Obamacare

Obamacare vs. the Current Flawed System

The New York Times' Nicholas Kristof's tale of woe shows why real health-care reform is still needed.

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New York Times' columnist Nicholas Kristof tells the story of a college pal named Scott Androes who has Stage 4 prostate cancer and would have been better off, says Kristof, had Obamacare been around a decade or so sooner. "If you favor gutting 'Obamacare,'" writes Kristof, "please listen to Scott's story."

But what follows is no easy-peasy parable of universal coverage uber alles. It's equal parts wilfully stupid decisions on the part of Androes and—this is no small thing—health care costs being driven up by precisely the sort of regulations and bureaucracy that Obamacare will put on a heavy dose of steroids. Far from proving anything about the need and urgency of the Patient Protection and Affordable Care Act, it simply shows that even individuals with the means to pay for coverage and the sort of education that ostensibly creates responsible adults (the story endlessly rehashes the irrelevant fact that Kristof and Androes are Harvard grads) sometimes make awful, even tragic, choices.

At the end of 2003, Androes, a bachelor in his 40s, says he went through a "midlife crisis" and quit his job as a pension consultant. He writes that he "didn't buy health insurance because I knew it would be really expensive in the individual policy market." He later found part-time work (which didn't offer benefits) doing tax returns for H&R Block and by 2011 he "began having greater difficulty peeing. I didn't go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision."

It wasn't an infection, as Androes and the urgent-care doctor he eventually saw thought at first. It was cancer that had advanced very far. Androes is being treated as a charity case in a Seattle hospital:

The bill is already north of $550,000. Based on the low income on my tax return they knocked it down to $1,339. Swedish Medical Center has treated me better than I ever deserved.

For Kristof, the moral of all this is clear: "It would have made more sense to provide Scott with insurance and regular physicals. Catching the cancer early might have saved hundreds of thousands of dollars in radiation and chemo expenses — and maybe a life as well." And, of course, Mitt Romney is an uncaring proponent of a health care system that is "repugnant economically as well as morally."

However, the article, which includes Androes' reflections as well as Kristof's more pointed commentary, doesn't really come close to supporting such a conclusion. Kristof notes that Androes "could have afforded insurance, and while working in the pension industry he became expert on actuarial statistics; he knew precisely what risks he was taking." In choosing to remain uninsured while able to afford coverage, Androes is hardly alone. In 2006, for instance, about 43 percent of uninsured Americans were in households making more than 2.5 times the poverty line.

Androes himself writes:

Why didn't I get physicals? Why didn't I get P.S.A. tests? Why didn't I get examined when I started having trouble urinating? Partly because of the traditional male delinquency about seeing doctors. I had no regular family doctor; typical bachelor guy behavior.

I had plenty of warning signs.

So maybe if he'd been forced to buy insurance against his will, he would have also visited the doctor for annual physicals including prostate exams or at least blood screens for that sort of trouble.

Maybe, though having insurance and using it for the sorts of regular care (such as blood screens for PSA levels) that would have caught this problem early on are very different matters. Although Kristof quotes studies that conclude close to 30,000 people a year die prematurely due to a lack of health insurance, the link between having health insurance and having improved health is far from clear. When it comes to prostate and colon cancers, studies of Medicaid patients in Florida and elsewhere show that despite having insurance, covered patients actually fare worse than uncovered patients who are equally poor.

So having insurance is hardly the be-all and end-all that many supporters of a universal mandate presume. That's even more the case when you factor in the likely outcome that an increase in the number of patients without a corresponding increase in the number of providers will hardly make it easier for people to schedule routine examinations. Add to that the lack of strong correlation between what Obamacare critic John Goodman says is "the amount of health care inputs and the overall health of a population." Other studies show that relatively low life expectancies in the U.S. are due to lifestyle choices (smoking, diet, and the like) and accidents (especially driving ones) rather than access to health care. And even taking that into consideration, studies show that not having health insurance and not having health care are not the same thing (the uninsured consume about 40 percent of the amount of health care as similarly aged insured indivduals).

Kristof says that Mitt Romney would consign folks like his friend to death with nary a second thought. That's not quite right, either, and it shows how quickly health care debates get reframed in partisan terms. As governor of Massachusetts, of course, Romney pushed his signature reform which is the very model of Obamacare. Had Androes lived in the Bay State rather than Washington, he would have at least been paying for insurance whether he wanted to or not around 2007 or 2008. And for all his bluster about repealing Obamacare, Romney has already said that if he becomes president, he's happy to keep various aspects of the law, including the ban on denying care due to preexisting conditions.

The story Kristof tells is not a happy one, to be sure. If Androes had acted differently, his cancer might have been caught much sooner when it was more easily treated. Certainly, that would have cost less both in terms of heartache and anxiety and in terms of dollars and cents. But the fact is also that Androes is getting treatment—and in a way that is not bankrupting him. And if you have deadly cancer, you're better off on average to be in the United States than anywhere else in the developed world; the five-year survival rates for most cancers are better here than in Canada, Europe, or Japan.

What's missing from Kristof's piece—and from too much of the discussion about health care reform—is any sense of how the current employer-based system (which Obamacare does virtually nothing to change) came into being and how an actual market in the provision of health care (not even insurance per se) might improve the situation. Why do blood tests and basic checkups cost so much? It's not because markets are allowed to work; indeed, it's precisely because every aspect of the delivery system is wrapped up in more red tape than we can imagine or untangle. By adding more bureaucracy and oversight from afar, Obamacare will certainly increase many of the problems it set out to address. And there's no reason to believe that the law—whose cost estimates are already climbing prior to full implementaiton—will make care cheaper or better. It might make insurance universal (in name anyway), but that is hardly the point of either Kristof's story or any real reform (for that, read this 2009 piece by Reason Science Correspondent Ronald Bailey as a starting point).

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  1. Firsteen!

  2. Kristoff is the master of stupid anecdotes. I shudder to think what would happen if monstrous science were able to combine Kristoff and Friedman into one horrible, cliche-laden, anecdote powered editorialist.

