August 17, 2007
From the desk of Jane Galt:Ezra Klein goes off on Giuliani's health care plan, and Andrew Sullivan's support for it:
I wonder how Sullivan would really feel in a world where the tax incentives were set-up to incentivize sparse health care coverage and high deductibles. That's a land that's very good for the healthy, and quite bad for the chronically sick. Sullivan increasingly strikes me as a first order idealist who ably sees the principles behind things (freedom! choice! equality!) and is stunned when policies based on those concepts don't appear to work.But here's why they don't work. Take Giuliani's health care plan, which basically rests of tax exemptions to help purchase care. It sets a standard deduction of $7,500 for individuals and $15,000 for families. Everyone will get precisely those deductions no matter what they spend. If you're 23 and your health care costs $2,000 a year, you still deduct $7,500, pocketing the difference. And that's the actual point of the plan. That's the incentive the plan is hoping will change health care -- it will incentivize everyone to buy less of it, and pocket more of their exemption.
If you're healthy, a world in which Giuliani's plan was law would be a world in which it was economically foolish of you to purchase high quality, comprehensive coverage. And that would be fine -- for the healthy individual. But insurance works based on risk pooling. If our hypothetical 23-year-old only uses $10 of health care a year, but is now paying $80 rather than $100 for his plan, that's less money that can subsidize someone with a chronic illness. Their costs go up. Their ability to cover their treatments go down. And they get sick and they die. And one day, ironically, this happens to the 23-year-old, too, because he's now 55 with heart disease, and the current generation of 23-year-olds are purchasing $50 plans.
I think it's a little misleading to talk about insurance pooling here. This isn't really insurance we're arguing about; insurance is voluntary. What we're really talking about is a tax. Single payer advocates are looking for the most politically palatable way to tax the young and healthy in order to pay for the health care of the old and sick*.
In this context, it is trivially obvious to state that any change that benefits the young and healthy will disadvantage the old and sick; if the young and healthy are paying less, the old and sick must pay more. But Ezra seems to assume, a priori, that this is morally objectionable. I'm not sure this is the case.
Assuming, arguendo, that we believe in making social-justice-enhancing forced transfers, I'm not sure that this particular transfer meets the needs of social justice. One might argue that the transfer should flow to those whose need is greater, but as a class, the old and sick are wealthier than the young and healthy. They have more assets, many have a guaranteed income, and few have children to support. Moreover, a need-based transfer would argue for some sort of means-tested programme, not an indiscriminate giveaway to anyone who happens to be sick.
Moreover, as a class, the old and sick have some culpability in their ill health. They didn't eat right or excercise; they smoked; they didn't go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports. Again, in individual cases this will not be true; but as a class, the old and sick bear some of the responsibility for their own ill health, while younger, healthier people have almost no causal role in the ill-health of others.
Perhaps they deserve it by virtue of suffering? But again, most of them are suffering because they have gotten old, often in high style. The young of today have two possible outcomes:
1) They will be old and sick too, in which case they are no less deserving of our concern than today's old and sick2) They won't ever get to be old and sick, which is even worse than being old and sick.
As a class, the old and sick are already luckier than the young and healthy. Again, for individuals within that class--those with desperate congenital conditions, for example--this is not the case. But I'm not sure it's terribly compelling to argue that we should massively disadvantage a large group of people in order to massively advantage another, equally large group of people, all to help out the few who are needy, or deserving, or unlucky.
* Yes, there are other arguments in favour of single-payer health care; but this particular argument is about taxation.
Posted by Jane Galt at August 17, 2007 3:00 PM | TrackBack | Technorati inbound linksWith what we spend on health care as a nation, if memory serves, the cost per person is about $500 per month. For the typical family with two and a half kids that is $2250 per month.
The cost of certain behaviors, what is mandated or allowed to be claimed against insurance and a host of other problems like third party admin of benefits, we have created a monster and nothing is as it once was.
There have always been healthy and unhealthy people. It is more likely we did a better job all around of managing our health years ago with less ability to affect the outcome.
So many people have become so conditioned to our polity in large measure being a gerontocracy that it doesn't even register with them that this is what they advocate.
Everyone gets sick, and everyone gets old. 1 in 5 people will get alzheimers, its not because of something they ate, or their lack of running. Everyone dies of something, and most of those things require medical attention before their death.
You are making the same mistake inherent to claims like "stopping smoking will save 100k lives a year". Those people will eventually die, even if people live longer that shouldn't affect the total number of people dying per year. (at least not in the long run)
When you place blame on people for thier lifestyles causing health expenses that others will need to pay for, you are making an assumption, that dying of a heart attack because you ate too much mikeyDs will cause more in medical expenses than being in a nursing home for ten years because of dementia 20 years later. There are too many uncertainties to make this calculation.
That's true, matt, but that doesn't argue against the elderly patient with assets liquidating their wealth prior to tapping the paychecks of 20 year olds. Heck, I'll compromise and simply advocate a 100% estate tax until all Medicare benefits expended on an individual are recaptured.
