Social Question

bkcunningham's avatar

If the federal government can force someone to purchase health insurance based on citizenship, then why can’t state lawmakers force their citizens to purchase a firearm?

Asked by bkcunningham (18444points) February 1st, 2011

Five South Dakota lawmakers have introduced legislation that would require any adult 21 or older to buy a firearm “sufficient to provide for their ordinary self-defense.”

The bill, which would take effect Jan. 1, 2012, would give people six months to acquire a firearm after turning 21. The provision does not apply to people who are barred from owning a firearm.

Rep. Hal Wick, R-Sioux Falls, is sponsoring the bill and knows it will be killed. But he said he is introducing it to prove a point that the federal health care reform mandate passed last year is unconstitutional.

Is it possible these lawmakers are bringing up the “guns-for-everybody” argument, because it is something that scares liberals just as much as socialized health care scares conservatives?|mostview

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54 Answers

missingbite's avatar

He is just proving a point. ObamaCare requires all citizens to purchase something some people don’t want. In my opinion, both are equally un-constitutional.

lillycoyote's avatar

It’s not only possible that that is the reason, they explicitly state that that is the reason for introducing the bill. From the article linked:

Rep. Hal Wick, R-Sioux Falls, is sponsoring the bill and knows it will be killed. But he said he is introducing it to prove a point that the federal health care reform mandate passed last year is unconstitutional.”

“Do I or the other cosponsors believe that the State of South Dakota can require citizens to buy firearms? Of course not. But at the same time, we do not believe the federal government can order every citizen to buy health insurance,” he said

bkcunningham's avatar

@lillycoyote yes. But I think the point is also to strike a discussion and logical thinking on the part of supporters of ObamaCare. What do you think?

tedd's avatar

The reason that “Obamacare” requires you to purchase health insurance, is because if you don’t the federal tax payer foots the bill the next time you go to the doctors. Its easy to say, “oh I’m healthy, I don’t need insurance.” Or that “Oh I’d rather just risk it and keep the money.” But the simple fact is if you get sick and go to the doctors they CANNOT turn you away, and the Federal Government foots YOUR hospital bill. Buying health insurance is frankly just being a responsible person, no different than car insurance in my opinion. And especially with them basically giving it to poorer people for free thanks to subsidies…. no excuse not to have it.

You’re required to have car insurance if you have a car. Its no different. Your failure to have insurance is going to cost the general public at some point.

iamthemob's avatar

Republicans and Democrats don’t have discussions about anything anymore. This is, perhaps, the worst way to try to create productive dialogue.

tedd's avatar

The real irony to me is that they’re calling this socialized healthcare. Its not. Socialized healthcare (which would be a GREAT thing for this country imo) would be if we set up a public option.

Obamacare is by far and away the largest expansion of the private sector in health insurance ever, and one of the largest investments into the private sector in history.

Cruiser's avatar

Ummm…read your own question for the answer.

“Rep. Hal Wick, R-Sioux Falls, is sponsoring the bill and knows it will be killed. But he said he is introducing it to prove a point that the federal health care reform mandate passed last year is unconstitutional.”

zenvelo's avatar

I think we should allow people to not buy health insurance. They just have to pay cash before services.

crisw's avatar


And, if they don’t have the cash, will you let them die? What if the person is a child whose parents did not buy insurance? Do you let the kid die?

zenvelo's avatar

@crisw they can get health insurance, they just won’t be forced. Kids get treated, if the parent didn’t get insurance, it’s prima facie evidence of parental neglect/reckless endangerment and the parents lose the child they didn’t want to care for. Over 18 and didn’t bother? Better not get sick, or hit by a car, or fall off a motorcycle, and you don’t get to complain because you weren’t “forced” to get insurance. But don’t force me to pay for people who think they are being coerced.

Personally, I think for-profit health insurance should be outlawed, and I’d be in favor of a single payer plan that works, like Canada and most of Northern Europe.

wundayatta's avatar

It’s one of the more stupid analogies I’ve seen, but what do you expect from a Republican who got held back in third grade ten times. Of he wasn’t held back, he should have been.

The reason why we mandate insurance coverage is because we are all in this together. People seem to have no problem mandating auto insurance as a condition of having an auto on the road. So what’s the big deal about health insurance? I suppose we could let people opt out. No insurance, no access to health care. Wait! That’s what we already have!