    1. It’s alive! ALIVE!!!

    2. Yes….it would truly be a monster!

      But what a punchable face that monster would have…maybe more than one!

    3. And then imagine what would happen if that being had a child with a fusion of Krugman and David Brooks … *shudders*

        1. Worse… Matt Yglesias.

          1. Yglesias is too fat and sweaty. Fortunately, such a chimera would be a genetic mule. The downside is that it would reproduce much like Justine Bieber via budding.

          2. Now that’s just insulting. Yglesias isn’t as bad as, say, Krugman. Not that Yglesias offers much. But there’s occasionally something interesting.

    4. The creature would eventually generate an anecdote about a cliche-ridden anecdote about cliches. Round and round it would circle, self-reinforcing and consuming all the ink, paper and bandwidth in the entire world. It would then package itself into an dense informational weapon about nothing and roam the stars looking for other planet to stupefy, bore and then destroy.

      1. “Wipe out all thought? My God, they’re like flying televisions!”

  3. Obamacare doesn’t really matter anyway, since we won’t have enough primary care doctors, and many of the ones we have right now are so fed up they’d rather chuck it all and ride the rails as hobos.

  4. At the end of 2003, Androes, a bachelor in his 40s, says he went through a “midlife crisis” and quit his job as a pension consultant.

    I haven’t finished the article yet… but a guy who made spectacularly stupid financial planning decisions was a pension consultant? I’m beginning to see through the haze of the nation’s public pension crisis…

  5. Why didn’t I get physicals? Why didn’t I get P.S.A. tests? Why didn’t I get examined when I started having trouble urinating? Partly because of the traditional male delinquency about seeing doctors. I had no regular family doctor; typical bachelor guy behavior.

    Why are we in such a hurry to bankrupt ourselves in order to help the stupid? I forget.

    1. Because the Stupid need love, too.

      It just appears they need a little more love than the rest of us.

      1. I’ve got plenty of love to give.

        Money and patience for the damned? Not so much.

    2. The Stupid are our future.

      1. I believe the stupid are our future
        Feed them cake and let them lead the way
        Show them all the idiocy they possess inside

    3. Because nobody should have to be responsible for a bad decision when there’s someone else you can hang it on instead.

    4. Why are we in such a hurry to bankrupt ourselves in order to help the stupid? I forget

      Not only that, but the idiot is getting medical care. Apparently excellent card because he is still alive despite the advanced state of his cancer when it was detected.

      And said care is not bankrupting him, like that should be a concern at all when your life is on the line, but I digress.

      So we’re supposed to believe that he would be metaphysically better off if someone had forced him to buy a product that he did not want. Or that society would be better off if the insurance company had taken a loss on him instead of a charity.

      And to enforce this theoretical betterment we are going to further distort the health care industry with unintended negative consequences for everyone.

    5. I have a good friend who has medical care and has not gone to doctor more than a few times in 30 years.

      My wife is about the same. I have to coerce her into going to the doctor every 5 to 10 years. But is she goes to a regular doctor, then she doesn’t go to the GYN for another 7 years. Only time she went to doctor was when she was pregnant.

      1. Libertarians are the masters of stupid, unbelievable anecdotes.

        WELL MY WIFE DOESN’T GO TO THE DOCTOR EVER, SO

        Nobody cares, dumbass. Your wife is stupid and stubborn, and most people need to go to the doctor more often than her. I guess she’s just one of the Randian ubermenches while the rest of the proles deserve to die.

        And this is coming from someone who doesn’t support socialized medicine.

    6. The better thing to look at is that Kristol admits that private charity has knocked his buddy’s healthcare costs from $550,000 to just over $1k. Still, he doesn’t see that you don’t need an expensive big govt program. This is actually an anecdote supporting Ron Paul’s assertion that Americans are the most charitable people in the world. They don’t need the govt to do take care of them.

  6. The bill is already north of $550,000. Based on the low income on my tax return they knocked it down to $1,339. Swedish Medical Center has treated me better than I ever deserved.

    Again, haven’t finished yet, but uhm, is the suggestion that with Obamacare, the treatment wouldn’t have cost $550,000?

    Kristoff’s friend only had to pay $1,339 of a half million dollar bill sans Obamacare, far lower than even his insurance premiums would have been.

    So if the assertion is that it still would have cost $550,000 with Obamacare, then the only argument left is who would have paid the $550,000 bucks. In this case, Swedish covered it. In another case… the federal government would have covered it? I’m now going to finish the article. God have mercy on my soul as I wade in.

    1. Amusingly, considering my post below, with my plan, it would cost me $2k (or $2.5k — I forget my annual deductible) out of pocket (or out of HSA, actually). Plus the premiums.

      Im thinking he made the smart financial decision, but a stupid health decision.

    2. No, the suggestion is that more people would have contributed to his medical care bill, Paul. Enjoy your soon to sprout anger ragboner over this man’s overdeveloped sense of perpetual adolescence.

    3. Guess it’s time to go back that career you gratuitously threw away in your mid-40s because you were “having a midlife crisis”.

      1. I threw my career away much earlier than that.

        1. Everyone is free to do so of course, you just shouldn’t throw your career away and then whine that you’re not able to pay for things anymore.

          Waaa! I’m having a mid-life crisis! Waaa! I need a new muscle car! Waaa! But I can’t pay for it AND quit my career! Waaa! Why can’t I have a Mustang AND flip burgers at Roy Roger! Life is so unfair waaa!

          It’s articles like this that make me think “having a mid-life crisis” is some sort of period where middle-aged guys regrees into adolescence.

          1. It’s articles like this that make me think “having a mid-life crisis” is some sort of period where middle-aged guys regrees into adolescence.

            Uhm, I think that’s exactly what a mid-life crisis is. And it’s why we laugh at guys who go through it. And then fork over our hard-earned cash when they refused to buy insurance.

