Welcome to 1984: Implied Consent and Socialized Medicine (LONG!)

[304065]

This thread has been brewing in my mind for a while, let's see what you guys think. It takes a while but hopefully will be worth it.

Many of the Liberterian types here espouse the view that we should repeal laws that "protect us from ourselves." Helmet laws, laws prohibiting use of Marijuana, etc., are all seen as being unduly restrictive of individual liberty, and any harm they prevent is really harm to the individual, not to society per se.

On its face, that concept doesn't seem that bad. In my world view, anyway, people should be responsible for their actions, and if they end up cracking their head open like an overripe watermelon, that's a cost that is borne individually.

But as they say in Hamlet: Ay, there's the rub. Where indvidual freedom has an external social cost, you open the door to state regulation. Bear with me.

Is it ACCURATE to say that such behavior only harms the individual?

Let's do a simple example. Bruce Cougar hops on his Vincent Black Shadow and smokes the balonies onto the 101 freeway. Unbeknownst to Cougar, motorist Keith Lavender has just returned from an all-night rave at Rawhide and is now doing the drive of shame at the wheel of his Subaru. His brain addled by residual MDMA, Lavender mistakenly enters the freeway via the offramp. Because a helmet clashes with Cougar's wifebeater and Levis, he isn't wearing one when he collides with Lavender who is going THE WRONG WAY at 100mph. Cougar and the bike part company, and the only thing that saves him is the grass-covered median. Because he had no health insurance, the 200 pounds of denim and hamburger that used to be Cougar gets packed off to the County ER.

But here's the trouble: Cougar just became a ward of the state in a permanent vegetative condition. He can no longer work, leaving his old lady and two small children with no visible means of support. His wife could go back to work, but she can't take the kids with her. What money he had is quickly, and I mean, in a week's time, absorbed by our overpriced health care system. Mom and the kids are forced onto AFDC. Tragedy. Destruction.

Should Cougar's desire to exercise personal freedom outweigh the social cost of his actions? His healthcare costs for a sub-acute care facility are running about $1000 per day. Public assistance to keep his family above starvation is costing the taxpayers $379 a month, plus another $80 for food stamps. To say nothing of the intangible destruction to the family that his irresponsibility has wrought.

Now, consider the case of Keith Lavender. (You DID read all the facts above, didn't you?) His consumption of ecstasy is something that only affects him, right? But clearly, it was a factor in the accident. Now let's change the facts. . . Lavender got burned on his first tab of ex, or so he thought, so he buys another one. But the first one was genuine, and so Lavender's body temperature shoots up to 105, leading to permanent brain damage. Self-imposed harm? Yes.

But our benevolent society refuses to simply let Cougar and Lavender die as a result of their exercise of personal liberty. But in the liberterian model, you can't have your cake and eat it too.

Where I'm leading with all this is that once you introduce state-funded healthcare, the state has an interest in regulating your personal freedom in order to keep its costs low.

In the insurance world, there's a phenomenon called "Moral Hazard," in which people who have insurance are more likely to engage in risky behavior, knowing their downside is protected. Moral Hazard effects are observable everywhere. And the driver of losses is individual behavior that's "risky." But the fundamental axiom of insurance is, "there are no bad risks . . .only bad premiums." E.g. do whatever you want, but insurance is going to cost you a pretty penny, or you're going to have to self-insure.

We are beginning to realize (here's your point, Nostatic) that obesity is one of the single biggest causes of health problems, either primarily (heart disease) or through comorbidities. Introduce state-funded healthcare that's taxpayer-subsidized, and you have, right away, a couple problems.

1) Since, in our progressive tax system, the responsibility for paying for social entitlements is not borne in relation to consumption or risk, but rather, income level, you have the country's wealthiest 2% paying for health care for 56% of the population. Therefore, people who are obese, smokers, big drinkers, etc., have little incentive to change their behavior on their own- it's like owning a Porsche and paying Buick insurance premiums; and

2) To control its costs, and remember that you can't individually assess each person a different tax in proportion to her health risk, the state has to regulate behavior.

