Cato Critiques Mandatory Health Insurance

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Massachusetts has just mandated that its citizens must purchase health insurance. In a new policy analsysis, "Individual Mandates for Health Insurance: Slippery Slope to National Health Care," the Cato Institute's director of health and welfare studies, Michael Tanner, offers some thoughtful criticism of such mandatory private health insurance schemes. Tanner highlights the difficulties in enforcement, in distributing insurance subsidies to the poor, and the problem of mandate creep.

Tanner writes:

Individual mandates cross an important practical and philosophical line: once we accept the principle that it is the government's responsibility to ensure that every American has health insurance, we guarantee even more government involvement with and control over large portions of our health care system. Compulsory, government-defined insurance opens the door to even more widespread regulation of the health care industry and political interference in personal health care decisions. The result will be a slow but steady spiral downward toward a government-run national health care system.

Of course, we are already on a slow steady downward spiral to a government-run national health care system. The Fed and states already pay for nearly 50% of all heath care. Tanner's way out of this death spiral?

On a fundamental level we must shift the health care debate away from its single-minded focus on expanding coverage to the bigger question of how to reduce costs and improve quality. That will require the introduction of market mechanisms to give consumers more control over and responsibility for their health care decisions.

Lowering costs and thus making coverage affordable to more people is a great idea, but the political dynamic driving the debate is the fear by a large segment of the public that they will lose their health insurance and become bankrupt. That fear is what is driving us toward nationalized health care.

One model for mandatory private health insurance is Switzerland, though it is admittedly not perfect. Every Swiss must buy basic coverage, and people can choose to purchase additional gold-plated coverage. I hope Tanner is right and that we can change the debate in time, but mandatory private health insurance seems to me to be only politically viable way to preserve some private health care and medical innovation. It's sad that we've arrived at this sorry situation, but there it is.

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  1. mandatory private health insurance seems to me to be only politically viable way to preserve some private health care and medical innovation.

    I ask this question every time a “mandatory purchase of health care will solve the problem” proposal comes up, and I never seem to get an answer: if it is to be mandatory, then what will the penalty be for those who do not buy it? How will it be enforced?

  2. “Health insurance? No man, that’s way too expensive. Yeah, bartender, another round for my friends! So the other night we were at the strip club and I dropped like $500. It was crazy. Oh dude, you gotta check out the new speakers I got in my car…”

    -Half the people I know

    And there’s the real story about why a lot of people aren’t insured, but we never seem to have that debate.

  3. Maybe it will be similar to the way states enforce mandatory auto insurance. Try to renew a drivers license, now you have to show your auto and health insurance card. Try to file for any benefit from the state, show proof of insurance. Try to buy property within the state, show proof of health insurance. Maybe they’ll even setup police checkpoints to force you to show your health insurance card, like they do for auto insurance.

  4. I ask this question every time a “mandatory purchase of health care will solve the problem” proposal comes up, and I never seem to get an answer: if it is to be mandatory, then what will the penalty be for those who do not buy it? How will it be enforced?

    Jennifer,

    From this article:
    “Individuals deemed able but unwilling to purchase health care could face fines of more than $1,000 a year by the state if they don’t get insurance.”

    I dunno how they are gonna determine who has or doesn’t have insurance, though.

  5. By SWAT teams that eavesdrop on domestic conversation.

  6. “Health insurance? No man, that’s way too expensive. Yeah, bartender, another round for my friends! So the other night we were at the strip club and I dropped like $500. It was crazy. Oh dude, you gotta check out the new speakers I got in my car…”

    -Half the people I know

    And there’s the real story about why a lot of people aren’t insured, but we never seem to have that debate.

  7. The Fed and states already pay for nearly 50% of all heath care.

    Wow, I hadn’t heard this before. Just for my own education, where does this number come from?

  8. In this case, they will first disallow the personal tax exemption for those who can afford, health insurance, but do not buy it. Later they will impose fines on these people. I’m not sure how the plan would deal with non-working adults who have no income. I suppose they could impose fines, but I’m sure that fines are about as compelling as ER bills to people with virtually no money.