    4. No, the point is that when people are making choices between money and health care, they often make poor choices. If getting physicals and preventative care is cheap, then cases like this get caught when it’s cheap and easy to treat.

      In other words, he’d be healthier and the health care costs would be lower and there’d be more resources to treat the much smaller number of people that don’t respond to early intervention.

      1. If getting physicals and preventative care is cheap, then cases like this get caught when it’s cheap and easy to treat.

        Unfortunately, too many people have reinvented the word “cheap” to mean “things I don’t have to pay for.”

        If physicals and preventative care are expensive, it’s due in no small part to health insurance and government subsidies being used for an increasing number of services that they wouldn’t have been required for 50 years ago.

        1. You’re misunderstanding.

          If people don’t have to consider the financial costs to get preventative and regular care, they are more likely to do so.

          If they do so, costs come down for all of us.

          The story here is a classic example of that. The system, some how, has to absorb the $500k cost. If, instead, he got care earlier, the cost would have been much lower.

          I disagree with your claim that uninsured visits for health care are expensive due to government subsidies. Can you back up that claim with any proof?

          1. I disagree with your claim that uninsured visits for health care are expensive due to government subsidies. Can you back up that claim with any proof?

            I see you deliberately ignored the whole statement:

            If physicals and preventative care are expensive, it’s due in no small part to health insurance and government subsidies being used for an increasing number of services that they wouldn’t have been required for 50 years ago.

            If you don’t think these are linked and at the source of rising health care costs–how many uninsured people actually go to the ER for treatment?–then there’s really no sense in trying to enlighten you. You clearly believe that government should be the main source of all healthcare spending.

            1. No. I do not believe that giving people access to health care increases the cost of health care. If it did, then countries with socialized medicine would pay more for health care than we do. They don’t.

              If you believe it’s an absolute truth you should be able to prove it rather easily. Saying “there’s no sense in trying to enlighten [me]” sounds like an admission that you believe it’s true but can’t prove it.

              1. No. I do not believe that giving people access to health care increases the cost of health care. If it did, then countries with socialized medicine would pay more for health care than we do. They don’t.

                We have all the access to healthcare we could ever wish for. The question is who is going to pay for it.

                If you believe it’s an absolute truth you should be able to prove it rather easily

                Federal spending on healthcare has gone from $50 billion in 1980 to over $800 billion today. Are you telling arguing that those increases are due solely to the private health insurance market or people not owning insurance? If so, you should be able to prove that rather easily.

                1. “We have all the access to healthcare we could ever wish for. The question is who is going to pay for it.”

                  That’s simply not true. We have as much access to health care as we can afford to pay for (and yes, health care paid for by private insurance is health care you have paid for). After that it’s the ER. The ER is not health care. It’s disaster recovery.

                  “If so, you should be able to prove that rather easily.”

                  Sorry, I didn’t make the claim, you did. Prove, as you claimed, that providing access to more health care increases health care costs.

          2. The price of advanced diseases will come down, but the price of insurance will go up. So even if you are one of the people who would be better off financially if you bought a high-deductible plan and paid for preventive care out of pocket. Even if you are one of the people who is responsible and rational enough to do that, it won’t matter. You’re going to be forced to pay the same price for insurance as the irresponsible and irrational, and your going to be forced to buy a plan that covers free preventive care. And all of that is going to end up costing you more in the long term than it would have if you’d had the freedom to buy a minimal plan and pay out of pocket for preventive care.

            1. I don’t believe that the cost of the type of plan you are talking about will go up. As insurance companies spend less on health care (because catching the disease earlier leads to lower costs for a cure), due to provisions of the ACA, they need to lowere their rates or give you a rebate.

              The only way that wouldn’t be true is if, to use the example in the article, the cost difference between catching the cancer early and the current cost is lower than the cost of early care for people that don’t have cancer. I think that’s highly unlikely.

              1. Not if you are a low risk person.

                Let’s say your low risk and responsible enough to pay for peventive care out of pocket. Then you could eaisly get by with a cheap high deductible plan, and the cost of paying for the preventive care will be much lower than the cost of paying for a comprehensive plan. So you are better off financially.

                What ObamaCare does is force you to purchase a comprehensive plan that covers free preventive care, vastly increasing your monthly health insurance bill. You aren’t gaining any healthcare advantage because you would have gotten the preventive care anyway. You aren’t getting any financial benefit because you would have had a $5,000 deductible anyway. All it does is force you to spend more on insurance.

                1. If you are already in a high deductible plan, under the ACA, you can keep it and they must provide you with free preventative care.

                  BTW, people with high deductible plans are more likely to have medical debt (http://www.irs.gov/publications/p502/index.html) and go bankrupt due to medical costs (http://goo.gl/UtWwS ) than anyone else.

                  In other words, people that take that risk, raise the costs for everyone else.

      2. Again, constant and ongoing preventive care isn’t cheap. It’s actually quite expensive to have a Doctor staring up your ass 24×7.

        1. Yes, constant care is expensive, since you only get it in a hospital or nursing home.

          Regular preventative care is much cheaper than the alternative.

          1. Are you sure? Can you point to the studies that show this to be true?

            1. No, but there are studies that show preventative care is more expensive. The problem is looking at one individual’s situation where catching something early may have lowered the cost of treatment then assuming that would be true for everyone, and should therefore dictate policy.

              But the cost of everyone getting repeated preventative care, which happens when it’s “free” outweighs the cost of treating the people that actually have something to treat.

              1. http://www.nejm.org/doi/full/10.1056/NEJMp0708558

                “Some preventive measures save money, while others do not, although they may still be worthwhile because they confer substantial health benefits relative to their cost. ”

                And http://jama.jamanetwork.com/ar…..eid=183301

                “The proper question for a preventive (or therapeutic) intervention is how much health the investment purchases. “

      3. Not if he avoids physicals because of, and I quote, “the traditional male delinquency about seeing doctors. I had no regular family doctor; typical bachelor guy behavior.”

    5. The feds wouldn’t have covered it under Obamacare. Those dirty rich capitalist insurance companies would have rather than a private charity. That’s better, right?

