Waiting Room
Claremont, CA. In the current conversation on health care, we often hear that the crises of costs and coverage are problems that come with an aging population. OK. Fine.

What’s not fine is the assumption that because an aging population is in part the cause of the health-care situation in this country, the aged most feel the effects of the health-care situation in this country – and have the most riding on the health-care bills that are eking their way through Congress.

Now, I like grandmas and grandpas as much as the next person. But this health-care debate is not only about, as so many people suggest, “your parents or grandparents.” It’s just as much, if not more, about your children.

As a report this week from the U.S. Public Issue Research Group reminds us, the health-care crisis in the United States is very much a young person’s problem. In fact, the report – titled “Uncovered” – reveals that young adults are the Americans most likely to lack health insurance coverage. Specifically:

  • 29 percent of Americans aged 18 to 24 are uninsured (compared to 17 percent of American adults overall).
  • 20 percent of college students (aged 18 to 23) are uninsured.
  • 38 percent of recent college graduates (aged 23 to 24) are uninsured.

Though other reports might quibble in the details, every report I have read agrees: Young adults are the Americans least likely to have (and have access to) health insurance, and they are the fastest growing group of the uninsured.

Some writers have speculated that young Americans tend to lack health care in part because they don’t think they need it; you know those zany kids today and their video games and their tattoos and their tongue piercings and their crazy sex orgies and their sense of invincibility that means they never visit the doctor.

But I talk to young Americans every day – young Americans who are privileged by almost every standard – and I hear lots of anxiety about health care. Just because my students don’t worry that they’re going to die in, like, the next week does not mean that they don’t worry about getting sick.

Seniors worry about whether or not they will find jobs that have health benefits. Underclassmen worry that a parent’s job loss will mean losing their own health coverage. Many of them take some form of prescription medication and so are reminded, every day, how much they depend on health-care coverage. And everyone knows that between the close living quarters and late nights of campus life, colleges are little germ festivals. Students are sniffling their way to health services all the time.

About a year ago, one of my students had a cough so bad she sounded like a freight train full of hyenas when she walked down the hall, but she ignored all entreaties to visit student health services. Eventually it became clear that she was terrified that the college doctors would charge her (or her parents) for the visit, and nobody in the family had health insurance.

And anyway: we’re not just talking about college-age people here. Almost a third of 20-somethings lack health care, as do almost a quarter of people aged 30 to 35. These are “young people” only in the most quantitative sense of the term. Many of us – since I’ll go ahead and admit to my own place in this age demographic – are homeowners, are parents, are not exactly throwing toga parties to celebrate our invincibility every Thursday night.

A year ago this week, my (32-year-old) best friend got fired from a very prestigious, high-skill technology job. Though she has a top-notch college degree and impressive work experience, she could not find another job with health benefits – at least, not before she was diagnosed with a pretty grim form of cancer. She is in the hospital now, facing down surgeries and chemotherapy and radiation, along with the knowledge that in a few months her health insurance (through COBRA) is going to run out.

There are many young (and youngish) Americans out there in similar situations, who not only lack health insurance but also lack visibility in the current public discussions of health care.

At the very least, there are strategic reasons for all elected officials to spend more time considering what is actually quite a substantial demographic – we’re talking about all Americans born from roughly 1974 to 1991 – whose partisan loyalties might not yet be set in stone. I might even go out (not so far) on a limb and say that any society that more-or-less leaves out huge swaths of its population in public-policy conversations is not doing itself any long-term favors. A sense of intergenerational awareness — not to mention intergenerational responsibility — is critical for the long-term health of any regime, as so many thinkers have said.

In whatever terms we see the current health-care debates, I wish that we saw younger Americans a little more clearly, or just a little more.

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  1. Susan,

    I’d compliment you highly on this wise little post of yours, except that Stewart just told us yesterday to shut up with giving each other kudos, so I’ll refrain. Just know that I can’t disagree with anything you say.

    I might even go out (not so far) on a limb and say that any society that more-or-less leaves out huge swaths of its population in public-policy conversations is not doing itself any long-term favors. A sense of intergenerational awareness — not to mention intergenerational responsibility — is critical for the long-term health of any regime, as so many thinkers have said.

    To pull your post into the mainstream of the invigorating morass of discussion here at FPR, allow me to argue that this point of yours is a strong argument for those of us who are community-minded (including local community-minded) to support, or at least be more sympathetic to, the national health care reforms being pushed by the Democratic party. So long as our political and socio-economic regime remains essentially what it is today (individualistic, capitalist, meritocratic, etc.), then it will inevitably be young people who will move around the country the most, and change jobs the most. By doing some of the things the which the bills under discussion do (like allow young people to remain on their parents’ plans longer, and prevent insurers from aggressively weeding out new applicants who have pre-existing conditions), it will arguably mean fewer unhealthy people, fewer indebted people, and more young people willing to take a chance on staying where they are.