    The plan is only expected to cover 95% of the population.

  9. We can juggle the numbers on health care coverage all we want, but it won’t change the basic facts underlying the problem: We have X number of doctors, and they’re all booked. Doctors are a scarce resource, and their cost is largely based on that.

    Then factor in the lawyer problem. We DON’T have a scarcity of them. We have such a surpluss, in fact, that they’re inventing work for themselves, and doctors are easy pickings for them. (Oh, some fatass got her stomach stapled, then kept eating too much and ruptured it? Woo hoo, I get to sue a doctor!) That increases health insurance costs for doctors, who pass the costs on to us.

    Too few doctors. Too many lawyers.

    If the government wants to make itself useful, how about tax incentives to steer some of these geniuses heading for law school into medicine instead?

  10. dead_elvis,
    The number is more like 46%. Another crucial point is that in dollar terms that 46% is more than many industrial countries pay for universal care (i.e. we spend more than double what a lot of countries do on healthcare, and we still have 40M uninsured).

  11. what will the penalty be for those who do not buy it?

    That’s easy. FEMA will confiscate their homes and the Defense Dept. will process their bodies into tasty, protein-rich MREs for the evacuees. Housing, health insurance and hamburger-helper for all! Never again will America be unprepared for catastrophe.

  12. dead_elvis,
    The number is more like 46%. Another crucial point is that in dollar terms that 46% is more than many industrial countries pay for universal care (i.e. we spend more than double what a lot of countries do on healthcare, and we still have 40M uninsured).

  13. “Individuals deemed able but unwilling to purchase health care could face fines of more than $1,000 a year by the state if they don’t get insurance.”

    Great way to start. And when they decide that doesn’t work they’ll take a page from the drug warrior’s handbook, putting people in jail for the rest of their lives to prevent them from performing behaviors that could ruin their lives.

    Also, I really don’t see how having the government require you to buy services from a private company, and punish you if you do not, is an actual improvement over having the government just pay for the damn services out of tax dollars in the first place.

  14. “Individuals deemed able but unwilling to purchase health care could face fines of more than $1,000 a year by the state if they don’t get insurance.”

    Great way to start. And when they decide that doesn’t work they’ll take a page from the drug warrior’s handbook, putting people in jail for the rest of their lives to prevent them from performing behaviors that could ruin their lives.

    Also, I really don’t see how having the government require you to buy services from a private company, and punish you if you do not, is an actual improvement over having the government just pay for the damn services out of tax dollars in the first place.

  15. dead elvis:

    Government programs pay 47 percent of the health care tab in the U.S.; spending on health care makes up 20 percent of the federal budget, and most state budgets too. If you paid $5,000 in taxes last year, around $1,000 went to health care programs.

  16. I’m starting to wonder if maybe the best solution isn’t to just start pushing for socialized healthcare while I’m still young. Since it appears to be inevitable, I need time for the system to be socialized, collapse completely, and be reprivatized again before I’m old enough to need a lot of healthcare.

  17. and be reprivatized again

    It’s not “privatized” now. Government laws determine who gets to be a doctor (and to qualify all you need to do is spend a six-figure amount of money and about one-fifth of your adult life in training). Laws decide which drugs will be sold, who gets to sell them, and who gets to buy them. Laws corrupt the market and result in a situation where the exact same service can have a hundred different prices depending upon who you work for, how long you’ve worked for them, and what middleman insurance company they pay premiums to.

    And now a bunch of freedom-lovin’ libertarian geniuses figure that the way to solve the problem is through MORE laws making it MANDATORY to buy the services of non-medically trained middlemen who make even MORE decisions about what kind of healthcare you can and cannot have?!?!

  18. Simon,
    From what I understand, plenty of people want to be doctors, but the AMA restricts the amount of people that get the title of “Dr”, so that the title retains its prestige and the amount they can charge.