But I mean seriously. If you do not have health insurance, you could not see a doctor unless you were willing to pay up front, cash on the barrel head, before you could get any care. Also, once you opt out of insurance, you can not get insurance until you have passed a waiting period of, say, five years.

What can I say? People who protest the health insurance mandate are either ignorant or heartless or both. It’s sheer lunacy. We are all in this together. That’s the whole point of insurance. Spreading the risk. If you don’t spread the risk, your insurance company goes belly up.

Right now, of course, we guarantee that any insurer with half a brain can make a great profit. That’s because we allow them to insure only healthy people. We say, we’ll pay for the healthcare of the poor and the elderly (the ones with highest costs), so you don’t have to take any risks on insuring them. You can insure the rich and healthy.

Oh, and by the way, we’ll pay for all the care of sick people who have no Medicaid but also can’t afford care. We’ll let them come into the emergency room and force the hospital to serve them. But we won’t pay for care that keeps people out of the hospital, just acute care when they get so sick they’ll die if they don’t come in.

This is not a health care system. It’s a health care shambles. And if the individual mandate is lifted and we don’t go to single-payer, the shambles will become…. become…. health care chaos. Or health care hell.

But no. We shouldn’t hang together. We should all hang separately. You can’t make me buy health insurance.

What? Car insurance? Sure. Long’s you don’t make me wear a helmet. It’s just sheer idiocy, of the most mendacious kind. Bet those politicians think mendacious has something to do with a super, bang-up sewing job. Sheesh!

bkcunningham's avatar

@wundayatta comparing federally mandated health insurance to auto insurance is as silly as Kathleen Sebelius comparing healthcare to buying a TV.

Summum's avatar

To compare health insurance to car insurance is not valid. You can elect not to drive and use public transportation. But forcing someone to buy health insurance and if they don’t they are fined is unconstitutional and is against how this country was organized. Yes the reason for the bill is to open the eyes of others to see what the health care is really asking us.

iamthemob's avatar

The thing is, I would love this if I felt it was (1) accompanied with a complimentary plan to bring individual health care affordability, and (2) coming from a group that I thought was truly conservative, and not the big-government Republicans we have to deal with now.

bkcunningham's avatar

@iamthemob do it on the state level then. If a good plan is devised, hopefully other states will follow.

iamthemob's avatar

No arguments here.

woodcutter's avatar

forced health insurance is not the same as forced auto insurance. Different things altogether. The states that make auto insurance mandatory make sure you can protect the other guy if you screw up out there on the road. If all you want is liability, fine just as long as the guy you trash has some kind of recourse. Then you can use an old 10 speed bike with the handlebars turned upside down like all the D U I offenders get, because your car was not covered. What a deal!

iamthemob's avatar

@woodcutter – the problem, though, is that those without health insurance can be an economic drain on society much in the same way as those without car insurance can. In both cases, the potential for shifting costs off the uninsured and onto the public is significant.

So they aren’t all that different – I’m not arguing for the Constitutionality of certain provisions, but the cost-shifting arguments are similar for both in that there is a fairness issue in such burden-shits. Requirements of the mandate can be justified (on one level, but not fully) in that it prevents free-riding.

woodcutter's avatar

Without the mandatory aspect of the health care reform it is dead on arrival. That was supposed to be where the money was coming from to add more people to the pot and cause premiums to go down…in theory anyway.

missingbite's avatar

@wundayatta I personally went from 1999 until 2004 WITHOUT car insurance. I did this WITHOUT a car. The government didn’t make me buy car insurance during that time. How do you prepose it is the same with Health insurance. Am I supposed to go WITHOUT life?

Car vs. Health insurance is two completely different things. Car insurance is based on the fact that you can hurt someone else with your car. Health insurance is for you alone.

BTW, I didn’t own a car for 5 years because I couldn’t afford it. I did however, have health insurance the whole time. But then again, my priorities are different from most.

bkcunningham's avatar

@iamthemob would ObamaCare not shift costs to the public anyway? I mean, who would pay anyway? There isn’t a magic health insurance money tree somewhere. Does it assure everyone has affordable insurance that covers medical fees at 100 percent? Of course not.

iamthemob's avatar

@bkcunningham – It would. The question – and I don’t think anyone really knows the answer, and I certainly don’t – is whether PPACA (could we drop the Obamacare everyone, please? ;-)) would shift it in a more efficient way.

