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This is what it's like to have health insurance on the individual market.

• Foreign Policy's web site has a new Afghanistan-Pakistan section.

• Sam Harris is not impressed with Francis Collins' attempt to merge theism and science.

• George Scialabba takes aim at the un-democratic Senate.

• Dan Barber explains the tomato blight.

By Ezra Klein  |  August 10, 2009; 6:47 PM ET
 
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Comments

I can't really get into the moot point raised by Scialabba given more pressing matters, such as The Author's Guild et al v. Google Inc., and S.899, and even 'Funny People' who won't allow themselves to be optimistic about their own futures.

Entrenched provisions, such as the composition of the Senate, are unique: and the Senate, as composed, is here to stay until the next revolution. An excellent paper provides a discussion of the as-yet unratified Corwin Resolution (12 Stat. 251) and a thoughtful discussion of the "illegal" revolutionary activity Scialabba used as bait in his argument:

"The 1787 Convention was extraordinary, however. That Convention had extraordinary powers, greater than the powers of the state legislatures or conventions that act under Article V, because the 1787 Convention was a revolutionary institution. It was selfconsciously extralegal; it did not conform to the procedures for amending the Articles of Confederation and did not claim legitimacy because of the Articles. Instead, the delegates to that Convention conceded that they were revolutionaries. They invoked the sovereignty of the people, and looked to the ratifying conventions and the court of history for vindication.[FN 215] Because they did not rely on the Articles for legitimacy, they were not bound by its restrictions but instead exercised the extraordinary powers of revolutionary constitution makers." ((Bryant, Christopher [University of Cincinnati - College of Law]. _Stopping Time: The Pro-Slavery and 'Irrevocable' Thirteenth Amendment_. Harvard Journal of Law & Public Policy, Vol. 26, No. 2, Spring 2003, p. 536.))

Posted by: rmgregory | August 11, 2009 12:05 AM | Report abuse

Maternity coverage is in most cases completely antithetical to concept of insurance. If one wants to make the argument that as a society we should just pay for maternity care to prevent having a family from being a luxury limited to the wealthy, then make that case (and I'd probably agree with you). But to suggest that a lack of comprehensive maternity coverage is a failing of individual insurance is to completely misunderstand the reason for and definition of insurance. The writer bought coverage clearly planning to get pregnant in the near future, and in a case like that why are the costs of childbirth something that insurance should cover? It is not an unexpected and unforeseen event. Did she really think that an optional payment of $126/month should cover the $7500 (her number) average cost of delivering a child? Is the concept of adverse selection completely foreign to her? Does she not understand the only people who would choose to pay the optional $126/month are those planning on getting pregnant in the near future? Sure, there are some people who don't want to get pregnant and will buy it "just in case", as well as some who plan to get pregnant and either cannot do it or it takes them long enough that the premium they paid for maternity coverage ends up covering a decent amount of the cost. But those are outweighed pretty heavily by the people who just want someone else to pay the bill for them to have a baby, which is why the cost of that coverage is usually so high. Like it or not, and as crude as it may sound (and leaving aside the obvious "survival of the species" reasons), in a lot of cases having a baby is essentially an elective medical procedure. Make an argument for a way our society can pay for that, but don't blame the individual insurers for not offering great coverage for something that is a pot of honey to the hungry bear of anti-selection.

Posted by: ab13 | August 11, 2009 12:09 AM | Report abuse

ab13,

great points. i won't even go into the idea of infertility coverage that's mandated in many states and people would follow the same adverse selection principles when it comes to that. The problem with most americans is that we want everything, don't know what it costs, don't care what it costs and expect someone else to pay for it for us.

Posted by: visionbrkr | August 11, 2009 7:40 AM | Report abuse

Gosh, it's too bad there are no horror stories about government health insurance too. Oh, wait -- there are.

Gosh, it's too bad Ezra only posts horror stories about private health insurance.

Oh -- and since when is having a baby the sort of catastrophic unexpected event that couples shouldn't have to pay for themselves???

