Skip to main content

THE MEME ITSELF


The great "Free Rider" myth is that there are these great numbers of people who can afford medical insurance, but who don't carry it. Instead, we are told, they simply use emergency rooms which are required by law to provide medical care to any and all who show up at their door for free. The extreme form, which taints all others and permanently imprints one's mental image is that these are healthy young, well employed yuppies who are rolling the dice in order to pound more bucks into their 401Ks.

This is false, insulting to our natural allies, and makes us look desperate to those who are aware of the real underlying truth of the matter.

Let's get a tiny dose of reality here just below the orange surgeons knot.

The Problem


This is like one of those "How many things are wrong with this picture?" puzzles, and it is doing us little good. For starts, it is simply not true. I don't know about you, but I am uncomfortable spouting falsehoods in order to try to sell some idea, plan or proposal. I do a shitty job of arguing if I am bullshitting and therefore fail to convince anybody. Using this meme weakens the credibility of those who repeat it if any of the hearers know better, and such credibility loss can spread if those who detect it spread the word. It also insults a very large number of people who are naturally in our camp and who we should recruit instead of alienate, the working poor and even a chunk of the bottom of the middle class.

Free LunchMedical Care in the Emergency Room?


The putative requirement for emergency rooms to provide medical care to people for free is a flat out myth. If you don't believe that, next time you get seriously ill, drop by the nearest emergency room and tell them you are uninsured, indigent and sicker than hell and see what happens. This falsehood is a radical distortion of a provision in COBRA that requires emergency rooms to provide some level of emergency care in a non-discriminatory manner, regardless of ability to pay, to persons undergoing medical emergencies.

What that means is that if you are dying or undergoing immanent organ failure, they must at least stabilize you before dumping you back on the street or transferring you elsewhere. They are required to give an appropriate exam to determine if you have a medical emergency, which may be simply a few questions or blood work or an ekg or whatever, and then to stabilize any emergency conditions.  This is not free, recipients of care will be billed, at abnormally high rates, and if they cannot pay at the time of care, they will be hounded by bill collectors until they do die.

What it also means is that people do not go there for free routine care, because they won't get any. People without any regular doctor or clinic, however, do go to such facilities on a cash-and-carry pay-up-front basis for treatment of injuries and ailments and if the facility can handle the workload, it might take care of them. The key here is that they have to pay up frontfor non-emergency care.

Affordable to whom?


Now what does affordable mean and to whom?  The free-rider propaganda meme was written by folks who don't know what affordability means because they have never known real want.  They are thinking in bourgeois English and using bourgeois thought processes. The result is as erroneous and deceptive as if it were intentionally misleading. This is best explained by example.

Joe, single and working poor, has $5 left after paying his monthly bills and stocking enough in the fridge to get by to the end of the month if he is very careful. He has no savings and his clothes and shoes are reaching the end of the road, but they will hold up for a while yet and he hopes to put the $5 aside toward contingencies, emergencies, medical needs or whatever. He passes a yard sale advertising, among other things, a pair of kid's bunny slippers for $1 and a really ugly "abstract" painting, also for $1. Can Joe afford either or both of those items.

To the economist, the CBO and others using bourgeois speak, it is obvious that he can easily afford them both. He has more cash on hand than either costs. He has enough cash that he can buy both without incurring debt and still have cash left over.  So, they are affordable.

To Joe and the rest of the working poor, however, they are not affordable, because Joe cannot use them. Nobody among the poor can "afford" to throw money away on something that they cannot use.

Affordable Medical Insurance



There has been a lot of palaver about what medical insurance costs. It varies with location and other things, but I'm going to set it for Joe's area at $4,900 per year. (This can't be that extreme because I have an acquaintance who pays $720 per month for single coverage, but it doesn't matter, because we just adjust Joe's disposable income to match .) We'll give Joe a better job, such that with major scrimping and absolutely nothing going wrong or breaking, and prices staying the same and him being able to walk to work and shopping, he can save $5,000.

Can Joe afford that insurance? Sure, he'll still have $100 left over, right?

