If a person chooses not to buy health insurance and then needs care, who should pay?

This week at a Republican presidential debate, moderator Wolf Blitzer offered this hypothetical:

“A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I’m not going to spend $200 or $300 a month for health insurance because I’m healthy, I don’t need it. But something terrible happens. All of a sudden he needs it.”

Today’s Question: Who should pay for his health care?

  • Hiram

    The shareholders of hospital and health insurance companies.

  • Jim

    That person should pay. They chose to not carry insurance so they pay the tab.

  • Clark

    Milton Friedman stated it best, there is no such thing as a free lunch,. Someone, some place is paying for the service.

    There is no such things as free health care. If the citizen can’t afford the I insurance, the cost is passed onto me in higher insurance rates or higher taxes.

    Somehow, someway the costs will always be passed onto to those who continue to earn an income.

    I am not aware of any economic downside to being a lazy fat slob who smokes and eats bacon all day as their health care cost will simply be passed on to others.

  • Wade

    While COBRA law has good intentions. We need to eliminate it. That would solve this whole problem. Hospitals could then turn people away who can’t pay.

    COBRA law as it sits now can fine a hospital $100,000 for each offense PLUS they’ll loose their Medicare/Medicade payments for 1 year. Obviously that’s a way bigger fine that serving some drunk without INS in the ER for a few hours.

  • Steve the Cynic

    In Canada, it wouldn’t be a problem, because people aren’t allowed to be so selfishly greedy. In the free-market utopia envisioned by plutocratic mad hatters, in which mercy is a vice, it wouldn’t be a problem, because hospitals could deny services to such fools and allow them to die of their stupidity. What kind of society to you want to live in?

  • Zach

    The important realization from Monday’s debate was that Tea Partiers will applaud and celebrate people dying in the streets if they can’t afford health insurance.

  • Luke Luther

    Such a good question. We pay for it either way through higher premiums or through increased costs. I think more importantly we need to know how the program will be administered, who will handle the appeals for the bankruptcy decisions, and what the exceptions to this will be. (Always a loophole in our legal system)

  • Hiram

    “They chose to not carry insurance so they pay the tab.”

    People in the health care industry chose to be in that business. And the guy doesn’t have the money to pay for his own health care. If we as a nation don’t want to foot the bill, we must find someone to send it to. Why not the industry concerned?

  • Rich in Duluth

    It depends on the kind of society you want to live in.

    If you want a compassionate society, then the cost should be spread over the whole working population. This is precisely why we need universal healthcare, like Medicare, paid for with sufficient tax dollars to cover the costs.

    If the society you want is “every man for himself”, then that hypothetical 30-year old doesn’t get the health care he needs and gets the full consequences of his terrible disease or accident.

    I listened to the debate and find it interesting that Perot wouldn’t answer Blitzer’s question directly and that Bachman’s comments also didn’t address the question. I wonder why it’s so hard for these people, who claim to believe in personal responsibility, find it hard to simply say “let him die” in a public forum.

  • Sue de Nim

    What astounds me is the fact that some of the people who think it would be okay to turn that guy away profess to be Christians. They want to keep Darwinism out of school science classes but embrace Social Darwinism as an economic theory. Whatever church taught them that’s the way things should work is not one I want to be part of.

  • Mike Berger

    This question serves as the backdrop to the healthcare debate. This is why I don’t understand those who oppose health insurance on the basis that they are healthy and should not have to purchase health insurance. I don’t care who you are, or how rich you think you are, if anyone went from healthy to all of a sudden in the hospital for an extended period of time, everyone is going to be asking for help in paying for their $300,000 dollar medial bill. No one realizes the need for healthcare until they have someone close to them that is in dire need of it, or becomes financially impaired because of it. This nation’s health system is one of the biggest reasons why we are so financially strained, and real change from our government leadership is needed to control the “capitalist” healthcare maket that is run on the basis of money and greed, not on compassion or care.

  • Rich

    One interesting aspect of the animus against Obamacare is that because of its delayed implementation, most American have yet to be affected by it at all. The objections are mostly speculative.

  • Ian

    It really raises the issue of whether we all should be obliged to contribute via a (‘tax system’??) that everyone has access to at least a basic coverage. (if not we all contribute any way as others have already pointed out). In that way even if one chooses not to buy insurance, they will be paying towards their coverage. But all of this assumes we have a tax system that has had all the loopholes removed!!

  • uptownZombie

    i guess that depends on if you’re a Libertarian or not.

    You are? well then, let the person die.

  • Kari

    The topic of health insurance is one that greatly pains my family and I. My husband and I are young, have had little to no health issues in the past 15 years, and have two small children who have no health issues at all. Yet we cannot get health insurance that is reasonably priced. I am a teacher in a small rural school, and the health program costs more than my monthly paycheck. In order to take part, I would have to pay the school. My husband is a farmer. No one seems to care whether the farmers, who support this country with food, have affordable health insurance. We are denied by all health insurance companies because of stringent guidelines and I cannot even get insurance to just cover my kids either.

