Without government regulation forcing insurance to cover specific conditions, which largely results from employee provided, group plans, people with chronic conditions would be able to get health insurance. It just would not cover their known, preexisting, chronic conditions. Again–looking for coverage of an existing condition is not looking for insurance. It is looking to get other people to pay for your condition. Period.

Putting them on the government dole is not better. It is still taking money from other people. Just be explicit about what you want. Be honest and say that you do not think people with chronic health problems should have to pay for them. Other people should.

And that is great if you are one of the many people. THe problem is that you will have a significantly different opinion if you were one with a chronic illness. These people will always be denied by insurance companies. ALWAYS.

In a free market all actors in the market must have the same or similar market power. Yet, in the health insurance market you have a situation were certain segments of the population will not be given the product at no fault to themselves.

The situation were there is inherent unfairness in such an important market must be addressed. The fact that libertarians address this as “who cares” shows that they are not thinking seriously about the situation.

But, the health care system can be reformed fairly easily.

I believe that everyone should get individual policies with reasonable deductibles from an unfettered market.

Individuals with chronic illnesses, such as asthma and diabetes should receive heavily subsidized reinsurance from the government. The reinsurance will cover costs associated with these chronic illnesses and remove this risk from the private insurance carrier. Then these individuals will be able to get the same health care insurance that you do.

People who cannot be covered by individual insurance programs must have an insurer of last resort. In my home state of Minnesota this program is known as MCHA. Such programs should be subsidized with taxes on the health insurance premiums of other people. This tax essentially is community pooling.

The “uninsured” would be continued to be covered by the governemnt, BUT, as with everything there should be appropriate deductibles based upon their income level. This will prevent the overusage and radical increase in demand. But, the point is, everyone would be covered. This coverage would allow us to efficiently deliver health care coverage to the poor and uninsured. There would be rules and rationing of this care that would be extensive, and waiting periods for the government “insurance” would be substantial and on par with the universal coverage state.

That is the cost of going on the government dole. THey will not get priority. THey will not get the best of treatment and equipment. They will not get the best doctors. And their access to specialist will be limited.

Maybe that would be incentive to become productive?

I think your first statement is incomplete. It would be better to say: “there is not a private health insurance company that will ever accept you for chronic asthma coverage“. And that’s true. It wouldn’t make any sense. To be fair to the other members of the pool, they would need to charge you at least as much as your care costs. But they might be willing to cover you for other risks unrelated to your asthma.

Second, I completely agree with the pooling aspect of insurance. You’re correct, it is the main reason for insurance. Without it, there’s no difference between paying a monthly premium and making monthly savings deposits. Because of pooling, I can draw on more than my own funds if the unexpected occurs.

But what do we mean by “unexpected costs”? I mean a one-time event: injuries resulting from an accident, a sudden illness, or an attack of some kind (heart attack, stroke, etc). An insurance pool can protect against these events. They’re limited in scope and probably will only effect a small portion of the pool at any one time. The more that the pool tries to cover — and the longer it pays out for each individual — the more it will need to charge. A pool that covers truly unlikely events will be very inexpensive. A pool that covers likely events will be very expensive.

This is why I said that David B was asking for a subsidy. He was asking for a regular, monthly payment that (from what he implies) will be needed for the duration of his wife’s life. To cover that kind of expensive, he and his wife would need to be members of a fairly expensive pool. In addition, the other members of the pool would be paying in money that would be going right back out to support he and his wife. That is the very definition of a subsidy.

I never claimed (and will never claim) that having insurance pay for catastrophic events is a subsidy. I only claimed that having insurance pay for ongoing, known costs is a subsidy. That is, costs that are known about at the time that insurance is purchased.

I don’t understand your third point at all. A private market can be created in the absence of government and non-profit guarantees. It is true that that market may not cover 100% of the conditions of 100% of the people. But that market will exist and will provide coverage for many people.

As for chronic conditions, the problem is the ongoing cost. The current system doesn’t really address that does it? It helps to make things look as though it’s doing something. But remember that money doesn’t grow on trees. The money is coming from someplace. It’s coming from those paying in for insurance who don’t tend to have things going wrong. They’re paying more. It also comes from the employers. Instead of paying more in wages, they have been paying that money into health insurance. It’s a catch-22 situation. The less they have for wages, the more we’re dependent on having insurance cover the health equivalent of an oil change or putting new belts on a car to get by. Think of how much you could cover if you had another $500-$2000 / month to cover health expenses. Changing the paradigm won’t create a utopia. But as a whole it lends itself to actually bringing down the cost of health care rather than having bureaucrats putting a cap on spending. A cap on spending isn’t reducing costs; it just limits spending. And the public as a whole putting a cap on spending isn’t any different than issues would have if they were struggling with finding insurance in the first place.

But this is typical of the libertarians. Their views on every subject ignores realities like this. Oh, the chronic illness is “forseen”, whatever that means. Apparently these people believe that a person with such conditions or medical history should just get on a high deductible plan like they have. But the fact is that such plans are not economical for such people because they have “forseen” medical costs.

A $5,000 deductible plan is great for people without any health problems. THe probablility of them having more than $1,000 in medical expenses are very low. Once you add up the actual medical costs and the low premiims of such a plan you get significant savings.

But what if you have chronic asthma and have about $300-500 in medications you take a month?

First, there is not a private health insurance company that will ever accept you. Your medical costs will always be more than any reasonable premium you are going to pay.

Second, the libertarian claim of “subsidy” is not a subsidy. It is reasonable health insurance pooling, another aspect of INSURANCE that you are completely ignoring. IN fact, this is the MAIN reason for insurance. I pay the premuims on my insurance so that if I run into unexpected costs the insurance “pays for it”. So, any catastrophic usage of health insurance I encounter means that I am receiving a “subsidy” in these freaks minds.

Third, the only way that a private market in insurance can be created is if the government or some other non-profit steps in to guarantee insurance for people who will not be covered by the underwriting process of for profit companies.

In general, I just don’t trust the free market with my health, and feel that some regulation is necessary to mitigate the influence of the bottom line. Also, my general problem with private charity is that it can, and does, discriminate. I don’t think that’s okay either.

I, too have a high deductible health insurance policy coupled with Health Saving Account. (Or is it a Medical Savings Account?) While visiting a lady friend of mine in another city several years ago she developed the flu. And as it was the weekend her regular doctor was not available. She asked me to check on a couple of nearby walk in clinics and I did so. One was $85 and the other was $115 for a visit. She chose the $115 clinic. I asked why. The $115 one was a little bit closer and “nicer” meaning newer and besides her insurances paid 100% for walk in clinics and it didn’t matter what it cost. Talk about a lesson in economics there.

It is very hard to make a comment about the fellow with a wife that has a chronic illness not having the particulars. My observation is that in the US the only people that die in the street are street people, commonly referred to as “homeless.” The vast majority of these people are schizophrenic, alcoholics, drug addicts or some combination thereof. I don’t think this applies to him or his wife. Dying in the street is a straw man argument.

“My wife needs really expensive, regular care, and it hits us hard.” I don’t know what “hard” is. However there is Medicaid for “really hard.” In my state, Louisiana, there is also a state charity hospital system where free health care is available for any and all conditions. I see no point in arguing about this fellow’s plight without knowing the conditions and defining our terms.