Wrong-O. One cannot afford what one cannot use, and that insurance is absolutely useless to Joe. Entry level bottom grade insurance will have a deductible well in excess of Joe's residual $100. Beyond the plan deductible, it will have a deductible for each particular sub-category of care, such that it will probably take well over a grand of out-of-pocket medical care payments before Joe qualifies for any coverage, and, that eventual coverage will have a mandatory up front cash copay of another 30 bucks or so. All the studies and statistics in the world will show that Joe can "afford" (bourgeois speak) that insurance, and they will all be wrong.

Irony much?


I'd like to present two scenarios for poor Joe.

In the first scenario he buys the insurance. He gets a case of pneumonia. Because the insurance has exhausted his financial resources, he cannot afford any medical care after losing a few days wages due to the illness and he gets worse and worse. It is possible that he will end up in emergency, unable to pay for any treatment and not covered by insurance because his insurance won't cover any.

In the second scenario, he doesn't get the insurance, spends a bit more on a somewhat better diet and socks the rest away. He might not even get sick, because he is getting better nutrition, but let's say he does. He has about $4,000 cash to go to the local clinic or emergency room and buy treatment.

In effect, buying medical insurance will prevent Joe from obtaining any medical care, while not buying insurance will allow him to pay for a few thousand of such care should he need it.

The Point

1) A huge percentage of those who "can afford medical insurance but don't get it" really can't afford medical insurance. The first half of the meme is based mostly on myth and partly on a few studies that make an improper use of the word "afford", assuming that one can afford stuff that one cannot possibly use.

2) These people aren't getting free medical care at emergency rooms -
     a) They can't get normal medical care in ERs without paying cash up front.
     b) Even emergency care is not free in an ER, those who cannot pay up front become indebted to the ER.

So, both legs of that 2 legged meme are false, and it would be really nice if we could all stop spouting it.

Originally posted to enhydra lutris on Fri Oct 05, 2012 at 01:05 PM PDT.

Also republished by Community Spotlight.

EMAIL TO A FRIEND X
Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags

?

More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  Happily, I hadn't encountered anyone here (7+ / 0-)

    using that despicable term.

    !! Four more years !!

    by raincrow on Fri Oct 05, 2012 at 01:16:01 PM PDT

    •  It is sporadic. After several "damnit, next time (16+ / 0-)

      I'm gonna diary that" events I broke down and started this diary. Then Mitt used it and two diaries lambasted him, awith tons of supporting personal experience comments, so I thought it was over. Nope, a few days later it started popping up again, so I decided to go ahead and publish this, tso that I can just point to it in comment threads.

      That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

      by enhydra lutris on Fri Oct 05, 2012 at 01:36:56 PM PDT

      [ Parent ]

    •  There are so many diaries here and so many (4+ / 0-)
      Recommended by:
      stormicats, enhydra lutris, DBunn, Simian

      comments, it can be hard to generalize. I haven't been around here very long, but I've found that sometimes there's a position I assume is commonplace, and then I'll stumble on a diary where the diarist and/or commentors are promoting just the opposite.

      When the Democrats were pushing for the mandates, I heard more than a few promote that meme as a reason why we needed them. I wasn't participating on this site at the time, but I got in a few nasty exchanges with fellow Democrats in person about some of these subjects.

      Because I've never had insurance through an employer, for most of my adult life I've purchased an individual policy and I understand the reasoning people use when they purchase it. In fact, I've avoided going to the doctor on occaision with similar rationales. Yes, I can afford a visit and get a diagnosis, but if it's serious I won't be able to afford the treatment.

      People would get so mad at me when I pointed out the potential difficulties with the mandates. I would get accused of being a parasite that didn't want health insurance when I was already paying through the nose for exactly that, nine hundred and something dollars a month for a single individual with no major health problems in an HMO that didn't cover prescriptions, mental health, vision, dental and lots of other things.

      •  Mandates is the wrong word (7+ / 0-)

        The word mandates evokes the idea of paying for something you may not use.

        It's possible "single payer" also has that connotation, but I think the thing that needs to be stressed is we will all need medical care at some point, and the only FAIR way to manage that system is if we all pay for it.

        We all pay for water: do we call it a MANDATE?

        We all pay for electricity: do we call it a MANDATE?

