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October 11, 2007

What Our Health Care System Is Doing

This post of Reihan's is very good:

I'm late to the story of the Frost family, but it perfectly illustrates the tension between "pro-family" conservatism and "anti-statist" conservatism....Here's my question: Would the world really be better off if, say, the four Frost children saw far less of their parents than they already do? I ask because we could imagine a world in which the Frost parents worked (even) longer hours a jobs that provided health care benefits, which would take an emotional toll not only on them but on their children, particular in light of the impact of the car accident. The children of parents who work night shifts, for example, tend to do worse in school, and they tend to have more behavioral problems. And we're talking about run-of-the-mill families, facing no sudden medical catastrophes.

Let's forget, for a moment, that the family actually couldn't procure insurance because the children suffered such grievous injuries in the car crash. The family's options would be:

1) Work more, so the children get less time with their parents.

2) Try and find a job with a corporation that provides benefits.

3) Sell their assets, like their house. This seemed to be the right's advice to the family, what with all the commentary about their $200,000 home.

Forgetting that two may or may not be possible, depending on the father's skills, the regional economy, and the luck of the draw, here's what we think families should do for health insurance: Sell their home, become absentee parents, or close down their small businesses. So health coverage is working against asset ownership, good parenting, and entrepreneurship. Something is truly wrong here.

October 11, 2007 | Permalink


What else did you think the right wants? You know the old saw about the right. The only care about a child till he/she is born. Then they don't give a damn about them. Don't want them to have insurance. Want them to go fight in unprovoked wars. You name it.

Posted by: Joe Klein's conscience | Oct 11, 2007 10:49:23 AM

Bingo. Malkin writes:

Well, yes, it sucks. But Earth to liberals: That’s how insurance works–if you don’t buy it before you need it, you shouldn’t be shocked if it’s impossible to get after you need it.

In her world, if parents "mess up" by not having a private policy before their kids are crippled in a car accident, then it's just too bad. No safety net for you(r kids).

Posted by: cardozo | Oct 11, 2007 11:11:17 AM

What about audacious hypocrisy? Bush proclaims his support for "family values" and recently attacked "Hollywood values." But it isn't Hollywood values which is causing working-class couples to avoid marriage in ever increasing numbers-- it is the lack of health insurance. Under the current Schip funding, an unmarried pregnant woman is covered for her and her child. However, if she marries her child's father, their combined income would make them ineligible. No one has advanced as great an attack on marriage and family values as has Bush with his veto.

Posted by: bmz | Oct 11, 2007 11:13:23 AM

In fact, as "Stalkin Malkin" herself admitted--unintentionally perhaps--her own husband QUIT his job which carried health insurance, so he could spend more time at home with their children. Now, "Stalkin Malkin" thinks that 'personal responsibility' is one thing for the Frosts, who at $45,000 a year couldn't afford to pay the 'pre-existing' clause costs to insure their children; but it is entirely another for herself and her house-husband, who chose to quit a job with health insurance benefits so they could suck off the government's 'health insurance' MSA, PAID FOR BY THE TAXES THE FROSTS PAY.

Posted by: Brighid | Oct 11, 2007 11:34:57 AM

It seems to me that those arguments apply equally well to any expense. Buying food is working against assett ownership, good parenting, and entrepenuership just as much by this argument. Are we advocating that all expenses incured by children must be paid for by society in general rather then the parents?

I don't really have a strong opinion on S-Chip (although the cigarette tax funding seems laughable) but it seems to me that at some point parents should be expected to be responsible for the needs of their children. We typically accept that the truly needy should be given help, but that line for truly needy typically does not include being truly needy so that asset accumulation, spending all the time one would desire with your children and investing in your own business can occur.

I'm certainly not going to judge the Frost's, I neither know enough nor care enough to do so, and policy by anecdote isn't the best way to proceed in any event.

Posted by: Dave Justus | Oct 11, 2007 11:38:32 AM

Why not just send someone to bust their kneecaps when they don't sell their assets? I'm sure Malkin can get some volunteers.

