Michael Hebert argues no:
Is it acceptable to allow people to choose to be without health insurance? I say no. There are too many common, potentially devastating medical illnesses lurking out there. If Cindy were to find a lump her breast, for example, she would probably lose her job and her health, go bankrupt, and eventually, after prolonged suffering, end up on Medicaid. She would also, with her pre-existing condition, be uninsurable for the rest of her life. It should not be the public’s job to pick up the pieces when an individual takes a risk and loses out. While one Cindy is a small risk for a society to take, a million of them is a serious risk, and one the public has a right to weigh in on.
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{ 31 comments }
Why not just require mandatory pre-emptive mastectomies for all women over 21?
That would reduce female breast cancer rates to zero, and is no different conceptually from compulsory insurance, or compulsory mammograms, or compulsory fill-in-the-blank.
Oh boy! I love it when people take things over the line to the point of silly. Way to add to the discussion…
Anonymous:
It’s called reductio ad absurdum, and it’s a perfectly permissible form of argument.
So yes, it is very much a “way to add to the discussion…” What exactly are you contributing?
I’ve had a similar thought about long-term care insurance. In Florida, we have quite a number of retirees who move here, age, and end up requiring nursing home coverage through Medicaid. They’ve paid their lifetime of taxes to another state and are now on our roll. I’ve often thought that persons moving here after a certain age should be required to obtain long-term care insurance or forfeit any future Medicaid eligibility.
It makes me chuckle when all the “give us the free market” physicians want the govt. to dictate that people be able to pay them.
Kip:
When society (ie you and me) are footing the bill to the tune of ten to hundreds of billions per year for people without insurance, then yes it is reasonable to bring up this subject. There are other compulsory programs kip. Do you pay taxes? Do you go to jury duty? Are your kids required to get vaccines before gong to public school?
PS The “proof by contradiction” argument you make comparing compulsory insurance to compulsory mastectomy shows how off base you are. Do you pay taxes kip? Same argument, why don’t you try that one with the IRS. Next time leave the latin out of it. It makes you sound like a pompous ass and you don’t even practice law (inspite of your name).
Um, Kip’s right. It is a form of logical argument. Just because you don’t know what it is doesn’t make it pompous. And if “society” gets to weigh in on all decisions that somehow affect it, where does it end? Shall I provide you with my contact information so that you may ask my permission should you ever wish to skydive, have children, or engage in any other activity of which I might bear some of the cost?
KipEsquire said:
“It’s called reductio ad absurdum, and it’s a perfectly permissible form of argument.”
The “absurd” in reductio ad absurdum refers to the absurd outcomes that are demonstrated using this form of argumentation, but in order to be valid the absurd outcomes must be actually possible to arrive from the argument being opposed and not an absurd outcome from a made up version of the original argument, whether explicit or implied.
In this case, pre-emtive mastectomies are not analogous to mandatory insurance and the argument is therefore not disproved by proof by contradiction. Thus Anon 11:47 is correct, kpesquire’s argument was silly rather than a devastating demonstration of argument using proof by contradiction.
The claim that anything compulsory is equivalent is patently false. A proper use of reductio ad absurdum shows this.
“That would reduce female breast cancer rates to zero, and is no different conceptually from compulsory insurance, or compulsory mammograms, or compulsory fill-in-the-blank.”
A logical extension of saying that compulsory insurance is equivalent to compulsory “fill-in-the-blank” would be to say that compulsory insurance is equivalent to compulsory anal gerbils. You might respond saying, “That’s ridiculous and absurd! That doesn’t make any sense!” And you’d be right, but the reason it doesn’t make any sense is because of the form of your argument in which you said “mandatory insurance” is like “mandatory fill-in-the-blank.” I filled in the blank and the outcome is absurd. That’s reductio ad absurdum. QED.
Why is it that the answer is never to stop subsidizing the risky behavior? Damn politicians. Econ 101, provide an incentive. . .
While we’re at it, let’s govern all the automobiles at 30mph. I want my insurance rates to drop, and I’m sick of all these risk takers who think 55 is “no big deal”!
Kip: Without boobies, American society would collapse in weeks.
Hmmm.
It seems that the breast cancer comment is merely a false analogy. So it demonstrates not the wrong point, but no point. Mandatory insurance doesn’t reduce the risk of disease, so the mastectomy point goes where? Nowhere. Mandatory insurance reduces the risk of medical indigency, and secondarily of dependency on the public insurance dole for the medically indigent.
If you want to make an analagous argument, ad absurdum, you might have suggested we also have mandatory retirement savings under IRA plans, or mandatory purchase of a house as a hedge against homelessness, or mandatory disability and unemployment insurance. Those may or may not all seem absurd, but they would be consistent and served as better examples of whether any sort of mandatory insurance against personal misfortune makes sense.
Another germane argument would be the argumentum ad whatwehavealreadyforcarsium. This suggests that since society has already figured out that drivers who don’t have car insurance are a risk to all members of society, we require all owners of cars to have insurance so that the number of accidents that can’t be compensated out of insurance is held at a minimum.
Another way of doing that would be to stop all people from using cars which would be the argumentum ad kipium.
“Kip: Without boobies, American society would collapse in weeks.
# posted by Ian : 2:29 PM”
First of all IAN, while males may collapse if women were to lose their breasts to surgery, I doubt that society would.
Secondly, you have heard of plastic surgeons, haven’t you?
Piss poor analogies for proper forms of argument is like watching old people ****. It makes my brain bleed.
Anonymous: buy a book and get back in line
Lisa:
Your brain bleeds from your own ignorance. Sorry but kip’s analogy is silly.
Oh puhleez. Kip was logical enough: he assumed (correctly) that the moral premise behind mandatory insurance is that the government can compel citizens experience some disutility (insurance fees, breast removal) for the sake of better, more efficient healthcare delivery.