This leads to ENCROACHMENT ON PERSONAL FREEDOM! Guess what, you can't smoke cigarettes anymore, because the cost of lung cancer will burden the healthcare system! Want to pop that '92 Cabernet Sauvignon, forget it, too much risk of Cirrhosis! Skydiving, motor racing, SCUBA, no way, Jasper, too dangerous!

Now, the astute thinkers among us may posit, "It would be too unpopular politically to clamp down on risky behavior," and they may be right.

When you get your drivers license, you "Imply Consent" to the forefeiture of certain of your Constitutional rights, namely, your right against self-incrimination. By accepting the "privilege" of a driver's license, you IMPLY that you will give evidence of your physical person in the form of a breath test or blood sample to Law Enforcement upon their request. You NEVER are forced to, but if you don't, you give up the privilege of driving.

Why not use the same doctrine for socialized health care? Smoke all you want, but if we detect nicotine in your blood, you aren't covered! Want to be covered, gotta lose weight!

It's not that far, from a Constitutional or procedural standpoint, to the limitation of personal freedom, because the cost of providing a universal entitlement is simply TOO GREAT.

Thoughts?

(And don't bother biting at the obvious red herrings out there, that wearing helmets makes you more likely to be a quadraplegic, that drugs aren't harmful, etc. Stay focused on the issue.)

[widebody911]

There's a missing element of personal responsibility here. "Cougar" needs to realise "hey, my beeotch and 2 f*ck trophies depend on me, so maybe I shouldn't get toked up and ride mah hawg without a helmet."

[304065]

Thom, I don't disagree with your point, "Cougar" needs to use judgment.

The problem is, he doesn't have any. So which is it, do we limit the capacity for the exercise of freedom for everyone because of his individual irresponsibility, let him die, or keep him as a ward of the state?

[widebody911]

Originally posted by john_cramer
The problem is, he doesn't have any. So which is it, do we limit the capacity for the exercise of freedom for everyone because of his individual irresponsibility, let him die, or keep him as a ward of the state?

It's like a large tree in the middle of the road; if the tree was always there, everyone knows to go around it, and few if any people run into it. If there was no tree, and you put one there in the middle of the night, people will hit it. People were not willing to accept the consequences of not riding without helmets, and various entities got tired of paying for it, so they were mandated. I guess nobody had the political 'balls' to stand up and say "fine, you can ride without a helmet, but if you crash/get run over, we're not covering head injuries."

The next problem I see with this line of thinking is that insurance companies will take it a step further: "fine, if you want to ride a motorcycle, which is inherently dangerous, we're not covering you." eventually escalating to the silly 'unless you drive an APC/SUV, we're not covering you...

[RickM]

We need to employ the freedom of "mercy killing" when Lavender and Cougar become vegetables of the state.

[gaijinda]

Many good points made. Our very high social net makes us consider the difficult questions that you pose.

Liberterianism always quickens the pulse of every red-blooded American - until the guy next door stops cutting his lawn and the junk cars now number three... "uh, hello mayors office, this is....." Democracy is difficult business, not for the weak of mind..

As for 2% of the population "paying" for health care of 56% of the population - I am not so sure I am on board with that. Simply by any standard of productivity, you do not have so few people generation so much wealth. We have an economic system that rewards business owners, professional and the like, but they do not make that money all by themselves.. And yes, we have a structural underclass that might not be adding much to the GDP - but I dont think it is all that big..

As to the important issue of the regulation of our behavior, that is far more likely than our society kicking out the plugs of the life support machines of those irresponsible among us.. Not providing a coverage because of smoking status or body mass index? Not going to happen, not with today's jury pool and voters..

It is that long and slippery slope - those who know better, have a better education and "care" more (I am NOT going to mention Hillary here) would love to regulate far more behavior than mere cigarettes. Beer is next, then booze. Just wait until the taxation-industrial complex gets a hold of GPS and speed cameras.. Fast food, beef, its all on the to-do list.. The problem is - it is a broad net they are casting. The heavyweight dining on MickyDees 14 times a week, has a whole set of different problems that the lightweight looking for a road trip snack.