  2. As someone in my mid-twenties, I know first hand how scary it is to not have insurance. I think a lot of people in this age bracket, myself included, are figuring out that playing by the rules no longer equals a good job with nice benifits. We were told that going to college would land us a good job upon graduation, and many of us went in debt to do that, hearing that going in debt now would pay off in the long run. Unforutnatly, now is not the “long run,” and I was dropped from my parents’ insurance when I got married. I was making huge payments on my college loans and could not afford my own coverage.

    A surprise pregnancy and a salary that barely disqualified me from recieving Medicaid made matters rather scary. Thankfully I quallified for Medicaid when we moved to a new state for graduate school, and we were able to have our baby without going into more debt.

    I share this to say that I believe the current problems with the healthcare system discourage young people from getting married and starting familes. First, you lose your health insurance from your parents when you get married. Then, if you are lucky enough to get insurance, does your insurance help substantially with the cost of childbirth (Afterall, this is the child-bearing demographic.)?

    These are issues I would like to see discussed, as I’ve witnessed these struggles first hand and watched my friends in similar situations. Thank you for this reminder. Now if only our policy makers read FPR…

  3. Great post Susan (sorry, Stewart). But, a point further: the generational issue is increasingly becoming zero-sum in an age of actual limits, and all the power, electoral weight and entitlement definitively tilts toward the elderly. Among the wisest columns yet written by Ross Douthat to date was one that observed that our current political alignment means that Medicare is being demagogued by both parties at the expense of the future of today’s young.

    But for now, their strategy means the country suddenly has two political parties devoted to Mediscaring seniors — which in turn seems likely to make the program more untouchable than ever.

    And if you think reform is tough today, just wait. We’re already practically a gerontocracy: Americans over 50 cast over 40 percent of the votes in the 2008 elections, and half the votes in the ’06 midterms. As the population ages — by 2030, there will be more Americans over 65 than under 18 — the power of the elderly and nearly elderly may become almost absolute.

    In this future, somebody will need to stand for the principle that Medicare can’t pay every bill and bless every procedure. Somebody will need to defend the younger generation’s promise (and its pocketbooks). Somebody will need to say “no” to retirees.

    We used to chuckle at the bumper sticker that read “I’m Spending My Kids Inheritance.” Turns out it was no joke.

  4. Frankly, Susan has a point about kids and medical insurance. I’m not smart enough to figure out a solution but I do know this…if we turn to the gummint, to socialized medicine, we will live to regret it. The gummint solution will be to limit health care and that has the very same result as that experienced by those poor folks Susan mentions who can’t afford medical insurance.

    Arben, am I right?

  5. I have a student with a stomach ailment that the doctors have not as yet diagnosed. He has insurance, good insurance, but he says whenever the doctors order a test, it takes the insurance company several weeks to approved it. In the meantime, he is suffering not only from the ailment, but from the anxiety of having to wade through the insurance company bureaucracy.

    There are those who say, “I don’t know the answer, but no socialism!” But such people, it seems to me, are content to benefit from socialism themselves. After all, if one is really opposed to socialism, then one ought not to pull that socialist lever in his home, the one that makes his waste disappear in a whirlpool into the socialized sewage treatment system.

    In any community, there are obviously some services which need to be socialized. Is medicine one of them? One can have that debate. But one cannot start with a “no socialism” position while themselves consuming socialized services. We can certainly look at the rest of the world to compare different models; the debate need not be merely speculative, but practical, comparing the efficacy of different models that already exist and are functioning.

  6. I think I’m with John Médaille, but I’d go a step farther. I myself am in the demographic age group in the author’s article. I am lucky enough to have insurance, but I’m more than willing to admit that it’s just that: luck. A huge percentage of my friends from college are uninsured.

    Where I want to go with this is to point out that for the Boomers and their parents–my grandparents–the jig may be up. The younger generation is sick to death of our elders consuming a disgusting percentage of government resources while pulling up the ladder as fast as they possibly can, so that my generation 1) winds up saddled with a mountain of debt, both personal and governmental, and 2) has no access to the very same services that our parents and grandparents have benefited from.

    I foresee a stark generational break in the works. Right now the Boomers and their parents form a majority of the American electorate, but that won’t last forever. When it changes, grandma’s getting thrown under the bus. It’s only far after all: she did it to us first. Why I should give a damn that seniors are scared every time we talk about not showering them with money is beyond me.

    Think about it: Medicare is for senior citizens almost exclusively. The massive educational subsidizes of the mid-twentieth century–mostly disguised in the form of the GI Bill and military R&D–have largely disappeared, resulting in a massive spike in tuition costs, just when government grants for students are converted into loan programs which amount to indentured servitude. Social security taxes are deeply regressive, as they’re limited to the first $90k or so of income, which older people are far more likely to exceed than anyone under 40. The AARP has been largely successful in passing legislation on the state level preventing insurance premiums for senior citizens from accurately reflecting their actual risk exposure, raising rates for everyone else.