What they prefer is decapitalization of the middle and working class. They would prefer to send us all down the drink, than make a rational investment in our human resources. No one should have to lose everything to save the life of their child. Pro-life, my ass. There is a reason that IRA's and property is a protected asset. To encourage investment, which is better for the economy. The current healthcare system is draining our economy. Plenty of people have gone into bankrupcy and poverty due to medical bills. it is no help to anyone when these people lose their home, business, and resources, and community participation.

Posted by: lilorphant | Oct 11, 2007 11:43:03 AM

> It seems to me that those arguments apply equally
> well to any expense. Buying food is working against
> assett ownership, good parenting, and entrepenuership
> just as much by this argument.

The expense of buying food doesn't randomly veer from $40/year to $400,000/year/child as the cost of medical care does. And we have organized our society so that the cost of most necessities of life can be born by a family of goodwill working reasonably hard (and keeping a reasonable amount of leisure time - which is the point of life IMHO). Not true of medical care.


Posted by: Cranky Observer | Oct 11, 2007 12:00:51 PM

I don't get the continued insistence, a la dave justus, that a phrase like "parents should be responsible for their children" has the slightest relationship to the issue at hand: what to do with underinsured, uninsured, or fragilly insured people when health care is a constant and predictably expensive cost-of-life that is handled by insurance companies rather than by medical professionals.

The decision a person makes to marry and have children takes place at one time in their life when they believe that they have the time, money, assets etc...to bear the burden of rearing that child. Its an irrevocable decision since you can't kill or return the child when its no longer economically rational for you to take on the burden of raising that child. No one can forsee *all* the dangers of life in this world: expensive births, difficult births, damaged children, car accidents, divorce, death, job loss. Just because some people manage to get through the crucial child rearing/supporting years without accidents doesn't make the decision of others to have children some kind of gamble we should be discouraging. What if you correctly calculate that you and your spouse will be able to hold good paying jobs with health care coverage for your children until they reach some magic number--18 say--and then they are hit by a car and permanently disabled and need to move in with you? You actually couldn't *buy coverage for that* so are you still some kind of deadbeat parent? Or are you just a person who is in trouble and needs a helping hand?

In fact, that is *exactly* what actual insurance would cover: we could have a system where each person could affordably purchase catastrophic care coverage that *couldn't be terminated* and where all that money was pooled without profits being skimmed off by insurance companies and that would be sufficient to cover everyone in the situation the Frosts are in. We actually don't have that kind of system. The "insurance" we buy as health insurance *isn't* insurance in that classic sense. Its more of a forced sucker's bet. The Frosts could have "done all the right things" and worked for a companythat nominally had health insurance and paid their premiums for years and *still* been cut of or denied benefits, or sufficient benefits when the accident happened.

Man, no wonder they are calling the republicans "Donner Party Conservatives" (h/t commenter over at tbogg). That perfectly captures the cannibalistic nature of conservativism these days.

Posted by: aimai | Oct 11, 2007 12:06:54 PM


I don't think that many conservatives advocate never helping out when trouble strikes, the debate mostly isn't whether or not that should happen, but 'when' it should happen. Should we as a society help out as soon as it may make it more difficult for someone to accumulate assets or after they have liquidated some of their assets?

Conservatives like me also believe that if the government takes care of everything, other undesirable consequences will happen, including more control by the government and loss of freedom and increased irresponsibility on the part of individuals. I certainly understand that many here dismiss those concerns, but I don't think it does those people any credit to simply assume that those expressing those concerns are insincere or evil.

I think many of your concerns and criticisms of our health care system are valid, although they are more general criticisms of our overall health care. I don't claim to have the perfect answer for health care, I suspect that their isn't one any every solution will involve difficult tradeoffs, indeed the denial that any 'downside' exists is one of my major concerns with those who advocate universal health care. I at least would be more easily convinced if the downsides were acknowledged and shown to be still the best set of trade-offs availible.

In any event, I don't think I am insincere or unfeeling. I also doubt that insisting that those who disagree with you do so out of evil motives does much to advance your cause.

Posted by: Dave Justus | Oct 11, 2007 12:26:41 PM

Dave Justus,

Frankly I don't know what motives drive Malkin and co. in their heart-of-hearts and don't really care. What angers me is the consequences of their actions. They responded to a family that made use of a legal program and then engaged in public advocacy for that program with intimidation, harassment, and outright slander. They weren't out to make a substantive case against S-CHIP, they were out to smear a family who dared to publicly oppose Bush.