  19. and be reprivatized again

    It’s not “privatized” now. Government laws determine who gets to be a doctor (and to qualify all you need to do is spend a six-figure amount of money and about one-fifth of your adult life in training). Laws decide which drugs will be sold, who gets to sell them, and who gets to buy them. Laws corrupt the market and result in a situation where the exact same service can have a hundred different prices depending upon who you work for, how long you’ve worked for them, and what middleman insurance company they pay premiums to.

    And now a bunch of freedom-lovin’ libertarian geniuses figure that the way to solve the problem is through MORE laws making it MANDATORY to buy the services of non-medically trained middlemen who make even MORE decisions about what kind of healthcare you can and cannot have?!?!

  20. 1) The obvious unintended consequence of mandating health insurance is to drive insurance premium prices up.

    2) There are folks who can’t buy medical insurance at any price, because they are denied due to pre-existing conditions. What do they do? Do they have to move out of Massachusetts?

  21. From the Pittsburghlive article and the Cato article:
    46 million Americans have no health insurance.

    From what I’ve heard, that’s not true; isn’t it really that around 46M Americans are uninsured for at least one day of a given year? (Cato’s 3.7Meg reference isn’t worth the dialup download).

    And there’s the real story about why a lot of people aren’t insured, but we never seem to have that debate.
    I’ve heard the debate (on Right-Wing Extremist Squawk Radio(TM)), and you’re right, most uninsured people can afford insurance buy don’t want to pay for it. Or as Cato says: “For these young, healthy individuals, going without health insurance is often a logical decision.”

    Cato:
    Advocates of a mandate argue that if we can mandate automobile insurance in order to protect society from the costs imposed by
    uninsured drivers, we should be able to do the same for health insurance.

    One bad idea deserves another. (Cato points out that mandatory car insurance doesn’t increase the number of people w/insurance).

    In fact, hospitals are legally required to provide care regardless of ability to pay.

    So, let’s see – we’ll force the hospitals to work for free, then, since people don’t really need to pay, we’ll force people to pay.

    Anyone see a “Road to Serfdom”-style downward spiral here?

  22. I also can’t wait to see how the government decides who exactly can “afford” health insurance. A healthy 20-year-old who can afford to buy insurance OR afford to save up for a house, but not both? Maybe he’s willing to risk going without insurance for a couple of years so he can save for his future, but guess what? That will be illegal.

    I am also wondering how this proposal will relate to Kerry Howley’s story linked here today, about people who DO have insurance but still end up screwed because the insurance basically only covers procedures minor enough that you could afford them without insurance anyway. If I’m going to be required by law to buy insurance, then will the insurance company be required by law to provide whatever services I need to cure what ails me? Not likely.

  23. Simon, I think “the basic fact underlying the problem” is that health care is an unusual economic good which, unlike most other goods, is price-inelastic with respect to demand (econ-wonks, did I say that right?) For most goods, when price goes up, you demand less. But for health care, you want it just as much no matter how much it costs. If you have a choice between a life-saving procedure and dying, you will be willing to pay an extraordinary cost.

    Then you add in two more factors: 1) Everybody has to die someday and, 2) Every day brings new, often exotic treatments. So you have more demand, more supply, and quixotically that danged desire-to-live thing keeps driving costs up.

    That’s the _basic_ problem, although I’ll grant you that greed and lawyers contribute to the quandary.

  24. “Cato points out that mandatory car insurance doesn’t increase the number of people w/insurance”

    But it sure as hell increases premiums: mine went 60% up when Alabama introduced mandatory insurance. Now, who do I sue? 😛

  25. Jennifer: I hear you. What’s your politically viable plan for stopping the slide to completely socialized medicine?

  26. Ah, the CATO Institute – mouthpiece of the American parasitical class…

    Says Michael “I Hate Our Constitutional Form of Government” Tanner:

    “On a fundamental level we must shift the health care debate away from its single-minded focus on expanding coverage to the bigger question of how to reduce costs and improve quality. That will require the introduction of market mechanisms to give consumers more control over and responsibility for their health care decisions.”

    Yeah, that’s what we need – more private profiteering off vital necessities! Hey, it’s working great in Iraq, huh?