Ezra Klein's motto about cutting health care costs: "Squeeze the providers."
All we have to do to be able to pay for better care is cut doctor salaries by a third, nurse salaries by a half, ban procedures we deem too cost-inefficient and legislate ourselves free drugs. Problem solved!
I like that third paragraph of Klein's-- the chronically ill "get sick and die" and that's somehow the fault of the greedy youth. More likely it's the fault of their illness.
Okay, I see he was trying to get at the fact that the chronically ill have greater and ongoing need and the expenses will eventually outrun their benefits, but that's a problem with all insurance plans, for some population of chronically ill people.
I wonder what percentage of people who become insolvent from medical costs do so because of acute medical needs vs. chronic? At some point, we all become chronic users of lifestyle drugs, because arthritis doesn't kill anyone, but treating it with prescription janegaltiprine sure makes it more tolerable to get through the day, to say nothing of preserving fine manual skills. However, there comes a point when getting a phone with bigger buttons is cheaper than another 6 months of janegaltiprine, the choice anti-inflammatory of seniors. Sure, we could shift that cost to the insurance company or the taxpayer, but that would be entitlement, either way. The question is, are people entitled to total normalcy when they age, or are they entitled to grow old?
If our hypothetical 23-year-old only uses $10 of health care a year, but is now paying $80 rather than $100 for his plan, that's less money that can subsidize someone with a chronic illness. - Ezra Klein
I'm no expert on either health care or insurance, but this scenario doesn't seem very likely to me.
Isn't the deductible the primary factor that differentiates the cost of health care plans? Our 23-year-old may be very healthy, but it isn't like he's able to save $20 a month by choosing a special "young guy" plan that doesn't cover Alzheimer's or other ailments that aren't likely to afflict him. He might save $20 a month by choosing a plan with a high (e.g. $10k) deductible, which makes a lot of sense if he's actually got $10k set aside (it never makes sense to insure against consequences you can afford - it's not statistically likely that your claims will exceed your premiums, unless the insurance company has hired really dumb actuaries.) But isn't it the older person who is more likely to have $10k set aside? Many, perhaps most, people in their 20s live paycheck-to-paycheck, and are saddled with debt (student loans, car payments, etc.). Opting for a plan with a deductible higher than he can afford to pay doesn't make much sense for our 23 year-old, unless he wants to sell his car and move back in with his parents in the event that he breaks his leg skiing.
If our hypothetical 23-year-old only uses $10 of health care a year, but is now paying $80 rather than $100 for his plan, that's less money that can subsidize someone with a chronic illness. - Ezra Klein
I'm no expert on either health care or insurance, but this scenario doesn't seem very likely to me.
Isn't the deductible the primary factor that differentiates the cost of health care plans? Our 23-year-old may be very healthy, but it isn't like he's able to save $20 a month by choosing a special "young guy" plan that doesn't cover Alzheimer's or other ailments that aren't likely to afflict him. He might save $20 a month by choosing a plan with a high (e.g. $10k) deductible, which makes a lot of sense if he's actually got $10k set aside (it never makes sense to insure against consequences you can afford - it's not statistically likely that your claims will exceed your premiums, unless the insurance company has hired really dumb actuaries.) But isn't it the older person who is more likely to have $10k set aside? Many, perhaps most, people in their 20s live paycheck-to-paycheck, and are saddled with debt (student loans, car payments, etc.). Opting for a plan with a deductible higher than he can afford to pay doesn't make much sense for our 23 year-old, unless he wants to sell his car and move back in with his parents in the event that he breaks his leg skiing.
Doesn't Giuliani's "plan" only help those who can be incentivized in this way? What about those who don't derive any marginal benefit from tax incentives? For instance, those who pay little or no income tax, because they are working poor, yet don't qualify for Medicaid. How do you incentivize that group to buy health care?
Giuliani's plan sounds like the typical "free market" copout that's so 1987. For god's sake, we're no longer in the Reagan era of triumphant conservatism. The Bush era destroyed whatever credibility conservatism had.
Time to switch over to the French system -- free health care for everyone, with impeccably high standards, and (Megan's diatribes on bloggingheads notwithstanding), hospitals that really do treat patients like they're at a hotel... for god's sake, they do your friggin' laundry, on the house!
Time to get real and start treating people humanely, instead of shoving everyone into a heartless, efficient "marketplace".
Human values trump "market values"!!!
What does "social justice" mean? I'd like to know. To the communist I guess it means perfect equality of wealth. To those who aren't communists it means... some arbitrary degree of inequality?
"Social justice" means "As soon as I can get a majority, I'll force the minority to submit to my will".
Moreover, a need-based transfer would argue for some sort of means-tested programme, not an indiscriminate giveaway to anyone who happens to be sick.
Well, it might, rather than argue for means-testing on the spending side, argue for means-testing on the revenue side (i.e, progressive taxation). That way, you know, old but rich Warren Buffet gets less of a net benefit from the Medicare funds spent keeping him alive than old but poor John Smith. I do realize, of course, it's a violation of the natural law to require tycoons to pay higher tax rates than paupers.