        When we pay for a police force or firemen, do we worry about it being MANDATED?

        No - because we know those public services that we will all potentially need, and we can't afford for them NOT to be there when we need it.

        The mandate language is just a convenient cover for a lot of shilly-shallying. Don't want to be "mandated" to pay for a public option if you aren't otherwise covered - then FOR HEAVEN'S SAKE lets build a universal health care system that we can all make equitable contributions to.

        Le nirvane n'existe pas. - Etienne Lamotte

        by breakingranks on Fri Oct 05, 2012 at 08:47:41 PM PDT

        [ Parent ]

        •  Unfortunately, there is no public option. I (6+ / 0-)

          think there would be less push-back if there were.

          I would be wary of using your specific argument because it can be challenged as follows:

          1) water and such are things that we pay for as we use them.

          2) Fire and police services are public services provided to whomever needs them.

          Medical insurance, in its current form, does not guarantee the person buying it any care, even if they do need care, and so is quite different from the other two types of goods and services. It is as if you had to buy 100 empty bottles before you were allowed to buy one with water in it, or as if you had to live in your house, paying for police and fire for 4 years before you could request help from the police or fire department, and they would only spend 1/2 hour on your behalf in any given year.

          That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

          by enhydra lutris on Fri Oct 05, 2012 at 09:00:41 PM PDT

          [ Parent ]

        •  Mandates are the key to privatizing the commons. (10+ / 0-)

          There's a huge difference to paying tax money into a common pool that provides for the common good through an accountable entity like the government and being required to contract as a comparatively powerless individual with a large, prosperous corporation. Firefighting used to be handled by private companies as well. We've been through that stage of development and I thought we had moved past it because it didn't work as well.

          Mandates are different than taxes. I thought that the Democrats were incredibly short sighted on that one and I still think they are. Never ask for a power that you wouldn't be comfortable seeing your worst adversary wield.

          Unfortunately it's behind a paywall, I think, but the October 2009 issue of Harper's had an article entitled "Too Big to Burn: AIG Plays God in a Man-Made Firestorm."

          •  One of the reasons that I think that the (5+ / 0-)

            existence of a public option would lessen the push-back, one could then elect to deal with a government entity and not a private insurance company.

            Thank you for the "privatizing the commons" perspective, I hadn't consciously looked at it from that viewpoint before now.

            That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

            by enhydra lutris on Fri Oct 05, 2012 at 09:30:16 PM PDT

            [ Parent ]

            •  I agree with you entirely. My feelings about the (5+ / 0-)

              ACA are more ambivalent than simply being in opposition to it. I do get that weren't going to have single payer and the situation was getting bad enough that something had to be done. From a personal perspective, it's probably all in all a benefit for me.

              However, I feel like the conservatives have been playing a long game, literally a decades long game, while liberals lurch from fight to fight. One of the things they want very badly is to privatize things that have been established as public goods over the last couple of centuries.

              It's one of the reasons I feel so strongly about public education at the moment. It's incredibly short sighted, I think, to not notice the huge amount of money that conservatives are dumping into promoting school privatization, which I won't name using the Orwellian term school reform.

        •  Most of the things you mentioned are public or (2+ / 0-)
          Recommended by:
          enhydra lutris, Joieau

          quasi-public.

          The word mandate is used because we are forced to buy commercial insurance. It's a very convoluted way to go.

          •  Health care absolutely should be (3+ / 0-)
            Recommended by:
            enhydra lutris, WheninRome, ozsea1

            considered a public good under the "General Welfare" clause. All the other industrialized countries have figured that out. The whole For Profit model is evil to its core, for the simple reason that we all need health care during our lives.

            Worse, the model is primarily tied directly to employment, as if this were still the post-war boom of the 1950s and '60s where people worked for the same company for 30-40 years. Today's working world is pretty short-term, and unless you've got private insurance, there will be notable gaps in coverage. That allows insurers to not cover pre-existing conditions. This connection between work and health care needs to go away, because our world - and how we as 'productive citizens' navigate the world - has changed significantly.

    •  I have heard it (5+ / 0-)

      Usually from center-right trolls who blather on about "ponies" and other crap, as well as the right wing claim that "without a mandate, everyone will rush to an emergency room every time they catch a cold."