    Face it: everyone under about 35 is getting a terrible deal. This can’t last forever. The sooner we start saying no to grandma, the better off our children and grandchildren will be.

  7. Kacy,

    I share this to say that I believe the current problems with the healthcare system discourage young people from getting married and starting familes. First, you lose your health insurance from your parents when you get married. Then, if you are lucky enough to get insurance, does your insurance help substantially with the cost of childbirth (after all, this is the child-bearing demographic)?

    Thanks for making an additional point in support of the searching questions Susan asks which I neglected to make above: an approach to medical costs which did more to make certain young people weren’t at great(er) risk of losing their or never being able to obtain any insurance, would take away at least one of the structural factors which discourage young(er) people from settling down, and beginning a family. Though, of course, Allan Carlson has been making this (traditionalist? socialist? both?) point for years.


    In any community, there are obviously some services which need to be socialized. Is medicine one of them? One can have that debate. But one cannot start with a “no socialism” position while themselves consuming socialized services. We can certainly look at the rest of the world to compare different models; the debate need not be merely speculative, but practical, comparing the efficacy of different models that already exist and are functioning.

    Very well said. I had hoped that the–sometimes informative, sometimes slightly deranged–public argument about Obama and socialism would lead to a more sensible appreciation of what we, as civilized people, invariably want to socialize, and what we do not; it hasn’t happened yet, but I still hold out hope. What that sensible discussion would involve, I think, is not the pointless debate “Socialism: yes or no?,” but rather a practical, two-pronged debate: “In the polity you live in (the United States, for most of us), a) what should be socialized, and what should be left to the market, and b) who and/or which level of government should do the socializing?”

  8. But wait….the Fine Satraps in our Babylon on the Potomac think about the younger generation…as well as other generations yet conjured all the time. After all, they are spending money now for these ehhh…ahhhh…uhhhh…beneficiaries to cover the check later. The politician’s best friend and most important constituent would appear to be the youngest or future youngest amongst us. I hope there is a line item in this Health Bill to cover the skeletal and muscular injuries resulting from an excessive rubbing of sticks together because with the lapsed republic reduced to penury everlasting, there is only going to be the old fashioned ways available to light the fire in the home hearth.

  9. Someone really needs to rope Patrick’s excellent post this morning into the health care discussion. American health care is the equivallent of living below sea level. What happened to good old American stoicism?

    How many of those young and uninsured carry a car payment? Or two? Cell phone plan? Monthly restaurant expenses? Stanford educated but wasting away of consumption for fear of actually paying for services? Pardon me while I break out the world’s smallest violin.

    Life is nasty, brutish, and short. And we think we can live below sea level without consequences. The Lord giveth, and the Lord taketh away.

    That said, there is a very serious generational theft in progress. And again, it defies commen sense to think that there will not be a reckonning.

  10. Now this is a perfect example of why the Front Porch is the place to be. It’s a rare thing for a health care conversation to begin sans the terrifying sound of teeth being sharpened. Kudos (yes, kudos!) to everyone for the thoughtful contributions.

    I, too, am a representative of this unhappy statistic, and with virtually no prospect of joining the ranks of the fortunate. At this moment in time, it’s not terribly worrisome: I am healthy and miserly enough that the relatively piddly costs I have faced ($350 a year and a half ago for a throat infection being most formidable) were dealt with quickly and hassle-free. If I dare to contemplate my very near future, however, I immediately being to feel a little sick…

    My soon-to-be husband, also in his early twenties, intends to pursue the blue collar life (plumbing and construction) in a state (VT) where companies are nearly always too small to carry insurance. There is a good chance he will be self-employed. Most likely we will both engage in little side-jobs to keep up the cash flow. If God wills and we are wily enough, we may even end up with some arable land… Neither of us has the remotest interest in the sort of jobs that generally come with “benefits.” And this suits us just fine (Who in this age of electric spinning toothbrushes really needs the dentist twice a year?) but for two things: babies and catastrophes.

    Ya see, having as we do rather antiquated notions about contraception, there is a more than decent chance I will find myself with the very expensive habit of bring new life into this world on a regular basis. An absurd and selfish indulgence, I know! With a bit of grit and preparation, childbirth can be done at an almost non-prohibitive discount price–maybe $2,000 with a mid-wife and without painkillers. Such a sum would hurt but not break; it’d be like buying a junky used car every 2 or 3 years. However, the art of childbirth comes with unavoidable and dire risk. Should anything, anything at all, go wrong at any point, as it very often does, the 1995 Corolla you thought you just bought suddenly turns out to be a new, decked-out Lincoln. And then you’re pretty much skewered.