    Here’s a market idea for ya’ – since the universities produce all the new meds and therapies anyway, how’s about we limit patents some more and get more meds and such over the counters? Is that market enough for ya’? I didn’t think so…

    This CATO bullcronkers is a pile of phony dung. They don’t care about free markets – they just want to profiteer off the “Insurance” (re: Investment Banking) industry and the parasite pharmies.

    “Lowering costs and thus making coverage affordable to more people is a great idea, but the political dynamic driving the debate is the fear by a large segment of the public that they will lose their health insurance and become bankrupt. That fear is what is driving us toward nationalized health care.”

    And when the Baby Boomers start getting a little elderly-er and all those bankruptcies start piling up because no one can afford the “market mechanisms” that are now driving up, and not down, costs, what shall we do then? More “decisions?” I’ve got news for you pie-eyed libers – there’s only one decision anyone wants to make regarding their healthcare – “fix me.”

    Jennifer, agentalbert, Chicagotom, SM,

    “I ask this question every time a “mandatory purchase of health care will solve the problem” proposal comes up, and I never seem to get an answer: if it is to be mandatory, then what will the penalty be for those who do not buy it? How will it be enforced?”

    Payroll tax.

    Dead Elvis,

    “The Fed and states already pay for nearly 50% of all heath care.

    Wow, I hadn’t heard this before. Just for my own education, where does this number come from?”

    You’ve been dead for too long Elvis. Look up the stats for just medicare alone and you’ll see. Let alone gov’t investment in R&D, charity care, etc.

    Van,

    “In this case, they will first disallow the personal tax exemption for those who can afford, health insurance, but do not buy it. Later they will impose fines on these people.”

    Yeah, and that’s the part of this Mass plan that I don’t like. All they really need is a payroll tax.

    Simon,

    “We can juggle the numbers on health care coverage all we want, but it won’t change the basic facts underlying the problem: We have X number of doctors, and they’re all booked. Doctors are a scarce resource, and their cost is largely based on that.

    Then factor in the lawyer problem.”

    Don’t be a goofus. That has very little to do with the rising costs.

    JMJ

  27. Jennifer,
    What kind of moon-man health insurance planet do you live on? You can get an HSA account with an $1800 deductable for $139/month for an individual here (http://www.ehealthinsurance.com). That cost is 100% tax deductable and the deductable amount can be invested in just about whatever you choose – you can overfund it and use it for retirement if you like. You can also find ones with no lifetime maximum – meaning they can’t stop paying after your catastrophic injury. Now, rates vary by state, but how can you say that HSA’s are only for “rich people”? It’s a matter of priority – do you want to pay to mitigate your risks, or not? I think HSA’s are great for younger, childless people – I would have loved to have that option before I had kids.

    As far as mandatory private health insurance, it’s the lesser of two evils, in my mind. That doesn’t mean I like it, or even think it’s a good idea. Do I have to choose?

  28. Don,

    And what of people who can’t afford $139 a month?

    JMJ

  29. Don Mynack, did you read Kerry Howley’s story today? Buy all the insurance you want–if something goes seriously wrong with you, they’ll find a loophole to explain why you’re not covered. I forget the statistic, but the majority of people who must declare bankruptcy for medical reasons HAD insurance. And when I was covered by a reputable HMO a few years ago, I still had to wait four months for something which required “immediate” treatment.

  30. I’d like to add to Jennifer’s point that the overwhelming majority of people who declare bankruptcy do so because of medical expenses.

    As for MSA’s, I have something similar called a flexible spending account, in which money is deducted from my taxable income and put into a an account with something like a debit card I can use for medical expenses. Problem is, the administrator’s computer automatically rejects all charges that differ, either up or down, from the copay for my health insurance. Thus, every time I use the account I have to provide additional documentation to the administrator. Sometimes I have to get the doctor to do so. Honestly I enjoyed dealing the with IRS more. Just because something is “private” is no guarantee of it’s perfection. I’d also like to note that I can’t change administrators; my employer gets to pick and they’re quite happy with this one.

