pay a monthly fee, for their entire life, is the best way to minimize the cost over a lifetime.

Of course, when you are young and healthy, you overpay, and only recoup if you live to a ripe old, decrepit age requiring lots of expensive medical treatment to get you to your last days.

Jerry|4.25.08 @ 1:09PM|#

When health insurance ceases to be about managing uncertainty, you really should start calling it something else.

|4.25.08 @ 1:18PM|#

layering on legislation requiring insurers and employers to ignore the information made available by quickly evolving science and medicine doesn't seem likely to help much.

That depends on your agenda. If you want to make the current system even more untenable and bring about a single-payor system it helps plenty.

just make it so insurance companies can't deny coverage and have to charge based on the average risk presented in the US.

So no financial incentives to live healthily, no financial punishment to smoke and be sedentary? One size fits all!

|4.25.08 @ 1:35PM|#

Aren't we all predisposed to some genetic condition/desease? We are human afterall; won't live forever. Barring some accident or homicide, sickness will surely be our dimise.

I understand insurance companies want to manage uncertainty (heck, that's is their business)- but, fuck, I don't care for the bastards.

|4.25.08 @ 1:36PM|#

When health insurance ceases to be about managing uncertainty, you really should start calling it something else

Single payer ?

Universal coverage?

Zeb|4.25.08 @ 1:39PM|#

Episiarch | April 25, 2008, 12:48pm | #
However, I don't think universal health coverage based on some sort of government and private mix is necessarily a terrible idea.

That's what they have in Britain and it's atrocious.


People always love to bring up Britain when this possibility comes up, which is one of the worst managed government health care programs. It would be a lot more honest to look at one of the better systems like Switzerland, Germany or Japan and talk about how a system like that would work for us than to just find the worst example you can think of and say "see national health care sucks".

Guy Montag|4.25.08 @ 1:41PM|#

Single payer ?

Universal coverage?

Communistic Collective care for the common good of society.

|4.25.08 @ 1:42PM|#

Episiarch,

Do all universal systems have to be like that of the UK? Is Japan's healthcare system - which is universal - atrocious? The Swiss have universal healthcare coverage, is it atrocious?

Guy Montag|4.25.08 @ 1:43PM|#

. . . talk about how a system like that would work for us than to just find the worst example you can think of and say "see national health care sucks".

That is why I avoid those arguments and go straight for "Socialism sucks".

Episiarch|4.25.08 @ 1:44PM|#

I don't know. I have had personal experience with the NHS so I can only speak for that.

anon|4.25.08 @ 1:44PM|#

Rationed care.

|4.25.08 @ 1:44PM|#

Episiarch,

In other words, there do seem to be some universal healthcare sytems out that appear to be working, and if they are working then they are models that might be appropriate to look at and draw knowledge, etc. from.

|4.25.08 @ 1:48PM|#

"That's what they have in Britain and it's atrocious." It's so atrocious that if you ran for office over there promising to end it you would then have no chance of winning. So you see, it must be terrible, since the people who live under it keep making choices to keep it.

Meanwhile I know it's bad because some friends have told me stories about their cousins and I read some articles in Reason magazine.

Yeah, OK.

|4.25.08 @ 1:49PM|#

Episiarch,

If I recall correctly what I have seen on the subject in Switzerland everyone has a base level of insurance that an insurance company cannot refuse to provide coverage for. They get this via either their employer or if they are poor enough through the government. People however can buy coverage over and above this basic form of insurance.

|4.25.08 @ 1:50PM|#

"I have had personal experience with the NHS so I can only speak for that."

Shit, it's worse than I thought. How different than:

"I had a bad personal experience with black people, therefore they are atrocious."

That's the reasoning...

Guy Montag|4.25.08 @ 1:51PM|#

Calidore,

Nothing stopping our healthcare industry from studying anything they feel like studying. As soon as you start forcing people to buy coverage just for breathing, or forcing people to pay for the coverage of others just because they are breathing, then you are stealing.

Stealing is not nice and neither is advocating it.

T|4.25.08 @ 1:56PM|#

One thing that would decouple a job and insurance would be to allow individuals to write off the cost of medical insurance, just like companies do. Another thing would be to remove some of the regulation from insurance carriers to allow them to write more customized policies.

TallDave|4.25.08 @ 1:58PM|#

"You don't want to be denied health insurance when you are at risk for breast cancer," said Sonia M. Suter, an associate professor at George Washington University Law School. "But it seems to me you really don't want to be denied health insurance when you have breast cancer."