  7. At the beginning of this year I quit my job in my early 40s.

    I had insuranced lined up before I quit, it overlapped for about 2 weeks, in fact.

    Individual policies arent THAT expensive if you live in a reasonable state. My catastrophic plan with an HSA costs me $135 per month plus whatever I put in my HSA.

    Doofus was a doofus.

    1. Doofus was a doofus.

      Therefore, we must create a mutli-trilion dollar, impenetrable bureaucracy to save these doofuses from being doofuses.

      We must never be allowed to learn from our mistakes or the example of others.

    2. But it doesn’t take much of a change in the story to put a non-doofus in his place and come out just as doofy. So, for instance, what if in the 1st year on your individual policy you developed a serious chronic condition that was expensive to manage (but would take years to kill you if it ever did), and your policy would not be renewed the next year? You’d be just as doofed up without having been a doofus.

  8. Why didn’t I get physicals? Why didn’t I get P.S.A. tests? Why didn’t I get examined when I started having trouble urinating? Partly because of the traditional male delinquency about seeing doctors. I had no regular family doctor; typical bachelor guy behavior.

    I had plenty of warning signs.

    I hate this man. Thank you Nick, for yet another solidifying anecdote to bolster my upcoming departure.

  9. “Swedish Medical Center has treated me better than I ever deserved.”

    Well – ya got that part right. Dumbass.

  10. my brother-in-law and father-in-law are both optometrists and they have the type of “catastrophic plan” that has iirc a 5k deductable. so, essentially they pay for all the small stuff, but if disaster hits (like this year, my medical costs have been over 100k — all paid by insurance) they have coverage. cost is pretty reasonable.

    will obamacare prevent them from continuing with such a plan? i’m not grokking how it affects such plans.

    1. I’m not sure, but I have heard that such plans are getting harder to find or more expensive. And I don’t think that they would qualify as the mandated insurance once that kicks in. So that sort of plan is probably on its way out. Which sucks because that is what health insurance should be. You know, actual insurance against things you don’t want to have happen.

      1. It doesnt fit the mandate. Im going to try to avoid changing mine though.

        1. thanks for the informative responses.

          they both roll their eyes at my govt. teat health care plan (60 free massages a year, 35 free chiro visits), but their health care plan seems to be the height of self sufficiency, common sense, and frankly the “american way” – freedom of choice. heck, they probably pay more in church tithings than they do in health insurance (LDS), and they know they won’t be bankrupted for 5k so why pay for a plan that micromanages all the small stuff. THEY manage the small stuff, and have peace of mind if/when disaster strikes. makes sense to me.

          if obamacare eliminates this kind of choice, that’s just disgusting. it’s just WRONG on so many levels

          1. My spouse’s school pays $21,000 for our family plan. That’s insane. I was self-employed for 4 years before my spouse went back to work, and we paid $3,500 per year for a family plan with a $2,500 deductible / person (3 people).

            So let’s see, pay $7,000 max plus routine doctor visits or pay $21,000 for the “convenience” of being able to go to a doctor at will.

            As far as I’m concerned, this is everything that’s wrong with health care in America. Ludicrously lavish health plans offered by employers, with very little opt-out incentive(*), for people who prefer not to budget expenses and deal with the “inconvenience” of shopping around for providers.

            (*) I get 1,000 a year for opting out of my current employer’s plan. Whoopdee-shit.

            1. my agency pays 100% of my plan. it’s 15k a year. spouse and children are covered at no additional cost. iow, same cost if single or married with 5 kids.

              my max payout in a year is … wait for it… just under $500. after that, EVERYTHING is covered 100%. prior to that, 90%.

              ditto for spouse and each kid. like if we all had surgeries etc. totaling 50k each. we’d have a max out of pocket of under $1500

              plus, we get 60 massages a year (90%-100% coverage), 35 chiro visits, and lots of other good coverage. hey, i even get mental health benefits 🙂

              🙂

              it IS ludicrously lavish. and there is NO opt-out incentive.

      2. I have heard that such plans are getting harder to find or more expensive.

        Because they don’t qualify under PPACA.
        Unless they are grandfathered in, you still have to pay the “tax penalty”.

    2. These plans are typically called Consumer Driven Health Plans or CDHPs. They will not survive under Obamacare because they do not pass the actuarial value test which is that the plan design covers at least 60% of the average members cost of care. The high deductible part makes that almost impossible.

  11. The friend even admits that he doesn’t deserve the care he is getting.

    And, he is, in fact, getting the care he needs. Even without insurance.

    1. Yeah, I admit I can never wrap my head around the argument.

      “We need Obamacare, because look how much my care would have cost me had I paid the bill for the care I got!”

      Is that what it comes down to with Obamacare? We’ve already agreed we’re going to waste our money on hookers and blow, now we’re just negotiating price?

      1. Nobody is making that argument.

        People make bad choices when determining cost vs. benefit for health care.

        If the barrier to getting health care is low, then regular or preventative care is more likely, and it decreases the instances of catastrophic care.

        It’s much cheaper to pay for years of physicals and early diagnosis cancer then it is to pay for cases like this.

        Look, this guy’s choices were bad, but are the norm, not the exception. We can either pretend that people make rational choices, or we can deal with the reality of human nature.

        Pretending leads to high health care costs for all of us, because each of us is paying for this bill, and others like it.

        1. Ah the old “people are stupid, but Washington has the best and brightest” argument.

          I have no interest in structuring society around the assumption of stupidity, even if that means dead bodies everywhere.

          1. Nope, that’s not the argument.

            The argument that this article makes, that people will make rational choices, though, is wrong. There a huge chasm between that and being stupid.

            I have no interest in structuring society around the lie of rational choice and health care.

            1. SOME people will make rational choices. Why are you taking the option of making those rational choices away?

              1. Because the norm leads to lower health, greater number of deaths, extra suffering, and higher costs for everyone.

        2. Look, this guy’s choices were bad, but are the norm, not the exception. We can either pretend that people make rational choices, or we can deal with the reality of human nature.