  31. I’d like to add to Jennifer’s point that the overwhelming majority of people who declare bankruptcy do so because of medical expenses.

  32. JMJ
    Medicare/Medicaid
    IC

  33. Karen

    The study: commissioned by Harvard’s Consumer Bankruptcy Project claim “The three main reasons that families with children cite for filing for bankruptcy are medical problems, job loss and divorce.”

    “Half have experienced a serious health problem” (notice how it DOESN’T say medical expenses)

    Where do you get “overwhelming majority”?

  34. Ironchef–The Harvard study covers only families with children? Perhaps things are different for single people or couples without children.


  35. Jennifer: I hear you. What’s your politically viable plan for stopping the slide to completely socialized medicine?

    Comment by: Ron Bailey at April 7, 2006 03:02 PM

    I know you didn’t ask me, but here’s mine anyhow:
    – Remove the artificial number control on doctors that drive the supply of them down.
    – Remove the artificial gatekeeper status of doctors that require people to needlessly consult with doctors for most prescription drugs and minor treatments.
    – Severely curtail pharma companies from patenting drugs and procedures directly derived from taxpayer funded research.
    – Deregulate malpractice insurance for doctors and remove the requirement that they need such insurance.

    Sit back and enjoy as doctors and the healthcare industry claw at each other in trying to provide you cheaper and more efficient service.

  36. Let me also add that I view the doctor as gatekeeper to my personal well being through medication akin to a middleman who refuses to allow me to negotiate with an original seller of certain goods – all the while using government to force me to negotiate with the middleman for the goods and not with the original seller. In addition they supress the ability of the seller to get word out by outrageously regulating advertising. Thus making the doctor the middle man for the seller as well, and just like all middlement do, they rip off both sides to pad their pockets.

  37. I know you didn’t ask me, but here’s mine anyhow:
    – Remove the artificial number control on doctors that drive the supply of them down.
    …etc…

    Those are the right answers, but they’re not “politically viable”; I’ve been truly amazed at the reactions of most people when I mention those same ideas to them. (Then the same people will complain when they have to wait for an appointment to get some ‘scrip’ refilled.)

    http://www.post-gazette.com/pg/04219/357527.stm
    Health care bills sink the ship in maybe 1 out of every 20 bankruptcies, Zebley estimated.
    A study of 1,931 consumer Chapter 7 bankruptcy cases from 84 federal judicial districts in 2000 found that medical debt per debtor was relatively small at $2,582, or about 5.6 percent of the general unsecured debt. But among those with unpaid medical bills, there were 14 people in the study with huge health care debts, including one individual with $615,000 in medical bills, according to the study by the U.S. Trustee Program.

  38. What’s your politically viable plan for stopping the slide to completely socialized medicine?

    “effective politics” is an oxymoron.

  39. Alas, none of metalgrid’s suggestions would do much to address the principal problem; namely, that people believe they are entitled to more medical care than they are willing to pay for. Modern medicine is not only highly (skilled) labor intensive, it is also highly capital intensive. For example, there is a perceived shortage of nurses as well as physicians (at least there was the last time I checked), and there is comparatively practically no barrier to nursing school. MRI machines, etc. are expensive.

    I’m all for reforming copyright and patent law. If anything, recent changes have gotten progressively worse. But the last thing we should want to do is restructure the present system eliminating the profit motive from medical and pharmacological research.

    Ideally, adults could buy drugs (excepting perhaps antibiotics) without perscriptions and avail themselves of anyone offering medical services and physicians could freely choose whether or not to get malpractice insurance. But we don’t live in that world. The general public wants to be protected from its own ignorance and to sue whenever anything goes wrong. There wouldn’t be a large supply of malpractice lawyers if there wasn’t a large demand and the overwhelming majority of people are opposed to relaxing, let alone eliminating, the regulation of prescription drugs and medical practice.