The simple fact revealed by the Frosts' story is that even homeowners with jobs and steady incomes can have trouble getting adequate health care and can potentially be bankrupted by health costs. S-CHIP is a program that has been fairly effective in addressing these problems, and it makes a case for further government action to provide health benefits. If you want to argue that there's a downside that outweighs these benefits, go ahead, but no one on the right is doing that.

I think it's because they can't.

Posted by: Justin K. | Oct 11, 2007 12:47:53 PM

Dave Justus,
Its.Not.About.You. And its not about me or my tone. I scarcely delude myself into thinking that posting on a web site advances anyone's cause. Its just a place to talk about ideas and policies.

Conservative *policies* in this country can only properly be understood with reference to actual Republican party policies. I'm sure you are a very nice person but the party you have chosen to affiliate itself with has shown itself to be, in terms of the actual policies it pushes, utterly at odds with what you say you value. That's your problem, not mine. As for whether your parties policies are "evil" or its adherents are "evil" I generally leave that kind of rhetoric to your standard bearers: bush, cheney, gingerich et al. They have proven themselves adept at using the language of morality to frame and reframe policy debates that might better be couched in terms of utility.

Under your president, and your congress, and with the cheerleading of the intellectuals on your side of the aisle the intrusive, abusive, controlling aspects of government are in the ascenscion--interference with education, health care, consumer protection, worker protection, natural resources, freedom of speech, freedom of assembly, freedom of travel... all of these have fallen under the control of a far more repressive government than any liberal democrat ever dreamed of creating or enforcing.

Again, I think blanket statements like "if the goverment takes care of everything" have no place in this discussion. The people are the government. If the people elect to pool their money for health care for all that is a legitimate democratic decision--as legitimate (if not more so) than the people electing to pool their money for the common defence against a military enemy. If the people elect to push out the middle man and demand that their health care money be managed for them by managers (the state) whose fiduciary responsibility is to the health and welfare of the client (the taxpayer) instead of to the health care business that is a perfectly legitimate solution to the problem. There are, of course, hazards to every course of action. But the fact of the matter is, and its not in dispute by the more honest of your bretheren, there are people in trouble in this country--a whole lot of people in trouble now, a whole lot of people about to slide into trouble--and the people may be about to decide to do something about it.

To put it in terms even a child can understand: when I want to purchase health insurance my goal is to pool my money with other people, a lot of other people, so that my lossess are offset over time by the size of the pool and the overall payments into the pool. I might elect to take the risk that I always pay in and never receive a payout for the chance that over time I will have a need I can't fulfill out of pocket and that other's premiums will take up the slack. That's how insurance works. But the for profit health insurance business *doesn't work that way.* They try to shrink the pool of the covered to collect the highest premiums, for the longest time, with the lowest payout over time. That's their business and I don't quarrel with it. But there's nothing miraculously efficient, or right, or good, or useful about this model. The fact is that the insurance company that my family uses doesn't have any kind of real duty of care towards me long term. It doesn't refund my money if, after a long time paying in, I am thrown off the plan for getting sick (as is happening to blue cross/blue shield policy holders around the country). And they don't have any duty to take me on (as the Frost's found out) once I've gotten sick and switched jobs. That's not because I'm not a good person, or a good risk (as the people denied health insurance for asthma or bleeding gums will tell you) its because its not in their financial interest to insure me. But its in my financial, emotional, social, and every other kind of interest to *have* insurance. And its in my societie's interest that I have insurance so I can receive everyday and catastrophic health care and remain a productive member of society. Some of your fellow americans have come to the conclusion that health care is *not* an individual problem and is *not susceptible to individual and highly contrived moral positioning and partisan politicking*. Maybe you'll get lucky and we'll win and then you and your family won't have to worry, as the rest of us do, that a job loss, death in the family, accident or just age and infirmity will crush us and our entire family *so private insurers won't lose a dime.*


Posted by: aimai | Oct 11, 2007 12:55:36 PM

The folks who are blaming the Frost's really do not fully understand that no matter how they frame the arguments, they cannot win this one, but that doesn't stop their shreiking animosity. Their moral relativity is obvious. No matter what the Frost's did or didn't do, what they should've done or not done, the crazies will find a way to blame them. The Malkinites et al are really attacking most of the middle class who are just one car wreck or medical emergency away from bankruptcy. The self-righteousnous and just plain meanness from this bunch of jerks is completely base and sickening, I can't really describe the depth of their depravity.