          Then that means the following choices:

          1) Go back to a cash-based payment system, and forbid insurance from covering anything other than emergency medical care–as in, “If I don’t get this treatment, I will die.”

          2) Implement a single-payer system with heavy rationing. The notion that healthcare is a “right” does not survive a single-payer system, because the state only provides coverage for what it can afford to pay. If you get a heart attack from guzzling Mountain Dew like mother’s milk and eating little chocolate donuts all day, too fucking bad–your family better hope you drew up a will before your heart exploded.

          Obamacare is a loser precisely because, like the stimulus, it doesn’t address the actual problem it’s attempting to resolve.

        3. Not everyone makes irrational choices.

          If I’m rational enough to buy a “catestrophic only” health plan for

          1. Server squirrels.

            If I’m rational enough to buy a “catestrophic only” plan and pay out of pocket for routine care, why should I be forced into a system designed around people who aren’t rational, don’t even buy minimal coverage, and can’t be insurced to get preventive care unless it’s free?

            You’re arguing that the system should assume, preemptively, that I’m irrational and force me to buy coverage designed around the assumption that everyone is going to be maximally irrational all of the time.

            It provides no benefits to people who ARE rational enough to buy coverage and ARE willing to pay out of pocket for routine care. it basically makes it completely not worth your while to exercise any kind of rational decision making. It incentivizes letting the state take care of you instead of making rational personal health choices.

            1. It will probably lower your rates over time as your insurance plan no longer has to subsidize the poor choices of others.

              1. That is not accurate.
                If you allow insurers to charge risk-based premiums (something ObamaCare forbids), then your rates will go down if you get the preventive care. That’s one thing many insurance companies offer. If you lower your risk by (say) not smoking, getting regular checkups, etc. your lower risk of having an expensive illness later is already factors into the cost of your insurance.

                ObamaCare explicitly forbids this. Insurers are not allowed to vary premium levels according to individual risk. They must charge everyone the same rate, whether or not they get preventive care. The only thing they are allowed to vary rates for is for tobacco use. (Not even heroin addiction.)

                So, again, you’re paying the same price, for an expensive comprehensive plan that covers free preventive care, even if you get the preventive care, even if you are iwlling to pay out of pocket for preventive care, and thus could get by with a cheaper plan. It thus destroys incentives to actually BE rational and responsible, and throws all the people who might be rational and responsible in the same pool as people who can’t bother going to the doctor unless it’s free. It destroys any financial advantage you might have gained from being responsible, and forces those people to subsidize treatments for everyone else.

                1. If … If … If ….

                  Sorry, that’s just not compelling when compared to the real market dynamics of health insurance and health care.

        4. It’s much cheaper to pay for years of physicals and early diagnosis cancer then it is to pay for cases like this.

          In the aggregate, I’m not sure that statement is correct.

          1. I believe it’s been studied and it’s not entirely correct.

  12. Hey, squirrels – thanks for eating my touching story of my brother who died at 29 under basically the same circumstances (avoided care – when he was INSURED even – and died from the cancer like Forrest’s mom).

    Moral of the story – neither my brother’s poor decisions nor Kristof’s little buddy’s have anything to do with the present shitty health billing process in the US, which will only continue to worsen under Obamacare. Their bad decisions are just – their bad decisions.

    FUCK

    1. Predicted Liberal response: Sure! Blame the victim!

  13. I read that yesterday (part of it, anyway). “Mitt Romney gave my childhood pal CANCER!” apparently.

    No evidence Kristof understands the difference between health care and insurance.

  14. So maybe if he’d been forced to buy insurance against his will, he would have also visited the doctor for annual physicals including prostate exams or at least blood screens for that sort of trouble.

    The only conceivable way to pretend this is true is if he suffered from the idiotic “Well I paid for it, so I’m gonna use it ALL” disease.

    Also, somebody should tell Kristof the mortality rate is still 100%. People die every fucking day, from falling off roofs, drowning, electrocution, car crashes, and genetic misfortune.

    1. Also, somebody should tell Kristof the mortality rate is still 100%. People die every fucking day, from falling off roofs, drowning, electrocution, car crashes, and genetic misfortune.

      “But my smart as a rock friend shouldn’t have to die NOW!”

    2. The mortality rate isn’t 100%. The mortality probability is 100%.

      /pedant

      1. Well, so far, 100% of people whose lives have ended have died.

    3. the idiotic “Well I paid for it, so I’m gonna use it ALL” disease

      Right. It’s kind of a perverse way of forcing everyone to get annual screenings, because they’re paying through the nose for insurance, so they might as well use it for SOMETHING.

      Yes, it will reduce epxnsises for a small percentage of people who will catch something early. But it will also mean that the doctors office will be clogged with people getitng routine screenings for anything that might be useful.

      At some point, people have ot take responsibility for their own health.

      If you can’t bother to go to the doctor when you start having trouble peeing, because you’re afraid of a few hundred dollars expense, that’s your problem. Why should the rest of the country design it’s health care system around your irresponsibility?

      1. Shorter, why should the responsible be forced into a system designed for the irresponsible?

  15. I’ve read that article.

    I can say the first willfully stupid decision his friend made was to quit his job because of “a mid-life crisis”.

    if you’re going to be self-indulgent enough to decide to giveu p your career when you hit 45, to go find yourself, you should realize that one of the things you’re giving up is the ability to pay for your own health care.

    Do we really wnat a system where people are encouraged to drop everything in mid life, abandon their jobs and careers and go “find themselves” – at public expense? Because any time you say “that’s ok, society will pick up the bill for your health-care/retirement/kids” that’s what you are doing. A society where 45 year old men can decide to quit their job an indulge themselves in a “midlife crisis” is a society where adult men have no responsibility for their own financial future. That’s really what we’re doing. Making it okay to go be a fucktard at 50 because your having trouble dealinth with mortality. By giving you a hefty safety net so even if you drop your health insurance, burn through your savings and assets, you’ll still be taken care of.