This is exactly why the health insurance system is broken. Imagine someone saying

"You don't want to be denied collision insurance when you have poor eyesight and reflexes. But it seems to me you really don't want to be denied collision insurance when you just totalled your car."

We're not talking about health "insurance" anymore. We're talking about socializing costs.

|4.25.08 @ 1:58PM|#

Guy Montag,

Say you are right. What if say the Swiss system is more efficacious from a strictly utilitarian POV than say a system of complete private insurance? In other words, it is cheaper, provides better care along a whole continuum of metrics, etc.

As for stealing, what of those who oppose the war in Iraq yet are forced to fund it via their tax dollars? These sorts of questions always raise the thorny issue of consent of course and what consent actually means. I know that there are a broad spectrum of theories on the issue of consent and I'm not to going to try to defend any particular one today.

TallDave|4.25.08 @ 1:59PM|#

The Swiss have universal healthcare coverage, is it atrocious?

That depends on whether you want an MRI for your persistent headache. You'll get it here, you won't get it there.

|4.25.08 @ 2:01PM|#

TallDave,

Do you have any sources which discuss that point?

TallDave|4.25.08 @ 2:05PM|#

Yes, Arnold Kling wrote a whole book on it. You are far far more likely to get an expensive diagnostic treatment in the U.S. than virtually anywhere else.

The difference between U.S. medicine and socialism is that socialism is more rational (and therefore rationed). That means they match diagnosis expense to outcome. We don't. You can get an MRI here pretty easily even if there's a very very small chance it will find any problem. That's not rational, it's "premium" health care, but if it's your head you probably want that MRI.

kinnath|4.25.08 @ 2:05PM|#

It's actually pretty easy to solve the US health care issues, just make it so insurance companies can't deny coverage and have to charge based on the average risk presented in the US.

Insurance is based upon risk. A young adult in "normal" physical condition has a low probability for incurring high medical expenses (outside of accident repair). An old adult with a known heart condition has a very probability for incurring high medical expenses.

If we are talking about insurance, then premiums should be based upon the probability of the insurer having to pay for treatments.

If you talk about spreading the risk around so that everyone pays a similar premium, then you are talking about "taxes" regardless of who is doing the collection of those taxes.

|4.25.08 @ 2:07PM|#

That depends on whether you want an MRI for your persistent headache. You'll get it here, you won't get it there.

You are guaranteed to get it only if you are willing to pay for it.

Otherwise, you will most likely have to get approval from your insurance to get an MRI covered for a headache, even if it is persistent, barring any other symptoms that would indicate a need for an MRI.

can we please stop pretending like the private insurance system doesn't involve some bureaucrats acting as gatekeepers and trying to ration out health care in a cost effective way?

The only difference, in this regard, is whether the bureaucrats are on the government payroll or if they are on a a corporate payroll.

TallDave|4.25.08 @ 2:08PM|#

That's not rational, it's "premium" health care, but if it's your head you probably want that MRI.

And, of course, if it's your money paying for it (even via insurance) you're in a much better position to demand it than if it's taxpayer money.

TallDave|4.25.08 @ 2:10PM|#

The only difference, in this regard, is whether the bureaucrats are on the government payroll or if they are on a a corporate payroll.

You can choose another health insurance provider if you don't like your coverage. Choosing another government is a bit trickier.

|4.25.08 @ 2:13PM|#

I would also like to add that the whole "Well what you really want isn't insurance" isn't really a compelling argument.

What most americans seem to want is a system that will limit the amount of money they will have to pay out of pocket while still getting the best health care possible.

They don't want to have to deal with cases where their insurance provider isnt constantly trying to deny them coverage or make you have to go through an appeals process everytime something expensive comes up, or (in a case I recently read about) the insurer comes back 3 years after they approved and paid for the procedure to come back to the insured and say "whoops..out bad...we shouldn't have approved it, pay us back the money we shelled out")

And I don't pretend like these problems only occur in government run or private run systems.

it may not be "insurance" it may not be reasonable or whatever...but that seems to be what they want. They don

|4.25.08 @ 2:14PM|#

TallDave,

You are far far more likely to get an expensive diagnostic treatment in the U.S. than virtually anywhere else.