    This country is broken when good, hard-working people can’t even afford a simple basic plan with a $10,000 deductible, just to use in case of a dire emergency. Can you blame that 30 year old? Maybe he has tried to get insurance and cannot get approved, or cannot afford it.

  • Denis Bell

    It shouldn’t even be a question… This is America and we’re the only industrialized country in the world that does not insure all of it’s people! It’s time to take the middleman and investors out of our medical system and be the world leader again…

  • Tom

    Who should pay? Who-ever wants to on a VOLUNTARY basis, possibly friends, family, or charities. The height of selfishness is insisting that someone else has to pay for you.

  • Alan Ktueger

    What if someone chooses not to pay for police or fire coverage? Who should have to pay police or fire deepartment costs when his/her house is burning or being invaded?

    Oh, right, they don’t get to make that choice.

    Should health coverage be any different? We choose as a society to not let people suffer crime and fire without help, why is it different with sickness and disease?

  • Jared

    Universal Healthcare takes care of the problem. An increase in payroll tax could very well provide a basic level of coverage for all. Perhaps then be able to purchase additional coverage if you could afford it? With the amount that already comes out of my paycheck to cover health care, if that were to actually be paid to me, the increases payroll tax would probably result in me getting more money per paycheck. I think the increase would need to be percentage based, which some people wouldn’t be happy with. Hypothetical, 3%, someone who doesn’t make enough to buy insurance does see a hit to their paycheck, but not having to worry about unforeseen medical expenses. Higher earners paying the 3%, likely a smaller hit then current health premium, would aid in spreading the cost out.

  • Kari

    Much like the other Kari that posted- I know people that just can’t get health insurance. Luckily I make enough to get a bare bones plan in case of emergency. But my younger sister- she can’t afford it. She works two jobs, has low rent, but because she’s trying to also get her college degree, she just doesn’t have the money for it. She’s applying for MinnesotaCare, but who knows if she’ll get in. Many healthy young people who don’t get health insurance do so because they can’t afford it- when you’re barely scraping by, you have to make sacrifices. And for many young people, that sacrifice is health care.

    This is why we need to drastically change health care- people should not have to sacrifice help in times of crisis to live.

  • suzie

    If you don’t want to pay for health insurance, and can afford it, you will be expected to pay the medical bill. Don’t care if it takes the rest of you life, and if you die before the bill is paid, it comes out of your estate.

    If you are working, but don’t make enough money to afford regular medical insurance, there should be a state program where you can purchase at least a minimum amount of insurance.

    Finally, if you are here illegally and you cannot pay, your country of origin will be charged the full amount of your medical costs plus service fees.

  • Hiram

    “If you don’t want to pay for health insurance, and can afford it, you will be expected to pay the medical bill.”

    You can expect all you want, if the money isn’t there it isn’t there. However, as others have pointed out, lunches aren’t free. Somebody has to pay the bill.

    “Who-ever wants to on a VOLUNTARY basis, possibly friends, family, or charities.”

    What if no one volunteers? Where does the bill get sent then?

  • Al

    The person should pay the bill themselves, upfront, prior to services.

    If the requirement that all have healthcare is overturned then Congress needs to pass a new law creating an objector list. If you choose to not have health insurance then your name is on the list. All health care providers can check the list when you come in and if you’re on it they can demand cash upfront for services. No cash, no treatment. Go cough up a lung or bleed out on the front steps if you are going to be so ignorant or stupid.

    There should be ways to help those who can’t afford insurance. But for those whining about the mandate to have insurance being uncostitutional – fine, have it your way. Better have a lot of cash or not get sick or injured.

  • Bob Moffitt

    I thought that the Hand of the Free Market would pay, but he’s nowhere to be found.

    Now we know why he’s invisible…

  • Anita Newhouse

    It’s really not an “either/or” question: either the individual pays or the taxpayer pays…..both parties will end up paying some portion of the bill ultimately. And while there are those who believe that an individual in our modern society can be wholly and solely responsible for their own needs and expenses, in reality this can no longer be true. This thinking is simply denialism.

    Insurance of any sort, using basic funding principles, spreads large costs over a greater pool of payers. More people participating in healthcare is good for everyone: healthy people are more productive, healthcare industry has more customers, government spends less time and money addressing public health concerns, and this makes advances in healthcare more timely and appropriate. The current cost differential between payers is a huge part of our healthcare system’s disfunction.

  • Chuck

    Important question. One has to ask oneself about “choice”. If you have to choose, as one writer noted, between providing life’s basic necessities (food, clothing shelter) for yourself and your family and insurance is that really a choice?