But we ARE providing this universal entitlement (health care). Some may be getting better care than others, and it may be inefficiently provided, but it is there. Those without health insurance are not dying in the gutters.. Is the cost "TOO GREAT", I dont know. There are few checks on the costs of healthcare (or the march of science) and it will outstrip our economies ability to pay these bills one day.

So what do we do? Fight the good fight. Protect our economic rights as we do others. Hopefully peer pressure will kick in, fueled by an example of personal responsibility and moderation by others.. (Go for it Cramer!) Will joys be found outside of food, substances and a sedentary lifestyle..time will tell..

[Moneyguy1]

Good post

Laws are there to protect not only the individual, but the public. YOu forgot to mention that after the collision, part of the bike flew through the air, into the bedroom of a nearby house and turned the father/husband into a parapelegic. His stock and trade was roofing, which he will never be able to do again. In addition to our motorcycle man and Subaru sweetie, we now have four more victims; te roofer, his wife, and two children. It gets more and more difficult to sort out.

[H.G.P.]

Originally posted by Moneyguy1
Good post

.....YOu forgot to mention that after the collision, part of the bike flew through the air, into the bedroom of a nearby house and turned the father/husband into a parapelegic. His stock and trade was roofing, which he will never be able to do again. In addition to our motorcycle man and Subaru sweetie, we now have four more victims; te roofer, his wife, and two children. It gets more and more difficult to sort out.

Into a nearby house whose owner CHOSE to live there.

[Beethoven]

Well, that's easy. Spend more money on education so that people learn that there are implications to their behavior. If not that, at least they learn to write as well John Cramer.

[CarreraS2]

The Libertarian model is fine, but, it's really an all or nothing thing. No helmet laws, no seatbelt laws, etc. are fine, if you are willing to let people fully accept their responsibility (i.e. they are responsible for their own health insurance - state and hospitals are gonna let you die if you don't have it).

But of course, that is never going to happen in the US. So the complete Libertarian utopia model can never work.

As you state: " once you introduce state-funded healthcare, the state has an interest in regulating your personal freedom in order to keep its costs low."

So the premise must be accepted that there is always going to be regulation of personal freedoms, and that is right.

The concept of "Implied Consent" for healthcare, though, just won't work. Why? For the exact same reason the Libertarian model doesn't work, as discussed above. Because NO MATTER WHAT, the state isn't going to let someone die. You drink 3 gallons of Tequila and come into the County ER with an exploded liver and no insurance, they will treat you the same as the innocent uninsured victim hit by a car.

Besides that, it would be a regulatory nightmare. Deny treatment to someone who is overweight at 280 lbs? 275? 250? 249? Implied consent with regard to a drivers' license works because the issues involved are black and white. (You WILL submit to the DUI test, or you WILL lose your license).

If you'd be willing to do what is necessary to make the Implied Consent theory work ("Smoke all you want, but if we detect nicotine in your blood, you aren't covered!" - by that I assume you mean you aren't covered, no one is going to pay, and we are going to leave you to die), then it would be a lot simpler to just adopt a "Full Responsibility" system - no insurance, no payment, you are left to die. The "Full Responsibility" system works just fine if one is willing to let the irresponsible die - and without all of the regulatory complications of an "Implied Consent" model.

(P.S. Your example of cigs is interesting. Aren't there restrictions on cigs already? Highly regulated, highly taxed. How much is a pack in NYC? My understanding is that cigs are highly taxed at least in part to discourage consumption. They are also regulated, and use discouraged, by bans on advertising, and public funds supported anti-smoking campaigns.)

[Hugh R]

Gaijinda you said "And yes, we have a structural underclass that might not be adding much to the GDP - but I dont think it is all that big.."

It actually is much bigger, consider this. In California, the state spends $6,400 per student to go to K-12. If you have two kids, thats $12,800 in state money to put your two kids though K-12. I imagine the costs in NY are similar. In California, the top tax rate is 8%, I think. So if you make $100,000/year then you only pay $8,000 in income taxes, add in the state average of about $3,500 in property taxes, and some sales tax and you might approach the $12,800 in costs just to put your kids through school, with nothing left for police, fire, roads, flood control, etc. And that's from someone make $100K/year. The fact is that the average person doesn't even pay for the goods and services that they use and take from the State. Its those top percentile of wage earners who carry everyone else. The middle class for the most part don't pay their "fair share" by "fair" I mean they put in what they take out. That's why when I hear "no tax cuts for the rich" it gets me going, they're the ones paying the taxes way in excess of what they take out of the system, and no, I'm not "rich", but the government would have you believe that anyone making over $60K/year should be taxed as "rich".