Time to switch over to the French system -- free health care for everyone, with impeccably high standards, and (Megan's diatribes on bloggingheads notwithstanding), hospitals that really do treat patients like they're at a hotel... for god's sake, they do your friggin' laundry, on the house!
Ah yes, the omnipresent mythological Other that solves all problems with a handwave in order to transport us into the Promised Land of milk, honey, and candy rainbows...and before breakfast, too! Wonderful!
In point of fact, every healthcare system that has tried to offer as much as possible to as many as possible for as little up front cost as possible, has either run into rationing or insolvency. There are currently rumblings of the latter in regard to the French system.
So far as I am aware, the most successful social healthcare systems have blended high tax rates (to provide the necessary funding), co-pay structures (to dis-incentivize moral hazard and abuse of the services offered), and a coexisting private insurance market (for those who want to buy coverage beyond the means of the system).
Or, to put it another way --
Human values trump "market values"!!!
-- is merely a chant for the pep rally, with no meaningful debate value. Market values are human values; markets are natural expressions of human behavior. Attempting to divorce them from healthcare only screws up the system by pulling out critical feedback mechanisms. To some extent this has already happened in the US, via the de facto price controls imposed by Medicare/Medicaid.
In Singapore's health care system, individuals pay for their own insurance (with a subsidy based on income) if it is not provided by their employers. They pay a substantial part of hospital bills out of medical savings accounts, which are compulsory and which are funded jointly by individuals and their employers. Singapore ranks 6th in the WHO ranking of national health systems. The US ranks 37th. Singapore ranks 15th in life expectancy. The US now ranks 42nd. Singapore has the lowest rate of infant mortality in the world. Forty countries have lower infant mortality rates than ours. The US spends 15% of its national income on health care. Singapore spends less than half that amount. Instituting Singapore's system in the US would head off a single payer system for the foreseeable future. I am semi-socialist, but I would happily accept a health care system here like Singapore's, despite its free enterprise orientation. The unwillingness of American conservatives to consider adopting health systems like Singapore's is a mystery.
Aren't you supposed to be blogging at the Atlantic now? It seems I read that somewhere?
When Klein is clear on the difference between a deduction and an exemption, I'll expend a few minutes considering his point of view.
"Social justice" means the same thing as "progressive": "I'm morally superior to you because this is how I characterize my policy preferences."
If one doesn't accept this definition, then the terms mean nothing.
Forty countries have lower infant mortality rates than ours. - Stan
This is often held up as evidence that the US health care system is in bad shape, yet it's a very misleading statistic. It says much less about the quality of care than it does about:
a) the fact that the US counts "births" differently than most countries - IIRC, any baby that shows any sign of life whatsoever is counted as a "live birth", as are very premature births that hospitals in most parts of the world would not even attempt to save.
b) the heterogeneity of our population. The Nordic countries have very low infant mortality rates, but this apparantly says more about their genetic robustness and the homogeneity of their population than it does about their hospitals, because Nordic women in the US also have very low infant mortality rates.
c) lifestyle choices. People in the US, including some pregnant mothers, do not take care of themselves as well as people in some other countries do. Maybe things like obesity and hypertension have an effect on fetal health?
Rob -
In an article in Am. J. Pub. Health (Vol. 95, No. 1, pp 86-90, 2005) the authors studied the relation between income level and infant morality in four cities, New York (Manhattan), Tokyo, Paris, and London. Their conclusion: "In stark contrast to Tokyo, Paris, and London, the association of income and infant mortality rate was strongly evident in Manhattan." I have found other studies that reach the same conclusion using as examples the US and a number of other developed countries. I see two explanations for the strong dependence of infant mortality on income level in the US as compared to the weak dependence elsewhere:
a) In the US poor pregnant women do not take good care of themselves, but in other developed countries they do.
b) In the US poor pregnant women cannot afford good prenatal medical care and counseling, but in other developed countries they can.
Which possibility seems more likely to you? And does this have anything to do with our lack of universal medical insurance?
In the US poor people eat fast foot. In other countries they grow gardens, eat less (and live on things like rice instead of french fries)
Universal health care isn't an insurance plan. As with most of society's infrastructure, it is spreading the cost across all the population. This benefits the society as a whole even if only a fraction is capable of making full use.
We build high standard roads in places only a very few people will ever go. We build huge airports costing billions when the majority of Americans don't fly. We have a gigantic judiciary when only a small percentage of Americans will ever need to go before a Judge. We have a good education system that turns out more Nobel Prize winners than any other country. And we have a military that consumes more than the rest of the world combined to defend us from a foe that doesn't exist.
Then we put in place consumer protections so we don't eat tainted meat, use harmful drugs, or kill ourselves driving dangerous automobiles. We police ourselves to minimize dangerous people from harming us. We organize fire departments to save our property and lives. In times of disaster, we fill bags with sand or donate money.
