OT's GONE WILD!

[tjb]

What if you were struck by an uninsured drunk driver while walking down the street and ended up in an induced coma for a few weeks?

Three years ago I was hit by an uninsured drunk driver who was thought to be going >50 mph. I was stopped.

It totaled my car but I emerged with only a concussion and had a regularly scheduled follow-up with my neurologist the next day, when I was also examined for the accident.

I suspect my comprehensive coverage would have covered my own hospitalization and I might be insured for that without comp, but the point is taken.

Since I had comprehensive, I received payment for my car less my $100 deductible. I recently received a letter from Geico saying they had abandoned their attempts to recoup their loss from the driver.

[tjb]

My biggest issue, or maybe it's just something I don't understand, is the difference between the doctor bill and the amount allowed by insurance. I've gotten bills for $500 that my insurance company said was only worth $40. So I only had to pay $40 (towards my deductible). If I didn't have insurance, my bill would have been $500? What the heck is going on there?

The insurance companies negotiate their own costs. You can frequently do the same when you aren't covered, although without much leverage.

Pricing is crazy and opaque. The only studies I've found about the effect of transparent pricing on health care use seem to be aimed at doctors' decisions, not patients'. Those doctor studies have not been promising about "market effects" in health care - at least price transparency by itself - as seeing prices has not affected use of resources.

Not surprisingly, doctors do a lot of things for individual patients (such as prescribe antibiotics aggressively) that they know is irresponsible judging from the data. It's another reason to be skeptical about what market pressures can do for health care.

[tjb]

Dani Rodrik on NAFTA. Bottom line, no real impact on jobs (job loss is almost entirely due to innovations, not trade), very real impact on low-wage laborers' income growth.

What did NAFTA really do?

In other words, those high school dropouts who worked in industries protected by tariffs prior to NAFTA experienced reductions in wage growth by as much as 17 percentage points relative to wage growth in unaffected industries. [tjb note: Also, other low-wage workers, like waitresses, saw their wages similarly depressed in these communities] I don’t think anyone can argue that a 17 percentage drop is small. As McLaren and Hakobyan emphasize, these losses were then propagated throughout the localities in which these workers lived.

So here is the overall picture that these academic studies paint for the U.S.: NAFTA produced large changes in trade volumes, tiny efficiency gains overall, and some very significant impacts on adversely affected communities.

The consequences of NAFTA for Mexico are another topic which would require a separate post. Let me just say that the great expectations the country’s policy makers had for NAFTA have not been fulfilled. Despite the country’s integration into North American production chains, overall productivity has stagnated. Mexico has been one of Latin America’s underperformers.

So is Trump deluded on NAFTA’s overall impact on manufacturing jobs? Absolutely, yes.

Was he able to capitalize on the very real losses that this and other trade agreements produced in certain parts of the country in a way that Democrats were unable to? Again, yes.

[UncleLar]

Absolutely I am.

As said, I went without Health Insurance for about a decade. I didn't need it. I had no problems.

If you feel it is a no-brainer, then get it. If you are in your 60's, and your idea of being "active" is doing the Santa Crawl, then by all means go get you some insurance.

Between my and my employer, there is probably around $10K per year going to my health insurance (I think about $3K from me and $6K from my employer). I think it would be much better managed coming directly to me, to take care of my own health needs.

If I get cancer when I'm 60, then I could possibly have almost a half million dollars in my account. If I have that money invested like a 401K, then I have the chance to not only be healthy, but wealthy.

Even if you are foolish enough to risk everything by not buying health insurance, you can't honestly suggest that you don't understand why a healthy person would want health insurance. You just can't be that stupid.

[Tom]

Lets not forget that the ACA is much broader than just individual insurance mandates and marketplaces.

[tjb]

This is neat:

http://www.nationalaffairs.com/blog/blogger/findings-a-daily-roundup

[Skeeza]

Even if you are foolish enough to risk everything by not buying health insurance, you can't honestly suggest that you don't understand why a healthy person would want health insurance. You just can't be that stupid.

Now you are calling me "stupid"? You are the one who does not understand the conversation, because you misrepresented what I said.

I did NOT say that I "don't understand why a healthy person would want health insurance". I said that I understand why they may choose NOT to have insurance.

Big difference.

[tjb]

Foolish and stupid are not strict synonyms, but I empathize with your reaction.

Given the chances you would have actually refused life-saving treatment in a dire situation when you had no insurance, I'd say you're more of a welfare cheat.

Making Ad Hominem Accurate Since 2017

[Skeeza]

What if you were struck by an uninsured drunk driver while walking down the street and ended up in an induced coma for a few weeks?

Perhaps I just do not buy into the lottery philosophy when it comes to these things.

• I don't have a bomb shelter in my basement in case the terrorists strike
• I don't have a huge stash of weapons in case robbers try to overtake my house
• I don't wash my hands 20 times a day in case I get a deadly virus

....I guess I just live by a different outlook than you. Isn't that what this country is all about?

[tjb]

Something of a reductio ad absurdam, there, @Skeeza. I presume you don't have meteor insurance (although I guess it's pretty cheap,)

2004 study: males spend $270,000 on health care lifetime (less than women because we live longer), two-thirds in the last part of life. My insurance was about $800/month before Medicare kicked in, lower as a younger person.

So, yes, as you can predict, insurance on average costs more than health care (hey, the Aetna CEO has to get his $15 million annually - it's tough to manage a business that requires so many people to administer it). Add in the compounding effect on your savings that you mentioned, and it's really not a good deal - on average.

However, federal law requires you to be treated for any life threatening illness (with some exceptions about who must do it that I don't fully understand the economic impact of - perhaps someone can help?).

