Nothing is Free

Lamb

God's Lil Lamb
Community Team
Administrator
Supporting Member
Joined
Jun 10, 2015
Messages
32,649
Age
57
Gender
Female
Religious Affiliation
Lutheran
Political Affiliation
Conservative
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
Everyone likes to get something for free. But is it truly free? Think about it. Someone is paying for your free item so maybe to you it costs nothing but that doesn't make it free. It's paid for by someone else. Whether through taxes, a donation or whatever.

Free healthcare? Not free really when your taxes go up to pay for it.

Free lunch? Someone had to pay for the ingredients to cook that lunch for you.

Free Starbucks coffee when you get to the head of the line...but someone in front of you paid it forward so it cost them, just not you.

We love hand outs. We love to take or receive. Free free free. But it's not really free to everyone.
 

tango

... and you shall live ...
Valued Contributor
Joined
Jul 13, 2015
Messages
14,695
Location
Realms of chaos
Gender
Male
Religious Affiliation
Christian
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
The only way one person can receive something without paying for it is if someone else pays for it without receiving it.

From there the only question is who is the "someone else" who gets stuck with the tab for something they never receive.
 

Confessional Lutheran

Well-known member
Joined
Sep 11, 2017
Messages
867
Age
51
Location
Northern Virginia
Gender
Male
Religious Affiliation
Lutheran
Political Affiliation
Moderate
Marital Status
Divorced
Acceptance of the Trinity & Nicene Creed
Yes
If I'm doing my part by paying the appropriate taxes, I'm fine with it. Nothing is free, except God's free ( for us) gift of Salvation. Of course, that too cost Someone. If it's not coming out of your wallet, they're taking it out of your hide.
 

hedrick

Well-known member
Joined
Jul 13, 2015
Messages
683
Age
75
Gender
Male
Religious Affiliation
Presbyterian
Marital Status
Single
It’s true. Nothing is free. But there are various ways to pay for things. No one objects to paying for defense from taxes.

It used to be that fire protection was private. If you didn’t have insurance, they’d let your house burn. We changed that many years ago.

Social security doesn’t have to exist. If people don’t plan carefully enough for retirement we could let them starve, or perhaps depend upon their church to feed them.

Bundling health care with employment has several problem. The most serious is the moral problem: we let people who don’t have the right kind of jobs die. (Yes, they can go to emergency rooms, but by then it may be too late.) For some odd reason this seems like a problem worth fixing except for Christians.

But there are also economic issues. By bundling it with employment we increase the cost of labor, incentivizing companies to automate when they might not otherwise. It also increases the cost of labor in the US compared to other countries, I think, although the case is more complex than it sounds. If you have a condition that is continuing, it turns you into a slave, since you can’t typically carry health care to a new employer, and I think in the long run the ACA provisions on pre-existing conditions are going to be removed. (I'm not sure quite why Republicans would do that, but it's clear that they will, despite saying that won't. At a certain point it's hard to avoid wondering if they're just cruel.) It incentives companies to treat employees as contractors or part-time employees, and leave those employees in the lurch.

It would be one thing if the alternative was a free, competitive market for health care. Maybe we could get some creative solutions from private enterprise. But the current system combines the worst features of monopolies and government control. Getting a truly competitive system is probably less realistic than moving to single payer, and that’s going to be a nightmare. (The difficulty of transition is so great that the only realistic path forward is an incremental one, creating a government system in parallel with the existing system.)
 

tango

... and you shall live ...
Valued Contributor
Joined
Jul 13, 2015
Messages
14,695
Location
Realms of chaos
Gender
Male
Religious Affiliation
Christian
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
I'd imagine there are many pacifists who would really rather not pay for defense through their taxes.

As you say there are different ways of paying for things and often the key question is which method is best. Of course even then the question "best for who?" comes into play.

Any system that gives out free money will be abused. It's human nature - why work if you can simply game the system and get as much money for free as you might have earned by working? Especially for the people at the bottom of the economic spectrum who may not have much in the way of employment prospects beyond minimum wage jobs where they may get minimal notice they are needed at work, and gaming the system not only means they get comparable money without working but they also get to plan their weeks because they know they won't suddenly get a text message saying they are needed at work this evening. As with so much else it becomes a question of balance - too far one way and the system struggles under the weight of people fleecing the system; too far the other way and the people in genuine need are abandoned to the mercy of whatever they can scrape together.