He asked how far you want to take that moral premise. And, none of the SHOCKED commenters really answered his question
“Mandatory insurance doesn’t reduce the risk of disease”
It might, if people got preventative care earlier (i.e. control lipids to prevent the disease, i.e. MI)
“Oh puhleez. Kip was logical enough: he assumed (correctly) that the moral premise behind mandatory insurance is that the government can compel citizens experience some disutility (insurance fees, breast removal) for the sake of better, more efficient healthcare delivery.”
Oh puhleez yourself. Oh, you have.
Kipesquire’s argument that all government mandated compulsory actions are equivalent is un-supported slippery slope nonsense. By his thinking, if the government can mandate helmet laws then they can mandate how often you can pee per day.
Evan is correct that the argumentum ad kipum fails.
–AnonEsquire
“It might, if people got preventative care earlier (i.e. control lipids to prevent the disease, i.e. MI)”
If we’re going to use the “it might because” standard, why stop at insurance? If people ate better they would need less preventative care. Therefore, let’s outlaw fatty foods.
“If we’re going to use the “it might because” standard, why stop at insurance? If people ate better they would need less preventative care. Therefore, let’s outlaw fatty foods.”
Indeed, or if we use poor people don’t deserve healthcare standard then there is no reason why people shouldn’t have their credit checked before being transported to an ER. Any one who’s FICO score isn’t 650+ should just be left on the side of the road…
Poor comparison, as simply being poor doesn’t mean you can’t make arrangements to pay for healthcare. It just may take longer.
“Poor comparison, as simply being poor doesn’t mean you can’t make arrangements to pay for healthcare. It just may take longer.”
That is why I proposed credit scores, as opposed to tax returns
But, in fact, ability to pay is an unmentioned part of KevinMD’s heartfelt disdain for government healthcare. Implied in his obsessive distaste for government involvement is the idea that poor people shouldn’t have access to health care. (Private, for profit health care systems certainly aren’t going to pay for them.) Thus, the corollary is that only rich people or those with the good fortune to have access to a group plan via the voluntary largess of their employer deserve healthcare and everyone else can just go die under a rock.
“It might, if people got preventative care earlier (i.e. control lipids to prevent the disease, i.e. MI)”
For the 100s time – preventive care is not money-saver. Preventive care is very expensive since you need to treat a lot of people to control their lipids for many years to prevent one case of the desease.
No opinion on the main subject, just tired of hearing about how preventive care is a money-saver as a justification of forcing paople to take preventive drugs or to be screened. Some people need to learn about NNT/NNS.
The idea the preventative care costs more made by people here is just so simplistic. Preventative crae concerns so many diseases and disease states, and sometimes doesnt even REQUIRE MEDS. For instance, do you know how many diabetics didnt realize that juice is a no-no until I told them? And strategies to reduce lipids by deit only. Patient sthnak me for explaining these things, and their pathophysiology. Vaccines are another one. And screening colonoscopies, which are a far sight cheaper than treatement of full blown cancer. And NNT etc doesnt apply for those with family histories, excess risk factors etc, so statistics alone are not the proof.
Primary care IS the way to reduce cost and waste (i.e. prevent useless referrals to specialists by mid levels who just arent “comfortable” cause they don’t have enough experience.)
Who are you guys saying that preventative tests are useless? I doubt you are medical professionals or you would know how retarded you sound.
Take just one test, a pap test, and tell me it is useless. In the 1950s prior to it being invented more than 35,000 U.S. women a year died from cervical cancer. it was the leading cause of cancer death in American women. 50 years later there is about 4,100 cervical cancer deaths a year. It is now ranked 13 among cancer deaths in women. How can anyone think prevention is useless. It is of great concern when Drs. talk of price of prevention being more important than human life.
Mike, I didn’t say that none of preventive measures are money-savers, only that one cannot make a blanket statement that all preventive measures save money. Some do save money – like non-smoking or vaccinations or maybe diabetes control. Others – like statins for PRIMARY prevention or some of the screening (mammograms) are not. Obviously, the lower the NNT is for a particular group the more like the measure is to be cost-saving.
Anon at 2:21, I didn’t say it was useless either, only that it doesn’t save money. These are two different subjects. Just because something doesn’t save money doesn’t mean it is useless. It is great that we have pap smears and statins, but the insurance shall pay for recommended tests and treatment. However claiming that something “saves money” when it doesn’t leads to employers trying to force these measures on people and penalize people for things like having LDL over 130.
Anon 3:09.. you make no sense. It cannot cost MORE to prevent these common disease sthan the treatments required for the full blown disease. Maybe for some individual ones in the SHORT term, but not overall. And as more drugs become cheaper and generic, the benefit will only rise.
STOP creating more problems for primary care doctors with the craziness and ludicrous staements.
“It cannot cost MORE to prevent these common disease sthan the treatments required for the full blown disease.”
Sure it can, especially if you need to treat 100 people for years to prevent 1 case of serious disease.
Of course you guys are looking at $$$. Just what cost do you place on a life saved?
Michael Rack ,with all due respect, if someone gets admnitted to the hospital because they didnt take their lasix, wouldnt you agree that a three or four day hospitalization is more expensive in the long run??? Or when they finally have that MI??? Or the DKA that goes to the ICU for a few days? It ain’t even close.
I have different topic to discuss about – We always come across lots of patients who do not pay for their services provided by doctor. If those pt needs to be seen again -can doctor refuse to see them atleast until old charges paid? Thanks
Dr.X
So what do you think about government subsidized birth-control pills. The college kids are up in arms about paying more for contraception! I say the taxpayer should not have to subsidize recreational sex! S.Jaques
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