I wouldn’t be surprised if, as suggested, the efficiency analysis is better done at the state level, considering the extreme variety in population and health status in each state.

Dutchess_III's avatar

As much as I like Obama, and as much as I’m all for the Health Care Bill, that is one provison have to disagree with. You can’t force someone to do something that’s good for them…although we do it all the time with seat belt laws and helmet laws…

kheredia's avatar

How is a firearm necessary? It doesn’t even make sense to me how you can compare a firearm to healthcare. I can go my entire life without needing a gun.. but I’m pretty darn sure I’ll need healthcare at one point or another. People who think they’ll never make use of their health insurance are living in a fairytale.

ETpro's avatar

I don’t know of any reason why such a law should be uinconstitutional.

I find it interesting that you believe linerals are afraid of firearms but conservatives are afraid of healthcare. I happen to like guns and shooting and I’m pretty liberal. But I can’t fathom why anyone should reasonably fear healthcare, and I most definitely don’t follow dearing that someone else might get healthcare.

lillycoyote's avatar

@ETpro I know it’s a typo but I just absolutely love the word “linerals” ^^ Are they liberals who can think in a straight line? LOL. I am one but I still think it’s funny.

dimxhazy's avatar


Last year, I had two robbers-rapists break in to my house during the middle of the night. I was unable to call the police without avoiding the perpetrators. Instead, I took my licensed M1911 pistol (which I always carry on me, and next to when I’m sleeping), sneaked up on the perpetrators, shot and wounded the two men. Only after I disarmed them was I able to call the police. Had I not have a gun, everyone in the house could have been raped and possibly killed as the criminals would flee the scene with all the stolen goods. Does this explain why guns are necessary?

Personally, I think the police are worthless. If you’re without a gun, and your life is in immediate danger, then you’re truly screwed, because either you can’t contact the police due to the circumstances, or in a circumstance where you do manage to contact the police, but by the time the police arrive, it’s usually too late.

ETpro's avatar

@lillycoyote Ha! How Palinesque of me. I guess I must have had linear thinking liberals in mind. Too late to edit now.

tedd's avatar

@bkcunningham The public is PAYING the hospital bills of everyone without health insurance right now, today, here in the USA. Thats the system that Health Insurance lobbyists were able to have congress crank out decades ago, and protect to this day. We didn’t want a situation where a hospital would try to check to see if you could pay prior to giving you emergency help, so the Federal government said if someone can’t pay, we’ll pay for it. So any Tom Dick or Harry who goes to the ER because they think their cold is the flu, and spends 2 hours clogging our waiting rooms, and gets a bill for $300 for the benadryl the on-duty-over-worked-doctor gives them and can’t pay it…. that bill falls to the federal government. (Side note:if we went with a single player government health care plan, EVERYONE could go to the on-average-6x-cheaper doctors office and get even better care at a fraction of the cost to the tax payer, not to mention they’d be paying into it themselves as well).

“Obamacare” says, “you know what, rather than pay the ER bill after the fact and wrack up the deficit spending, we’re just going to take that money up front and offer the poor a subsidy to make it so they can afford regular health insurance” ... and in the process they cover EVERYONE, with insurance that will actually cover regular medical care, rather than the ER care they’re getting now….. Hell it WAS a Republican idea, Mitt friggin-make-me-the-next-president Romney implemented it himself as governor of Massachusetts.

Dutchess_III's avatar

You know, adults below a certain income level used to qualify for state insurance. I had if for two years, until it suddenly disappeared in 1994.

I agree with @kheredia—you can’t compare the two.

@dimxhazy This question is not about your right to own a gun.
Now, I’d like to know how you knew the burglars were intent not just on robbery, but on rape too? Did you know them personally?

dimxhazy's avatar


I was responding to “How is a firearm necessary?” and I found out that they were rapists through the police records. They were both convicted of rape on separate occasions, and met in the same prison after sentencing. The records were a mile long full of all the crimes they were convicted of(these were older men).