Bundling healthcare with employment does create problems, as you say. Breaking healthcare away from employment would certainly have benefits but would also have costs. Just like the "Affordable" Care Act had many winners but also had many losers, and objective discussion proves increasingly difficult as many people simply fall back on their preferred mantra of "my premiums have tripled" or "are you trying to take away my insurance?"

Even single payer is fraught with problems. In the UK the NHS is free at the point of use (note that it isn't "free" because someone has to pay) and is riddled with all sorts of its own problems. Firstly there's a huge amount of waste, waiting lists can be staggering, people frequently find themselves caught up in a "postcode lottery" where they find that their own local health authority won't fund a treatment but if they lived half a mile away they would be under a different authority that would find it. And then comes the problem of just getting to see the doctor in the first place. In the US it's easy to see the problems that something like COVID-19 presents, if people don't see the doctor because they are afraid of the potential bills (and a $5,000 deductible is a pretty powerful disincentive to see the doctor). In the UK when the doctor's office gets swamped you might have to wait 2-3 weeks to see the doctor, which would have much the same overall effect. For example, I had a friend who was having chest pains in his 20s and the doctor couldn't see him for three weeks, so he ended up going to the emergency room (thankfully his heart wasn't packing up). The NHS also has problems with people who just don't show up for appointments and don't bother cancelling them, but also has problems when people do cancel their appointments and the system doesn't register it, prompting them getting a nasty letter about wasting resources. The NHS also does all sorts of unhelpful things to try and scrub up a bit of cash, from charging for parking (it's always fun when you paid to park only to find your appointment is delayed, and you don't know if it's safe to go and pay for more parking because if you're called while you're feeding change to the meter you'll get tagged as a no-show, but if you don't go out then you'll get a heavy fine for overstaying your parking ticket), to charging for TVs at the bedside (good luck sleeping on the ward if someone else on the ward is hard of hearing and has their TV on loud at 3am - apparently their right to watch TV trumps your right to sleep).

A major problem with the concept of "health insurance" in the US is that much of it isn't actually insurance at all. Insurance is about the transfer of risk, so coverage for pre-existing conditions can't be considered "insurance" - to ask an insurance company to cover a condition that already exists is akin to trying to take out fire insurance after your house has burned down. Of course people with conditions need to be treated, and the notion of insurance running in discrete 12-month windows just complicates the best way to go about providing treatment. Likewise expecting routine maintenance to be covered by insurance would be akin to expecting your car insurance company to pay for new tires and oil changes.

And hence the question comes back to the simple one, who should pay for healthcare? It's easy to see why something like treatments for cancer should be funded through taxation because many (most?) people who are diagnosed with cancer haven't necessarily done anything specific to cause it. But what about things related to obesity or smoking, just to give a couple of examples? Should a heavy smoker who is diagnosed with lung cancer or emphysema be treated on the public dime? Should the 450lb person who is diagnosed with diabetes be treated at no cost to themselves? Even without looking at people who are obviously unhealthy, should a super-fit mountain biker who crashes their bike and needs major reconstructive surgery have to pay towards the cost of their treatment? And in a system where there is no cost at the point of use, what steps should be taken to prevent the abuse that will inevitably occur? An example here - a doctor friend of mine recently posted an article about an elderly person who died, leaving many thousands of pounds worth of unused medication. They had collected all their prescriptions (not paying anything for them, due to their age), they just didn't actually take any of the medicines. So the NHS paid thousands for the drugs that ended up in the trash. Even a modest charge encourages people to consider whether they really need the medicine, but even a modest charge can prove prohibitive for people at the bottom end of the income scale.
 

hedrick

Well-known member
Joined
Jul 13, 2015
Messages
683
Age
75
Gender
Male
Religious Affiliation
Presbyterian
Marital Status
Single
You raise two questions, neither of which really differentiates between the current system and single-payer.

You’re right that there are problems controlling resource usage with “free” systems. However insurance systems have the same problem, because you have a fixed payment, after which you expect all your health needs to be handled. In both cases rationing is used. Similar approaches are used for insurance and single-payer systems. The current single-payer systems are funded at a lower-level per person than the US system. Not surprisingly, this results in more rationing and longer wait times in some cases. We could fix that by keeping the same funding level we have now, though I wonder whether that is the likely result.