[CamB]

That's why when I hear "no tax cuts for the rich" it gets me going, they're the ones paying the taxes way in excess of what they take out of the system, and no, I'm not "rich", but the government would have you believe that anyone making over $60K/year should be taxed as "rich".


I still reckon that the only way this can be "fixed" (ie lower taxes) would result in a punitive reduction in services for low income people - in other words, pretty widespread poverty. I wouldn't want to live in such a society, so basically I grin and bear it when paying taxes.

John,

I think this issue is pretty complex. Health problems suck, but how many people reading this can honestly say they take good care of themselves - I'm talking about healthful food, exercise, sleep, moderation of bad stuff.

Then, how many can say they do it because they want to avoid spending $$$ on health costs. While I look after myself, I don't do it to save money - I do it for quality of life, now and in the future.

It doesn't do much for life quality now, so I have to be doing it for "later". From my basic observation of human nature, I'm at least somewhat of a minority AND I would expect the minority doing it to keep costs down is even greater.


So I see two issues:

1) people are no pre-disposed to moderation, and lack of moderation can be expensive in the long term;
2) certain activities are risky, which means some of the time they are expensive. This applies less of the time because many people prefer not to run the risks.

I guess, in along winded fashion, I'm sorting out the answer in my head.

Generally speaking, the items that are legislated against are those which have negative externalities (eg, smoking, speeding, drugs). Also generally speaking, there is resistance to legislating against items which primarily affect only the person in question (eg fatty food).

I don't know that there is necessarily the excessive curbing of personal freedoms. It is only excessive if you consider the curbing of rights to do activities which affect other people directly as being "oppressive" - think passive smoking.

[gaijinda]

[QUOTE]Originally posted by Hugh R
[B]Gaijinda you said "And yes, we have a structural underclass that might not be adding much to the GDP - but I dont think it is all that big.."

It actually is much bigger, consider this. In California, the state spends $6,400 per student to go to K-12. If you have two kids, thats $12,800 in state money to put your two kids though K-12. I imagine the costs in NY are similar...."

Hugh - I am thinking of those "sitting on the stoop" doing nothing.. No job, nothing. If you want to talk about the entire infrastructure of public expenditures - this opens a whole new can of worms and many new threads..

[Hugh R]

Cam and Gaij

One of my points I guess that I didn't make is that this forced flow of wealth from the rich to the poor artifically alters the free market. Consider in the United States Section 8 housing subsidies. People who qualify can get a $1,200/month apartment with the government picking up $900/month. This does several things, it artifically drives up the clearing price of rents in Los Angeles, it allows people to live where they can't afford, it makes housing more expensive, which makes it so fewer and fewer people can afford housing in an already expensive area to live.

I'm not saying that society shouldn't pay to educate kids (althought at least in Los Angeles, the school district does a pretty poor job of it), or that kids from poorer families shouldn't get the same education as kids from richer families. Maybe with less government hand outs, people would tend to fend for themselves and their families more.

BTW Cam how much of a problem is illegal immigration in New Zealand? Do you have lots of illegal immigrants on the social dole their? Not trying to be confrontational, just to understand more of where your coming from.

[CamB]

You can't get the dole if you are an illegal immigrant --> you have no ability to sign up.

We have a relatively minor problem with illegal immigrants. There are quite a lot of overstayers (it is easy to come visit, but less easy to get a permanent work visa), often Pacific Islander or Asian, who generally stay with, and are sometimes supported by, family members. We don't have the same issue you have with Mexico or Australia has with boat people - we are in the middle of nowhere so illegal migration en-masse isn't an issue.

I mean, there is still a problem - the newspapers a couple of weeks ago were full of articles about a guy who is in the country illegally, is being given state funded dialisis and has been arrested a couple of times for beating his wife. He can't be sent home (to Tokelau I think) because he will die without the hospital access he currently has.