Was it my daughter's fault her baby was born sick and 3 months premature, spending the first 2 months of her life in NICU and costing more than a million dollars for her care? No, but I'm sure these animals (not to demean the animal kingdom, but I can't call them human) would find a way to blame her. Yes, she had medical insurance, but her part to pay was 20%. Do the math. 20% of $1,000,000 is $200,000! How many of these assholes have that kind of money sitting around in their bank accounts? Sell her house? She rents. If it wasn't for a charitable foundation that stepped in to help out, she and her husband would be paying these bills for the rest of their lives. And oh yes, she WAS receiving threatening phone calls from the hospital on a regular basis.

If there is a hell, I hope Michelle spends eternity there for the havoc and hell-raising for which she's directly responsible.

Posted by: shaker o salt | Oct 11, 2007 2:08:22 PM

I don't think that many conservatives advocate never helping out when trouble strikes, the debate mostly isn't whether or not that should happen, but 'when' it should happen.

Exactly. For instance, when Trent Lott's Gulf Coast house was destroyed by Katrina, he deserved not just a new house at the taxpayer's expense, but, in the President's words, a "fantastic house."

The Frosts, on the other hand, can suck eggs.

What a country.

Posted by: Uncle Kvetch | Oct 11, 2007 5:11:53 PM

((((((uncle Kvetch))))


Posted by: aimai | Oct 11, 2007 7:10:53 PM

Back at ya, aimai. 8^)

Posted by: Uncle Kvetch | Oct 11, 2007 9:36:36 PM

"Are we advocating that all expenses incured by children must be paid for by society in general rather then the parents?"


That was today's edition of 'Simple Answers to Pointless Questions. Please tune in tomorrow to see us tackle - ah, why bother . . .

But Dave, what's your preferred scenario? What would you have had us have the Frosts do?

Posted by: Dan S. | Oct 11, 2007 9:50:16 PM

Posted by: aimai | Oct 11, 2007 12:55:36 PM

I read far far too many blogs and comments, and I feel confident in saying: Comment Of The Year. For real.

Posted by: Kathleen | Oct 12, 2007 2:46:16 AM

If your enterprise does not earn you enough to provide for your family, it is not really enterprise but a hobby. Look for real work and do not ask government to subsidize your hobby.
As for choice between parenting and earning money, the answer is known for centures: mother does the first, father the second. Motherly care is really time consuming, and for good fathering it is enough to spend holidays and evenings with your children.

Posted by: Sergey | Oct 12, 2007 4:48:50 AM

Dan S.

I have already, I thought, made it clear that I am not interested in making personal judgements about the Frosts, and I also don't think that an individual anecdote necessarily makes for good policy.

What I was trying to comment on originally was a broader proposition that the post seemed to be pushing, that if a families necessary expenses, in this case medical but I don't see why medical expenses should be unique, make it impossible for them to engage in assett accumulation, or spend as much time with their kids or engage in entrepenuerial activities we should, as a society, step in and help them. That seems way overbroad to me.

Certainly the Frosts seems somewhere close to the line (at least before the accident) where they could have made choices, at some sacrifice, to purchase private medical insurance. They are not an obvious example of a family who could easily afford it, but they are also not an obvious example of a very poor family. From this perspective I think that they do provide a useful example for this debate.

However, the principle alluded to above, that assett accumulation, time with kids and pursueing whatever actvity you most desire, without regards to its practicle ability to support yourself, extends well beyond the Frosts. Should we pay for medical care for a family that has several kids because the parents have decided to take a year off of work to write their great novel? What if those parents have a much greater financial assetts then the Frosts?

And of course the tax money that goes to these Families is coming from someone else, perhaps limiting their ability to accumulate assetts, spend time with their kids or pursue entrepenurial activities.

Posted by: Dave Justus | Oct 12, 2007 9:37:45 AM

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