You believe that people should pay for bad decisions. However individual illnesses can’t be traced to specific decisions. About all you can do it charge more for risky behavior or refuse to cover certain people. In practice this tends to lead to some people not being covered for many illnesses. It’s not clear that this results in lower cost for others, but it’s also not clear that that’s what people want. they may simply want to see punishment for people they think have made bad decisions.

At any rate, I expect that over time the US system is going to begin doing more and more of this. As electronic monitoring becomes easier and genetic testing cheaper, I expect insurance companies will start mandating exercise and other approaches to improve individual health, and rates may be higher for people with genetic predispositions to illness. Whether this is making people responsible or is unwarranted intrusion is a matter of philosophy. I don’t see any reasons governments can’t do this as well. You can't, however both oppose the nanny state and favor attempts to punish bad choices (unless, of course, you object to nanny states but not nanny insurance companies; I think most of us won't see much difference).
 

Josiah

simul justus et peccator
Valued Contributor
Joined
Jun 12, 2015
Messages
13,927
Gender
Male
Religious Affiliation
Lutheran
Political Affiliation
Conservative
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
Everyone likes to get something for free. But is it truly free? Think about it. Someone is paying for your free item so maybe to you it costs nothing but that doesn't make it free. It's paid for by someone else. Whether through taxes, a donation or whatever.

Free healthcare? Not free really when your taxes go up to pay for it.

Free lunch? Someone had to pay for the ingredients to cook that lunch for you.

Free Starbucks coffee when you get to the head of the line...but someone in front of you paid it forward so it cost them, just not you.

We love hand outs. We love to take or receive. Free free free. But it's not really free to everyone.


You are not listening to the Democrats!

When the government GIVES something, it's a free gift.




.
 

tango

... and you shall live ...
Valued Contributor
Joined
Jul 13, 2015
Messages
14,695
Location
Realms of chaos
Gender
Male
Religious Affiliation
Christian
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
You raise two questions, neither of which really differentiates between the current system and single-payer.

You’re right that there are problems controlling resource usage with “free” systems. However insurance systems have the same problem, because you have a fixed payment, after which you expect all your health needs to be handled. In both cases rationing is used. Similar approaches are used for insurance and single-payer systems. The current single-payer systems are funded at a lower-level per person than the US system. Not surprisingly, this results in more rationing and longer wait times in some cases. We could fix that by keeping the same funding level we have now, though I wonder whether that is the likely result.

Any system has to be rationed. It's a simple reality that, unless huge numbers of additional medical staff are hired (which carries a cost), demand for healthcare will exceed supply. When that happens the question isn't whether healthcare is rationed but the method by which it is rationed. It's the same with everything else - in the free market rationing happens because the price adjusts until supply and demand match. It's just not much of an option if you get the choice between paying money you don't have or just dying.

Part of the problem is that some on the left seem to think that socially funded healthcare systems represent the land of milk and honey where everything is just wonderful, while some on the right think that rationing by insurance company is perfectly acceptable while rationing by local health authority is one step from communism.

You believe that people should pay for bad decisions. However individual illnesses can’t be traced to specific decisions. About all you can do it charge more for risky behavior or refuse to cover certain people. In practice this tends to lead to some people not being covered for many illnesses. It’s not clear that this results in lower cost for others, but it’s also not clear that that’s what people want. they may simply want to see punishment for people they think have made bad decisions.

This is pretty much what I was saying, rather than any explicit statements of what I believe should be done. As with many issues it's not a nice easy black-and-white matter. It's easy to find examples of people who have major health issues that are almost certainly self-inflicted through ongoing bad lifestyle decisions; it's equally easy to find examples of people who have major health issues because life just dealt them a dud hand, people who suffered a tragic accident, people who were attacked in the street, and so on. And then just to complicate things further you get mental health issues that seem to strike with no rhyme nor reason, sometimes leaving people unable to live a productive life and therefore taking away any chance they might have had to provide for themselves.