So I agree with your earlier point. Instead of defending freeloading, though, which is so unseemly, I think you should work toward the Let Freeloaders Die in the Street Act of 2017. The good news is that the political climate seems to be right for it!

[mjg]

Perhaps I just do not buy into the lottery philosophy when it comes to these things.

I don't have a bomb shelter in my basement in case the terrorists strike
I don't have a huge stash of weapons in case robbers try to overtake my house
I don't wash my hands 20 times a day in case I get a deadly virus

....I guess I just live by a different outlook than you. Isn't that what this country is all about?

Hmmmm. I don't have a bomb shelter either. I do have a .45 on my nightstand in case someone breaks in while I'm asleep. I don't use anti bacterial anything (except on cuts) to wash.

But health care isn't a lottery event. A broken leg skiing could set you back years financially. Frankly I don't give a rip if you have health insurance or not if you are willing to waive any care you can't afford. If you aren't, then you are full of crap.

[jyd]

Perhaps there should be some sort of means test for insurance based upon your tax returns and average annual medical expenses over your lifetime. If you have a demonstrated ability to pay for your expected medical care out of pocket, you won't be required to buy insurance.

Others may know better than I, but I believe that if you and I each go to the same doctor for the same thing and I have insurance while you don't, you pay MSRP and I don't due to lower rates negotiated by my insurance company.

Quasi-related: if you meet the above income standard, I don't think you should be eligible to receive Social Security, either. You don't need that safety net (even if you've paid into it).

[UncleLar]

Now you are calling me "stupid"? You are the one who does not understand the conversation, because you misrepresented what I said.

I did NOT say that I "don't understand why a healthy person would want health insurance". I said that I understand why they may choose NOT to have insurance.

Big difference.

A few points.

One, the exact words that I took exception to were

If you are healthy, why do you need health insurance?

So don't tell me that you were only talking about "choice" when you specifically mentioned "need" to start things off.

Secondly, I didn't say that you were stupid. In fact, I said the opposite. My exact words were "you can't be that stupid", implying there must be another reason for you to take the stance that you are. I was just having a hard time figuring out what that other reason might be - thought maybe you might just be trolling.

Lastly, even though you got lucky and got away without needing health insurance for ten years, doesn't mean that you made a smart decision, nor does it mean that every healthy person can expect to be as fortunate as you. You were lucky not wise.

I'm wondering, what's your retirement plan? Hit the lottery when you turn 60?

[Skeeza]

So I agree with your earlier point. Instead of defending freeloading, though, which is so unseemly, I think you should work toward the Let Freeloaders Die in the Street Act of 2017. The good news is that the political climate seems to be right for it!

Funny, they didn't seem to be dying in the streets before the ACA. They were being treated, they were uninsure, and my premiums were LOWER !!!! How does that work?

[Skeeza]

But health care isn't a lottery event. A broken leg skiing could set you back years financially. Frankly I don't give a rip if you have health insurance or not if you are willing to waive any care you can't afford. If you aren't, then you are full of crap.

Why not, instead of health insurance, I get a complete Health Savings Account. Put in $800/mo.

If I break my leg skiing, I have lots of money to pay for it. If I don't break my leg, I have lots of money period.

But, I don't have insurance for a broken leg. I have insurance for the hypothetical catastrophic accident or severe illness. I can pay for the broken leg.

[Skeeza]

Others may know better than I, but I believe that if you and I each go to the same doctor for the same thing and I have insurance while you don't, you pay MSRP and I don't due to lower rates negotiated by my insurance company.

I never had dental insurance, and I still don't. I pay out of my pocket.

Usually if you call up and tell them you do not have insurance, and you are paying out of pocket, they give you the "negotiated" rate.

I was at a Health Care fair, and was looking at the rates being charged for dental coverage. When you do the math on the coverage (and I talked to several companies), You would almost have to have a major dental event just to break even on those plans. They were unreal in how little they cover. NO WAY I will get dental insurance !!!!

[mjg]

Why not, instead of health insurance, I get a complete Health Savings Account. Put in $800/mo.

If I break my leg skiing, I have lots of money to pay for it. If I don't break my leg, I have lots of money period.

But, I don't have insurance for a broken leg. I have insurance for the hypothetical catastrophic accident or severe illness. I can pay for the broken leg.

None of this addresses my point. Would you be willing to waive health care you can't afford? Whatever that might be -- cancer treatment, bad accident, etc.?

[Skeeza]

None of this addresses my point. Would you be willing to waive health care you can't afford? Whatever that might be -- cancer treatment, bad accident, etc.?

Yes, as I did for almost a decade. It's not a theory, it's something I did.

I don't believe that the Health Care concerns should be met with people being required to get insurance. I think Health Care ranks with Higher Education as one of the most unjustly expensive industries we have. I don't believe you can fix it with dousing it with more and more money.

If you are required to pay for these things, then the providers can charge what they want.

[jyd]

I guess we as a society need to decide what we'll do when uninsured people need care but can't afford it. To date, our social compact has been to treat these people anyway with the result being that everyone else chips in for the cost,

Skeeza, I'm not arguing that you haven't needed insurance so far; I'm trying to solve for what to do if you, or others, will die without medical care that you can't afford.

[mjg]

Yes, as I did for almost a decade. It's not a theory, it's something I did.

No it isn't. You didn't suffer from any illness or injury you couldn't afford. My question is would you be willing to turn down treatment for something you can't afford. You were fortunate enough to never have been put in the position to make that choice. My guess is you'd accept the treatment and let the rest of us pay for it. Most people would do the same.