    The other frightening possibility is, of course, a catastrophic illness or accident. May God bless and comfort Susan’s friend.

    So what do I think should be done about health care? I’m deeply ambivalent. On the one had, as others have noted, socialized services are not to be equated with actual socialism. On the other, as Mr. Cheeks reminds us, the government is thoroughly inept. Back to the first hand, who else but the government could actually insure anything at this point? Then again, are we really comfortable with the inevitable hidden costs of such a huge government undertaking? Bah! Who really knows?

    One thing seems for certain: it is a socially deadly and morally unthinkable thing for any system to discourage people from having children. It seems myopic in the extreme for people in this debate to focus overwhelmingly on issues that don’t pertain to raising a family. Instead we’re all up to our usual political tricks, fighting like dogs over a plate of meat. With a proper view of things, I think, we would never treat health like meat. It is not a commodity, nor is it “right.” It is, well, now what did Wendell Berry say about it again?

    It’s all horribly confusing. I only know that having a baby or getting cancer should not entail potential financial ruin.

    Co-ops are appealing to me… Something like the Samaritan Ministries the fundie evangelicals have going. Unfortunately, our Papal allegiances disqualify us from membership.

  11. While I agree that our government is engaged in unconscionable inter-generational theft, and this is one of the great economic and moral issues of our age, allow me to dissent from your specific claim. If you are discussing a health-care system involving 300 million people, you are necessarily dealing with aggregate populations. While we all know there are 20-30 year olds who get sick, in the aggregate it is the healthiest portion of the population, requiring the least amount of care, and using the least amount of resources. Under those circumstances, not getting insurance would not be the worst gamble in the world for any particular individual. Conversely, those on the older end of the demographic scale are the least healthy and require the most care. In the aggregate, the bulk of the resources would necessarily go there.

    I can’t see any solution to the so-called “crisis” that doesn’t involve eliminating the tax benefit for employers. Giving the insurance benefit directly to the consumer would allow greater flexibility in making the sorts of financial choices Caleb noted.

    Finally, the whole issue of the so-called “death panels” has obscured probably the most difficult but also important part of the health-care debate: the bulk of costs are accrued in the last six months of a person’s life. Until we figure out what to do with end-of-life issues, a discussion made more opaque by secularism, we won’t get any traction on any of the other issues.

  12. I do think that the younger generation will one day hang us by our intestines for making them pay so much for a college education. And there the problem seems to be very similar to what’s going on in health care: the costs are inflated both by a top-heavy adminsitrative structure and just by the fact that the loan officer is willing to pay that high price and, hey kids, you can pay him back when you’re in your 20s, and 30s… and 40s…

    When you look at how much basic health services cost, you get the feeling that a health care reform plan that fails to address costs, like this one, won’t accomplish very much. My sense is that the US will be dealing with this issue in a much more extensive (not to mention socialist) way in about a decade’s time, after this reform has failed.

    For myself, the situation is the reverse of what we’re talking about here because I’m 35 and living in Canada after growing up in the states. The sytem here is not perfect and there were trade offs to adjust to. However, the Canadian system is nowhere near as “troubled” as US commentators claim it to be, and having lived with US health care and Canadian health care, I prefer the Canadian system by a longshot. Actually, I’ve yet to meet an expat going either way who prefers the American system.

    To give an example, our friend Brendon, who is about the age we’re talking about, got out of university and was working at the family used car lot in Thunder Bay and, one evening he collapsed in the driveway. He was rushed to the emergency room, diagnosed with leukemia, and spent the next year in the hospital getting treated. Eventually, he got a bone marrow transplant that saved his life. Not only did he get state-of-the-art care (contrary to what cable news pundits in the states would have you believe), but his total bill (beyond what was covered by the state) was about $1000. Something like that is just not fathomable in the US.

    Having said that, about 30% of Canadian health care is purchased privately and we’re the most socialized system in the world. I think there will be a larger private component here in the future, and something like a dual system would likely work best. But, when Canadians talk about the system, I don’t think they look at it as socialism as much as providing for the common good. The idea of the common good is discussed much more frequently here. It would also an appropriate topic of discussion on this site I’d say.

    Now, my father is a lobsterman in Maine who buys his insurance. The cheapest coverage he can get in the state runs him about $500 a month, which means that he’s basically hanging on by his fingernails and waiting to turn 65. I believe nearly 30% of the state is without coverage, which was the national norm in Canada when they scrapped private insurance here. The main problem is that his premiums keep going up. I believe average insurance premiums rose by about %138 in the last decade in the US. The end result is that he is a lifelong Republican who believes quite strongly that the US needs, “a system like you guys have in Canada”, and actually thinks the Republicans will eventually create something like that because they care more about the working class than the Democrats do.