    It seems to me that in a country such as ours – everyone should have access to basic healthcare and we all should pay for it. The same way we pay for police and fire protection and National defence.

    All of our Representatives and Senators and their staffs and covered by ecellent healthcare plans that are fully paid for by we, the taxpayers, since we also pay their salaries. Why do many elected officials want to deny healthcare to so many citizens while they, themselves partake of it?

  • Neil C.

    The healthy 30-year old making good living who decides to gamble and loses the bet pays. Hands down! Same as going to a casino.

    That’s not a common scenario though.

    A much more common scenario is people of any age making a bad living for any number of reasons who truly cannot afford health insurance or health care. Then who pays? Given that there are 10′s of millions of them and even Michele Bachman doesn’t want them dying on the streets, then society pays.

    Government run universal health care, with significantly rationed services (“no sir, you may not have both hips and both knees replaced tomorrow”), funded by payroll taxes, with the ability to purchase supplemental insurance to increase the level of care you are entitled to is inevitable.

    Obamacare doesn’t suck because it’s over-reaching. Its sucks because it is under-reaching!

  • GregX

    anaylsis of annecdotal situations does not lead to rational results. the basic concensus is … we are not, as a nation, truly cruel enough ( er.. libertarian) to just let people die when we have the equipment and facilities to treat them. that essentially implies that we are going to bury those costs for people who can’t pay into the system (private or public). Of those two systems – one them also embeds the cost of profit – in the case of “declared non-profit organizations” embeds excessive compensation for its executive ranks and passes high value to its shareholders. the other – has substantive sunshine on its books and madates absolute limits on wages/costs at all levels.

  • Max

    I think the question, and the health care debate in general, incorrectly focuses on who pays for what and how, instead of asking why health insurance should cost $200-$300 a month or why medical bills are so high that they would cause someone to go insolvent.

  • Vicki

    First let me say that I am a healthcare worker and have thought long and hard about this. I think that healthcare should be a right in one of the wealthiest countries on earth. NO ONE should have to choose between getting care for themselves or their family or keeping a roof over their heads or buying food. That said, if you CHOOSE not to get insurance then be willing to accept the consequence of your actions. You want individual liberty? So be it, but no one else is obligated to help you if you double down and lose. Want care? Upfront downpayment and payments thereafter. Default? Then the law will take care of you. ER will provide care if it is a true emergency ie. life, limb, eyesight or come in ready to deliver a baby (which is all the current EMTALA law is supposed to cover but I digress), otherwise you are own your own. And PS, you can’t sue because you made a wrong choice and have to suffer for it. I’m sure the family of the man who was killed when riding without a helmet in protest of the helmet law was comforted by the fact he was exercising his civil liberties. As a “country based on Christian principals” we should be willing to give more to help those who have less; but those of you who don’t want the government “in your business” don’t expect it to help you when things go wrong.

  • Anna123

    Two aspects of buying health insurance bother me: (1) It’s expensive. Per the comments by the Karis below, many people simply cannot afford it. For those living on a fixed income, it will dig significantly into expenses. (2) Even being pricey, one is not sure the insurance company will cover one’s expenses, and at what rate. Despite all the money one may sink into premiums over the years, a person can still get wiped out simply because of the cost of the care (which is unknown up front) and denial of coverage.

  • Vicki

    Oh and Alan K? Believe it or not there are communities who have to pay for fire fighters because they are all volunteers…I used to live in one…and if you chose not to pay your house burns. They will save properties around you who have paid, but you are on your own.

  • Glenn

    This is too easy- the GOP should pay!!

    Glenn

  • Chris

    Why don’t we all ditch insurance? That would solve the problems. Too many people are focused on the “WHAT IF” not the “WHY SHOULD I”. The problem is too many people have insurance, if we ALL ditched it then the cost of health care would really decrease.

    Insurance companies clearly make tons of money off of us, well if we paid as we go and saved the money (for just in case) we wouldn’t have these problems. The idea that insurance somehow protects us is complete BS, they don’t cover a whole lot and you will have to pay big bucks when your sick anyway.. on top of that, once you are too sick to work you lose your insurance. So I ask what is it good for? BTW, I am 28 healthy and have really good insurance (through work), but I would much rather have more money in savings than the joke that is insurance.

    Also, if we had a pay as you go system do you really think we would have so many fat people or smokers? I mean seriously, when do we take responsibility for ourselves.

  • Wendy

    I continue to be appalled by the Tea Baggers who espouse to be devout Chrisitians, or is it ” born again Christians”—who sit in judgment of their fellow Americans when ” their God” is supposedly the only judge of the human race. Since when did these so-called Christians get appointed to stand in as judges? To talk about the 30-yr old who needs medical care but has no insurance and say ” let him die” is in complete conflict with the Christian moral code—which actually is founded on “Whatsoever you do to the least of my brothers—that you do unto me.” It isn’t just obese smokers who don’t have insurance, as someone commented on this post—It may be you next month or your child who loses health care, a job, a home Be careful when you’re making rules for others–what goes round often comes around.