Do you know how many rapists and murderers are in this country? I know, because I checked out the CIA statistics, and the numbers are beyond comprehension. You Should I have taken my chances to find out if the robbers were going to rape and kill everyone in the house before I shot them?

Dutchess_III's avatar

Well, I don’t feel they are necessary. You do. Each to their own.

If you feel the need to actually sleep with a loaded gun ON you, maybe you should consider moving.

dimxhazy's avatar


I don’t recall of any crime free states, do you? I live in New York City. The crime statistics are actually very low here. The entire reason I was targeted, was because I live in a good neighborhood. There were more then one incidents like this in the neighborhood. When people have financial difficulties during a recession, they start targeting the wealthy.

Dutchess_III's avatar

Didn’t say my state, or my town, was crime free. I just don’t feel the need to own a gun.

bkcunningham's avatar

@Dutchess_III this is part of the reason I posted the original article. I think it is educational to have this part of the conversation, the practical side, not just rhetoric. Of course it would be unconstitutional and even ludicrious to require you, you personally, to purchase a firearm “sufficient to provide for your ordinary self-defense.” What if it was done to make everyone in the community safer or other arguments of the sort, if I’m making myself clear. The same as with health insurance. There are provisions in ObamaCare that exempt certain groups for moral reason.

incendiary_dan's avatar

@ETpro said: “But I can’t fathom why anyone should reasonably fear healthcare, and I most definitely don’t follow fearing that someone else might get healthcare.”

Maybe not fearing per se, but there are many that reject the idea that industrialized medicine is good or healthy. I, for instance, don’t want to be forced to go to regular checkups with a person who I have fundamental disagreements about health and the human body. Many of these people are doctors, usually naturopaths and such. Of course, none of these people are conservatives to my knowledge, at least none I’ve met. I much preferred the public option plan, primarily because it was an option, and therefore wouldn’t force people with philosophical problems with industrial medicine. Luckily, I understand there are exemptions for religious and spiritual purposes written into the healthcare law, so we’re all good. Plus, there is probably a large portion of people who only want to get emergency care covered, so I bet plans that offer that will become more available.

Fearing what other people choose to do for their healthcare is just silly, though.

Venezuela and Switzerland both have measures that arm a large portion of their population with some sort of minimal training. As I understand it, this is Switzerland’s form of National Guard; get trained, get given a gun, be on standby in case the country is invaded. It’s a bit different in Venezuela, where it’s peasant militias being funded by the government to protect their farms from mercenaries, drug traffickers, and corporate goons coming in from Colombia. I could see programs that could work in certain areas of the U.S., depending on the needs of a local community. But as this suggestion was obviously made to prove a point and not be taken seriously, obviously nothing will come of it, least of all constructive conversation.

wundayatta's avatar

@missingbite Car vs. Health insurance is two completely different things. Car insurance is based on the fact that you can hurt someone else with your car. Health insurance is for you alone.

This I believe is the major difference between anti-universal health coverage and pro-universal health coverage people over this debate. Anti-coverage people think that health insurance is for you alone. Pro-coverage people believe that we are all in this together.

The reason why we are all in this together is that we, collectively, have to pay for health care for everyone. We pay for the care of people without health insurance through our taxes. As a result, people with insurance pay for a disproportionate share of health services in this country.

The problem is that it is all hidden from us in that it is paid for through general appropriations that fund Medicaid and Medicare and uncompensated care. The fact that we pay for all care collectively and the fact that people with no insurance have higher health care costs are the cause of higher health spending without the insurance mandate.

So all the reductions in Medicaid spending will, in a few years, lead to a dramatic increase in tax-financed health care spending. This is because no person can be turned away from a hospital emergency room. Since people will have been without insurance, they will have waited until they could no longer wait any more to go to the ER, and their health care will cost an enormous amount more than they would have cost had we given them insurance.

So all of us, and especially those of us who have private health insurance, are subsidizing those without insurance. We are paying for their care. And we pay in the most inefficient manner possible for their care.

You point out that you don’t have to pay car insurance if you don’t drive a car. This is true. However, we do require every car driver to have car insurance. The problem is that there is no analogous situation in health insurance. There is no way that a person can “not drive a car.” We are all alive and as long as we are alive, we have the potential to need health care. So the state has a legitimate interest in forcing everyone to have health insurance. People could opt out, but they’d have to die in order to opt out.