    I don’t what the answer is either, but as someone who’s considered a Tory in Canada and a radical Maoist in the US, my concern first and foremost is with social stability, and I just can’t see how expecting people my age and older to spend their lives in hock to college loan officers and insurance companies, and often to credit card companies, is conducive to fostering that stability. No matter how many flatscreen TVs you give them.

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  14. Caleb,
    Why do you go to such lengths to be an ass? There are far more productive and spiritually healthy ways of making yourself the center of attention.

    That said, I’ll grant that this post does focus a bit too much on the college-educated. They’ll likely eventually work their way into positions with coverage, are far more likely to have parents with means to help them, and are likely to postpone having children anyway. It’s a rough road for them (in reality, surely, but it’s accentuated by their higher expectations not being met), but the burden is far heavier on younger folks in the working classes. They see no hope. Unions are throwing them to the wolves in order to protect the benefits of their older members, many are fully convinced that federal programs will no longer exist by the time they’re eligible for them, and many know all to well that our society couldn’t care less about them, just wanting them to keep doing the dirty work and keep their mouths shut and pop out enough babies to survive and do the same twenty years from now. Being a nineteen year old with a child is a somewhat terrifying prospect in America today.

  15. Thank you for bringing this up Susan. As a member of that demographic I’ve been very frustrated to be told repeatedly that people our age don’t carry insurance because we are healthy and reckless. That attitude is rare in my experience. The people in that “young” people demographic are more often fighting tooth and nail for insurance coverage.

    And I’ll echo Kacy here, the women of that demographic are the women of childbearing age. For them, the battle is not just to get insurance, but to get insurance through an employer. Without that, they are left with the option to pay extra for maternity coverage, which in many cases secretly doesn’t cover anything beyond a healthy pregnancy. Moreover, once you begin coverage you can’t get pregnant for 6-9 months, depending on the policy. Which means you might as well have saved that money you spent on the coverage.

    Unless you have a health insurance plan through your employer you cannot protect yourself from financial ruin should you have a troubled pregnancy (which is highly likely, you just don’t hear about it because people prefer to keep that kind of trouble private). The trouble is, especially in your twenties, your employment situation is incredibly unstable. Thus the current system discourages young people from starting families during their optimal child-bearing years.

    Taxing employer health insurance plans to help individuals pay for private policies does not help young women and families get the coverage they need. The fake maternity coverage sold by insurance companies for private policies needs to be labeled for what it is: fraud. Whether there needs to be a new law to make that clear or old laws need to be enforced, it would seem the government is inevitably going to need to step in if we want a pro-family society.

  16. No. Caleb’s right.

    Our technical obsessions over what the precise blueprint of a bureaucratic system must be to make even a dent in this crisis are going to amount to very little because they ignore the fact that the pervasive and growing American attitude of entitlement (evident even in some comments here) combined with the nature of health care and suffering inevitably leads to exploding costs in any system feasible with the “increase services or decrease taxes” government that we have. And I do think the U. S. has a worse case of “entitlement” than other nations.

    I have health insurance. I have not gone to the doctor in the past six years. This is a good thing, though I suspect the technocrats among us are shaking their heads in disapproval. What I don’t see is any encouragement to our friends and neighbors to use less health care.

    Jeff Polet’s comment is also spot on. Part of the systemic reason we over-use health care is the same historical reason it is over-comprehensive rather than catastrophic: because it is subsidized via employer-provided insurance tax exemptions. Make tax exemption apply to non-employer sponsored insurance as well or get rid of subsidies for employer-sponsored insurance to make it an even playing field for employer and non-employer sponsored insurance. This is probably the only time you’ll see me ask for higher taxes.

    But again, none of these good ideas will gain any traction as long as we declare, subtly or not-so-subtly, that we are entitled to health care as a matter of justice and so the government, as enforcer of justice, is responsible for all the cases that engender pity rather than non-governmental communities.

    Health care is simply not an area of life that is sustainably served by large governments except in lucrative times of unsustainably large global economic growth and not having to pay for children (who are expensive) because we’re preventing them from being born.

  17. Socialism is a failed concept for so many things. However, as John points out the sewage system works pretty well. Many who decry socialism turn a blind eye to the largest socialized element in the federal government; the military. Not only do we pay a million salaries, benefit packages, and retirements, we subsidize thousands of corporations in the form of vendors, R&D, and those god awful think tanks whose opinion is predictably that we need to spend more on defense. And sadly we subsidize the national security of many nations.

    And why do we have a sewage system? Primarily it is for public health reasons. I pay my taxes responsibly, and I am no fan of big government. But I would gladly redirect my portion of my income taxes to socialized health care system and reign in the military. Some forms of wealth don’t translate well into the abstraction of money, and health care is one of them. Caleb is right, life is nasty, brutish, and short, but there is no reason we cannot be civilized about it.