      Really?

      I have to point out that the people in the movie Sicko actually had health insurance.

      And God said, "Let there be light"; and with a Big Bang, there was light. And God said "Ow! Ow My eyes!" and in a flash God separated light from darkness. "Whew! Now that's better. Now where was I. Oh yea . . ."

      by Pale Jenova on Fri Oct 05, 2012 at 08:51:02 PM PDT

      [ Parent ]

    •  I have seen plenty of that sentiment expressed (3+ / 0-)
      Recommended by:
      divineorder, enhydra lutris, ozsea1

      Although I am not sure the exact term was used. I seem to recall a diary that got hundreds of recs and what may or may not have been a thousand comments that used the term "goddamned freeloaders", full of self-righteous people who had never had to purchase their own health insurance in their lives congratulating each other for coming down on those who were really at fault for health care problems in our country: folks who can easily afford to buy insurance but won't because anybody can get free full-service health care on the taxpayers' dime with no strings attached. And according to those who post such diaries and comments, just about everybody can afford to pay for insurance premiums.

  •  good explanation (14+ / 0-)

    Thanks for giving a factual overview of emergency room care and the price of insurance.

    "If I’m wanting what I don’t have, I’ve got to do what I ain’t done” from the song “First Light. by Grant Dermody 2010

    by RosyFinch on Fri Oct 05, 2012 at 01:19:47 PM PDT

  •  back a 10 or so years ago (14+ / 0-)

    Before my wife and I got married she had to go to the emergency room because she was having severe chest pain.

    They rushed her in did a bunch of expensive test and after all night figured she wasn't having a heart attack, unlikely in a 21 year old, but was having massive acid reflux.

    She had no insurance so a bill for a couple of thousand dollars was sent.

    A few months later she had to go to the emergency room again because she her eye hurt so bad she couldn't even think and could barely see. Turns out she had a scratched cornea from some debris getting in her eye.

    The bill was only a few hundred dollars this time.

    We were already engaged by the second ER visit at this point but not married so she didn't have my insurance.

    We moved the wedding up once and then she got sick again so we moved it up again. Eventually we just eloped partially because she had to have insurance.

     The medical bills even from a walk in Patient first style clinic were too much.

  •  Wonderful wonderful diary! (23+ / 0-)

    Thanks so much. Such a clear explanation of a complex topic.

    People paying individual rates in our "free market" system are completely screwed.

     We are a nation where a large part of our workforce is working 2 or even 3 part-time jobs and not one of them offers health benefits.

    We are the only "advanced" country that has a large percentage of personal bankruptcies caused by medical bills.

    Not only does our morally corrupt and fiscally insane healthcare system create great wealth for the insurers, it is also a poverty machine that can strike any of us at anytime EVEN if we are insured!

    I have been writing and blogging about this stuff for literally years. If President Obama is defeated and Obamacare is actually repealed, I believe I will become a permanent tourist in other countries because I, even as a TOURIST, would receive better and more affordable care than in our supposedly "great" country that loses close to 50,000 citizens a year due to lack of care.

    There's American Exceptionalism all right, but it is that we offer exceptionally poor healthcare to our citizens.

    When will this madness end?

    “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

    by Phoebe Loosinhouse on Fri Oct 05, 2012 at 01:27:08 PM PDT

    •  asdf (11+ / 0-)
      Not only does our morally corrupt and fiscally insane healthcare system create great wealth for the insurers,
      That is a whole other diary in itself. Getting medical care supports and enriches huge numbers of people. That is what for profit medical care is about.

      Not only are there hordes of well paid employees (and tons of low paid foreign nationals in the pharma and med supplies industries), not only are there ludicrously well paid executives, but there are shareholders up wazoo, which include pension plans and other industrial investors.  Said ahareholders demand and receive healthy returns.

      Insurance and pharma companies have been touted for most of my life as great investments, stuff that should be in every portfolio because their high profitability is almost guaranteed.

      That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

      by enhydra lutris on Fri Oct 05, 2012 at 03:00:49 PM PDT

      [ Parent ]

      •  Don't forget costs of all the med records tech (5+ / 0-)

        ...is being passed on to the patient.