Apparently in Japan the use of MRIs and other expensive diagnostic equipment is (a) far cheaper (to the patient) and (b) more common than in the U.S. This also may be the case in Taiwan, but I am not quite sure. So there is at least one place in the world where such treatments are more common than in the U.S.

ChicagoTom,

The only difference, in this regard, is whether the bureaucrats are on the government payroll or if they are on a a corporate payroll.

As that is the case the issue becomes which system will allocate healthcare resources in the "best" way, which leads to the thorny issue of what exactly one means by "best." For me the more this issue is unpacked the less the rhetoric from the major camps in the U.S. on this topic make sense.

|4.25.08 @ 2:15PM|#

TallDave,

FYI: In the case of Switzerland the government does not mandate which insurance provider one uses.

|4.25.08 @ 2:19PM|#

You can choose another health insurance provider if you don't like your coverage. Choosing another government is a bit trickier.

True, but most insurance carriers are all adopting very similar tactics especially in the face of reduced profits (let's remember that insurance companies don't really make money off of just collecting premiums..they collect those premiums and invest them. So when the economy goes south, insurance companies ROI goes south, and in some cases they translate to real losses instead of gains, and sometimes they raise premiums to make up for their bad investments)

Furthermore , people can vote for politicians who will fix the complaints of a national system, or vote out politicians who wont.

In fact, i would venture to say that the government might be more responsive to the complaints of the people using the system because they won't have to worry about keeping profit margins up, and elected politicians can be fired if people aren't happy with a government run program.

kinnath|4.25.08 @ 2:23PM|#

As that is the case the issue becomes which system will allocate healthcare resources in the "best" way, which leads to the thorny issue of what exactly one means by "best."

There are limited resources. Someone always gets fucked. The question is whether it is the poor that cannot pay or the rich who are not allowed to pay for rationed services.

kinnath|4.25.08 @ 2:24PM|#

In fact, i would venture to say that the government might be more responsive to the complaints . . .

What planet do you live on?

|4.25.08 @ 2:24PM|#

ChicagoTom,

Yeah, I don't think I'm entirely sold anymore on the notion that "private insurance only" is always the best way to deal with the issue of healthcare coverage. The problem is though is that any system of coverage is going to have its good and bad points. It is in weighing them that one runs into a lot of difficulty.

|4.25.08 @ 2:26PM|#

kinnath,

Well, in the case of Switzerland the rich can as far as I can tell continue to pay for as much healthcare as they so desire. Indeed, that seems to be one of the ways that Swiss health insurance companies compete - by offering packages over the base level insurance programs.

|4.25.08 @ 2:26PM|#

Is mandating health care coverage for everyone that terrible of an idea?

Is mandating that everyone drive a car that gets 40 MPH such a bad idea?

Is banning the use of incandescent light bulbs that terrible of an idea?

Is banning animals fats and trans fats and white sugar and anything else the government deems bad for you such a bad idea?

Is throwing millions of people in jail for taking drugs that harm no one else such a bad idea?

Did you answer all of these questions "no", Calidore?

kinnath|4.25.08 @ 2:33PM|#

Well, in the case of Switzerland the rich can as far as I can tell continue to pay for as much healthcare as they so desire.

And in Canada it is prohibited by law.

Mandatory private insurance, universal coverage (government funding of insurance for poor people), universal care (single payer systems), . . . pick one a make a point instead of asking lots of open ended questions.

|4.25.08 @ 2:35PM|#

In fact, i would venture to say that the government might be more responsive to the complaints of the people using the system because they won't have to worry about keeping profit margins up, and elected politicians can be fired if people aren't happy with a government run program.

Wow, Chicago Tom. You really trust the government and hate private enterprise, don't you?

You absolutely CAN personally fire a non-responsive health insurer. Your vote against a politician, OTOH, has about a 0.01% chance or less of being the deciding vote in an election, and even if it is the deciding vote, you have a really remote chance of your politician being the swing vote on legislation of your choice. So you basically have zero chances to personally change the government if you don't like what they're doing.

And the quest for profits makes insurers responsive to your individual needs. The ability to gerrymander a congressional district that virtually ensures a congressperson's reelection makes them not quite so responsive to the public, and allows them to virtually ignore what you personally want them to do.

|4.25.08 @ 2:36PM|#

prolefeed,

Is mandating that everyone pay for public roads and the repair thereof a terrible idea?

When it comes to issues of where the government legitimately may intervene in the affairs of individuals there are going to be disagreements over dividing lines. I don't know of any perfect test for determining such.