Certainly there are some people out there who just want to see some kind of karmic justice doled out to the people who made decisions they thought were inappropriate, even if the cost to fix the problems were trivial. At the same time there are those who don't see any problem with constantly mounting bills to help the people who steadfastly refuse to help themselves. As with so much else, figuring where on a hugely blurred scale of grays to say people have to take at least some responsibility for their own lives turns into a matter of opinion rather than fact.

At any rate, I expect that over time the US system is going to begin doing more and more of this. As electronic monitoring becomes easier and genetic testing cheaper, I expect insurance companies will start mandating exercise and other approaches to improve individual health, and rates may be higher for people with genetic predispositions to illness. Whether this is making people responsible or is unwarranted intrusion is a matter of philosophy. I don’t see any reasons governments can’t do this as well. You can't, however both oppose the nanny state and favor attempts to punish bad choices (unless, of course, you object to nanny states but not nanny insurance companies; I think most of us won't see much difference).

This is something that has arisen many times over the years in the UK. The NHS, which offers healthcare "free at the point of use", is struggling to keep up with demand. Over the years there have been proposals to refuse to treat smoking-related issues because they are considered self-inflicted. Never mind the amount of tax that smokers pay into the system, they can't be seen to be getting anything back in exchange for their taxes. Then there was talk that obese people needing things like knee replacements should be denied because their excess weight caused the problem.

An eternal issue with any method of funding healthcare other than letting everybody pick up the tab for what they use as they use it is exactly as you describe. If you are paying for my healthcare, at some point it becomes reasonable for you to dictate the conditions under which you will pay. If you are underwriting an insurance policy for my healthcare it becomes reasonable for you to consider things like my lifestyle choices - if I exercise regularly, eat healthily and don't smoke it's perfectly reasonable for you to charge me a lower premium than you would if I smoked heavily and spend my life sitting on the sofa stuffing my face with chips.

It would be a hugely unfortunate endgame if people had to choose between the comparably undesirable options of trying to fund their own prohibitively expensive healthcare, or totally sacrificing any concept of privacy on the altar of Nanny State or Nanny Insurance who demanded to know absolutely everything about everybody so that treatments could be enforced or denied.
 

Lucian Hodoboc

Well-known member
Joined
Jan 1, 2019
Messages
1,343
Location
Eastern Europe
Gender
Male
Religious Affiliation
Theist
Political Affiliation
Conservative
Marital Status
Single
Acceptance of the Trinity & Nicene Creed
No
God's grace is free.
 

Claraviolet

Member
Joined
Apr 15, 2020
Messages
10
Gender
Female
Religious Affiliation
Hindu
Acceptance of the Trinity & Nicene Creed
No
That sounds pretty good
I never thought about that before. I suppose there is nothing truly free except for the air, because these days, we are even paying for the water
 

Lamb

God's Lil Lamb
Community Team
Administrator
Supporting Member
Joined
Jun 10, 2015
Messages
32,649
Age
57
Gender
Female
Religious Affiliation
Lutheran
Political Affiliation
Conservative
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
That sounds pretty good
I never thought about that before. I suppose there is nothing truly free except for the air, because these days, we are even paying for the water

I have well water so it's free but it needs a pump so I still pay for electricity. argh
 

tango

... and you shall live ...
Valued Contributor
Joined
Jul 13, 2015
Messages
14,695
Location
Realms of chaos
Gender
Male
Religious Affiliation
Christian
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
I have well water so it's free but it needs a pump so I still pay for electricity. argh

I guess you could rig up something hand powered, if you really wanted :)
 

Lamb

God's Lil Lamb
Community Team
Administrator
Supporting Member
Joined
Jun 10, 2015
Messages
32,649
Age
57
Gender
Female
Religious Affiliation
Lutheran
Political Affiliation
Conservative
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
I guess you could rig up something hand powered, if you really wanted :)

Yeah no. I remember trying to use a hand pump for well water at a park once and I couldn't get it to work!
 

tango

... and you shall live ...
Valued Contributor
Joined
Jul 13, 2015
Messages
14,695
Location
Realms of chaos
Gender
Male
Religious Affiliation
Christian
Marital Status
Married
Acceptance of the Trinity & Nicene Creed
Yes
Yeah no. I remember trying to use a hand pump for well water at a park once and I couldn't get it to work!

You could save on a shower by simply introducing a leaky hand pump :)
 
Top Bottom