I would think that all these examples help society be better. The health of the nation's citizens should be no different. The healthier society is, the better society will be. To suggest I got mine Jack, screw you is the typical response of those who are taking the money but not contributing.
I see two explanations for the strong dependence of infant mortality on income level in the US as compared to the weak dependence elsewhere:
a) In the US poor pregnant women do not take good care of themselves, but in other developed countries they do.
b) In the US poor pregnant women cannot afford good prenatal medical care and counseling, but in other developed countries they can.
Which possibility seems more likely to you?
Stan, good points. The correlation between income and infant mortality within countries that you cite is obviously something which the overall differences between countries that I mentioned can't account for.
As to which possible explanation seems more likely to me, I'd guess that it's some combination of both.
Since we are talking about the poor, we are talking about Medicaid. What kind of "prenatal medical care and counseling" does Medicaid provide, and how does this compare to the quality of care available to the poor in other countries? What percentage of poor pregnant women in New York fail to utilize the care and counseling available to them, and how does this compare to the percentage in other countries? Also, I'd be curious to know whether infant mortality rises or falls as you go just above the income threshold for Medicaid eligibility (I believe it's around $20k/yr. for a single pregnant woman in NYC).
I don't accept prima facie that the poor in New York are no more or less dysfunctional than the poor in other hand-picked cities (Tokyo, London, Paris) around the globe. It may be that drug use is more rampant in New York. It may be that stronger familial and cultural ties exist in, say, Tokyo, and almost any pregnant woman would consider it unthinkable not to see a doctor and follow his orders.
These are all just questions. I don't know the answers. But you did raise a good point.
Rob, thanks for your courteous response. We'll have more information on this subject when Romney's medical insurance program in Massachusetts gets going and papers start coming out on its effect on public health. Re your question on Medicaid, a single pregnant woman in New York state is eligible for Medicaid if her annual income is less than $20,400, but I don't know how much care she's entitled to.
"The young of today have two possible outcomes:
1) They will be old and sick too, in which case they are no less deserving of our concern than today's old and sick
2) They won't ever get to be old and sick, which is even worse than being old and sick."
Or maybe three outcomes?
http://www.ted.com/index.php/talks/view/id/39
http://www.sirtrispharma.com/
Stan,
I am very pro-free market and have been, as you have, very intrigued and struck by how smart the Singapore system is. I am not a big fan of mandates but we use mandates in other insurance markets (most notably automobile insurance) to good effect. The ideal system would, IMO, involve a combination of mandatory catastrophic health insurance (which would be means tested and subsidized for the poor) and medical savings accounts. Insurance claims and payments would be filed and paid to patients directly.
Steve
> I am not a big fan of mandates but we use mandates in other insurance markets (most notably automobile insurance) to good effect.
How will a health insurance mandate be imposed?
With auto insurance, there's a vehicle that can be taken away. If someone has an accident who doesn't have insurance, we throw them in jail. We deny them a license if they can't show evidence of insurance. And so on.
Are you going to jail folks who don't buy health insurance? How are you planning to find them?
"Time to switch over to the French system -- free health care for everyone, with impeccably high standards, and (Megan's diatribes on bloggingheads notwithstanding), hospitals that really do treat patients like they're at a hotel... for god's sake, they do your friggin' laundry, on the house!"
I do NOT consider Michael Moore to be a citable source.
-dk
They didn't eat right or excercise; they smoked; they didn't go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports.
Way to proofread your blog posts, genius. Tee-hee!
Jesus, what a sick fuck you are, lady.
Nice job, Atlantic. This is why I don't fucking read you.
When Klein is clear on the difference between a deduction and an exemption, I'll expend a few minutes considering his point of view.
When brownshirts like yourself can come up with a credible difference between Nazis and "libertarians," I might quit laughing at you.
"they drank to much"
perhaps they were too busy learning proper English.
"they drank to much"
perhaps they were too busy learning proper English.
Wow, just wow. Must be interesting going through life without a conscience.
so, I reckon you are an example of perfect lifestyle and will never ever get sick, nor will you die, right?
Further, I reckon you will never ever need the help of another person for anything, right?, because you are perfect?
Frankly, I think you are a first rate shit of a person.
furthermore, your argument against single payer if based on the false premise that it is all about making the young pay for the old. Do you think the old do not nor never have paid taxes?
Tell that to my 85 year old father and you better be ready for a smack-down...
They didn't eat right or excercise; they smoked; they didn't go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports.
I like how you sort of sped through this sentence with one hand over your eyes, peeking through the fingers, typing half-blindly with the other hand (hence the 'typos'), as though half of you knew how truly, heinously moronic the other half of you was being, and yet all the one half could do was watch the other half commit this howling inanity, somehow powerless to stop it. Reminds me of something out of Poe. Bravura performance, really, considered as an embedded reductio of your own stupidity.
Remember, Megan is Too Good to, say, be hit by a speeding drunk-driver. Her model of emulation isn't John Galt but Marie Antoinette.