Is this a libertarian litmus test?

(a) Yes, pretty clearly people will get there on their own if gas prices rise high enough, etc.

(b) I wouldn't recommend it, but I don't think it will have any serious consequences down the road either. So yeah, I don't favor it but I am not going to get worked up over it either.

(c) That is a terrible idea in part due to the surveillance aspects associated with such a move, in part because of the large waste of funds associated with the bureaucracy needed to fund such a project, etc.

(d) In other words, do I support the drug war? No, I would say in the main that I do not.

|4.25.08 @ 2:41PM|#

kinnath,

...pick one a make a point instead of asking lots of open ended questions.

No. I'll continue to ask open ended questions as long as I am puzzled about this particular issue.

|4.25.08 @ 2:45PM|#

What I think is so sad about people's (legitimate) fears of the implications and consequences of genetic testing is that they lump all genetic testing together. Some think it's all disease risk, which is scary on several counts including a misunderstanding of "risk" vs "yes you've got/will get X" and fear of employment discrimination or health insurance problems. Others write it all off as useless - I'm gonna die of something, who cares what it is? or Who gives a shit if my ear wax is wet or dry?

Another problem is the learning curve - very few people understand how to properly interpret gx test results and there are plenty of people willing to sell tests to you without backing it up with knowledge. Quackery, in essence.

All this clouds and biases people against the sorts of genetic testing that really is useful in saving lives and/or reducing healthcare costs, and these tests have no effect (or shouldn't, anyway) whatsoever on employability or insurability. In fact, insurance companies now cover a wide range of genetics testing.

But still, every couple of months we get a call from an individual who insists on paying out of pocket because they don't want their insurance company to know.

And all we're doing is assisting with drug choice and dosing guidance.

I suppose an employer could say, "hey, you're a 2D6 poor metabolizer and you were tested because you're going on antidepressant therapy. I'm not gonna hire this head case!" But I didn't think employers were allowed to nose into our health records. Is that not true?

The knowledge that can be gained from genetic testing can be absolutely invaluable and it depresses the hell out of me that fear and ignorance are preventing patients and their physicians from enjoying the benefits of the available - and ever-expanding - state-of-the-art science.

Guy Montag|4.25.08 @ 2:46PM|#

Calidore,

Say you are right.

Well, I am right about the stealing part, especially since mandating health coverage is nowhere near an enumerated power in our Constitution. I suggest you begin an amendment campaign right now.

What if say the Swiss system is more efficacious from a strictly utilitarian POV than say a system of complete private insurance? In other words, it is cheaper, provides better care along a whole continuum of metrics, etc.

So, you are advocating a completly voluntary system where people get to chose if, or which, insurance company insures them? Should have said so in the beginning. I like that. How about knocking down some of that over-regulation we have in that industry now too? I thought I was disagreeing with you before. Sorry, just misunderstood.

As for stealing, what of those who oppose the war in Iraq yet are forced to fund it via their tax dollars?

Enumerated power again. I suggest you vote against the elected leaders who make decisions that you don't like. Maybe amend the Constitution to make sure a Sr. Senator from Mass. or CA has Commander in Chief authority. Also, create a war declaration form, so that when the Congress authorizes the use of force that it will be clear to people what that it is not an authorization for a vacation on a very large beach, or other overlooked destination.

Nothing is Socialistic about providing for a national defense.

These sorts of questions always raise the thorny issue of consent of course and what consent actually means. I know that there are a broad spectrum of theories on the issue of consent and I'm not to going to try to defend any particular one today.

Judges make all soers of decisions that I, and most others here, do not like. However, it is not theft to use out tax money to pay them and operate their little law palaces. There is nothing Socialistic about that at all.

It IS theft when the government takes your money and uses it on someone else for something they should be paying for themselves.

kinnath|4.25.08 @ 2:46PM|#

No. I'll continue to ask open ended questions as long as I am puzzled about this particular issue

Here, I'll help you out.

1) Isn't sad when poor people suffer? Yes

2) Don't we have some moral obligation to help them? Maybe

3) Aren't government mandates the best way to help them? Fuck No

|4.25.08 @ 2:47PM|#

That first line should read "(sometimes legitimate)"

|4.25.08 @ 2:54PM|#

Guy Montag,

Well, I am right about the stealing part, especially since mandating health coverage is nowhere near an enumerated power in our Constitution. I suggest you begin an amendment campaign right now.