  • Kyle

    You can’t frame the issue this way. As a moral issue, the person who chooses not to have health insurance should pay for their own care. As a practical issue, that often isn’t possible. So the cost of care gets spread out to everyone else, taxpayers and insurance companies and other hospital patients alike. And as others have noted, this is also the case if a person does have health insurance that happens not to cover all of the bill.

    The alternatives are to allow hospitals to deny care without immediate proof of insurance or to remove the ability to legally choose not to carry health insurance/adequate health insurance. This is the operative question, as regardless of who should pay with the current system everyone actually pays.

  • Tom

    We can’t even begin to think adequately about this — or other issues related to wealth — without acknowledging that we are living on unevenly distributed fossil capital, and getting close to having spent our legacy.

  • Ben Hermerding

    The Declaration of Independence (in our Founding Fathers’ words) says we have the right to life, liberty, and the pursuit of happiness (based off of John Locke’s words: life, health, liberty, and possessions). If I were a Tea Party Patriot- which I am not- I would abide by the words of Founding Fathers and say it is the government’s responsibility.

  • tanya

    they should pay for any and all expenses if they need care, it’s their responsibility after all. if that means losing their home, having wages garnished and perhaps going after their family members to get the bill paid, then that’s how it should be. i don’t like our health insurance system and i’m very happy that the affordable health care act was signed into law, and i pray it doesn’t get destroyed by the republicans/tea partiers in congress. these people that want the right to not have to be mandated to carry health insurance (and want to end the affordable health care act), still have to take responsibility for their care and the cost of it! if someone doesn’t want to be required to buy health insurance, then they need to sign a binding waiver that says they will pay for any care they ever need, and is necessary the burden will be put on their family, home, estate, etc! i’m pretty sure if someone thought long and hard about that possibility, they’d probably change their minds!

  • CF

    My answer to the question is that in this specific situation, the hypothetical person should pay his own way if indeed he can afford so-called “insurance” but declines it. But this hypothetical person is a very small minority. The reality is that those without so-called “insurance” can’t afford it.

    The real problem is the cost of health care to begin with and the mafia kingpins who own the system. We never got “Obama-Care”, what we did get is “Congress-Care” which is wholly inadequate. COBRA is a slap in the face and an insult to those unemployed.

    Should we deny care based on one’s own arbitrary moral assumptions? That is for hospitals to refuse care for smokers whether insured or not. If so, then let’s say you are speeding down the road and hit a tree. Since you were speeding should the rescue squad ignore the crash and let you die in the wreckage? Why should I have to pay for an uninsured, unmarried woman who gets pregnant and has a premature baby costing a million dollars for intensive care?

    The real question is WHY does it cost a MILLION(!) dollars to care for a premature baby in intensive care in the first place?

  • Shane

    That’s a silly question. Of course the person who needs the care should pay for it. If someone decides not to buy homeowners insurance and their house burns down who should pay for it? If someone decides not to buy auto insurance and wrecks their car who should pay for it?

  • DisabledInDuluth

    I am “lucky” enough to have healthcare that is funded by all of YOU. Before I was disabled, I was working and helping to fund someone else’s healthcare and one day I will be working again and hopefully paying taxes to support those that cannot support themselves.

    I go to the doctor on an almost weekly basis for one thing or another. I don’t think my health issues make me more important than the 30 yr. old in perfect health who chose to not buy insurance and meanwhile gets hit by a car or comes down with a bad case of swine flu Too bad for him! He can’t work, or maybe he can but all of his money will now be collected to pay for ridiculously high priced lab tests, uncomfortable hospital beds, plastic tubes jammed into his arms and crummy meals fed to him three times a day.

    The healthcare system is broken. But it seems to me that most people these days don’t care about that. What they do care about is themselves and if their world is sparkling and full of money trees they don’t care about the unfortunate people that cannot afford to pay the high price of having their life saved or at least prolonged.

    Because that is the point – everyone at some point will get sick – too bad for you – you chose to go it alone. Your insurance drops you, you’ve voted away Medicare and Social Security. Maybe divine intervention will save you but really, you’re all going to heaven anyway – you may as well enjoy the ride and definitely not take any ” hand outs”.

    Oh and while you’re voting away government funded healthcare and making your rich friends richer – you know, the ones that wouldn’t help you if you were in need because we’re all in it for ourselves-you should have gotten a better job….you might want to consider the fact that inmates in this country, the “lowest of the low”, have better healthcare and dental than you will ever have.

    Go them!

  • Rachel

    The person who is sick should pay. HOWEVER, their money is coming from a pool that they have added to by purchasing items, alcohol, and food through taxes (other people have contributed as well). This way, when the emergency happens and health care is needed, there are no worries, because you get what you need as a citizen. You also don’t have to worry ever because you know you’re going to get what you need.