    Mr. Bailey has asked for politically viable alternatives to the status quo or socialized medicine. I see mandatory minimum health insurance as, at best, a stop-gap measure because our history presents example after example of minor, tailored programs swelling over time. The only long-term alternative is a reduction over time in the labor and capital costs of medicine. Eventually, that will come, but in the meantime there is no politically viable alternative as long as the general population believes, as it increasingly does, in an open-ended entitlement to health care regardless of cost.

  40. But for health care, you want it just as much no matter how much it costs.

    This isn’t completely true. The healthcare market, like any other market has been shown to behave similarly: What you don’t pay for, you over use. I have witnessed this personally, and studies back this up. There’s a lot of overprescribing of medications, for instance, that wouldn’t occur if the price was felt more directly by the consumer.

    You are generally correct in the case of needed or catastrophic care- ie, I’m having a heart attack, I’m not refusing treatment as my body spasms on the floor because I’m concerned about cost- or I think I can get a better price elsewhere. There was a recent commercial (don’t remember the product) where a guy’s apartment was knee deep in water after a plumbing failure. The horrified plumber came in and was then grilled for a bid from the homeowner because he was ‘shopping’ for the best deal…

    Anyhoo, the medical markeet has simplicities and complexities like any real market. There are elements that are overused because they’re ‘free’- or costs are deferred.

    my wife works in a major hospital emergency room, and they see people arrive there because they have a common cold, or a mild case of the flu: sniffles, body aches. The doctor will give them the prescription you’d expect: fluds, bed rest, take two of these, call me in the morning. People show back up the next day saying “I’m not feeling better yet, fix me”. As you guessed, these people have 100% coverage.

  41. “Health insurance? No man, that’s way too expensive. Yeah, bartender, another round for my friends! So the other night we were at the strip club and I dropped like $500. It was crazy. Oh dude, you gotta check out the new speakers I got in my car…”

    Well, I’m sure that happens but a lot of the people I know who do the bar/speaker/stripper thing do have insurance. While someone lik myself does not consider health insurance a good value either- because it isn’t.. and I don’t spend my money on bars,cars,etc. I prefer to buy things that are valuable to me and who are you to decide that I should waste my money on your pet thing.

    How much is health insurance a month? Can you get it for me for about 5-6 bucks? If not, there is no point. In the last 4 years I have spent a total of a few hundred bucks on doctors ( I had insurance prior)..

    If the goal is to force me to waste money, then I guess this works just like car insurance. I have car insurance because if I don’t I lose my tags, get fined,etc. But I have never once benefited from having it. I have sent in a check every 6 months for the last several years for some liability BS insurance just so I can drive.

    I am a healthy person, so why would I spend more money in premiums than I would spend if I pay cash/check/credit at the doctor? IF I have some kind of accident that requires a large payment, unless its millions I will probably have the money saved ( I have the money saved becaue why? Yes, because I didnt blindly pay hundreds of dollars a month for a service I dont use).

    So, No I really cant afford Health insurance. For me buying lotto tickets would probably be a better and more moral investment. I would also rather be able to pay for things like house, food,etc. If you force me to buy heath insurance you are taking food from my family!

  42. “From the Pittsburghlive article and the Cato article:
    46 million Americans have no health insurance.”

    I have never understood the point of these statistics. Usually they are just taken out of cntext to equate “insurance” with “care” when they are not the same thing.

    If you are the type of person who pays for your own food, house, clothing,etc…then there is little difference with paying for your own health care ( and you may decided purchasing insurance is or is not a good value and make that decision yourself just like you decide what car, house, and cut of steak to buy).

    The more important statistic is not who doesnt have insurance, but who can’t obtain ( about 0) and/or pay for treatment. I would say if someone needs emergency treatment, pretty much 0% of the population does not have healthcare access. If they can’t pay, there are charity hospitals, doctors and hospitals will make payment plan arrangements, give uninsured discounts, or you can just not pay and file BK or sue for FDCPA violations and get it wiped out, or whatever.

    To me saying so many Americans don’t have insurance matters about as much as “46 million Americans dont have a country club membership”

  43. Karen–

    That statistic is little more than a lie, very ably fisked by Todd Zywicki at Volokh.

    http://volokh.com/posts/1108558247.shtml

  44. If the problem is a doctor shortage, why don’t we free up all those MDs working at abortion clinics by making it illegal?