Well, we aren't necessarily talking about our constitution, are we? Or let me put it this way, would it be stealing in a nation where its constitution via a free and fair referendum mandated some base level of health care coverage for all? Your original statement on the matter as far as I can tell didn't specify.

Enumerated power again.

That assumes the legitimacy of the Constitution, correct? An issue of consent that is hotly debate amongst libertarians if my observations of conversations about the Lysander Spooner are any indication of such.

Modern militaries, etc. are about as socialistic as one can get. Indeed, there is a reason why there are phrases like "war communism."

|4.25.08 @ 2:57PM|#

kinnath,

The issue regarding what system of health care to follow is more than about poor people, so I'm not quite sure why you mention it.

kinnath|4.25.08 @ 2:58PM|#

Well, we aren't necessarily talking about our constitution, are we? Or let me put it this way, would it be stealing in a nation where its constitution via a free and fair referendum mandated some base level of health care coverage for all? Your original statement on the matter as far as I can tell didn't specify,

The purpose of the consititution is to protect the minority from the will of the majority.

Democracy is two lions and a lamb deciding what to have for lunch.

|4.25.08 @ 3:00PM|#

Guy Montag,

The only thing I am advocating is a discussion of the merits of the various types of proposals for healthcare coverage. I can say that I am not enthusiastic about either a completely government run system or alternatively an entirely private system either.

kinnath|4.25.08 @ 3:01PM|#

The issue regarding what system of health care to follow is more than about poor people . . .

Ammended

1) Isn't sad when bad things happen to good people? Yes

2) Don't we have some moral obligation to help them? Maybe

3) Aren't government mandates the best way to help them? Fuck No

|4.25.08 @ 3:01PM|#

Time to sell short the US health insurance industry.

What exactly were their lobbyists busy doing for the last decade, while this bill was on its way through Congress?

|4.25.08 @ 3:02PM|#

kinnath,

I'd say that there are several purposes to it and scholars vary in their opinions as to which is paramount.

Other Matt|4.25.08 @ 3:03PM|#

So no financial incentives to live healthily, no financial punishment to smoke and be sedentary? One size fits all!

Exactly. We'd get that anyway with a socialized med approach, so why not do it in a way that puts some form of healthy (reduce overhead) competition into the equation vs unhealthy (tell people they're SOL unless they go to another country beacuase they smoke, as I read someplace that they're doing out to the east on an island someplace).

GG|4.25.08 @ 3:07PM|#

I was pleasantly surprised by this poll. The way the Ds tell it, the whole nation is clamoring for universal health care.

Twenty-nine percent (29%) of American adults favor a national health insurance program overseen by the Federal Government.

I suggest you begin an amendment campaign right now.

Arizona is on it.

Guy Montag|4.25.08 @ 3:09PM|#

GG,

Of the many suggestions I have tossed out here, this freaking one has to be the one a State adopts? UGH

TallDave|4.25.08 @ 3:20PM|#

Apparently in Japan the use of MRIs and other expensive diagnostic equipment is (a) far cheaper (to the patient) and (b) more common than in the U.S.

They also have a uniquely Japanese solution to health care rationing.

Japan's suicide rate is the highest of any developed country; and ranks within the top-ten countries in the world with the highest rate of suicides. A study published in 2006, suspects that health problems were a factor in almost 50 percent of the Japan's suicides in 2006.

|4.25.08 @ 3:23PM|#

Wow, Chicago Tom. You really trust the government and hate private enterprise, don't you?

Not at all.

i just have faith that pandering politicians would be more responsive to concerns about a national health care plan, than CEOs currently are towards deficiencies in their coverage.

As it stands, there have been a large number of insurance companies whose MO is to deny as many claims as possible and to keep from having to pay out on legitimate claims for people who have coverage. They purposely make it as difficult as possible and make you jump through bureaucratic hoops. They also direct adjusters to deny everything (my sister was an adjuster for CIGNA, and those were her orders...deny everything the first time through and make them file appeals)

So forgive me for not believing in the responsiveness of executives who encourage these types of things.

They are responsive to shareholders and profits not to the insured who have complaints about the deficiency of their coverage.

And just because I don't care much for the private enterprise with regards to the health insurance industry (based on the behavior of the industry itself rather than some kind of philosophical objection) doesn't imply that I hate free enterprise. I just don't worship at the alter of it and sometimes I think that some industries are full of bad actors, or some industries don't work and play well with the profit motive.