Posted by: whoisjohngaltcom | August 11, 2009 8:28 AM | Report abuse

What ab13 said.

Insurance is fundamentally about protecting yourself in situations where there's a risk, but far from a certainty, of the occurrence of a costly event and usually unpleasant event that you wish to AVOID.

I'm not a defender of the health insurance industry, but if I were in their shoes, I wouldn't sell maternity insurance to a young woman who's trying to get pregnant: such insurance would necessarily cost almost as much as the the event I'd be insuring against.

(Say, anyone remember the baseball strike of 1981? The team owners bought insurance against a strike, and Lloyd's of London stupidly sold it to them, not realizing that the owners were actually trying to force the players to strike. That's another example of insurance that should have cost almost as much as the event being insured against.)

I agree that we, as a society, should largely pay for the costs of childbearing, so that, as ab13 says, childbearing isn't a luxury limited to the wealthy or those on Medicaid. But that should be done in a manner that spreads the costs over the entire population, rather than expecting the seller of a single individual policy to pick up the tab.

Posted by: rt42 | August 11, 2009 8:33 AM | Report abuse

The Ayn Rand guy asks: "Oh -- and since when is having a baby the sort of catastrophic unexpected event that couples shouldn't have to pay for themselves???"

Because childbearing has become quite expensive, compared to times past. And if only the wealthy in America can afford kids, then each generation of Americans will be much smaller than the one before, and next thing you know, we won't have a country anymore.

Maybe I'm wrong, but I believe even libertarians feel a nation should have the power to act for self-preservation, even if it places impositions on the citizenry, e.g. taxing the citizenry to defend one's borders. Think of this similarly.

If that argument doesn't grab you, then kindly remember that, much as libertarians are overrepresented online, you folks only constitute a minute fraction of Americans. The rest of us have simply reached different conclusions than you about the virtue of paying taxes to promote the common good in ways that go far beyond the police, the courts, and the military, despite having heard all the libertarian arguments to the contrary plenty of times over the years.

Posted by: rt42 | August 11, 2009 8:42 AM | Report abuse

Ezra,

You missed this link

http://papers.nber.org/papers/w15213

"Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors.... We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system. "

Posted by: staticvars | August 11, 2009 9:09 AM | Report abuse

And I, in turn, am unimpressed with Mr. Harris's attempt to define theism and science as mutually exclusive by showcasing a handful of people trying to use theology (essentially philosophy) in place of science, and then saying that because of this, rationality and faith are inimical. That's like saying that medicine and left-handedness are fundamentally opposed because of a group of left-handed doctors that are bad at their jobs.

But even the reason/faith argument isn't as nearly clear-cut as he wants it to be. If we're just sticking to judeo-islamic-christian religion (which the author seems to be most interested in), he's ignoring what theology is, in place of attacking the easier, more vague 'faith.' The author (and myself, for that matter) appears to believe that science is a rational process, a series of deductive conclusions based on evidence.

He then tries to set up religiousness (faith) as the opposite to that. The problem is that the opposite of rationality is irrationality. True, the example of theology and religion mixing is irrational, but again he's essentially picked a straw man to flog. Religious belief isn't irrational, it's arational. There is a logic to theology. Like I said, it's just a form of philosophy, but it relies on an underlying assumption that is non-falsifiable. Just like any type of philosophy, theology (even to a degree personal theology) is subject to logic and reason. While the main mode of philosophy is deduction through logic, interpretation and a basic factual view, just because the two operate differently doesn't mean they are mutually exclusive.

Maybe the author is annoyed that people are trying to substitute (generally junk) theology for scientific facts. I probably would be, too. But his argument goes way too far. Instead of a candid discussion of the role faith could play in our understanding of the universe, he creates a false dichotomy- there is either science or there is religion- based solely on the fact that the two are not interchangeable. In the end, this kind of half-baked, needlessly broad argument is just as harmful- and reasonable- as the junk science he is railing against.

Posted by: Fnor | August 11, 2009 9:24 AM | Report abuse

rt42,

but if everyone is in the risk pool then we all share evenly, that is as fair as possible. that's why an individual mandate is necessary and insurers were willing to get rid of pre-ex as long as it came with an individual mandate.