    I experienced this when I was in living in Norway for a semester . I know Norway is labeled “socialist”, but when I needed to go to the doctor I had no worries. I had to pay approximately $20 and everything was taken care of. They didn’t ask for my insurance (not that it would have worked there anyway), I was a visitor living in the country and it was $20. Done. Granted, everything cost more and it took some getting used to, but it paid off for me, because I didn’t worry when I suddenly experience a new health problem that I didn’t know how to diagnose myself. I would love to move back to Norway, it works, the citizens love it there. But I also hope America can learn from this example.

    Thanks.

  • Maria

    I find this question absurd. Almost no one “chooses” not to buy health insurance because they are too stingy or greedy. They do not buy it because they cannot afford it. Therefore, a person who cannot afford several hundred dollars a month for insurance will not be able to pay several thousand for emergency care. Of course the government will end up paying by default. Why not admit the situation and pool our resources ahead of time in a logically thought out government health care system the way virtually every other country with means has done? Also, insurance really does not protect a person all that much. We paid about $8,000.00 when our newborn ended up in a hospital for “observation” for two nights. And we had insurance. No medical procedures, no medications, no hospital food (entirely breastfeed), she just sat there with a bad cold (RSV) and we lost the bulk of our savings.

  • Sara

    It does not matter if he chose not to have insurance, because he is in the hospital using resources and amassing charges.

    If he doesn’t pay then we do one way or another. If the hospital “covers the cost” then it is spread out among everyone else using the hospital. If an insurance company takes on the bill then everyone else has premiums raised. If the government (that’s us) pays, then we all pay.

    People without insurance put off preventative care, annual check-ups, etc. until a minor, inexpensive to deal with issue, becomes a life or death — and extremely expensive — trip to the emergency room. We all pay for those expensive trips now through increased medical and insurance costs.

    Universal healthcare simply and openly admits that we are already all paying, and it might actually improve health overall because people will have fewer excuses for putting off medical care.

  • NANCY

    in 1983,working full time for a non-profit, on grant money i was without insurance. due to the salary i was paid, there was no way i could even entertain the idea of paying for insurance on my own. luckily, i had been healthy for many years. until that summer…on july 1st, while traversing a steep boulder field in colored, i was struck by a very large boulder. that boulder had come from somewhere above me as i was near the bottom of the canyon. the force of the boulder caused burst fractures and compression fractures of my spine. luckily, i had worked with back patients and in a past life and knew a little about what might go on. i was not immediately paralyzed. i had some immediate medical attention in a small town in colorado, after which i decided to wait to get back to the twin cities – where i knew good physicians.

    after a long and painful ride back in the back of a pickup, i made it to the docs here. through examination, it was discovered that i had an extra wide spinal canal which had saved me from immediate paralysis. i did suffer some nerve damage and some deficit in sensation, also some trouble with drop-foot. i ended up with two surgeries in an attempt to repair my back. one was an experimental surgery (which i had to pay for anyway) involving using my lower rib to act as a strut in holding my back together. that failed almost immediately. i was kept in an immobilizing body cast for months while awaiting the 2nd surgery which basically entailed fusions and harrington rods.(which i also paid for)

    my medical bills were extreme! i was grateful for being spared the paralysis, but holy smokes! (later, discovering through attorney general hatch’s investigation of other situations, that uninsured had been charged more than insured patients). the bill was carefully audited and yes, i had been over charged. i used all my savings bonds that my grandparents had purchased for me. my parents dipped into their retirement funds. we finally paid the bill in full.

    it is difficult if there is no way to pay for insurance without skipping a roof over your head or food in your belly. if you can afford it, i would assume you would be denied medical assistance.

  • Chris in StupidMaine

    Thanks, Rachel, for bringing up Norway. I’ve been lately reading about their “socialist” system, as well as other European systems that vary, but maintain a similar theme. That is to say, the population contributes to a pool that the population draws on as needed. Society takes care of society. The costs differ from country to country, but by and large, they are minimal compared to what we pay for healthcare. Part of the reasoning is that costs are controlled by the government because prices are negotiated for the ENTIRE POPULATION. This isn’t an easy issue, but certainly, if virtually every other developed society can provide healthcare to their citizens, so too can we. If that’s “Socialism,” give it to me all day long, and by the bucketful!

    And another thing – for all you “pull yourself up by your bootstraps” types out there (you know who you are), I’d like you to actually try pulling yourself up by your bootstraps. Good luck.

