Yesterday, I had a discussion with my neighbor about Obamacare. He is conservative and opposed to it on the grounds that it restricts his personal freedom not to have insurance. He is about my age (late 70's).  I pointed out that he is on Medicare with a good secondary insurance from his former employer and is therefore unaffected by ACA, his reply was that he would be if he didn't have insurance and that was enough to make him mad.

The argument that the uninsured use emergency rooms for which he pays indirectly through increased hospital costs did not make any difference to him since he never sees those costs explicitly. The man is a retired software engineer and might be expected to understand things better, but his rightwing mindset prevents it. He said he preferred the country he grew up in where you still had choices. In that country—before Medicare—one third of people our age lived below the poverty line.

This illustrates the difficulty in getting people to understand public issues. Once the issues have been framed in an emotional setting, reason departs.

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Would voluntary insurance cover alternative medicine?

Likely not, but if someone prefers to use alternative medicine, they could use their healthcare money for the alternative medicine, rather than being fully insured. 

As I said, they can spend money both on the compulsory insurance and on their own choice, but if they don't have money to spare, that's a problem.

During the past week, I've spoken to several people who now have health insurance only because of ACA.

Two were opposed to ACA and somewhat wry about their now benefiting from it.  Still opposed, but thinking twice about that opposition.   In some cases, people I talked to went to a free clinic, which was highly strapped for resources, and just continued their prior medications without monitoring.  Not ideal, but far better than going without.  Still, diabetes, for example, takes a toll on all organ systems, and only way to know if you are in control is by monitoring.  And that undiagnosed colon cancer, gradually invading one's organs, is best treated by early discovery and removal.  Profoundly less costly that way, and live saving.

I also spoke to someone who will be ending their health insurance, but wants to be tested for every possible thing while currently on health insurance.  I pointed out, you can't be tested for a car accident, heart attacks and strokes and cancers happen to people regardless of the tests, and just one of those can impoverish.

I also know instances of people who now can get health insurance coverage. One is my youngest son, whose employer has never provided insurance and who has been paying $800 a month to cover his wife and children, but not himself.

Another is the son of a friend, who is unemployed due to vision problems and is waiting for an eye operation he cannot afford on his own. His premiums will be subsidized.

No one should be without health insurance. You never know when you will be involved in an automobile accident through no fault of your own or come down with something serious like cancer or heart disease. Every state requires automobile liability insurance. This is not much different.

Every state requires automobile liability insurance. This is not much different.

As I said, it wouldn't be objectionable if they required everyone to have catastrophic health insurance. 

Other kinds of insurance are different from health insurance because they are for unusual expenses.  You only have to deal with the insurance once in a long while, if you're in a car accident or a burglar invades your house ...

Full health insurance, which they are requiring everyone over 30 to have, is different.  It applies to routine medical bills, and thus the insurance company is in a position to dictate how you get your everyday medical care.  This is an unprecedented invasion of people's private lives, of their choices about healthcare. 

It doesn't help that Obamacare benefits some people!  As I'm saying, when it hurts other people, that is a problem.  I don't know why that's so hard to understand.  I really do exist.  

And when your neighbor objects to Obamacare because it takes choices away from people - he is entitled to his own values.  You appear to be judging his situation purely in a financial way.  But there are other aspects to how we live our lives, and we have other values besides money.  If your only criterion for living your own life were maximizing your money, you would probably have been an actuary rather than a math professor. 

I always thought full health insurance was bizarre because it extends so far beyond unusual expenses.  The concept of insurance is to deal with unexpected, unusual financial hits. 

And, as I said, full health insurance has shown itself to be a burden in time and emotionally also.  When that insurance co. was so unethical in underpaying my claims, that was a big burden on me, emotionally and in time.  It was a struggle to get those jerks to pay!  For the government to force this on everyone, regardless of their personal tolerance for bullshit, is a huge imposition.  And again, that it would benefit some people, does not help.  If they are going to force something on everyone then it needs either to be a minor imposition, or to take care of individuals' needs.  We supposedly have a society that cares about individuals, where people have individual rights, not just what happens to people on average. 