"Moreover, as a class, the old and sick have some culpability in their ill health."
Yes, damn that whole aging thing. If only there were some way to stop people from passing a certain age. Maybe we could implant little jewels in there hands that glow red until they hit 30, at which point they turn black and, well, you know the rest.
Nah, it's been done
http://en.wikipedia.org/wiki/Logan's_Run
My advice: get in on Soylent Green futures now.
I'll skip past the breathtaking amorality of your positions to note one ironic fact: the reason that mass poverty was alleviated among the elderly was the implementation of Social Security.
I wonder if you advocate the elimination of Social Security? If so, your entire argument would represent one big Lord of the Flies race to the bottom.
"furthermore, your argument against single payer if based on the false premise that it is all about making the young pay for the old. Do you think the old do not nor never have paid taxes?
Tell that to my 85 year old father and you better be ready for a smack-down..."
Bravo b.
The old have paid for the young. Where in hell does Jane think that the vast public infrastructure that existed on the day she was born came from ... the tooth fairy?
Sorry, but I'm laughin' my ass off here whilst saying a fervent prayer 'lord, don't let me be withing 20 feet of this person when ya show her that what goes 'round comes 'round'!
There's some folks you'll stop to help change a tire on a cold rainy night...there's others ya don't.
I normally don't do this kind of thing, but this has got to be the dumbest thing I've read in a long, long time. You obviously have no idea what you're talking about. Everyone gets sick. And if you have your way, there will be far fewer young people becoming old people than if Ezra gets his way.
BTW, my seemingly healthy sister was diagnosed with leukemia some time ago, and were she not lucky enough to have had employer-insurance at the time, she'd be dead. But I guess that was her fault. How dare she be so privileged as to get leukemia! Unfortunately, it made her lose her job so she had to pay for the insurance herself. But it was still far, far cheaper than having to pay for the extremely expensive treatment herself. And to think, all those poor young suckers on her insurance plan had to foot her bill, just so she could live the leukemia high life. And she wasn’t even old!
And yes, it was a government program that allowed her to keep her insurance. And again, had she not had that job at the time, she’d be dead. Lucky her. But oh no, you labeled insurance a tax. Now it’s evil. Brilliant!
Jane, your parents should have told you this and not left it up to a stranger to break the news to you. Honey, you're a moron.
And here's a weird criticism of Ezra:
I think it's a little misleading to talk about insurance pooling here.
And that's weird because Ezra didn't talk about "insurance pooling". He said "risk pooling". And whether you consider involuntary insurance to be "insurance" or a "tax", it still involves risk pooling. That we all pool our resources together in order to avoid a common risk. And that concept is the very basis of insurance, whether it's voluntary or not.
Talk about misleading...
BTW, it's a little known fact that the older you get, the more income you make. So healthy young people are less likely to pay as much in tax as middle-aged people; who also need health care. And wealthy old folks with lots of assets are also likely to pay more in taxes than most young folks. And by the time you start having kids, you'll be damn glad you had insurance. I am.
In reality, there's only a very small time period in most people's adult lives that they won't need insurance. Perhaps you'd like to watch your kids get sick, but I never have. Or perhaps you just won't get them their annual well check-ups or immunizations and will keep them locked-up in a closet to make sure they don't harm themselves. We'll do anything to ensure that low income young people shouldn't be forced to put money into a plan that they almost surely will require some day.
What's pathetic is that this essay was so obviously written backwards. It started with the conclusion that involuntary insurance was a bad thing, and then sought some sort of justification to explain why that might be; and had to distort reality about irresponsible old folks taking advantage of young folks to make even a flimsy argument. But I guess that's how conservatives do everything. BTW, the issue isn't that young people will pay for the old, but that rich people will pay for the poor and middle-class. Can't you people get anything straight?
I hope you and all who agree with you become deathly ill with an very rare, incurable disease due to a cellular mutation no one could have prevented, have to go on disability insurance from your employer, get terminated from your job once you've been out for a year, shortly thereafter have your disability insurance suddenly stop payments for an invalid reason because they can, lose your health insurance because you no longer have any income and you have exhausted all your savings and assets paying for what that insurance didn't pay for, while you are battling the Social Security system because your disease is so rare they've never heard of it, knowing that Social Security will not provide you with Medicare until you have been on Social Security for two full years and you cannot get on Medicaid until you are on Social Security, and having to file lawsuits for what you are legally entitled to because you have paid for it, and doing all of this while completely indigent and having to rely on family and selling what remains of your belongings just to survive while having to rely on a free clinic for whatever health care you can get for your rare, incurable disease no one has ever heard of and which could kill you at any moment without notice and which is considerably worsened by stress.
Like me.
No.
Wait.
That would be going too easy on you.
But then, at least, you might be able to understand why we must have single-payer universal health care in this country, just like all of the other wealthy civilized nations in the world.
And shut your trap.
Why do you guys think you have to reinvent the wheel every frickin' time? Look at how other countries do it - they just about all do it better than you for less cost. Pick a system you like.