        Medical centers are being gouged up the wazoo for these elaborate and yet under-whelming systems. While the systems are getting better, patients are still being billed for the iterations of over-priced blah0ware.

        By the way, I think this is part of the problem behind rising university tuition costs, too. No one is really sure how and where the cost of the the "necessary technology" and "progress" is being absorbed. By the time the future is here (at which time the technology is supposed to realize savings), the technology is obsolete or involves a more highly paid workforce to maintain and develop it.

        Le nirvane n'existe pas. - Etienne Lamotte

        by breakingranks on Fri Oct 05, 2012 at 08:09:26 PM PDT

        [ Parent ]

        •  That may be on its way out. Kaiser (6+ / 0-)

          Permanente has an internal, system wide electronic medical records system, and for a fee they'll burn your medical records on a thumb drive that you can carry around with you.

          That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

          by enhydra lutris on Fri Oct 05, 2012 at 08:13:04 PM PDT

          [ Parent ]

          •  If only you realized (3+ / 0-)
            Recommended by:
            divineorder, enhydra lutris, BusyinCA

            the cost of the "experiments" that led to that system. It would give you a whole new insight into the rising costs of medical care.

            Consumers pay for the investments companies make in their own future. This is also part of the reason larger companies have an ongoing competitive advantage over smaller ones: they can absorb the costs of developing big technology that will help them stay ahead - and they just pass it on to the consumer as they go.

            Le nirvane n'existe pas. - Etienne Lamotte

            by breakingranks on Sat Oct 06, 2012 at 01:22:49 AM PDT

            [ Parent ]

  •  Great diary about a very important subject. (17+ / 0-)

    I find that people who have health insurance through their work generally have absolutely no idea how the individual insurance market works, how expensive it is and how hard it is to get.

    You can't scare me, I'm sticking to the Union - Woody Guthrie

    by sewaneepat on Fri Oct 05, 2012 at 03:27:38 PM PDT

  •  Thanks for telling it like it is (6+ / 0-)

    I seldom read stuff here that is for the under six figure crowd.

    Hoping to get my family hooked up with the ACA.

    How big is your personal carbon footprint?

    by ban nock on Fri Oct 05, 2012 at 07:53:09 PM PDT

  •  THANK YOU! ER is NOT free and not comprehensive! (5+ / 0-)
  •  Ah, thank you spotlighters. Sorry if I'm late (3+ / 0-)

    with that, but I just now saw the blurb up there.

    That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

    by enhydra lutris on Fri Oct 05, 2012 at 08:00:59 PM PDT

  •  Fallacy of Mitt's Emergency Room Safety Net (11+ / 0-)

    Mitt's ER safety net idea has often been attacked as one of the causes of inflating health care costs in general, but it is high time some one pointed out that it's not "free" either. This diary really lays down some home truths.

    I can personally vouch for this truth: I've had to go to the emergency room at the County Hospital for medical care several times. Far from being a moral hazard tempting over-utilization - the County Hospital represents a 9+ hour day trip where any evaluation will focus on cheaper, well-funded issues (i.e. doctors always want to test you for diabetes and give you a pap smear, but they won't test for rarer conditions since those tests are expensive).

    For each of those trips I got a large bill I couldn't pay, and an eternity of bill collector calls that are the only mar on a perfect credit record (I've always paid my bills on time, made my student loan payments when they aren't formally deferred, and carry no credit card debt at all). It is certainly unfair that people with no income or not only billed for medical care - they are outrageously over-billed because they are forced to use the ER "safety net".

    Another thing you might mention about indigent care is in some places (I can only speak for Berkeley, CA) people who qualify for welfare can get some basic medical care and tests subsidized. BUT prescriptions are not free - even if you have NO INCOME. So the doctor might determine what is wrong with an indigent person but there is no means of treating it.

    Anyway thanks for busting another one of Mitt Romney's egregious lies. Single Payer with active cost/fraud oversight of the system is the ONLY fair solution.

