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04/15/2007

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jim

I am a 62-year-old male, lifelong happily uninsured. Health insurance is wasteful, inefficient, highly discriminatory (against young males, low-earners, non-breeders, etc) and carries all sorts of moral hazards, like hypochondria and encouraging the over-production of babies that we could get already potty trained and ready to work from Mexico. Health insurance, treated as an investment, returns about 20 cents on the dollar, on average, according to my estimates, once all the inefficiencies are taken into account.

Though I have paid loads in taxes to support Medicare and Medicaid, when I retire to Brazil, none of their benefits will be available to me, including the drug benefit, because those socialist programs make no provision for an Amerikan to get medical care or drugs [unlike Social Security benefits] in a foreign country. Thankfully, I can get good and cheap, or even excellent and expensive, healthcare in Brazil and generally don't need a prescription for drugs, but this represents paying again for what I've already earned. You can be sure that I will have no qualms about visiting the USSA and milking Medicaid and emergency rooms for all they're worth if I develop a serious illness. A solution to this problem would be for the gummint to buy me out of my participation in their socialist programs with a lump sum at age 65, as Germany did with their Rentenversicherung obligations to me when I abandoned Germany and its socialism in 1975. Even better would be for them to arrange with Brazil to trade me for a Brazilian youth who would be happy to slave away in the USSA, at least until he catches on.

N.E.Hatfield

jim, If you're so disencahnted with the place, you're always free to leave. Bye, Bye! And don't let the door hit you on the backside on the way out.

Bob

When I first started working I had, in effect, a single-payer health-care plan. I paid the provider (thus I had some incentive to minimize costs, and the provider had some incentive to maximize satisfaction); then I applied to my health care plan for reimbursement (thus I had an interest in higher benefits, and my employer had an incentive to maximize overall employee satisfaction for a given payroll cost).


I explained the working of the plan this way to my dentist, at one point: my employer probably had no particular interest in whether my dentist lived or died, but may have had some interest in whether I felt I was being treated fairly.


As an aside, I must admit it's more convenient with direct reimbursement, but it does shift the incentives.


I think this was as close to ideal as a plan is likely to get, these days. The only improvement I can see from a social standpoint would be to eliminate the tax preference for medical insurance. (As Milton Friedman pointed out years ago, the tax preference itself is a legacy from employers' successful attempt to subvert wage-price controls during World War II.) I earn a comfortable living, and there is no particular reason why my insurance premiums, my insurance reimbursements, and my medical reimbursement savings plan should all be given preferential tax treatment to the detriment of taxpayers at large. I would support Prof. Friedman's concept of the negative income tax to compensate individuals at the lower end of the income scale (who realize precious little in any case from tax preferences). On the other hand, I have no illusions that the consequent tax revenues would be diverted to areas more to my liking.

jf

As Posner indicates, poorer individuals and families are already covered through Medicaid, so no additional subsidy for lower income persons is needed to implement compulsory coverage of catastrophic health problems.

As I indicated in my comments to Posner's statement, you would really benefit from either talking to an individual who doesn't have health insurance, or doing some research on people who once had health insurance, but are now on Medicaid. Please, enlighten us.

nakliyat

thank you very much very very nıce.........

Henry

What will happen to healthcare during the next depression? Will the linking of healthcare to employment blow up in America's face?

During a depression, the economies of other countries might be buffered by their nationalized healthcare systems, but America might be punished twice over by a positive-feedback loop wherein healthcare people lose income and jobs because their customers lose their's.

Maybe the political equation during a depression will finally result in a single-payer system.

n.e.hat

Henry, Fear Not! In our new, modern, and globalised "service economy", all thoughts of economic downturns are banished. In other words, can't and won't happen. "Live the dream" as if there were no tomorrow!

Ever get the feeling we are all living in the bunker in Berlin in 1945? ;)

Jack

Despite Jim's abrasive and blunt manner doesn't most of his points hang together?

I am a 62-year-old male, lifelong happily uninsured. Health insurance is wasteful, inefficient, highly discriminatory (against young males, low-earners, non-breeders, etc)

......... well wasteful and inefficient to be sure. As for "against young males" many don't buy in or pay anything......... UNTIL later in life.


and carries all sorts of moral hazards, like hypochondria and encouraging the over-production of babies that we could get already potty trained and ready to work from Mexico.

............ curmudgeonly hrsht here, Jim

Health insurance, treated as an investment, returns about 20 cents on the dollar, on average, according to my estimates, once all the inefficiencies are taken into account.

.......... probably close, but would those of modest assets, primarily their homes, want to roll the dice? Might be a good bet for those with several million to cushion the "bad rolls". but with tax deductions and the relatively small premiums I doubt many in that league opt to "self insure"

Though I have paid loads in taxes to support Medicare and Medicaid, when I retire to Brazil, none of their benefits will be available to me, including the drug benefit, because those socialist programs make no provision for an Amerikan to get medical care or drugs [unlike Social Security benefits] in a foreign country.

.......... Isn't this an excellent point? If a retiree opts to head south whether to lay in the Sun and never take another lick, to relieve the pressure on our own pricey and crowded retirement havens or to bring American skills to a poor country, why shouldn't his well-earned benefit follow him? Especially as medicos in most other nations would be very happy to take the Medicare or Medicaid payments so often scorned here? Woudn't we ALL benefit if Jim buys gets his prescription drugs in nations where they are but half to a third that of the price-fixed US??


Thankfully, I can get good and cheap, or even excellent and expensive, healthcare in Brazil and generally don't need a prescription for drugs, but this represents paying again for what I've already earned.

............ Yes, it does.

You can be sure that I will have no qualms about visiting the USSA and milking Medicaid and emergency rooms for all they're worth if I develop a serious illness. A solution to this problem would be for the gummint to buy me out of my participation in their socialist programs with a lump sum at age 65,

......... It would be interesting to know what that fair price might be. I'm sure someone knows. Problem is that even after a buy-out I suspect Jim would be admitted to an ER here.

as Germany did with their Rentenversicherung obligations to me when I abandoned Germany and its socialism in 1975.

.......... wouldn't it be great if we joined with nations such as Germany in providing universal health care? That way we could have reciprocal arrangements and travel freely.


Even better would be for them to arrange with Brazil to trade me for a Brazilian youth who would be happy to slave away in the USSA, at least until he catches on.

......... If he were one of the millions of poverty stricken street urchins he'd likely be happier "slaving away here" than in Brazil where the wage/wealth pyramid is still steeper than that of the US has become over the last 40 years. Later he too may wish to return after earning US per capita income of $45,000 and spend it where per capita income is $3500? Even our rapidly shriveling debt-backed buck should be welcome down there, eh?

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