You absolutely CAN personally fire a non-responsive health insurer.

Unless of course your insurance comes from your employer. Of course you can choose to just go without or go get a private policy and lose the benefits of group coverage and potentially pay higher premiums, and still possibly get the same claims denied or have to go through the same runaround. It's not like insurance companies tell you upfront that they are gonna do whatever they can to not have to pay.

kinnath|4.25.08 @ 3:30PM|#

i just have faith that pandering politicians would be more responsive to concerns about a national health care plan, than CEOs currently are towards deficiencies in their coverage.

And I repeat, what planet do you live on?

The problem is that once the politicians get involved, those of us that don't share your beliefs are preventing under pain of law from opting out of your preferred solution.

|4.25.08 @ 3:30PM|#

Also, create a war declaration form, so that when the Congress authorizes the use of force that it will be clear to people what that it is not an authorization for a vacation on a very large beach, or other overlooked destination.

Considering how many Congresspersons have been trying to spin their votes for "authorizing military force" as something other than a declaration of war after it became apparent the whole thing was a huge mistake, perhaps a strict Constitutionalist such as yourself could understand the need for clarity in labeling to pin politicians down.

|4.25.08 @ 3:34PM|#

i just have faith that pandering politicians would be more responsive to concerns about a national health care plan, than CEOs currently are towards deficiencies in their coverage.

For over three years now, a majority of Americans have wanted us to get the heck out of Iraq.

Good luck getting the govt to change their mind about letting you get an MRI for your headaches, out of fear that you might vote against them.

kinnath|4.25.08 @ 3:36PM|#

My wife had both knees replaced at the age of 45. This is perhaps 4 or 5 sigmas out of the norm. Needless to say, the insurance company was reluctant to approve the operations. The director of our HR department at one point called the president of the company administering the insurance to determine what the hold up was.

We work for a good company, and perhaps our experience was outside the norm. But I can say with great confidence that my wife would have been confined to a wheel chair before getting treatment under just about every "universal" program in any of the developed countries of the world.

The fact that your company sucks doesn't mean the my wife and I should be forced to give up our fairly high quality insurance.

GG|4.25.08 @ 3:50PM|#

Of the many suggestions I have tossed out here, this freaking one has to be the one a State adopts? UGH

The other two are a hell of a lot worse.

Is this really so bad?

" The Freedom of Choice in Health Care Act" would amend the Arizona Constitution to insure that, whatever type of health care legislation ultimately emerges from our legislature, it will not be able to restrict our freedom of choice of private health care systems, plans, or options; it will not be able to prevent us from directly paying for lawful medical services; and it will not, in any way, be able to force us to participate in a plan or program if we don't want to.

What's more, our legal counsel, Clint Bolick (co-founder of the Institute for Justice, and currently Director of the Goldwater Institute's Center for Constitutional Litigation, among other things), who designed the language for our initiative, believes this might actually prevent a further FEDERAL intrusion into the healthcare system. He says that there is legal precedent for state constitutional law actually trumping federal law when the federal law trespasses into an area of police power that has been traditionally reserved to the states under the US Constitution. So passage of this amendment in AZ and other states would at least give us a fighting chance against those in DC who want to force us into a one-size-fits-all national health care plan.

economist|4.25.08 @ 3:57PM|#

"The Swiss have universal healthcare-is it atrocious?"
This is completely off the wall, but I always like to mention Switzerland's universal gun ownership when arguing with proponents of gun control.

economist|4.25.08 @ 4:02PM|#

Chicago Tom,
The fact that pandering pols would be more "responsive" is the entire reason I'm against universal health care. It would become hideously expensive, as politicians extended the definition of "basic care" to cover every new and expensive procedure and drug known to medicine at taxpayers' expense. At least with private insurers one can say "Screw you guys, I'm not going to deal with this crap" and take your own chances. With the government you have to play ball, whether or not you'd rather do without.

|4.25.08 @ 4:10PM|#

The problem is that once the politicians get involved, those of us that don't share your beliefs are preventing under pain of law from opting out of your preferred solution.

That's not necessarily true. Any system can easily be designed to let you opt out of receiving benefits, or go a private or out of pocket out. But no, you wouldn;t be able to opt out of paying for it.

Just like I can't opt out of the drug war or the Iraq war or paying for a border fence. I'd rather pay for universal health care than any of these.

