The argument that you'll pay for your own healthcare instead of getting insurance doesn't work

I've been hearing on various radio shows and reading in papers and blogs that a lot of people don't want mandated insurance like most of the civilized world has, because they'll pay for anything that happens to them, even if it means going into debt. Some are saying that they set aside as much money as insurance would cost. Either way, the logic doesn't fully work, and you're still a freeloader.

I'll blame part of this on the societal attitudes that contribute to invisibility of people with disabilities, but the people who are saying this just really haven't done any research. Sure, people in some lines of work could pay off the costs of a broken leg, or eventually pay off cancer treatment. Even so, I'm guessing most of these people haven't even seen the hospital bills for this sort of thing. Inflated hospital costs aside, it costs a couple grand just to walk into an ER. My hand surgery that took about half an hour was in the tens of thousands. Yes, these kinds of bills fall into the "payable" category for many people.

All of this assumes that these people aren't ever going to acquire a disability that doesn't allow them to work. Unless you're one of the very richest people in this country, you don't currently have enough money saved up to pay for all your expenses for the next 20 or 60 years while you're living in a group home and taking a fistfull of meds every day that sometimes are successful in allowing you to form a coherent sentence or functionally complete a task.

Some of these people say that if they got in a horrendous accident and needed life support, they'd kill themselves. Putting aside how most of them can't possibly mean this and just don't want to part with their precious paycheck, most acquired disabilities don't involve long-term dependence on any sort of life support that one can opt to remove. If someone sustains a brain injury and can't work or live independently, there are absolutely no sorts of living wills or legal orders, pre-existing or not, that allow an individual or his/her guardian to choose to kill the person. A guardian also can't decide that someone without basic life skills can leave a facility and go wander around in traffic. The courts will decide that this isn't in the best interest of the person. You know those mumbling incoherent people wandering the streets panhandling? Those are the higher-functioning of the people who have brain injuries and/or psychotic disorders. Those are the people who have enough ability to eat and keep safe so that they're legal competent to choose to refuse treatment. A lot of people who have acquired disabilities aren't in any place to choose. But more importantly, if people really had good information about the disabilities they could possibly acquire, I really don't think very many of them would say that they'd prefer that if they get in a car accident, they aren't fed or bathed or provided with any sort of activities, since they don't believe in being part of the healthcare system.


carmen said...

feeding and bathing someone isn't expensive. im sure there are those willing to do this for 15 an hour. assuming the bathing takes 25 minutes, say 7 dollars a day. the cooking can be amortized over 8 people, given the skill of the chef. so roughly $1 of labor, per person. 16 dollars is plenty of vegetables to make a vegetarian meal for these people. so $2 for the food, and $10 total for bathed and fed. ive actually studied my receipts and cooked for this many people 150 times. give or take. don't tell me i'm full of sht

now we know it costs a lot more than that on the final bill for health care. for me, rent has always costed me 10x as much as every other expense combined. we know these fed and bathed people need a roof over their head. to the tune of 800-1000 a month for spartan accomadations. why is this so? i think a large part of it is credit/monetary expansion in the fiat regime. even if extremely-lax lending practices are over and a correction has occured, the current prices and historical growth reflect a 'what the market will bear' increase in prices enabled by debt

as for the health care costs, for me the most interesting balancing act is that of obama to please both large oligopolies, and the demands of the people for parity with the rest of the western world. you, the consumer are paying for the FDA to exist to say that only 10 new drugs are be approved this year so the cost of entry is prohibitively high, while supply is also artificially reduced. of course you're also paying for the courts for the ability to reduce a competitor infringing upon a patent (or doing anything that hasnt been officially 'approved' by FDA) to legal rubble.

so the bottom line to making healthcare affordable to all would allow it to be a total free-for-all in terms of providers and treatments, eliminating any requirements for accreditation. the emotional argument of protecting people from harmful treatments or quasi-professionals tends to work on most people. in such a system consumers still pay more for known quality and reputation.

the obsession with a coveted proprietary-FDA-approved treatment slot drive us towards ever more expensive treatments that are simply newer, not necessarily better.

that the citizen would now be required to pay for this thoroughly corrupted and systematically-constrainted gouging/airbag market is insidious. i'm willing to kick in a little bit in case my neighbor gets run over by a garbage truck while passed out in a gutter and is relegated to the situation you describe above.

the notion that it has to be expensive and therefore some kind of massive boondoggle has to exist to support it is bs. that only exists because people/companies have figured out how to game a system, also acquiring the warm-fuzzy 'helping people stay healthy' care-vibes at the same time.

eeka said...