    Le nirvane n'existe pas. - Etienne Lamotte

    by breakingranks on Fri Oct 05, 2012 at 08:02:09 PM PDT

  •  $2100 a month for my wife and me (8+ / 0-)

    and it will go up another 15-20% next year. HUGE deductible and no drug plan either. Three years away from Medicare, and no options. We've been able to manage, but its getting harder to do, and we sure could have used the money for retirement. We realize that we are among the fortunate..................

    We really don't hear much about working people that can afford and are willing to pay a fair amount for decent insurance, and how difficult that really is. They just talk about how we want "free" insurance.

    I would like to see one of these dickwads call around and get quotes for a typical middle-aged couple, a couple that like most of us have had some/any significant health issues at all in their life. Current health does not even matter, really. I guess a quote of a couple of thousand a month wouldn't even register, though.

    "Horse Prom is black-tie, m*therf*ckers!" John Stewart

    by hooktool on Fri Oct 05, 2012 at 09:39:21 PM PDT

  •  I got little sleep lst night, so I'm going to (0+ / 0-)

    pack it in for now. I'll rec and reply to any subsequent comments tomorrow.

    That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

    by enhydra lutris on Fri Oct 05, 2012 at 09:56:46 PM PDT

  •  WA, under insurance commissioner Deborah Senn (3+ / 0-)

    The state required coverage of pre-existing conditions on individual plans, but had no mandate to enroll.

    You may prefer the term "adverse selection", but the result is the same. People got insurance for the duration of a pregnancy and then dropped it, and there weren't enough healthy people paying in to cover the claims. Before long it became impossible to buy an individual policy at all in the state.

    Joe, in your example, is the reason PPACA has three legs. Purchase subsidies for the Joes of the world stabilize the structure, the other two legs of which are a mandate and preexisting condition coverage.

    •  Thats a somewhat different subject, and I (0+ / 0-)

      don't have enough information on the WA law, rate structure, economy etc. Adverse selection is a real risk, especially where rates are extreme and coverages and payouts are low. The natural reaction to being gamed is to try to game those trying to rip you off.

      PPACA is a very different thing, and should make insurance affordable for an increased number of people, and also lessen the numbers of insured who cannot afford or obtain care in spite of their insurance. Slowly those to be covered by Uncle Sam will also get the word, find out how to get the coverage, jump through the hoops and become able to seek needed care if they can find providers who accept medicare as payment in full.

      I anticipate massive increases in profits for insurance, pharma and providers of medical care as well.

      That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

      by enhydra lutris on Sat Oct 06, 2012 at 08:43:16 AM PDT

      [ Parent ]

  •  1000 recs. Hope that this makes the list. n/t (2+ / 0-)
    Recommended by:
    enhydra lutris, BusyinCA

    Paul Ryan has risen to prominence because he thinks that poor people should suffer and he doesn't mind saying so.

    by VictorLaszlo on Fri Oct 05, 2012 at 11:14:49 PM PDT

  •  I have one employee who says no to insurance (4+ / 0-)

    Out of 30 employees, I have one wingnut who does not want medical insurance. I pay the first $100 of the meager coverage and the employees pay the rest. Some are young and pay only $31 per biweekly paycheck. Some are older and pay up to $87 per paycheck. Others are covered by medicare or by spouses or parents.

    When this one wingnut came eligible, he went off on how the  government was forcing him to be covered. I informed him that he wasn't required to participate until 2014 and that if he chose not to participate in 2014, he would have to pay an IRS penalty of $95. He chose to sit out of the insurance program until a future date. I imagine his off time is spent ingesting pot rather than doing fun things like bike riding or snowboarding so I guess it works for him. Until he has to visit the emergency room.

    We are both hoping he never has to go to the emergency room. In the Republican utopia, he will never have an emergency.


    i just baptized andrew breitbart into the church of islam, planned parenthood, the girl scouts and three teachers unions. - @blainecapatch

    by bobinson on Fri Oct 05, 2012 at 11:22:21 PM PDT

    •  ... and there you have (4+ / 0-)

      your "free rider." Someone who has been offered a chance to participate at a reasonable rate but chooses not to.

      I understand the diarist's point. I've had to purchase a policy on my own and it wasn't pretty, and now that my employer pays part of the cost I am very grateful. My husband, son, and I are all uninsurable outside of a large group arrangement.