Such is life.

Good luck getting the govt to change their mind about letting you get an MRI for your headaches, out of fear that you might vote against them.

I'd rather take my chances with that rather then trying to get a for private entity to act in a way which puts their bottom line at risk.

It's really an issue of sacrafice and bearing burdens.

The reality is people will make much more of a stink about bad health because they themselves will bear the burden of any sacrifices being made re coverage then about a war being fought thousands of miles away with no sacrifices being made by the general population.

If there were a draft instead of merely stop-lossing volunteers, or there was a tax increase instead of paying for the war via increased deficits and loans-- I would imagine we would have been out of Iraq by now.

|4.25.08 @ 4:11PM|#

Am I missing something? Are you guys under the impression that people do not get denied coverage by their private insurance certain procedures like MRI's? It happens all the time.

People here often say "hey, in Country X you get denied procedure Y." Of course here insurance companies deny people coverage of procedures all the time. And if you are without insurance I guess you are denied 100% of them (interestingly someone at this point usually replies by pointing out that the government picks up a lot of this, which is an odd point for libertarians to rely on, isn't it?). So why is any of this an argument against these nationalized systems?

I think a better argument is found above by the poster who said under our system you can change carriers. That's somewhat meaningful (I say somewhat because often you don't realize your insurance sucks until you have a condition that would keep you from getting covered by another company).

|4.25.08 @ 4:16PM|#

The fact that pandering pols would be more "responsive" is the entire reason I'm against universal health care. It would become hideously expensive, as politicians extended the definition of "basic care" to cover every new and expensive procedure and drug known to medicine at taxpayers' expense. At least with private insurers one can say "Screw you guys, I'm not going to deal with this crap" and take your own chances. With the government you have to play ball, whether or not you'd rather do without.

True, it could be expensive. But maybe they can cut the defense budget, or the DHS budget or the DARE budget, and divert some of those monies to health care instead.

There are so many things the government is wasting A LOT money on, paying for health care
would not offend me one bit -- especially if it forced them to cut in other places.

But I agree--cost is a concern. But costs are still steadily rising as it stands. Is the status quo better? There are a lot of things that could be done to contain costs and still provide the better benefits/care than many insurance providers are currently providing.

kinnath|4.25.08 @ 4:21PM|#

Such is life.

My preference for private insurance does not require you to contribute to my insurance.

Your preference for public insurance does require me to help you pay for it under penalty of imprisonment for non-compliance.

These are not equivalent.

If your only response is "such is life" then my only rational response is "go fuck yourself".

kinnath|4.25.08 @ 4:25PM|#

Being forced to pay for things we don't want to pay for now, is not justification for adding new things that we are forced to pay for.

|4.25.08 @ 4:32PM|#

If your only response is "such is life" then my only rational response is "go fuck yourself".

I don't want to pay for wars of aggression, or for the drug war. But I do. I dont have a choice. Such is life.

It's called taxation, and it happens all the time. Deal with it. If you dont like reality, then kill yourself.

Being forced to pay for things we don't want to pay for now, is not justification for adding new things that we are forced to pay for.

Americans would not accept a high enough tax rate to pay for it all. Universal Health care would force cuts elsewhere.

If I have to pay taxes I would rather pay for things that actually give stuff to people than paying to take away peoples life liberty and freedom.

Other Matt|4.25.08 @ 4:34PM|#

Being forced to pay for things we don't want to pay for now, is not justification for adding new things that we are forced to pay for.

Point of note, I never said you had to pay for it, or even have it. All I'm saying is that if tune one or two things, the system goes from one based on exclusionary profiteering to competition based on service (OH).

kinnath|4.25.08 @ 4:53PM|#

Other Matt, ChicagoTom wants to play chicken with the Federal Government and drag us all along for the ride.

The fact that the government does a lot of things we libertarians want it to stop doing does not justify adding a bunch of new things for the government to do under the misguided goal of running the government out of money.

If you want to make some rational argument that quality or quantity of services will improve when the feds take over, then do it.

Bitching about Iraq and the WoD is totally irrelvant.

kinnath|4.25.08 @ 5:01PM|#

By the way, the last "you" was directed to ChiTom not Matt.

|4.25.08 @ 5:15PM|#

"""Democracy is two lions and a lamb deciding what to have for lunch."""

Liberty is a well armed lamb.

|4.25.08 @ 5:17PM|#

"""Bitching about Iraq and the WoD is totally irrelvant."""