  18. I’d like to add my input to this conversation, as one of the culprits in this mess. Yes, I said “culprits”. For you see, I, and Kacy, Ryan, and Marianne (my apologies to any of the former-youth I may have missed), are part of a generation that doesn’t care one bit about the political life. Having the mellow tones of Johnny Cash on in the background of writing this post has inspired me to be less than venomous towards my fellow brethren, and the fact that some of us may participate fully and to the utmost of our abilities in the political life does nothing to lessen the validity of my statement that we are a generation of slackers, and perhaps the first generation to truly have grown up as “men without chests”. Our voting rates are some of the worst in history (that’s hyperbole that may be validated by a rogue political scientist) and we do nothing to forcefully and substantially change the climate in which we find ourselves and our brethren suffocating.

    I would tend towards Caleb’s sentiments, except for the fact that Christian charity and compassion compel me to not merely be apathetic but righteously indignant towards the situation and culture in which I may one day raise children. I am extremely blessed with the job that I have, and I want everyone to enjoy even a sliver of the benefits that I have been graciously given. Right now we’re left battling the political machine for a partial ban on abortion and left scratching our heads about conscience protection.

    Finally, I wouldn’t feel completely vindicated (emotionally satisfied?) if my rant doesn’t somewhat find in my sights the generation a step removed from us, the baby boomers, who hang out around here especially. We could use some help, and I hope this place of cyber-meetings turns into a springboard for “real-world” action.

  19. My mind unfortunately went, for one second, to the thought of a single, national sewage system. Dear Saint Darwin of the Galapagos…

    On a more serious note, I don’t think it is right to force people to give to charity against their will. When it comes down to it, that’s what taxing people to pay for other folks’ health care is, and it kills charity, creates justified class resentment, fosters dependency on the state instead of on family, friends, neighbors, and closer communities.

  20. Finally a discussion which isn’t focused on “young people nowadays stink”. My earthy neighbor has a fav expression – don’t spit into a well you may need to drink from. And for sure it seems to me that our frequent disparaging of the youngers looks a lot like spitting into that well. I recall when I got old enough to understand exactly why my mother kept jars of water in the basement – nuclear annihilation – and how angry I was to have “their” problem dumped in my lap. And given the possible long term nature of many of our problems, even the 20 somethings among us may need to consider how thoroughly ticked off their kids may be when they understand what kind of world Mommy and Daddy will pass on to them. If for no other reason than a desire to be able to stay on the bus, we need to start finding solutions to these problems.

    While I tend to agree that the government is not likely to be a very good health care provider, the free market has demonstrated they definitely are not good health care providers. I love the idea of co-ops and think the bishops would do us all a lot more good if they spent their time facilitating more of that instead of holding press conferences on their refusal to be forced to do abortions. As I understand it, the problem with these co-ops is that the pools are thus far so small they cannot cover catatstrophic illness – which nowadays includes having a baby.

    As for socialism – crying “socialist” at every proposal offered may be emotionally satisfying to some but it is at best obstructionist when it isn’t completely inaccurate. Government is an effort on the part of a people to organize themselves to promote their welfare. So in that sense every co-operative effort becomes “socialism”. Americans once prided themselves on their pragmatism – so let’s get down to pragmatic solutions to health care and pass on the ideological blinders.

    And yeah – let’s rein in military spending – cause if we don’t start re-ordering our priorities we may find we have spent all that money on a military that has nothing left to defend.

  21. Kathy this is not true,

    “Unless you have a health insurance plan through your employer you cannot protect yourself from financial ruin should you have a troubled pregnancy (which is highly likely, you just don’t hear about it because people prefer to keep that kind of trouble private). The trouble is, especially in your twenties, your employment situation is incredibly unstable. Thus the current system discourages young people from starting families during their optimal child-bearing years. ”

    Where are you getting your information from?

  22. One thing that is interesting about the “employer discount” that people refer to is that I’m not sure what they are talking about. Perhaps I am too young (low thirties) for it to matter, and it will be different once I’m older. I currently pay $65/month for my health insurance, with a $1200 deductible, and $2400 max out of pocket. My wife does pay more, presumably due to having kids, and perhaps more likely to go to a doctor than me.

    It is similar to what we paid before, and much less than we paid if you count what the employer subsidized. I worked at a 200 person company. My friends at smaller companies, who don’t have their insurance subsidized by the employer, pay around $600/month, and one of them went to private insurance on his own because it was cheaper than what his company could get.

    I did just look up rates for a relative, who will likely be getting private insurance next year, and due to her living in NH, her rates will be double what they would be if she lived in PA. I have no idea why that discrepancy exists, unless it is local monopolies.

  23. And now reading a couple other comments – I for one don’t turn a blind eye to the government spending in other areas like the military, research, subsidies and pork in every bill I’ve ever read. I think the way our country is run is absurd. Somehow people don’t realize that our current rate of increasing debt (11 billion dollars a month – I think) has to be paid by someone.