Assisting the poor

it artifically drives up the clearing price of rents in Los Angeles

Yeah, I agree, it does. What is the alternative though? Either the rents drop to what can be afforded without govt intervention, or they drop to a point where there is a sort of substandard equilibrium, with increased overcrowding and/or financial hardship (ie, too great a percentage of income being spent on rent). While I don't doubt a (more efficient) equilibrium would be reached, my feeling is that it would be a socially unacceptable one.

Maybe with less government hand outs, people would tend to fend for themselves and their families more.

I think this is a myth about poverty. For every person one can find who is poor, lazy and feeding off the system, I would expect to find at least one person who works there ass off in a low income job and still struggles to make ends meet. Poverty in the US (and NZ) doesn't mean going without food every day, etc, but it means a pretty low quality of life ---> have a look at the map on the link below and assume that if someone is below the poverty line they are lacking in at least some of the basics required for life, and have few, if any, luxuries. They will also have reduced access to healthcare and education.

http://www.usccb.org/cchd/povertyusa/map.htm

I guess I come from a viewpoint that I don't care where people who are in poverty come from, how they got there, or whether they are there because of there own mistakes or bad luck. I just want to have a society which has structures to look after and educate (ie fix the problem). If this means there is a certain percentage which abuses the welfare system, then I can live with that.

The other "myth" is that people don't try to work their way out of poverty because it is too comfortable. Look at the income levels listed here - being below these income levels would truely suck, and offers plenty of motivation.

http://www.usccb.org/cchd/povertyusa/povfact9.htm

Alternatively, for the pretty multimedia:

http://www.usccb.org/cchd/povertyusa/tour2.htm

(sorry for the long post - I organised and presented a whole bunch of stuff on poverty in NZ last night to a youth group, so I am full of info right now...)

[Hugh R]

Lots of compassionate good points Cameron. But consider this, if that Section 8 family gets $900/month, that's $10,800/year, which is very close to what I paid the state of California in income taxes last year. BTW, Section 8 money comes from the Federal Government, I believe, or most of it. Anyway. If the equivalent of what I pay the state goes to support one family, and you multiply this by the tens of thousands in Los Angeles County alone, let alone the rest of the state or country, You have large numbers of families supporting other families, not building roads, not upgrading water systems, etc. Add on to Section 8 housing and you've got food stamps, education for their kids (discussed in my post above), subsidized electricity, and natural gas telephone, medical via' the emergency room, and pretty soon what it looks like to me is that for every family of four in a way lower income bracket than me, all the taxes paid by two or more "upper middle class" or higher families are going to support each one of those poorer families.

As you stated in your post, You can't get the dole if you are an illegal immigrant --> you have no ability to sign up. You don't have that problem in New Zealand, why should we have to pay for the illegal immigrants here?

Places like Los Angeles are very expensive to live, and if you don't have the necessary education, skills and abilities to make a decent living here on your own, then you should live in a less expensive part of the country.

I realize that I'm interspersing illegal and legal residents here, but the issue is still the same to me. I object to people "living" off the government. Which means "living" off of me. I took unemployment insurance for two months once when I was unexpectedly laid off, and thats it. Until they put lifetime caps on welfare, there were people who used to live in the vicinity of my first house who had three and four generations of family members on welfare. WTF is up with that?

[CamB]

I had the stats for NZ yesterday, and the multigenerational welfare families are definitely the exception (well under 10% of beneficiaries). They are a very public exception, however.

I am not sure that I know the answer to your question. Assuming there was a job (or that they are on welfare) which city/town should the "section 8 family" move to?

Is the problem that LA is too expensive, or is the problem that low wage workers in LA don't get paid enough?

This is pretty complex stuff. For instance, my initial reaction to your question about subsidised rents is that the landlords would suffer! However, I had to modify that in my mind, because I think it would create slums. If a significant proportion of the population can only afford $300/month in rent, then the value of the housing drops. If the rents won't drop, then more people have to squeeze into the same space (to afford, say, $600/m).

If they move away instead, there might be no jobs at all, or they would have to find accommodation for $300/m (which I would expect doesn't exist in your country - building costs would be too high).