Do you have any idea how asinine it sounds to have a debate on health care systems based entirely on hypotheticals when you have good empirical samples to hand? Sheesh.
And may Jane never have to gain knowledge of how wrong she is the hard way. There are times when people are responsible (at least in part) for their conditions. This cannot be ascribed to a class.
A good health care policy is not only about getting the best treatment after you get sick. It's about preventing to get sick. Infant mortality in the US is higher because of lack of prenatal care and screening and testing. Only with regular check ups can a physician detect that something tends to go wrong during a pregnancy. Usually it can be resolved by just a slight change in diet or with inexpensive treatment.
Your stupidity and lack of humanity are both engaged in a titanic struggle to outdo each other. Do you seriously believe that people can control their health conditions across the board? Do you think you are exempt from the plague of illness or old age?
You really are a child.
Moreover, as a class, the old and sick have some culpability in their ill health. They didn't eat right or excercise; they smoked; they didn't go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports.
The ignorance of this statement is breathtaking. Maybe old people get sick because...well...they're old! As we age, our bodies work less efficiently, and become mmore susceptible to disease. Not to mention, should we base health pollicy on who we can blame for getting sick? "Yes, Joe Smith, you led a good healthy life, you get insurance coverage. Your wife, on the other hand..."
Besides, it should read, "they drank too much". If you're going to make infantile arguments, at least get the grammar right.
I suppose, once you get beyond the casual knee-jerk rejection of social mobility and safety net policies, wrapping this argument in free market philosophy might not seem so sinister.
But just think about what you're saying and square it with the world as it is. People get sick. Often it is not their fault. And often what you term "behavior" is in fact an occupational hazard for which they should be compensated. Unless you think that smoking is the same as, say, working in a factory.
This argument - morally, ethically, and epistemologically - is simply unsustainable.
Is this really what they plan to do at the Atlantic? Conservative, free market types see their world crumbling around them, their perfect president sitting at 30%, and their Mideast adventure going down the toilet, and they continue to get rewarded with blogs and an ever larger presence on the teevee?
As a class, the old and sick are already luckier than the young and healthy.
Damn those lucky duckies! Oh, to be 80 and sick rather than 21 and healthy.
Sure, I'll pile on - why not? Jane, you ignorant slut (apologies to SNL) - this may be the single stupidest thiing I've read in months, and I peruse "Swampland" pretty regularly. "The old and the sick bear some responsibility for their own ill health." Yeah, those ignorant, incosiderate seniors - didn't anyone ever tell them that living to an advanced age is bad for you? My father-in-law just passed away at age 93 after a six-month struggle with leukemia. Prior to that, he was the proverbial "healthy horse" despite a life that would have killed Ms. Galt by the time she was 16. Growing up during the depression he was obliged to take a job that exposed him to pure ammonia and just about ruined his sinuses - for which he never received treatment. He volunteered for service in WWI and served as a forward artillery observer, which led to frostbite in both of his feet - for which he never received treatment. Nevertheless, after the war he was a New Jersey state racquetball champ and and an active swmmer and runner. He continued to play racquetball until age 90 despite having a shoulder, hip, and knee replaced in his 70s and 80s because of chronic wear from injuries he suffered during the war. In the 20+ years I knew him I can never recall him having anything more serious than creaky joints and the occasional sinus problem. He never smoked, drank perhaps once a month (if that) and was more active at 85 than the bitch who wrote this heartless screed ever was or will be. But I guess he brought on his own demise, right? Ms. Galt, my father-in-law and folks like him made possible the cushy life you have today, so I think it's time you shut the fuck up and apologize to the millions of fine people you slandered in this pitiful mind-puke of an argument. If this is what the Atlantic considers deep thought, it's time to call Jack Handy...
As a class, there is no one sicker and poorer than Libertarians and Randian cultists.
Sooner or later, everybody dies from something, no matter how "careful" they might be.
You might as well enjoy it while you can, no matter how old you are, because it appears a new "cause of death" is fast approaching: stupid bloggers.
Sooner or later, everybody dies from something, no matter how "careful" they might be.
You might as well enjoy it while you can, no matter how old you are, because it looks like a new "cause of death" is fast approaching: Jane Galt's version of the Final Solution.
Jane,
Don't listen to all these whiney realists. You are soooo right. Old sick people choose to be old and sick. I choose to be young and healthy... forever, as I'm sure you do. The behaviour of these freeloading "senior citizens" sickens me*, especially when you consider that young people, as a class, don't drink, smoke or do drugs. They don't eat crappy food and they choose not to get cancer.
Moreover, I have been building roads, schools and hospitals since I was one month old. I've given everthing to make this country what it is today and I've received nothing in return. My parents, on the other hand, gave me nothing and have, quite frankly, been freeloading their entire old & sick lives.
I say we tax the old people more and give the money to the young and healthy so they can stay young and healthy. Also, I want an extra rebate because I have to spend time with my grandparents who smell and who do nothing but drone on and on about what they did in the war. I wish they would just hurry up and die and then the young and healthy could inherit their piles of assets.