      But -- I also know right wingers who puff up and say "I don't need health insurance, why should I be forced to buy it?" Well, the thing about insurance is it's there in case you need it. You don't waltz in and buy a policy the day AFTER you've been diagnosed with cancer, or hit by a truck.

      I hope your employee doesn't wind up ill or injured and uninsured.

      •  Insurance Marketing Partly to Blame (6+ / 0-)

        HMOs and insurance companies have been way too loud about their "savvy" attempts to focus on young people who don't yet need insurance. By making this such an overt business tactic, younger people started to feel exploited and used - like they were being tricked into footing the bill for the older generation.

        The thing Congress did to most sabotage health care reform was to take Single Payer off the table. Anything other than Single Payer will seem to fall unfairly on some group, and thus "Obamacare" can be used as a political football forever.

        Reliable medical care is as an important part of the public infrastructure like police and fire-fighting and sewage treatment facilities. You don't see anyone rising in resentment over having to pay for those things. That's because they are perceived as being for everyone and paid for by everyone. There's no setting up one group to pay for everyone else.

        Le nirvane n'existe pas. - Etienne Lamotte

        by breakingranks on Sat Oct 06, 2012 at 01:48:00 AM PDT

        [ Parent ]

      •  Still no free rider because he will get no free (3+ / 0-)
        Recommended by:
        Lisa, bobinson, BusyinCA

        care. There you simply have an uninsured nut.

        That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

        by enhydra lutris on Sat Oct 06, 2012 at 08:33:49 AM PDT

        [ Parent ]

  •  We're in EXACTLY this position (2+ / 0-)
    Recommended by:
    enhydra lutris, BusyinCA

    ..and it's horrible. And you're right. And why, dear God, we need Single Payer.

    I think people use the "Free Rider" meme to throw the GOP's own language back at them, but the problem exists just as you say it does, so access is not actually obtained with most plans.

    If you can find money to kill people, you can find money to help people. --Tony Benn

    by rhetoricus on Sat Oct 06, 2012 at 07:27:28 AM PDT

  •  Thank you for this Diary (2+ / 0-)
    Recommended by:
    enhydra lutris, BusyinCA

    I just don't understand why we democrats have allowed this right wing myth to stand. The idea that one can get free medical care at the ER should be attacked every time it  brought up. The hospital may be forced by law to treat you, but it's not free. You will be given a bill, and if you are one of the working poor who cannot afford insurance, that bill will bankrupt you.
       And the media plays right along with the myth. When Romney talked about the free heath care one can obtain at the ER in his interview with Scott Pelley, Scott simply went along with it and suggested that that was not the most efficient way to treat people.

    If the casualties of principle are not healed, the physical casualties will continue to mount.----Martin Luther King

    by goobop on Sat Oct 06, 2012 at 08:07:23 AM PDT

  •  Free Rider IS NOT a Republican Meme (2+ / 0-)
    Recommended by:
    enhydra lutris, BusyinCA

    Free Rider is a basic concept in economics referring to  people who enjoy the benefits of a public good without paying their share for it.

    Now, the term Free Rider may or may not apply to the case of people who refuse to pay for health insurance, but plan to "benefit" from the provision of "free care" if they need it. However, I agree with the diarist that this is probably relatively rare, and the care is not free (nor usually public) in any event.  

    I think in the case health care, the notion of "Free Rider" applies more to someone who doesn't buy health care on the gamble that they won't need any care at all, driving up the cost of insurance for everyone else, because the insured pool as a whole is a higher risk pool than it would be with their participation and the participation of others like them.  Their hope is that they will stay healthy enough to avoid the system altogether, or that out-of-pocket medical costs will total less than their premiums would have been if they were insured.  Their plan is to delay insurance until they get old enough that the benefits of the insurance will outweigh the costs of the premiums.  This is a dicier situation than the one the diary describes.  They're not strictly Free Riders, because in economics the term refers to people benefiting from a "public good" without paying, and we don't really treat health care as a public good in the first plase.  However, in the case of catastrophic care, these folks will get more or less unlimited public care even though they made the gamble not to buy insurance in the first place.  Maybe hundreds of thousands of dollars in care is worth th price of a personal bankruptcy -- or maybe it's not.  But that's not my primary point here.