    1. Also,

      It means that we are supposed to places a higher value on his health than he does.

  16. “It’s equal parts wilfully stupid decisions on the part of his friend and?this is no small thing?health care costs being driven up by precisely the sort of regulations and bureaucracy that Obamacare will put on a heavy dose of steroids.”

    1) I can’t believe you’re criticizing people for their own behavior. Don’t you know that being a victim (of cancer or anything else) indemnifies victims against any sort of personal responsibility? It’s like the first clause in the contract!

    2) Your observations about how more of the same bureaucratic fluff isn’t the solution to the problem sounds like a desperate gasp of someone who thinks ObamaCare is about helping sick people or the poor. They’re siccing the IRS on people who would rather try to keep their homes than buy health insurance!

    ObamaCare may have been about helping the uninsured at some point, but now it’s just about glorifying great Obama almighty. You can’t mess with the narrative–it’s already scripture.

  17. Side note: another problem with the current system is that, because everyone letst heir insurance pay for everything and has no idea what it acutally costs, people assume that routime medical care is very expensive.

    It really isn’t. You’ll pay $100 or so out of pocket for an annual office visit checkup. A prostate cancer screening, I’m not sure how much, but I doubt it’s more that $200. You only do this once a year, so it’s small potatos.

    The worst thing the current system has done is make people unable to budget for routine health care the way they do for the monthly cable bill. People will pay $80/month for cable or $100/month for electricity, but an annual cancer screening for $100-$200 busts their budget because they think of it as an “unexpected” expense. They don’t plan for routine care.

    1. Yeah, that’s the thing. If you don’t go to the ER, the routine stuff is not so expensive. $100 out of pocket is a lot for some people if it is totally unexpected, but there are very few people who won’t be able to put that much aside for a checkup every few years or the occasional need for antibiotics or something like that.

      1. Right, it should figure into your monthly budget. At some point you have to make a choice Do you pay $20 extra for premium cable, or do you put that $20 aside to pay for you dental checkup and your annual physical?

  18. Sorry, as far as I can tell your argument comes down to a flawed idea and an unproven claim.

    Your flawed idea is that making bad choices on cost vs. benefit for health care and insurance is anything but the norm. Humans have a very difficult time with these kinds of decisions. Public policy needs to keep that in mind, otherwise we all wind up paying more for our beliefs in a fantasy world where nearly everyone makes the right choice.

    Your unproven claim is “Why do blood tests and basic checkups cost so much? It’s not because markets are allowed to work; indeed, it’s precisely because every aspect of the delivery system is wrapped up in more red tape than we can imagine or untangle.”. I believe that regulation is part of the cost, but insurance overhead is larger. Regardless, Obamacare should make both cheaper, not more expensive.

    If both of these are wrong, and I believe they are, your entire argument melts away.

    1. I believe that regulation is part of the cost, but insurance overhead is larger. Regardless, Obamacare should make both cheaper, not more expensive.

      How is making insurance cover routine care going to make routine care less expensive? You hide the costs from patients and they will stop caring what it costs. You make it mandatory for insurance to pay for it and doctors will charge whatever they want. Why is this difficult to understand.

      Costs are spiraling because consumers are insulated from price signals and third parties are being forced to pay for things without having nay control over the decisions. This is simple. This is easy to understand.

      1. “Costs are spiraling because consumers are insulated from price signals and third parties are being forced to pay for things without having nay control over the decisions. This is simple. This is easy to understand.”

        It may be easy to understand, but is it right? No, it’s not.

        1. Well, ObamaCare is permanent institutionalization of that system. So, WTF?

          You’re arguing that we need to make third parties pay for people’s preventive care, because otherwise people won’t get preventave care because they’re just too lazy and irresponsible to do it. We have to force them to buy insuance and force the insurance company to give it to them for free.

          That’s gaurenteed to make preventive care more expensive, not less.

          1. “You’re arguing that we need to make third parties pay for people’s preventive care”

            Nope, I’m saying we, as a society benefit when we make it easy for people to choose to get preventative care.

            “That’s gaurenteed to make preventive care more expensive, not less.”

            Perhaps, but it will decrease health care costs overall.

            1. You’re doing that by forcing people who are rational and responsible enough to buy preventive care when they need it to subsidize FREE preventive care for people who can’t be bothered to get it unless they don’t have to pay a cent.

              Are you aware of how ObamaCare regulates insurance premiums? Are you aware that everyone is required to buy a comprehensive plan that covers FREE preventive care, even if it would be cheaper on average for you to buy a high-deductible plan and pay for preventive care out of pocket?
              So even if you WOULD be rational and responsible enough to pay for preventive care, you’re going to be FORCED to pay for the all-encompassing comprehensive plan?

              You complain that people aren’t rational enough to get preventive care unless it’s free, and then you remove any incentive for them to get preventive care unless it’s free by making them pay the same price for insurance anyways. You’re destroying all the financial benefits of being responsible enough to buy insurance and get preventive care even if it’s NOT free. You’re simply taking that option completely away from people.

              1. Perhaps, but it’s also quite possible that your costs will go down.

                Look, I don’t really care about your freedom to choose an insurance plan. Is that really an issue for you? I suppose in some kind of academic way you could make a case that it infringes your rights, but so does having a speed limit on a road.

                1. It’s quite possible that your costs will go down if we enact sodomy laws.

                  I don’t really care about your freedom to spread HIV through buttsex. Is that really an issue for you? I suppose in some kind of academic way you could make a case that it infringes on your rights, but so does having a speed limit on a road.

                  1. What a ridiculous comment. You can’t compare choosing health insurance (not even health care choices, but insurance choices) with something as central to a person’s life as ones sexuality.

                    1. What a ridiculous comment. You can’t compare creating a massive, over-arching government bureaucracy that will end up costing taxpayers trillions of dollars while further cementing the power and authority of the federal government to having speed limits.