Ponies for all the young healthy people!
*Well, it would sicken me but I don't get sick 'cos I'm young & healthy like I mentioned.
If I didn't know you from your old blog I'd assume this was satire.
Seriously, "dangerous sports?" Like what, Nazi-killing? Did they even have bunjee cords and Mountain Dew back then?
Damn. Wasn't this piece satire? It's gotta be...along with some of the opening comments.
Please tell me it's satire.
Gosh, it's good to know my MS and diabetes are my own fault for high living. Thus, my death from being unable to afford medication will be just and everyone can believe they were blessed with better health because God loves them more, or something.
Also, I'm only 40, so I didn't know I was old. But I do know that no company will sell me individual health insurance, my only hope is in pooled risk. If I loose my job, I'm toast. Nor can I start my own company.
dear megan,
did you stop to think how it might make people feel when you wrote this column that seems to blame sick and elderly people for being, well, sick and elderly?
my guess is that you didn't. a number of previous commenters have alluded to this, but let me spell it out for you so that it is totally clear: what you are saying hurts people's feelings and makes them very angry. how do you think you might feel if you had a loved one who was older and who had health problems that were hard for them to deal with, and then you read something written by someone else that seemed to imply that they didn't deserve compassion and care? i know that it made me feel angry and sad to think that you don't believe that my beloved grandparents don't deserve the best care available. are there people in your life like that?
also, you come off as seeming kind of like a bully when you pick on sick people. you know that, right? i'd encourage you to think more about that, because it seems particularly unkind to target vulnerable populations.
i understand that your money is important to you, but your money, or my money, or anyone's money is not more important to me than the old people i know and love, and the ones i don't. just remember that you and everyone you know will get old someday.
and maybe try to think a little more about what you write before you write it. good luck.
"As a class, the old and sick are already luckier than the young and healthy. "
Okay, I'm sure I'm piling on but Jesus Christ, that may be the stupidest thing ever written on a blog. (I qualified this, you notice, to take out stupid things said by Bush, O'Reilly, Hannity, Rush, the WSJ editorial page, Rudy & the Gang of Bush Clones, etc.)
Look, you idiot, NO ONE who's sick is in a lucky class. Repent..now..lest these words haunt you in your old age.
If you don't know enough people to know those who have a horrible lifestyle and yet stay healthy - or those who have a saintly lifestyle and get sick - lucky you.
Take some time to think about what you're saying before making yourself look like a shallow fool. Good advice for anyone with a blog and no editor, BTW.
For anyone interested, I totally destroyed this post at my blog, along with a post she made yesterday at her new blog:
Tail-End Thinking
An Excerpt:
But as I said, Megan's got the dynamics of this all wrong. This really isn't a case of the old feasting like irresponsible vampires on the young. This is the poor and middle-class feasting on the rich. And as I said, it's more likely that the rich are going to be older people who need insurance. And so Megan's point is entirely absurd. She had her premise and desperately sought out any kind of justification for it. But it failed miserably on every level and exposed her to obvious criticism of being both mean and dumb.
But I don't think she's really mean. I don't think she really blames people for getting old or sick. That was dumbness talking all the way. And the dumbest thing she did was adopting her conclusion in the first place. The rest of it was just a futile attempt to justify that initial mistake. But I guess that can be said of everything conservatives do. It's not their reasoning that's at fault. It's that they chose to be conservatives in the first place.
Does Ayn Rand's urine really taste like lemonaid?
I'm trying to imagine Jane on a lifeboat...
http://www.imdb.com/title/tt0037017/
Seriously, "dangerous sports?" Like what, Nazi-killing?
Well, Nazi-killing was a dangerous sport. I don't know why all those silly young men made the career decision to engage in something so foolish back in the 1940's. You won't see today's young and healthy people being that dumb.
The Stoopid is overwhelming here. Perhaps we can fund healthcare by taxing the Maroons posting such screeds as this.
Are all Libertarians sociopaths, or just you?
If it's appropriate to segregate human needs and providers as suggested, Jane, I suppose I can drive a lot more carelessly as well. What need have I to reduce speed as you impede traffic in a crosswalk? I have places to go! You may need to cross the road, but why should that be MY concern?
Fie on your egalitarian laws!
Who raised you? Wolves? How did you self-finance that glorious pre-Ivy League childhood?
Much regards
I made a snide comment earlier about a lack of conscience, but perhaps I was too judgmental. I forgot that you can just say "as a class," and thereby eliminate all humanity and morality from your analysis. It's just an academic exercise! Whee! As a class, Americans are richer and more affluent and better-off than ever! Look, I can do it too!
We can't really consider things like income-distribution and health care policy under real-world circumstances, can we? That's HARD.
As one of the sinners who will deserve whatever I get, I wonder if Megan has some kind of risk-weighing mechanism in mind.
See, I've gone skydiving a couple times. And I smoke.