    My point here is that, while a good debate can be had over whether the young not buying insurance constitutes "Free Riding," and the diarist might well win that debate, the term "Free Rider" is not evil, or despicable, as some commenters have said here in more global terms.  We need to be clear that the notion of Free Rider (generally) IS NOT a conservative meme.  As Wikipedia defines it:

    "The term free rider comes from the example of someone using public transportation without paying the fare. If too many people do this, the system will not have enough money to operate. Another example of a free rider is someone who does not pay his or her share of taxes, which help pay for public goods that all citizens benefit from, such as roads, water treatment plants, and fire services."

    Free Rider is a critical concept in economics, and one that refers to people who can afford it but still refuse to contribute to the public good, while still benefiting from these public services.  This is hardly a "conservative" notion at all.

    Just because we may rightfully dispute whether or not those who are able to afford insurance but don't buy it are Free Riders, we should be careful not to demonize the term overall.

    Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has. --Margaret Mead

    by The Knute on Sat Oct 06, 2012 at 09:43:11 AM PDT

    •  Free Rider is a GOP meme solely in the (2+ / 0-)
      Recommended by:
      The Knute, BusyinCA

      context of health care, true. The problem with titles is that they are condensed.

      I disagree that those not buying insurance change the risk pool and drive the costs up. That would be true for classic pure insurance, but what we have in the US today is pretty much a scam and the costs and prices are pure oligopoly market prices. Insurance companies are massively profitable and prices are not based simply on risk sharing and risk distribution.

      That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

      by enhydra lutris on Sat Oct 06, 2012 at 10:17:37 AM PDT

      [ Parent ]

  •  Free? (2+ / 0-)
    Recommended by:
    enhydra lutris, BusyinCA

    I just paid off a $245 ER bill, I incurred before I got insured. ER's btw, are allowed to vastly overcharge for services and medicines.

    "My case is alter'd, I must work for my living." Moll Cut-Purse, The Roaring Girl - 1612, England's First Actress

    by theRoaringGirl on Sat Oct 06, 2012 at 10:34:02 AM PDT

    •  The only surprising thing about your post is (3+ / 0-)

      that the bill was only $245.

      In my experience locally, $245 will just about buy an aspirin, processing of the intake paperwork, and a judgmental look that says you're not really sick enough to be in the ER.  Just goes to show, again, how broken the system is.

      Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has. --Margaret Mead

      by The Knute on Sat Oct 06, 2012 at 11:19:28 AM PDT

      [ Parent ]

  •  Most excellent diary. (1+ / 0-)
    Recommended by:
    enhydra lutris

    Another one of my gripes with common misunderstandings about the sad health care system we must endure in the US, is billing.

    I have a $3,000 deductible policy. If I should need some expensive care, a naive person might think I just pay the $3,000 and everything after that is covered. Wrong.

    Here's an example. I need an MRI that costs, say, $3,000. If I get it done, I have to pay for it to full-fill my deductible, right? No. I have to pay for it, sure, but when I get my insurance report, it states that of the $3,000 charge, they only 'allow' a $1,500 payment. So I have paid, in addition to my insurance premiums, another $3,000 and I still have another $1,500 left on my deductible. Plus the 20% of the first $1,500. :(

    And even if I somehow manage to pay in enough to reach my deductible, I still have to pay 20% of all future costs, because they only cover 80% maximum. WTF? And if I am really sick or severely injured and therefore cannot work, my pay-checks stop coming in. So how can anyone afford serious treatment? Again, WTF?

    Another part of the medical scam system we suffer is the co-pays. And another is prescription drug costs.

    I hope you can write more on some of these things, because you explain it so well. It is a joy to read your diaries.

    p.s. I had Kiaser-Permanente years ago and it was the best care system I have experienced in the US. I wish I could get it now.

    Mitt's full of it / Ryan's lyin' -- "Your money and your life."

    by BusyinCA on Sat Oct 06, 2012 at 01:12:09 PM PDT

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site