There is another way out of this, for those who don’t want universal coverage. And that is to remove the mandate for hospitals to treat everyone who comes through the ER. If hospitals could force people to show them the money before treating them, then people could opt out of health insurance without affecting others; without driving up the cost of health insurance for others.

Do do anti-universal coverage mandate people want to live in a world or a country where people can be turned away from hospitals? They can’t possibly want that. But they refuse to understand the world they live in. They don’t understand or believe that they are hurt when there is no universal insurance mandate. They don’t understand or believe that they pay more taxes when there is no individual mandate. They don’t understand or believe that we are all in this together.

missingbite's avatar

@wundayatta I understand the point of it costing lower if more people have insurance. What I am against is the Government mandating it. Driving a car is a privilege. The difference is that even though I was not driving a car, my tax dollars still went to fix roads and other infrastructure that many people may not individually use. I don’t have a problem with that as I too benefited from the roads.

Where we disagree is that comparing car insurance to health insurance. By your rational, all citizens should have car insurance even if they don’t have a car. Ludicrous IMO.

iamthemob's avatar

@missingbite – I think that the issue is about whether something is a “right” generally, a “requirement” practically, and reducing the amount of freeloaders in a system.

It is no one’s “right” generally to have a car. So, if you want to have the privilege of driving, with it comes a responsibility to require that you be covered if something goes wrong so that you can pay for the mistake to another. Insurance is a way of ensuring that people who can’t afford to pay for stupid driving are generally paying upfront, so is a way to prevent those freeloaders from getting away with no responsibility (e.g., the judgment-proof).

It is, however, a “requirement” in some areas – and that complicates things. If the vast majority of the population is required to have a car, then making it a tax-based cost doesn’t affect those who don’t to a great degree, and also allows for cost to be spread more generally.

I believe that health care is a right. No one should have to worry about their bills, and rebates for responsible behavior can potentially inspire some behavior that increases that behavior. And since everyone eventually uses it, a system that ends up paying for it and shifts the cost to taxpayers generally ends up having the same effect as one that charges everyone up-front. But it doesn’t do anything to inspire responsible behavior – as those without health care insurance will often wait until there are big problems and the cost will be higher. So, a generally mandated participation reflects the reality that (1) everyone sees a doctor, (2) we pay for it anyway, and (3) no mandate may cause the costs to be higher.

I do believe, however, that the mandate should be state-based, and not nationwide.

Dutchess_III's avatar

Another way that the two aren’t comparable is they can force me to own a gun, but they can’t force me to use it and I probably wouldn’t.

They can force me to have health insurance but they couldn’t force me to use it….but I bet I would!

bkcunningham's avatar

@Dutchess_III another person shouldn’t be able to force you to purchase either.

Dutchess_III's avatar

I agree @bkcunningham. Just pointing out one of the many reasons they’re trying to compare apples to pears.

iamthemob's avatar

@bkcunningham – Other people already bear the cost, however, even if it’s not a direct purchase.

bkcunningham's avatar

@iamthemob you could say, others bear the cost for my neighbor not owning a gun and protecting himself and keeping the community safer.

iamthemob's avatar

@bkcunningham – That’s a tenuous, rather than direct, connection of cost.

bkcunningham's avatar

@iamthemob should I be forced to eat certain foods or participate in certain activities to keep others from bearing the cost of an unhealthy lifestyle?

bkcunningham's avatar

What happens when people file bankruptcy and it includes their medical bills? This was an argument someone used in another thread about the constitutionality of ObamaCare and the ruling by judge Vinson. I’m just curious, what happens to the bankrupt medical bills in the argument.

iamthemob's avatar

@bkcunningham – No. Nothing has suggested that you will be forced to do anything.

The suggestion is that, indeed, you will be forced to pay by participating in the insurance program, or you will bear the cost of those that choose not to have insurance in a system that allows free choice of whether to participate.

In either case, you are forced to pay – the question is, in which system will you pay less? That’s what is often lost.

wundayatta's avatar

@bkcunningham You know I really don’t mind if you make foolish choices—so long as they don’t affect me. Unfortunately, you choosing not to have health insurance has a significant negative impact on me. I can not force you to live a healthy life, but I can, I hope, force you to pay your share of a bill you’ve been shirking.