But I also work out, go hiking, eat very little meat, drive carefully, socialize frequently, and have never married nor had children. All of which are good for one's health. (Marriage and childbirth are known to be huge risk factors for women's health.)
So I wonder, do all the healthy things I do outweigh the smoking and skydiving enough so that I "deserve" medical care?
If so, does someone who marries young and has lots of children, but doesn't smoke or skydive, have the same deserved-ness quotient? Or someone who drinks but runs marathons; or someone who doesn't drink or smoke but is a coalminer; or someone who smokes and drinks but is a vegan; or someone who doesn't smoke or drink but is a deep sea diver; or someone who likes to hunt; or someone who's a jocky; or a test pilot; or someone who eats a lot of meat but does a cleansing fast every month?
Not very many people's lifestyles stand up to the kind of risk analysis Megan wants to see used. In fact, hardly anyone's does - except, maybe, nuns and monks (no, wait: they drink!).
That's why (universal) health insurance uses risk-pooling. Everyone puts money in the pot, whatever their risk factors. In the fullness of time, some of them will need more healthcare than others. The old drinking smokers might actually need less healthcare than perfect-lifestyle people (such as, presumably, Megan) who have the bad luck to get into a major car accident - or are caught in a fire - and need months of major and reconstructive surgery followed by years of plastic surgery and physical therapy. If the pool of money has been contributed to by everyone, for decades, there's enough to go around.
Another problem with judging peoples' worthiness by their lifestyle is that the list of exclusionary lifestyles just gets longer and longer. The idea of excluding people for eating too much meat used to be a joke. Now it's next on the list of things to deny coverage for. What's next? Living in potential hurricane paths? Earthquake zones? Tornado-prone areas? Near major intersections? In inner cities?
Oh, and Megan? I, too, am interested to know just how you plan to avoid ever becoming an old sick person. If you have the secret of eternal healthful youth, you could make a lot of money sharing it.
uhm am I the only person who remembers that diseases are communicable? Putting aside alzheimers etc, the visit to your average doctor is extremely expensive (especially in cities where most Americans live) without insurance. So people without insurance generally don't go to the doctor unless there's a very very good reason. Mainly, they're about to drop dead.
Which means highly communicable diseases such as Tuberculosis, and Meningitis can spread and cause disease amongst EVERYONE, even the insured. This is why NYC goes door to door in the poorest neighborhoods and gives free testing and treatment. It's not kindness on their part, it's because their terrified of an epidemic.
As for the uninsured and the underinsured - as a society we're already bearing the cost for these individuals. they go to public hospitals and skip out on their bills.
You're also ignoring the fact that one of the main reasons insurance is so costly, why treatment is so costly is because most of our communities, hell insurance itself is designed in a way to encourage us to be sick. I.e. to drive everywhere, to eat poorly, to not work out. Many health insurances, for example will provide a person with nutrition information and gym membership reimbursement...only if you already have a chronic disease. In other words prevention is neither talked about nor encouraged.
i think jane's on to something here; after all, iraqi's don't get 'sick and old' bc we simply kill them, or create an environment that will kill them, before they get to that point. brilliant!
thus, i advocate global nuclear winter; that way nobody will get sick or old anymore and we won't have to worry about health care bc everyone will be dead.
checkmate.
You lefties are the source of the stupidity around here. And such potty mouths - do you kiss your moms with them. If I were the moral vacuum that most you are, this is where I'd wish death on you and the filthy whores that pass for your mothers.
I really look forward to the day you get cancer so I can come to the hospital and laugh in your face, you cruel, twisted bitch.
If you want to put this in a moral context and consider whether universal care brings with it a "virtuous" calculation as is a favorite term with Meagan, at least, I think the only truly meaningful value is "cost shifting". Every society that beleives its citizens should live must care medically for people without means. It is not only not surprising that illegal immigrants and other "undesirables" use our health care system, it is inevitable.
Whether it is reviving a junkie or treating our enslaved labor pool of hotel workers, the only alternative is to let them die. China's current health care is the most libretarian on the planet. IF you dont have cash, you dont get treatment- whether you 4 or 94. Our society is not organized in that fashion, and frankly I hope never to live anywhere that is.
The calcuation is not whom to treat. As the Leader says "We have universal care, you just go to the emergency room." (actual quote) with the obvious corrollary of "Just provide the wrong name and address, and it becomes socialized medicine!" We will pay for everyone until we as a society decide to let people die- whether from bad decisions or bad luck.
Until they choose to live in Locke's state of nature, the question in a liberatarian mind SHOULD be- what it the most efficient way to provide medical care. Cost shifting is expensive, lacks tranparancy and is inherently immoral and unfair. It happens in the price of insurance, the amount of taxes, and the price of a car. We are at a competitive disadvantage making economically unwise and selfish (not in a good, liberatarian way) decisions.
There is no system that would be comparable to an American single payer system, because no one has started from where we are. Simply transferring money from party to party, doctors offices having staff dedicated to keeping track of one form or medical status coding scheme from another is just wasteful.
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