Posted by: visionbrkr | August 11, 2009 10:00 AM | Report abuse

Another flaming lib says:
"Because childbearing has become quite expensive, compared to times past."

Um, nope. It's still pretty much free, as millions of women in the third world prove every single year.

What's expensive is to have a lot of highly trained, highly skilled, highly experienced people there to help you have your baby there when they could all be doing something else -- like tending to the needs of someone who does have the means to pay them.

If you cannot afford all that, then get a midwife. Like the rest of the world does.

It is entertaining, though, to watch you libs base your reasoning on false premises.

Posted by: whoisjohngaltcom | August 11, 2009 11:47 AM | Report abuse

ab123 said:

"Maternity coverage is in most cases completely antithetical to concept of insurance."

The problem is the cost of delivering a baby, as with the cost of any medical procedure, is skewed upwards for those who don't have insurance in order to pay for the administration of those who do. A patient who pays for treatment out of pocket will nearly always pay more than another patient's insurance company for the same procedures. Until this is remedied, your points are irrelevant.

Posted by: slantedview | August 11, 2009 5:04 PM | Report abuse

whoisjohngaltcom:

You'd be wise to educate yourself about the concept of skewed medical costs for those who are uninsured (as referenced in my previous comment).

Posted by: slantedview | August 11, 2009 5:05 PM | Report abuse

"The problem is the cost of delivering a baby, as with the cost of any medical procedure, is skewed upwards for those who don't have insurance in order to pay for the administration of those who do."

Um, no. The problem is that a baby is not an unexpected catastrophic medical cost for which one insures herself. In practice it is a perfectly foreseeable event for which the participants simply seek to have someone else pay.

Also, this is the first post I've read suggesting that the uninsured are actually subsidizing the insured. You're apparently smoking crack. In fact, the privately insured are subsidizing everyone else, including Medicaid and, to a lesser extent, Medicare. But thanks for the chuckle.

"A patient who pays for treatment out of pocket will nearly always pay more than another patient's insurance company for the same procedures."

1. A good reason to carry insurance.
2. Providers will often negotiate to the HMO rate if the uninsured actually offer to pay.

Posted by: whoisjohngaltcom | August 11, 2009 6:44 PM | Report abuse

"A patient who pays for treatment out of pocket will nearly always pay more than another patient's insurance company for the same procedures."

To me, this is not an argument for insurance, but an argument for group discounts. What about something like a vision plan? You don't really get insurance for glasses, but I am paying something for a vision plan, which is more of a group discount plan than insurance. I have glasses that are 10 years old that I got from JC Penney for $45, but I still use the plan to go to the eye doctor every other year to get checked for various things at a discount. I could go every year, but it's not worth it to me.

I can see a system like this being much more equitable for all health care, when coupled with catastrophic insurance. For a government plan, the plan negotiates discounts and the participants get allowances to spend, based on need.

The true key for any system that is going to work, while maintaining our system of private health providers and pharmaceutical manufacturers, is something that allows consumers to shop around. If I am happy with glasses from JC Penney and happy to go to the doctor every other year I shouldn't be forced to pay for people that want some fancy glasses and want to go to the doctor every three months.

Consumer power works- just think about food- even more crucial to life than healthcare. If we had single payer for food, do you think the current system of restaurants of varying levels and grocery stores (and kiwis from NZ that cost less than a postage stamp) would exist?

Posted by: staticvars | August 12, 2009 8:41 AM | Report abuse

To Fnor:
An understanding of the world that is predicated on a poor assumption, whether it be the FSM, Platonic Solids, or the existence of one of the various Gods is simply not very useful, no matter the beauty of the logic that extends from the baseless assumption. You are right in suggesting that the true offense is made when one of these understandings is used in an attempt to interfere with the process of rationally understanding the world. In this case, starting with a bad assumption really harms humanity.

Posted by: staticvars | August 12, 2009 8:48 AM | Report abuse

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