Oh, I'm not disagreeing at all that healthcare costs are inflated.

Your figures sound about right for someone who's completely stabilized, thus able to live at home and have an unskilled person taking care of them.

The folks I've worked with who have severe brain injuries often have trouble swallowing, chewing, ambulating, etc. Many are also prone to very rapid psychiatric changes that can affect safety of themselves and the people around them. They need to have credentialed people around to ensure that they're safe. The nature of brain injuries is also that these things can change very rapidly, because that's how our neurology works. Someone might be able to chew and swallow one day, then the next day their brain is sending totally different signals and they're likely to choke. This is why most people on our unit were fed by an occupational therapist or speech-language pathologist, since these people have advanced degrees that include evaluating swallowing. A layperson can't tell if someone is swallowing something correctly.

Same goes for other things; many of the people on our unit needed a PT present when they were transferred in and out of the bathtub. Many were completely dead weight due to their injuries, so they needed a Hoyer lift, which cost several thousand dollars just for the equipment, not counting having a PT or OT reviewing and possibly customizing the sling to make sure it works safely for that person. Someone who's really spastic needs to have a PT present during the lifting in case a leg suddenly moves in an unpredictable (to most of us) way and risks tossing the person off the lift. People with brain injuries usually can't be bathed in 25 minutes, btw. It might take that long to make sure the person's muscle tone that day is appropriate to the lift you used the day before, add correct padding for new bedsores, get a doctor's order for putting meds on them so they don't get worse, etc. Might take a couple hours. And PTs and MDs don't work for 15 dollars an hour. Plus it might take 3 or 4 people.

Many of the people in our program were also evaluated daily by me to see what their social/emotional state was like. Someone who had been calm and pleasant for days might suddenly be looking for a way to kill him/herself, or might have developed a sudden idea that someone else was harmful and needed to be killed. I don't work for $15 an hour.

People also have a human right to have rehabilitation, so that means sessions with PT, OT, speech, psych, social work, beyond just what's needed to meet their very basic daily needs. They also have a right to educational and/or leisure programming that they can participate in, and a person who is skilled in providing programming that works for nonverbal and/or actively psychotic people doesn't work for $15 an hour either.

Bob said...

Let's face it... most (vast majority?) of the uninsured are that way because they can't afford insurance --- and they CERTAINLY can't afford those hospital bills without insurance.

Are we willing as a society to withhold medical care and let people bleed in the streets after an accident because they're uninsured and poor? If not, then requiring everyone to have insurance seems to be the sanest option.

Anonymous said...

Thank you eeka for this post. I have a minor disability and I'm sure I cost a lot more than carmen thinks I should. I can work part time, drive, shop, bath myself, etc. I look 'normal.' But I am on four different medications, requiring frequent visits to the doctor for adjusting. I get physical therapy to maintain my functioning. Acupuncture helps a lot but isn't covered by my insurance.

Let me ask carmen. Don't I deserve all the medical care that is needed so that I can be a functioning member of society? I could skip all the meds, all the PT and be completely disabled, dependent on a $15/ hr person to help me, living in cheap accommodations that I can't clean for myself and having someone else cook for me (oh, and I can't eat strictly vegetarian. I can't eat nuts and must limit my dairy and I need the protein. My doctor has actually told me to make sure I eat animal protein to maintain my health. I'm sure I'm not alone in this). Then I might just want to commit suicide.

I also disagree with deregulation. There is a reason the FDA exists and there is a reason it takes so long and so much money for drugs to be approved. I am not willing to try medications that have not been thoroughly tested for safety. I do not want to be the person who first shows that a drug has major side affects.

Lack of accreditation and regulation means there would be a lot of junk health care out there. How do you tell if your health care is junk? I can, I am well educated. But what about people who only have a high school degree (or less)? Or those with mental illness or brain injury that reduces their ability to reason? Is it fair to leave them open to harmful, unregulated medical treatments and con artists?

I am definitely for requiring everyone to have health insurance and requiring insurers to cover pre-existing conditions (my health insurance gets paid FIRST, even before housing and food cause if I ever let it lapse I'll probably never be able to get it again). To do less is inhumane.

I hope you will allow me to remain anonymous. I don't like to talk about my disability.