                    2. I didn’t. I compared regulations on what kind of health insurance you can have to what speeds you can drive.

                    3. What do you think Medicare, Medicaid, and Obamacare are? Because those “regulations” do exactly what I describe.

                    4. You’ve changed the subject.

                      Are those large government programs? Yes. Are they relevant to the question of whether government regulation of health insurance takes away a “freedom”? No, they are not.

    2. Mighty big “should” there, friend. And us libertarians tend to think (based on experience) that anytime government gets its clumsy paws on something, the price goes way up and the benefits go way, way down.

      Why couldn’t the govt prove its ability to lower costs and improve benefits with the VA, medicare and/or medicaid?

      1. “Why couldn’t the govt prove its ability to lower costs and improve benefits with the VA, medicare and/or medicaid?”

        It can and it has.

        1. Medicare is the greatest demonstration of why having an open-ended “right” to healthcare causes exponential cost spiraling. The epidemic of medical inflation began in the 60s from the very beginning of the program.
          Any savings are piecemeal, isolated, cherry picking. The overall trend is Medicare costs spiraling out of control and driving inflation in the healthcare market in general.

          1. Worse than that the costs are not easily directly attributable to Medicare as so much of the costs of the program are shifted by providers from Medicare to private insurers.

        2. It can and it has

          Are you fucking kidding? Have you actually seen how much federal spending on healthcare has shot up the last 30+ years? It’s at a 9% annualized clip.

          1. And is doing better than private insurance – http://goo.gl/Pl5FI

            And it’s not due to cost shifting, either – http://goo.gl/jklNz

            1. Private insurance != free market insurance.

              1. Yeah, let’s all believe in the fantasy of free market… Look, we don’t have a completely free market. We never will, so let’s talk about the real world, shall we?

    3. I believe that regulation is part of the cost, but insurance overhead is larger. Regardless, Obamacare should make both cheaper, not more expensive.

      Having to take on anyone regardless of their health history will not lower the cost of health care. You don’t introduce greater complexity to an already complex system and expect it to be easier to maintain, and you don’t add more people onto a health care plan and expect health insurance companies to not add to their administrative overhead to make up for the case load.

      And in any case, if you can’t refute the article linked below with actual facts and figures, then there’s really no sense in trying to make your case.

      http://www.oftwominds.com/blog…..07-09.html

      1. That article makes the same error I posted above – people do not make ration choices on cost vs. benefit when it comes to health care.

        1. Some people DO make rational choices.
          Why should those people be forced into a system that is designed for the irrational?

        2. That article makes the same error I posted above – people do not make ration choices on cost vs. benefit when it comes to health care.

          Maybe we should do what the article suggests–get rid of the subsidized healthcare systems–and actually find out.

          Try again, dumbass.

          1. Why should we try a system that we already know doesn’t solve the actual problems?

    4. Your flawed idea is that making bad choices on cost vs. benefit for health care and insurance is anything but the norm. Humans have a very difficult time with these kinds of decisions. Public policy needs to keep that in mind, otherwise we all wind up paying more for our beliefs in a fantasy world where nearly everyone makes the right choice.

      This is the same tired argument that was trotted out when HMOs were created. They were supposed to be a cure for spiraling healthcare costs, but ended up being a complete trainwreck.

    5. No, sorry. Regulations are the killer. Regulations are why I spend more time typing notes than seeing patients. Regulations are why I have to write 4 pages of crap every visit. And please don’t assure me that this is because I’m not computer savvy, or because I don’t use an EMR. I am, and I do.

      The red tape IS the problem. Put it this way. Every patient I see, I have to fill out the equivalent of a tax return. And if I get it wrong, I’m liable for both civil and criminal prosecution.

      Regardless of what you “believe,” Obamacare will dramatically increase both regulation and overhead costs.

  19. There’s not a person alive in this country who wouldn’t see a doctor if he had trouble urinating. None. Well, except for this guy, who made an effort to NOT see a doctor by fearing out of pockets, instead of visiting free clinics or taking advantage of various programs. My unemployed mother was checked twice for cancer in the last 3 years, with little money leaving her pocket.

    If every single American (300 million plus) visited the hospital just once a year to get checked for cancer, that will result in lowering health costs?

    1. out of pocket costs

    2. Not only that, but we could easily train people to do rectal exams on each other (hard to do yourself) the way they did with breast self-examination (which unfortunately turns out to be ineffective). It’s not a difficult skill to do rectal exams, which can detect not only prostate tumors but also rectal ones; a high percentage of colorectal cancers are within the palpable zone by a long finger; it’s just that we’re not limber enough to bend over and still get a finger in there to any decent height in ourselves.

      It’s also cheaper to get a stethoscope y sphygmomanometer to check your own blood pressure than it would be to see the doctor a few visits for it.

  20. According to Lancet Oncology, the 5 year survivor rate for prostate cancer in the U.K. is 41%. Whereas the 5 year survivor rate for prostate cancer in the U.S. Is 91%. Socialized health care run by the Government may lead the stupid, fat, lazy, drunk feel as if the government loves them, but not so much if they get cancer of the ass.

    1. Unfortunately the prostate cancer survival figure is extremely prone to misinterpret’n because the earlier you detect any fatal process even if you do nothing for it, the longer survival from that time will be! It may be just a matter of developing longer range in predicting the means of someone’s death.

  21. Just for interest, I plugged into ehealthinsurance.com, and asked for quotes for a 52 year old in Seattle.

    There were 35 plans, with varying deductibles and so forth, starting at $200/month. So for the price of 2 lattes per day, this dumbass could have gotten insurance.

    So aside from the fact that insurance doesn’t equal medical care, he could have easily purchased coverage. He didn’t, because he’s stupid.

    1. The real problem isn’t that he didn’t buy *insurance*.

      It’s that he chose not to go to the doctor at the first sign of trouble, to save on the out-of-pocket costs of the testing. Stupid decision.

      The argument is that if he was forced to buy insurance he would have been more likely to get the preventive care early.