Maybe, are we paying for the heathcare of Iraqis in Iraq?

economist|4.25.08 @ 5:40PM|#

MNG,
It's true that HI companies love to try to deny claims, but they also have to operate under the terms of the policy you take out. If they violate it, you can rightfully sue them for breach of contract. It's not a perfect system, and it would be nice if people didn't have to be dragged kicking and screaming to fulfill agreements that they voluntarily chose, but it's sure as hell better than imposing an obligation on everyone against their will. And to Chicago Tom, if you want to talk about ending the expenditure of funds on the War in Iraq and on drugs, I'm more than happy to do so. The difference between us is you would have the government's beneficiaries pocket the savings through subsidized healthcare while I would use it to balance the budget as it stands (tax cuts can wait until we get the deficit under control). But this argument is pointless, because the government will continue to spend on things you don't like and, if it adds what you do like, it will be as an expansion of its current functions because in a democracy, the two lions will always decide to divide the lamb between themselves rather than leave it alone.

Daniel Reeves|4.25.08 @ 5:49PM|#

May I come out of the shell? I'll admit it: I'm not a libertarian by ideology. I'm only libertarian leaning because I think it's pretty efficient With that said, I don't know if I like this bill or not. Simply put, I hate health insurance in general; I'd much rather just see all of this system fly out the window and start anew with insurance savings accounts or simply no insurance. But in all honesty, while I still think it's a shitty idea, I actually think that universal health care would be ever so slightly better than our current system.

I don't want to pay for wars of aggression, or for the drug war. But I do. I dont have a choice. Such is life.

It's called taxation, and it happens all the time. Deal with it. If you dont like reality, then kill yourself.

But saying that it's life is not justification for it over something different. It's an is-ought fallacy.

|4.25.08 @ 8:08PM|#

I've not seen comments as to who owns your genetic speicmens. I'd guess this and follow on legislation are desirable only because some entity other than the individual will own, control and disseminate your most private information.

The medical insurance clearinghouse data bank on 'roids, no doubt to be held by the feds for 'national security' reasons.

I opt out.

Colonel_Angus|4.25.08 @ 9:05PM|#

It seems like a lot of people who favor socialized medicine aren't aware of the role the federal government has already had in fucking up the medical industry. The cost is driven up by a bunch of financial and coverage regulations on health insurance. Medical companies lobby to regulate out the competition such as importing drugs. The federal government apparently thinks there can be too many doctors so they regulate that too again driving up the cost. Then there is the liability insurance problem. What does anyone know about illinois?

If we could cut through bullshit like this insurance would be cheaper.

piperTom|4.25.08 @ 11:31PM|#

The bill requires discrimination against that majority who do not have genetic markers for disease. We would have gotten cheaper health insurance -- but NO, that wouldn't be "fair".

This bill is nothing but a tax on the healthy, transferring wealth to the ill. Socialized medicine through the back door.

economist|4.26.08 @ 11:33AM|#

it's mine,
You can't opt out. Whenever the government does something, it's because it won't work the way they want it to when people can opt out. That's the justification they give for all government programs. With some government activities, such as defense, police, open-access commons, and certain types of infrastructure, there is a free rider problem in which individuals benefit from a service without paying for it, which is usually the more conservative justification for govt. action. However, welfarism is enforced by the government because no one is going to give up huge portions of their income to pay for the upkeep of the unproductive. And, ultimately, all government social programs from TANF to social security are in some way welfare schemes. National Health Care would be no different.

Sick Bitch|4.26.08 @ 1:00PM|#

Hey piperTom,

Have u had ur DNA test?

How would u (and ur children) like 2 be denied things?

economist|4.27.08 @ 10:10AM|#

Sick Bitch,
How would you like to be forced to commit to paying huge sums of money if someone gets sick from something that wasn't your fault?

economist|4.27.08 @ 10:12AM|#

They need to make an addendum to this bill requiring that companies not discriminate in hiring based on employees' intelligence, since it is in part based on genetics.

economist|4.27.08 @ 10:17AM|#

Actually, this bill is sort of like eugenics in reverse. Instead of actively weeding out defectives (which, I would like to point out, I am also strongly opposed to) this bill is designed to reduce the impediments to their survival and reproduction. Yes, I am a social Darwinist. And I think the best way to deal with overpopulation is to get rid of all government welfare. Deal with it.