  • http://www.foundingfathersforum.com Jefferson

    This person should have to face the consequences of his actions. He took a gamble and they lost, the young man should end up with lots of medical bills and if he cannot pay them then he can always declare bankruptcy. I see very little difference between someone who chooses not to purchase healthcare and someone who runs up too much credit card debt; both made a bad choice and if the bills are large enough both will end up in bankruptcy. BTW, the Norway example is a very bad one…they have less than 5 million people and fund much of their government and economy through oil/natural gas revenues from the North Sea.

  • Chris in StupidMaine

    @Jefferson –

    Being a good liberal, I will concede that Norway might not be the best example (though I wouldn’t say “very bad”) as oil/gas represents 20% of their GDP. But – and you stated it for me – the public owns the lion’s share of the oil production. Point is, that industry’s revenues go to the public good – i.e., healthcare, retirement, etc. Additionally, as the petroleum resource is recognized as finite, the bad old Norwegian government is using oil revenues to encourage and develop new industry to take the place of the oil industry once it’s tapped. Do we have a state industry that can provide like this? No. Why not? It’s Socialism. So what?! Call it whatever the hell you want. If it works, and we can take care of our society, who gives a rip what it’s called? Problem is that we don’t want to take care “we.” We only want to take care of “me.”

    There is private industry in Norway, but it’s highly regulated and heavily taxed. The citizens are also progressively and heavily taxed. This allows for revenue which the government can apply to the public good. Average per capita income is in the mid $50,000 range. I will pay a heavy tax burden for the peace of mind that I and my neighbors are afforded healthcare and a retirement income.

    Look, no system is perfect. I don’t doubt that Norway and many other European countries will struggle with their respective economies. But no one can tell me with a straight face that the American situation is best. Free market trickledown economics just isn’t working. Well, it isn’t working for all of us… The cream does not always rise to the top. Opportunity simply does not exist for everyone. There are always special circumstances that can’t be accounted for. Nothing is black and white.

  • Brian D

    This question would not come up if we had a national, tax-funded health care system.

    In 2000 the WHO ranked the U.S. health care system 37th in the world. France was number 1. Oh dear, when will we learn?

    I suspect the next time the WHO ranks nations based on their health care systems, the U.S. will fare better. The Obama-led health care reform took us in the right direction. We have a long ways to go.

    Why don’t we stop being arrogant (the world has nothing to teach us, because we’re Americans) and look at and study what’s succeeding in the rest of the world. We could start with France. Or maybe the nations that are rated in the top ten. Can you imagine our political leaders saying, let’s leave ideology behind and just study what works? Nope! Neither can I. That would be so un-American.

    We can probably count on MPR posting a variation of this same question sometime in the future. Maybe next year. And the year after that. And the year after that. And we’ll still, as a nation, pound our chests and exclaim, we have nothing to learn from the rest of the world! We are the greatest! Why? Because we are who we are.

  • Brian D

    Glenn–Great comment!

  • Brian D

    Glenn–Great comment!

  • Brian D

    Glenn–great comment.

  • stuart klipper

    Might this not be one of those matters that would boil down to WWJD?

  • matt

    Who pays now? Who pays once ACA is implemented? Who would pay under a completly govt free solution? The answer is all the same, society as a whole pays the cost. Many commenters below assume no health care without govt assuming that compassion only exists when it is coerced, there is no proof of that and abundant proof to the contrary.

    If you and nine other people were shipwrecked would you need a leader to command you to care for the sick? Even if two of your fellow islanders refused to help would you then just say “screw it if they ain’t helping neither am I”? So sans govt you would provide for the needy even though others would fail to help right? Newsflash that is exactly what we do now while billionaires skip out on the whole nasty tax thing we just have a middleman that gives them a pass. Then the middleman gets his cut, swings a piece of the action to his buddies and gets to kill people in far off lands, or in Texas and we say that is the compassionate way?

    WWJD – vote libertarian, his best-selling book is based on the same principles.

  • Sarah

    I frequently hear a double standard in answers to the question. The same people who say that “individual choice” and a “free-market” are needed to lower costs and increase access to healthcare, also say that people (typically hypothetical “young people”) are irresponsible for not purchasing insurance when they are healthy. The fact is people, including young people, make tough choices based on their risk and their income. If you think that people are responsible to each other and should have to contribute to health care costs before they are sick, why not all contribute to one national purchasing pool so we are all responsible for and benefited by our health care resources?

  • Steve the Cynic

    “WWJD – vote libertarian, his best-selling book is based on the same principles.”

    Sorry, I can’t take seriously anyone who who says, “Jesus would agree with my politics.” Communists, monarchists, anarchists, antebellum slaveholders, and a host of other such misguided folks have all insisted Jesus was on their side at one time or another.

    Matt, you have a higher opinion of human nature than I do (or Jesus apparently did, for that matter). If you seriously think volunteer compassion would solve the health care problem, if only the gummint would keep its paws off, you apparently haven’t done much observing of the way people actually behave. And even if it could, why should the burden of social responsibility be borne only by the virtuous? Why should the greedy be allowed to shirk their share of society’s responsibility in caring for its weakest members?