In that sense, it’s a tax. We run prisons and they cost money. You might love prisons and be happy to pay for them, but I think they are a waste of money—and what’s more, I can show you lots of evidence that supports that assertion. So I don’t want to be paying for prisons. But I do. I do my share, even for stupid policies.

You, because you don’t think your decisions cost me money, want the freedom to eat bacon fat all day and then when you get a heart attack, expect the hospital to treat you—for free, if you don’t have any money. Well, I’m tired of being robbed from. I want you to pay your fair share instead of being the leech you have been. (Well, probably not you, @bkcunningham, since you probably have insurance, but people who are uninsured and can afford it—those are the leeches).

As to guns—again, forcing people to own them is an idiotic policy. It will raise the death rate both during felonies and also in accidents at home and in suicides. The cost is not worth any benefit that a few people may stave off a few criminals.

There is no remote comparison between forcing people to own guns and forcing people to pay their share of the health care system. It’s perfectly ludicrous. I can’t believe I am dignifying this discussion with my time.

bkcunningham's avatar

@wundayatta you are making alot of assumptions about “me.” I personally do have health insurance. A cadillac plan as they say. I am blessed. There was a time in my life when I didn’t have insurance and managed without costing you or anyone else a dime thank you. I have a sister-in-law, her husband – my brother- died unexpectedly from a fast cancer a year ago December 13.

She has no medical insurance of any kind. She cleans houses for a living. She isn’t a leech and doesn’t expect anyone to pay her medical bills for her. She cleans houses for a living. We, me and my family, her family, have all chipped in to help her.

She hasn’t asked anything of “you” @wundayatta and would die herself before she would. I know countless others like my sister-in-law. So don’t group everyone, especially “me” into your tidy little ideas of the world.

That might be how your world works. It isn’t how mine works. If they are uninsured and can’t afford insurance, how are they going to pay for it now? Think about what you just said.

wundayatta's avatar

@bkcunningham Well, like I said, I thought you had insurance.

It’s nice that you help out your sister-in-law, but that isn’t the only cost of not having insurance that I pay for. Because she doesn’t have health insurance, even though you pay out of pocket, you have a much higher administrative cost for her care, and you don’t pay all of that. Some of it is shifted onto people who are insured.

Also, you have the cost of her lost productivity, which will be higher because, even knowing you will help her out, she probably doesn’t go to the doctor when she first thinks she needs to the way you can. So that means that she’s sicker when she goes, and that her care will cost more and she will lose more days of productivity than she would if she were insured and trained about how to use her insurance.

That also costs me. It might not be her, but there is almost certainly someone out there who delayed care and died as a result, and they were working on an invention that would have made a significant difference to our economy. That hurts us all.

No, she hasn’t asked anything of me, but she has taken it, none-the-less. We all spend way too much on health care and get far too little in return for what we spend. It’s a huge money pit and the extra money we spend on it produces nothing in terms of extra value. We could get more value from less spending if everyone were insured and you didn’t have to waste your time trying to help your sister-in-law get and pay for her health care

This is how the world works, whether or not you see it that way. We are all in this together, whether you want to admit it or not. The fact that so many people deliberately blind themselves to this reality costs us all an enormous, incalculable amount. I know I’m not being very polite about this, but I’ve had it up to here with the way people keep on insisting we should tie our feet together as we seek to improve our world. I guess I’ve decided that making friends and influencing people is no longer the point. I’m just horribly frustrated I’ve got a pretty good (although not Cadillac) plan myself. I think it costs me $14,000 per year. If we had universal coverage, my insurance cost would probably go down to $8,000. I think I could find something fun to do with the other 6K. I really do. But the world keeps on insisting that we should drive up health care costs senselessly and that I should have to pay for it.

Republicans hate taxes. Well this is a hidden tax that is spent in the most inefficient manner possible. I mean, no other nation does it as stupidly as we do. And for so little effect, too. It’s an enormous scandal, but no one can see it. Everyone thinks that Medicaid is the problem. Or Medicare. No one sees that the whole fucking system is rotten to the core. Well, some people do, but the people one would least expect to like wasting money, want the current system to stay in place. It’s just pure idiocy.