      But , he could have had a high-deductible plan and that would limit his risk exposure. That would prevent him from burning through his IRA or going bankrupt.

      ObamaCare effectively bans those plans. They don’t qualify as insurance. You HAVE to get the comprehensive plan that covers preventive care with zero co-pays and no deductibles. As if you are incapable of getting those things unless they are “free”.

      What is ultimately the problem is that this preempts even the possibility of individual responsible decision making. You’re not even giving people the *chance* to get preventive care on their own. You’re not even letting them demonstrate whether they are responsible or not, you’re just forcing everyone will-nilly into a system that makes them pay potentially MUCH more than they really need to (because comprehensive coverage is very expensive), in order to save a minority of people from making irresponsible choices. You’re making the responsible pay for the care of the irresponsible, with no choice, no options, no reason to be responsible, and all the benefits of potentially being responsible taken away.

  22. In 1996 my libertarian friend Peter Perras/Psyras died from rectal cancer just 6 weeks after he started complaining of symptoms. In his papers I found a letter he’d gotten a year and a half earlier from a testing outfit saying that in response to his question about testing for his prostate, he’d have to make an appointment for a visit. Peter was so turned off to medicine (as a result of a previous experience) that apparently he wanted to bypass doctors somehow to get his testing done, but could not. Had he had a prostate exam then, I know from the location of his rectal tumor that it would probably have been discovered and would probably have been operable.

  23. Scott Androes died this morning. You can debate the variables about what he might or might not have done if he had health insurance. I knew him. He was a complex person. He had an aggressive cancer. He was sick. He played poker. My bet is that he would have seen a doctor sooner than later if access were easier. Even if Obamacare wouldn’t have saved his life, he would have been more informed and he would have had more choices during his last months, days, minutes. And finally, as if this is really the most important issue in a debate that should be be about morality — the bill to all of us (yes to all of you who posted here) would have been less. RIP Scott. You have made a difference.

    1. “Even if Obamacare wouldn’t have saved his life, he would have been more informed and he would have had more choices during his last months, days, minutes”

      My condolences on the loss of your friend, but this statement is pure speculation and your opinion.

      “And finally, as if this is really the most important issue in a debate that should be be about morality — the bill to all of us (yes to all of you who posted here) would have been less.”

      1. Again, ‘the bill to all of us’ is more speculation and your opinion.
      2. Who are you to lecture anybody on morality?

      1. All of this commentary is speculation, is it not? Is this forum always so confrontational?

        The bill to which I refer is the entire roll-up of Scott’s unpaid health costs, which will, by definition, due to the inefficiency of the system, drive up future insurance premiums. That cost has to be absorbed somehow. It might not hit your plan, but it will hit someone’s plan. Or their employer’s plan.

        Scott’s first hospital stay was 51 days. Let’s say he got quicker treatment for his illness, which he says he would have done (so I’ll take him at his word), and didn’t have to stay in the hospital so long. Maybe he could have been in a skilled nursing home – that’s a differential savings we, as an insurance-paying public, could share in. That’s not opinion; it’s math.

        Didn’t know I was lecturing on morality. Sorry you took it that way. I’ll just state my bias and shut up. For me, issues of improving overall human health, reducing suffering, and caring for your neighbor are more important moral imperatives than the pursuit, management, and retention of individual wealth – goals that are central to the ideology of some of the writers on this thread. Now that’s an opinion.

  24. May he rest in peace.

    Looks like Nick is now a punching bag over at this website dedicated to critical thinking. Well, a website run by a professor of philosophy that basically cherry picks logical fallacies from conservative commentators. Of course, liberals and liberal websites are immune.

    What I find most amusing is the assertion that A) Gillespie is conservaitve and B) Koch funds Reason as if that diminishes the work here. I don’t see their logic here. That Koch stops funding, libertarian thought whithers?

    Again, the professor constantly links to liberal rags funded by Soros. That’s ok I reckon.

    I bet you he’s in the Biden won on “substance” camp.

    Ugh.

    http://thenonsequitur.com/?p=3845

  25. ” Why do blood tests and basic checkups cost so much?”

    Actually, they don’t, if the bill is being paid by an insurance company. Anecdotally, my shoulder surgery listed for about $10K, but the final bill was actually about $2K (a billing statement got sent to me by accident). I’m sure the hospital and surgeon and everyone did just fine with the $2K split between them. I strongly suspect that most the “list” prices that we hear about are a farce and the true cost acceptable to the providers is significantly less.

  26. I don’t wish cancer on anyone, my mother died from breast cancer when she was 42 years old. Is the concept of personal responsibility completely dead in this country? I bust my tail and do the best I can to hold onto my job in order to meet my financial obligations and responsibilities. A case of “middle age crazy” does not justify Obamacare. What is not being said is that socialist governments do not allow for a middle class. Just as socialist governments have a ruling class and a working class, socialized medicine will have two levels of care. A top of level of care for the elites and a bottom level for everyone else. The fallacy that access will be easier for the non-elites, the poor and the have-nots under Obamacare is grossly immoral.

  27. It’s a tie game, folks: With the first of three presidential debates down and the vice presidential sideshow over, the two men at the top of the major party tickets will face off once again in yet another 90 minute debate, but putting on a carefully scripted show. cheap nfl jerseys positions. If either candidate started talking a good libertarian talk, even if only on a few subjects, they wouldn’t ever be trusted this late in the game. And the game here is not just this general election but the whole of their political careers.

  28. Let us hope the preceding paragraphs rouse the nation’s guardians from their torpid slumber, and alert them to the peril that threatens the very fabric of our nation. Let us hope. This insouciance seems ill-advised, when you reflect that Virginia’s Eastern Shore, where the chicken attack took place, is home to the Wallops Island Spaceport ? a crucial piece of the nation’s transportation infrastructurecheap nfl jerseys positions. I can’t tell if this article was Hinkle trying, poorly, to make a point about regulatory waste or Hinkle doing a rambling Andy Rooney schtick, poorly.

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