  • Kristina

    So we would cover him if he were unable to buy it because he did not have the money for a miriad of reasons. OR we punish and bankrupt the man who works for a living, probably worked hard for his degree and decided to take a risk. So once again, if you are poor you win. Win as in, not lose your home, your savings. I guess that was the risk the poor person took not having a savings account. Not having something the gov’t could exploit.

  • Matt

    @steve,

    You make assumptions of why a no govt solution would not work, I can point to concrete examples of how govt interference degrades health care. But to give you positive food for thought – The nations blood supply is done on a voluntary basis, we run into shortages sometimes but all in all it is an efficient reliable system based on the generosity of others. I heard a great story on the way home tonight about how the area in Texas ravaged by wildfires has asked that no more donations be sent because they are overwhelmed. You and I contribute 2.4 percent to national health care without blinking an eye and it covers a lot of people. Charity is neither hard nor expensive.

  • Josh Gruber

    This question goes to the heart of the debate over the so-called “individual mandate”. If someone either cannot afford health insurance or refuses to buy it (and can afford it), I might be paying for their uninsured status by having to pay either higher provider fees or insurance premiums when the uninsured person incurs medical bills that he cannot/will not pay.

    The mandate, if means tested, means I will subsidise health insurnace for someone who can’t afford it. This is far preferable to paying for major medical expenses when the cost will be far greater than an ounce of prevention. As for the person who can afford it but won’t buy insurance, I don’t want to pay for the recklessness of a freeloader.

    We accept private coercion (anyone who has a mortage can’t get it without buying homeowner’s insurance). It’s the same thing with health insurance. As long as someone is alive and needs medical care, I have an ineterst in their wellbeing…and it’s cheaper for me to help them have insurance than bailing out someone without insurance, not to mention their family, their ability to work and pay taxes, and everything helps that can too easily happen when you play “health roulette” and go without insurance coverage.

  • Steve the Cynic

    @Matt

    And I can point to concrete examples of how the profit motive degrades health care. No system invented by humans is going to be perfect, and there will be unintended consequences no matter what the policy (or lack thereof) is. However, as I look around the world, I see numerous examples of health care systems with far fewer problems than ours has. Every single one of them has more government involvement than ours does, even with “Obamacare.” The successful ones either are very tightly regulated (like in Germany or Switzerland), or have a single-payer system (like Canada) or are run outright by the government (like Britain and France). They get better results, and the taxes that go for health care are less than we pay in insurance premiums. Yes, they have problems, too, but folks there are generally less dissatisfied than Americans are. I have yet to meet a Canadian who is willing to trade their system for ours. When Canadians move here, it’s usually in spite of our poor health care system, not because of it (except for medical specialists, who can extract more profits from sick people here). The arguments against a single-payer system are ideological, not evidence-based.

  • Kevin VC

    If a person ‘chooses’ to not get health-care?

    Choice means option, or a opportunity to get. If one does not have the money by definition they did not have the opportunity….

    There are some radical minded people who just fail to come to terms that people are in this situation. As the middle class vanishes to feed the tax break for the wealthy…. its becoming a everyday situation.

    Now if this is someone of means and can pay for it…. Say someone in the middle class or higher, then of course the hospitals and like have the option of collections.

    Nothing has changed there. You pay your bills if you can afford to. You have a obligation.

    If you can not afford the bill, you often do not go and see the doctor, the situation becomes worse and eventually its a emergency room visit, which skyrockets the bill….

    You can not get money from the poor, its part of the definition of being “POOR”. Common everyday logic and sense tells you this.

    Now that leaves a provider needing to replace supplies, pay for staff, and other used facilities that are not compensated. This is part of why medical bill get bigger…..

    We are all paying for those who can not.

    If they could have gotten the $5 antibiotic or the splint, or just help early on, then the bill will not skyrocket to $5,000 when its a emergency room visit which then gets distributed to all our bills.

    We are paying for it, like it or not.

    Lets just keep the bill smaller by getting them the care they needed earlier so its not a monster come to destroy us all.

    This is why universal health-care is and was needed long ago.

  • Rex

    If I read one more person post “The US has the 37 best health care outcomes in the world” as an measurement of the quality of our health care system – I am going to rip out my liver. Having the best outcomes is not the same as having the best care. The QUALITY of the patients determine outcome more than health care provided. The obesity and diabetic rates are much higher than comparable countries. Other countries (right or wrong) do not try to save extreme pre-mature babies- we do at a huge cost to our system. Other countries (again right or wrong) do not spend the huge amounts of end of life care that we do. Thus we spend alot more money for very little gain. Now ask yourself this- If you dear mother had a terminal illness and there was a drug that cost $250,000 that would extend her life by say 6 months and then she would still perish. Should we as a society pay for it? We would greatly add to our expenses with little improvement in health care outcome. Now you see why those stats are so inaccurate.