    I guess it is the same people who continue to run up credit card debt and don’t really think about ever paying it off. Or get crazy car and house loans, etc.

    And though I bought a house last year, I am eligible for the $6000 tax credit if I wanted to buy a house this year. Crazy. Who makes up this stuff, and why do folks keep electing them?

  24. Bob Cheeks, I would agree with you about the gummint, except that I have some recent experience with the private sector. Everything the gummint is accused of, the private sector has done to me, and many others. Insensitive bureaucracy, telling you what doctors to go to, mindless appeals processes where facts fall on deaf ears, you name it, the private sector has done it. Oh, this counts against your deductible because you went to the third floor lab instead of the second floor lab, please pay $186.

    Now for me, I’d like a low premium, high-deductible policy, and pay some money into a Health Savings Account. I’m not going to empty the account every year, so I can roll it over, and save a bundle on premiums. But, I’m good at math, my mother trained me to keep good track of money, I am capable of writing long letters to recalcitrant bureaucrats and regulatory agencies and sit tight waiting for them to blink first — it may not be for everyone.

    If there is a huge monopolistic private sector, selling something we cannot live our lives without in the modern world, like medical coverage, the gummint has to do something, as our representative, to keep them in some sort of bounds. I’d like to see every proposal from Nancy Pelosi’s to Paul Ryan’s bound up into one big omnibus bill, giving each of us the CHOICE of any of the above options.

  25. Ryan, you are correct about the generational aspects of this debate. I keep reminding my students of how much money they will owe me in a few years, when I hit social secuity and Medicare. My generation arranged everything to their own convenience. The “No Socialism–Hands Off Medicare” tea-baggers said it all. We had few children, and the few we had we expect to support us in style. Will they continue to support us? As I remind my students, “we vote and you don’t.”

  26. Haven’t read the whole thread yet — very good points about the constitutional assumptions(*) re: common good that just have never been debated — urgency requires me to ditto Ralls and draw attention to the special case that Susan’s scenario refers to (what will expire first – the patient or their COBRA coverage?) is not as dire as it first looks, :


    The Hipaa laws were amended to MANDATE a private insurer in each state to accept certain customers who’s COBRA expires so long as three conditions are met (**) each state will be different, I linked to PA for that’s where my hubby and I found the only “free market” company willing to do business with us (ie there’s just no market for folks our age: no company offers any policies that can conform to all the gummint requirements for a price folks can cover from earnings and still meet their other expenses, such as roof and board)

    (*) socialism, vs private “group” health coverage from private “employers” IMHO is still moral hazard, since I’m not free to use the remuneration I earned — ie my property — in the wisest way I discern, I’m shackled to the wisdom of my “betters” to do that for me, until they go out of business for all their prudential judgements… and my investment in my health and that of my family is rendered worthless.

    (**) ie that corporatist-socialism some adamantly want to call the “free market” — fuggedaboutit — we have never had free markets in healthcare, we’ve just had the most expensive socialized care in the world. That’s the searing hypocrisy we hear all round, ‘cos as a Nation we’ve not been able to afford it for some years now and have borrowed from our creditors just to cover fixed costs. There is no “disposable income” left to debate over, any more spending and our creditors could come down hard and cut us off pronto. They’re just busy redesigning a new reserve currency behind closed doors so that their “common good” economies will still able to conduct business. Us? We’ll be left with worthless green paper and our peculiar flavor of “the common good” — a bankrupt geriatric nanny state.

  27. Gotto snicker along with Siarlys “Oh, this counts against your deductible because you went to the third floor lab instead of the second floor lab, please pay $186.”

    THAT is the hyprocrisy I refer to, and that is the hypocrisy the Bishops and any other “common good” evangelists have to answer for when they make claims to do charity in truth, for the ‘veritate’ is sorely lacking in their social justice regime. At least Catholic Georgetown U. has the temerity to take their lamp (faith) from under their bushel basket (endowment) and support the work of those compiling the lists to navigate the morass of injustice of our “rights” based democracy. If I own the title to the ‘right’ to healthcare then how come I have to mortgage it to my employer just to purchase ‘access’ to my own right? Its ludicrously illogical, juridically incoherent and morally corrupt! Let the debate begin, but define your terms please. Insurance cannot possibly mean what most of the folks in the thread take it to mean. To share costs by pooling risks re

  28. sorry slip of the fingertips occasioned my premature post: here’s the concluding thought:

    To share costs by pooling risks requires an actuarial limit to the “risks” ie what we consider to be an unforeseen financial shock, something we cannot cover from our usual earnings. Many healthcare costs do not fall into that category, and do not belong in any insurance plan. Catastrophies — unforeseen maladies that severely depredate the value of the asset — is what car or home-owner insurance covers — and that actuarial limit is what we should be discussing here too, if we want to make any sense to each other.