The government imposes a lot of work on me around tax time.  I put up with that without complaining (but of course, not cheerfully) because it only happens once a year.  But health insurance hassles are ongoing and they involve the insurance company assuming some power over your medical care, they involve injustice if you have unusual medical problems. 

I realize there are people who seek care in emergency rooms because the ER can't turn them away.  However, compulsory insurance won't necessarily help with that.  As pointed out in that link, when you contemplate changes involving people, you have to see what actually happens.  Your thoughts about what "would" happen aren't necessarily what actually happens. 

For the government to force this on everyone, regardless of their personal tolerance for bullshit, is a huge imposition.

How does that compare with the imposition of heavy medical expenses or lack of treatment on those unable to get insurance due to a pre-existing condition?


I also wouldn't object if they let people self-insure for everyday medical bills, with a medical savings account or something like that.  But that also isn't allowed in Obamacare - it forces people to deal with insurance company bullshit (or they grab the money via a fine, without helping you at all).  

Here's another problem with Obamacare -

So we have this healthcare system that is extremely expensive relative to a lot of other countries - but average life expectancy isn't all that great.  Lots of people have diseases that are self-inflicted - type 2 diabetes caused by obesity, COPD causing by smoking, etc. etc.  That's a big reason why there are such huge medical costs. 

And the answer of Obamacare is - force everyone to help finance this broken situation!  And force everyone to support the insurance industry. 

How about looking to solve the root causes instead - instead of demanding that everyone pay for their neighbor's diabetes or COPD - how about applying the research on the causes of obesity, by changing the social environment, the built environment, advertising?  Similarly for smoking and excessive drinking, which are also very expensive - instead of financing the resulting medical bills, work to eliminate the cause.

We already pay for the uninsured.  How is Obamacare changing that? 

It's not changing that, but it is reducing the ranks of the uninsured so that the overall cost may be reduced.

The problem with medical insurance is that it must cover routine care along with exceptional care, but the fundamental concept behind insurance is that it covers unusual risks which may fall on people at random by spreading the risk over a large population. That idea does not quite work with routine care, which everyone will need sooner or later. The only argument you can make is that some people need much more of it than others and you never know who that will be in advance.

That was my point.  That we were already paying for the uninsured so, why is she singling out Obamamcare?

The problems you cite are not due to Obamacare itself but to a healthcare system that is focused on making money for hospitals, insurance companies, pharmaceutical companies, and doctors. It's the American way and apparently what the majority of people prefer.

Obamacare actually represents regulation of the health insurance industry. It prevents them from denying coverage to people on the basis of pre-existing conditions. The only way that provision of the law was acceptable to the insurance industry was by assuring them they would acquire many new customers over which to spread the risk.

This for-profit health care system has produced high quality care, but that care is badly distributed. The conservative solutions are 1) buying insurance across state lines, 2) tort reform, and 3) health savings accounts. The first would allow large insurance companies to put small ones out of business, the second would prevent awards for pain and suffering, no matter how bad, and the third is merely a tax break for rich people.

As long as we insist on a system that makes money—free enterprise is our God now— there will be many problems in distributing health care services. The ACA law will improve life for many people, but no law can cover all circumstances to the satisfaction of everyone involved. The question has to be settled on the basis of what serves the most people in the best way. Right now there are millions able to get health insurance who were blocked out of the market. They are getting needed and in some cases life-saving surgery, hospitalization, and medicine that was unavailable to them before.

Many observers believe the penalty for not getting insurance will not be collected—that that part of the law will not be enforced vigorously, so that may be your best choice.

What of those, like my sister, who are born with diabetes? That certainly wasn't self inflected. What should they do??


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