  • Steve the Cynic

    The US has the 37 best health care outcomes in the world! Can I watch, Rex?

    One of the key indicators in that assessment was infant mortality, which is unrelated to any of the factors you mentioned. Ours is far from the best. Furthermore, I keep reading comments from free-market ideologues who say that if health care is a government program, people will have less incentive to maintain a healthy lifestyle. If that’s so, why do Canada, France, Britain, and the Scandinavian countries have lower obesity rates than we do? Could it be that if everyone pays, there’s peer pressure to stay healthy?

  • Matt

    @steve,

    By your argument, that other healthcare systems that our superior have more govt intervention, what can we deduce is the extra something that govt adds to the mix? Is it the funding? Would not a healthcare system funded just as generously by other than taxation be as wonderful? Is it by mandating levels of care? Cannot that same commitment be made by free will? Are we to believe that only govt can command such a task? Is it equal access, no discriminating between the banker and the pauper? Were this true anywhere, especially in govt, it would be wonderful, but is this something that we the people are not capable of unless we do it with quotation marks as “We the people”? Have I missed where the magic comes in? As far as I can see healthcare, whether it be provided by govt or not is the application of manpower, knowledge and physical resources. I don’t see the need to add the threat of violence, which is the one tool govt has that society does not, to make it superior. You are absolutely correct that the difference is ideological.

  • Rex

    Steve the cynic- What I tried to type was from an early post stating the US had the 37th best health care system in the world. Fact is that most of the metric used to determine this outcome have alot to do with the habits of the American people- not our health care system!! For all the fat, lazy and non-compliant patients in our country- the only possible thing that would motivate them to become healthier is money (in the form of fines or higher co-pays). I simply love it when Obama goes on to blame the health insurance companies or the doctors for ALL of the increased health care costs without ever blaming the patients. Just imagine how much money our country would save if every able bodied person walked 30 minutes a day. Nope – can’t talk about that. Experts love to talk about “preventive” health care like it is quantum physics- NO!!- eat in moderation, exercise daily, sleep well, moderate booze and don’t smoke- WOW that is complicated. Interesting that you mention infact mortality- from your posts you sound liberal in nature- Are you as just as concern about these infants right before they are aborted?

  • Steve the Cynic

    Rex, if you knew all my opinions about everything, you’d have trouble pigeonholing them as either “liberal” or “conservative” or anything else, so I’ll ignore your red herring about abortion. Instead, let’s talk about this assertion of yours: “For all the fat, lazy and non-compliant patients in our country- the only possible thing that would motivate them to become healthier is money (in the form of fines or higher co-pays).” That’s pure, unadulterated, ideological bullshit. First, I’m instantly skeptical of any assertion about “the only” way to do anything. It reflects a lack of imagination. There’s usually more than one perfectly adequate solution to any but the simplest of problems. Second, it assumes that money is the most important motivator for people, which is patently false. You can’t assume everyone is as greedy and money-grubbing as you are. Third, if your assertion is correct, why do those countries with more socialistic health care systems typically have less of a problem with obesity, etc., than we do? That kind of evidence-free thinking is what’s preventing our public policy makers from finding real solutions to real problems.

  • annecink

    First, I remind you that the person in this scenario made a good salary and MADE A CHOICE not to purchase the very affordable health insurance. That is different from a mother of three young children whose husband leaves her, or a 58 year old man who loses his job and can’t find other work.

    I don’t think anyone thinks the young man should be turned away from a hospital in an emergency. But he should have to pay as much as possible for his treatment. Maybe his wages should be garnished for the rest of his life, or until the bill is paid. Maybe he should have an additional 10% tax added to his annual tax bill. Somehow, there should be consequences for his choice. He still gets the same treatment as you and I and we pay his bill, but when he leaves that hospital, he knows he has just incurred the biggest bill of his life.

    I feel the same way about a 28 year old, six years out of college, who never wants to find a real job. He wants to surf all day, so he waits tables at night and lives the beach bum lifestyle. I don’t think it is fair to make me buy his health insurance. He is making a lifestyle choice that does not include paying for his own. What to do with him – garnish his pitiful salary for the rest of his life? I don’t know, but I do know that it is a fully honorable argument that I make.

    Liberals make us out to be evil and heartless because of our objections. You paint us with a broad brush, saying we don’t care about the needy. Well, stop it! In none of the scenarios above is the person “needy”. They choose to live without health insurance and we think they should be responsible for that decision!

  • Chris in StupidMaine

    @annecink

    Understood – I think your point is clear. Please provide a solution for those whose circumstances have not left them with a choice. Wouldn’t it be simpler and cheaper if we all pooled our resources to provide for each other – slackers, hard workers, & those without a choice alike?