    A healthcare “lay-away” payment scheme is already available in the law, but most folks don’t understand that, they’ve never been taught their “rights” (the moral hazard of our school system is another argument for another day) so they do not exercise them.

    Ross Douthat I think gave this argument the most visibility in the pages of the New York Times last month:
    To assist our fellow citizens defend their rights, more of us need to start talking about the crooked logic inherent in the debate, rather than just shouting incoherently about “oppression” from “the Other” – WE are the other, we oppress ourselves with our own laws and private conduct. The moral hazard? The ones doing the consumming (myself and John Medaille’s generation) have contracepted or aborted out of existence the ones we need to do the paying. Where is the “just price” of that? You get what you pay for, and the process of price discovery is about to blow us out of the water, fiscally speaking.

  29. Siarlys, re: your critique of ‘private insurance companies,’ I quite agree with you. However, we might ask ourselves, how do these ins. cos get away with it?
    I might suggest they’ve crawled into bed with gummint and are plowing the American citizen in concert.
    Somehow it all turns back on gummint, or gummint failure, or gummint oversight! Which is all about bribery, blackmail, and deceit…all of them human failings come to a boil in gummint.
    And, unlike some who visit these pages, changing from one gummint to another only assumes a new set of corrupt bureaucrats…although they may be “our” bureaucrats, they will soon enough be ‘corrupt’.
    So what I’m-a saying is until we have a “Come to Jesus” event…until we are, collectively, brought to our knees, in prayer and supplication, we’re probably not going to restore the olde republic, or defeat the evil communist/capitalist cabal! It’s an olde story, Siarly, an olde story!
    Can I get an AHMEN!

  30. Bob, I can’t give you an AHMEN, because Ahmen means “I agree.” I don’t totally agree, but we have something here worth talking about. Government and business are terribly intertwined with each other. If these insurance companies have no other connection with government, they are generally incorporated. A corporation is an artificial person, created by government license and government fiat. Without special legislation to authorize such a thing, there would be no such thing. I’m not opposed on principle to limited liability: if I buy stock in General Motors, I don’t want to be responsible for the managers going $25 billion into debt. Maybe my stock value drops to zero, but no lower than that. But, corporations become big and take on a life of their own. So, either we need to pull the plug, or we need to control and regulate them.

    No we’re not going to restore the old republic, because it was based on the notion that every citizen was a freeholder, and employment was a bit of extra cash on the side, we could take it or leave it. That’s a truly free market. Ninety percent of the population today need to “get a job” in order to live. That is not a free market. It is, however, the foundation for Marxism, even though we know that Marxism hasn’t provided a solution. On the other hand, we don’t seem ready to abandon all the material goodies that come from an advanced technology and economy.

    So, I’m looking for, how do we build as much individual autonomy as possible back into our big complex economy and government? When it comes to health care, we need lots and lots of options. My employer doesn’t get to pick my plan, although my employer may have to contribute to my plan, even my union doesn’t get to pick my plan, although I was a union shop steward once, and the gummint doesn’t get to limit my options.

    First, as some have suggested, I can opt in or opt out. If I opt out, I agree that I am totally responsible for the cost of any emergency care I received, and can be turned down for major surgery — the story of the ant and the grasshopper.

    Second, there should be about three different kinds of “public options” which will compete with the private insurance companies. These companies are fighting that tooth and nail, which tells me it could be a good thing. They will be funded by premiums, not tax dollars. They have to sink or swim and pay their own way. They can be coops, mutuals, or gummint-sponsored, but I can choose any of them or any private plan I want.

    Third, I get a wide range of choices between total coverage, at high premiums, and catastrophic coverage, at lower premiums, with or without a health savings account.

    I’d like to go back to medical care under the old republic, where the doctor was a phone call away, and the hospital had about twenty beds, half of which were often empty. But then, if a complex operation to clean out my arteries could prevent a stroke and extend my life twenty years… either that is only for the very rich, or we set up some way to pay for it. And that requires some gummint involvement, or we’re at the mercy of the corporations.

    The real problem is, this makes too much sense for the real gummint to get it right, so I’ll probably be joining you in complaining about whatever we end up with when all the dust settles.

  31. Siarlys old palsy we’re mucking about in an age ripe with disorder. And, I’m figurin’ that in these experiences of social disorder it’s reduced down to us, the person. It has, I’ve been assured, always been this way. There’s nothing new going on. So we ask the question, we seek the answer in truth, and hope for the best. We are human, often we are corrupt, or we are the victims of the corrupt, be they man or gummint or evil corporation.
    I might suggest that if we live our lives constituted by the divine ground we’ll do pretty darn good. We’ll be able to apply that reason that magically becomes the Nous, and see to our recovery in an understanding of God’s own reality, not some damn thing we construct to satisfy our demons, our grotesque ghosts that haunt all deformed existence.
    Siarlys, your are seriously seeking the truth of things and that’s good.

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