And you know what? If we cleaned up the health care problem, our deficit problems would disappear like that!

bkcunningham's avatar

@wundayatta what are you talking about, “Because she doesn’t have health insurance, even though you pay out of pocket, you have a much higher administrative cost for her care, and you don’t pay all of that. Some of it is shifted onto people who are insured.” You don’t know what you are saying! You have no idea where or how she gets medical treatment when she is sick. You are making things up to try to prove a point, but it is nonsense.

“So that means that she’s sicker when she goes, and that her care will cost more and she will lose more days of productivity than she would if she were insured and trained about how to use her insurance. That also costs me..”

What in the name of heaven are you talking about? That is more nonsense to me. Trained about how to use her insurance so it won’t cost you when she can’t go to work cleaning houses. You have to explain that one, ‘cause it went right over my head. She doesn’t currently have insurance and it isn’t costing you anything. I get the productivity part, but it isn’t costing you anything. What am I missing here?

wundayatta's avatar

For every visit for any health care, there is an administrative component. People who self pay cost more (not your SIL in particular, just people in her situation in general) in terms of the paper work required. That increased administrative cost affects all of us, because it increases the administrative load for the health care provider, and those administrative costs tend to be spread out across the entire patient base.

People who pay for their own care, it seems to me, are more likely to delay that first visit longer than those with insurance. So they are worse off when they first enter the health care system, and thus more costly.

People who are insured may not necessarily change this habit, just because they have insurance. They still, it turns out, delay getting care in the first place. For example, people who get Medicaid still tend to enter the health system through an ER, which is the most expensive way to do it. Therefore, they need to be trained in the proper use of the system. That includes learning how to identify a primary care physician, and learning that it is much better to go to the pcp first instead of going to the ER first.

The lost productivity does cost me something, but it is invisible to most people because it is an opportunity cost, and most people think that doesn’t make sense. It is the same thing as if we invest in the military, we get much less back than if we invest in any other sector of the economy. Fewer people get jobs and less money is circulated.

There is always the possibility that, had your SIL had health insurance (this is purely hypothetical), she would not have been sick as long and she would have gotten an education and a job in some lab and gene sequenced an antidote that could fight off multiple flus. Again, I’m not talking about your SIL in particular, but of people in a similar situation in general.

What you are missing is the interconnectedness of people and what people do in their private lives does have an effect on others. Let me give you an example. Most people believe that property rights should be absolute, right? It’s your property, and you can do what you want with it. So you start making some product that pollutes the stream in your back yard that runs into my back yard and kills all my cattle who drink from the stream.

There are many more scenarios like that that are much less obvious; the impact of poor health and lack of access to health care is one of those cases. The poor health of anyone costs me money through what is called “cost-shifting.” Medicaid does not pay the full cost of health care, so hospitals charge insured patients more to make up for that. People who “self-pay” cost more because they are less likely to pay in full, so those costs get shifted onto all of us who are insured. Your SIL may pay up her bill, but that is rare. Most people without insurance are without insurance because they can’t afford it. And even with your SIL, you help her pay her bill (I think you said that). Where would she be without your help? It is better that no one should have to worry about paying for health care.

People get better care if they don’t have to worry about paying for it. Having insurance allows us to teach people how to take care of themselves better. It allows for more preventive care. Our current system, and the system we’re discussing both do not deal with this problem. There will still be all kinds of cost-shifting. It’s be even worse if we continue to allow people to not pay into the system while still receiving health care.

Your SIL may not be a free rider, but many others doing her job are. We all pay for that because the cost of unpaid for care is shifted onto those who do pay for care, especially onto those with “Cadillac” plans.

There are only two ways this can work and one is clearly more humane. We can force everyone to pay for health insurance and then provide insurance to everyone. On the other hand, we could drop the requirement for hospitals to serve everyone, thus allowing them to turn away those who can not pay, and then we can allow the free market to work. Insurance only works if you only have to pay for the people you insure. Right now, we are forced to pay for care for everyone, whether or not they are insured. Remove that mandate or insure everyone. Those are the only two ways we can eliminate the inefficiencies and cost-shifting that are endemic in our system. At least, the only two ways I know of.

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