  45. “Health insurance? No man, that’s way too expensive. Yeah, bartender, another round for my friends! So the other night we were at the strip club and I dropped like $500. It was crazy. Oh dude, you gotta check out the new speakers I got in my car…”

    -Half the people I know

    And there’s the real story about why a lot of people aren’t insured, but we never seem to have that debate.

  46. Sorry my message kept posting, some sort of computer issue.

    JACK-

    That was exactly my point. I’m not telling you what to spend your money on. Spend as much as you want on your “pet thing”, it’s your decision. And there’s the rub: IT’S YOUR DECISION. I have no problem with these people blowing everything they have on whatever instead of inurance, as long as they accept that they have made their decision. Unfortunately, that’s not how it works. They blow the money on whatever they want, and then complain it’s “not fair” that healthcare costs money when they need it, and now the rest of us are expected to pick up the tab when Hillary Clinton rolls out her sob story cases.
    I work in the restaurant industry, and know TONS of people who make pretty decent money (often on par with or greater than the salaries of their white-collar peers), but are 35 years old, living with roomates, carless, and perpetually broke. Meanwhile, those peers own homes and appear to be financially secure. How can this be? Because a lot (I dare say the majority of) restaurant people blow most of their money on partying 5-7 nights a week. They could buy health insurance, but instead they chose to do lots of coke. That’s fine with me if they want to do that,the fact that uninsured bartenders who pull 70K+ a year are counted in the statistics of “why we need socialized medicine”, I get pissed.

  47. Sorry my message kept posting, some sort of computer issue.

    JACK-

    That was exactly my point. I’m not telling you what to spend your money on. Spend as much as you want on your “pet thing”, it’s your decision. And there’s the rub: IT’S YOUR DECISION. I have no problem with these people blowing everything they have on whatever they want instead of inurance, as long as they accept that they have made their decision. Unfortunately, that’s not how it works. They blow the money on whatever they want, and then complain it’s “not fair” that healthcare costs money when they need it, and now the rest of us are expected to pick up the tab when Hillary Clinton rolls out her sob story cases.
    I work in the restaurant industry, and know TONS of people who make pretty decent money (often on par with or greater than the salaries of their white-collar peers), but are 35 years old, living with roomates, carless, and perpetually broke. Meanwhile, those peers own homes and appear to be financially secure. How can this be? Because a lot of (I dare say the majority of) restaurant people blow most of their money on partying 5-7 nights a week. They could buy health insurance, but instead they chose to do lots of coke. That’s fine with me if they want to do that, but the fact that uninsured bartenders who pull 70K+ a year are counted in the statistics of “why we need socialized medicine” pisses me off.

  48. “the AMA restricts the amount of people that get the title of “Dr”, so that the title retains its prestige and the amount they can charge.”

    I must point out that the AMA is a medical market player, not the government. When you talk about the free market, you are talking about this kind of manipulation. The only way to stop the AMA from doing this would be government intervention. (not sure I believe that this is a problem or the source of increased health care costs, but it that is your argument, you should think about what you are saying).

  49. science,

    Nope, federal and state laws mandate that only graduates of AMA-approved medical schools can become licensed physicians. Unsurprisingly, the AMA tells those schools how many students they should graduate, and no medical school which plans on remaining in business would risk incurring the wrath of the AMA.

  50. Crimethink
    Nope.
    Just because the government has decided to use a private market player’s certification as a license benchmark, doesn’t make the AMA the government. The government could just as easily set the quotas and require the AMA to meet them. In your response you make my point for me. Given the freedom, market players don”t always work in the best interest of society. They work, almost always, in their own best interest. Government’s role in the market is to make sure everyone is playing fair. That’s known as regulation.

  51. Crimethink,

    Unless you are advocating that we don’t need to license doctors and that it is the government license that is the problem. Maybe, but I don’t know if a freemarket license process is gonna work here. The competition model doesn’t seem to put pressure to create more doctors.

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