From: Smigrodzki, Rafal (SmigrodzkiR@MSX.UPMC.EDU)
Date: Wed Jul 18 2001 - 17:54:47 MDT
I can't resist joining in the discussion about health care - maybe because I
am busy with it about 12 hours/day, leaving too little time for the
extropian thing.
Miriam quoted:
>I think the biggest difference between the socialized health care system
and
>the US health care system is that people in the US see a bill that is
closer
>to the real cost
Miriam wrote:
True, and that is cool if you can afford it. If not then just die. :-)
Health is too important. Too many other businesses rely upon people's
health, not to mention all the people who rely upon their health. :-)
By all means gamble with washing powder, telephone systems, car tyres...
but not people's lives.
#### There is a very important moral issue involved in paying for medical
care with tax-derived funds - namely, isn't it morally wrong to take money
under duress, (the IRS), ultimately backed by a threat of death, to pay for
other persons' life-saving procedures?
I would say it depends.
There are some people who just don't care much about their health - they
smoke, drive drunk, blow their cortical vessels with cocaine, and then come
to depend on public largesse for treatment and other support, without ever
paying a dime into the pool of insurance money. I would have no compunction
about letting them rely on private charity for their needs.
But then, there are other people, those who you are probably thinking about
- the nice, hard-working, regular folks, who sincerely want to pay but just
happen to make too little money for full insurance, after paying for food,
rent, utilities, kids' college fund. I am willing to help them, to some
extent, and to support the use of governmental oppression to force other
citizens to help, too.
How would you know that somebody is nice and honestly willing to pay their
health bills? And, another important element, not all persons have the same
needs - there are people willing to spend their last dime on nutritional
supplements and the best medicine there is. Others, having 10 000$ to spend,
might allocate only a few hundred dollars for health, and prefer to spend
the rest on a Caribbean cruise.
I think that a workable and fair system would offer tiered,
government-standardized but privately run insurance plans to all citizens.
Every participant would have to pay a premium. If you define a person's
disposable income (DI) as the difference between the actual income (I) and
basic life-support needs, LSN, (1500-2500 kcal/day of the cheapest,
reasonably non-toxic food, + rent for 30 sq.ft of living space, a set amount
for clothing, etc.), then the premium for the top-tier health plan would be
the lower of the following numbers:
P=DI=I - ISN
or
P=actuarial cost of insurance
For the plan offering for example 60% of the top coverage, the premium would
be:
P%= DI x 0.6
And so on.
The difference between the actuarial, free-market cost of insurance, and the
premiums paid, would be covered by tax money. The system would encourage
diligent shopping for the best plan at the lowest cost, because the
customers would be paying a lot of their own money, in terms of percentage
of their disposable income. However, nobody would be denied care because of
the inability to pay.
Thus, even the poorest, but very health conscious person could afford the
best medicine. Those who would want to spend some of their disposable income
on, let's say, lipstick, would pay only a percentage of the DI, and receive
less care, assuming the full personal responsibility for their choices.
Nobody would get hurt, except by their own nonchalance, and nobody would get
a free ride either.
Rafal Smigrodzki MD-PhD
Dept Neurology University of Pittsburgh
smigrodzkir@msx.upmc.edu
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