[turbo6bar]

Originally posted by CamB
This is pretty complex stuff. For instance, my initial reaction to your question about subsidised rents is that the landlords would suffer! However, I had to modify that in my mind, because I think it would create slums. If a significant proportion of the population can only afford $300/month in rent, then the value of the housing drops. If the rents won't drop, then more people have to squeeze into the same space (to afford, say, $600/m).

Landlords won't suffer. They just won't get as rich. For "Section 8" housing, the game is buying a junker house. Fix it up so it's liveable. Rent the house "Section 8" for more than it's worth on the free market.

I don't rent Section 8. I buy a house for say $65k, and rent is $825/month. Another investor buys a junker in the city for $30k and adds $5k in repairs. That landlord can get $800-850/month renting via Section 8. However, I do enjoy a better property in a better neighborhood that appreciates over time. The other landlord owns a big cash cow.

Let me reiterate. Section 8 is not a subsidy for landlords. That's not saying some landlords haven't gotten filthy, stinking, obscenely rich catering to Section 8.

Back on topic, it's unfair for one person to stay in shape and eat well, while another person can eat like a d@mn slob and both pay the same insurance premiums. You can't get a big a$$ and expect my wallet to pay for your health problems. Then again, I've never been famous for being a team player. When I used to work for a living, I despised lazy co-workers. Now, I'm self-employed, so if the job isn't done, look in the mirror.
Jürgen

[Hugh R]

In my mind, what it does is all of what you said and more. Subsidizing anything house, steel, corn, skews the market place. I think that if there were no Section 8 housing anywhere, people would move to where they could afford. Overall rental prices would drop because of lack of price supports, as housing prices dropped (rental mostly) more people could afford them. Yes there would also be more substandard housing and more crowding as well. All of these things would happen, yes you could get housing price drops, a few who didn't qualify for Section 8 who made too much would see houses become more affordable to them and you'd see people at the bottom end forced out/down and into more crowded places, all at the same time.

Interesting question: "Is the problem that LA is too expensive, or is the problem that low wage workers in LA don't get paid enough?

Were seeing exactly this problem in Santa Barbara which is on the coast north of LA about 90 miles. Its very, very expensive and far enough away from Ventura to the south and San Luis Obispo to the north that they're having problems getting hired help who will work for at or just above minimum wage. I mean gardners, and the like, not waiters and waitresses who mainly consist of the white kids from the University of California at Santa Barbara (where my daughter will be attending in the Fall). What they're seeing is an increase in the market clearing price that they have to pay for gardeners and other manual labor in order to attract that kind of labor to Santa Barbara, although most of it commutes from Ventura. Its not a matter of LA being too expensive, or labor being underpaid, its the market clearing price. Again, nobody has a "right" to live anywhere, they have a right to live where they can afford. Its why I live inland about 30 miles instead of on the beach. Its where I can afford to live. If you can't afford to live in Los Angeles (or anywhere else) without sucking taxpayer money in order to do it, you should move somewhere else. Should I demand that I get government subsidies in terms of rent control so that I can live at the beach?

Whats the difference between saying I want to live in Malibu at $10,000/month versus where I live at say $4,000/month, versus someone who wants to live in south-central Los Angeles (poorer area) at $1,500/month, versus where my sister live in New Mexico where you can get apartments for $750/month?

[Moses]

Originally posted by john_cramer
...motorist Keith Lavender has just returned from an all-night rave at Rawhide and is now doing the drive of shame at the wheel of his Subaru...

After reading that I was just sure somebody was going to get rear ended.

Anyway, great points. Perhaps when common high-risk behaviors are identified, a premium can be applied. Maybe require all motorcyclists to carry health insurance. If they opt to go sans-helmet, they pay more. smokers already pay more for their health insurance.

Put me in the camp that thinks the protection of personal freedoms should be primary, even if society pays a bit. I don't want to see maverick mountain climbers, sailors, free divers, base jumpers or X-games athletes priced out of their passions. They are part of what makes America great.

Also, the pithed motorcyclist actually represents an insignificant part of the national medical budget. Let's talk about medical expenses incurred by terminal patients in their last six months of life!