Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
jnc4p
Kevin S. Willis
Michigoose
lmsinca
markinaustin
Arcanaut
novahockey
quarterback
ScottC
yellojktWhy you never see the black & white Flinstones episodes in the synidcation packages:
Speakin’ of how they used to smoke it up back in the day, here’s Desi Arnaz on I’ve Got a Cigarette–I mean, I’ve got a Secret.
Winston was obviously the brand of choice back in the day.
Not much has changed. Only now, it’s vajayjays.
Any one who listens to No Agenda knows it’s Big Pharma and various feminine hygiene products forcing all the big networks to shoehorn the word “vagina” into episode after episode of “comedy” programming. And if you’ve watched many sitcoms in the new season, it’s as good an explanation as any. Because I’ve heard the word in every sitcom I’ve watched, at least once, this season, and in every case the joke falls flat. It’s all about the Monistat.
Filed under: Uncategorized |
All Things in Moderation 
Interesting reflection on cigarettes and some of you are young enough that you may not believe me but it's completely true. Thirty years ago you could smoke inside a hospital. Our oldest daughter became very ill one year when she was just three and for some reason the blood work came back very dicey and they thought she might have leukemia. Thank God she didn't but we were sent to a Children's Hospital in Orange County (CHOC) where she was to have further testing done. They put her on the cancer ward and the first night once I got her to sleep, I went to the visitors lounge on that floor to get a cup of coffee. I opened the door and could barely see across the room the smoke was so thick. It's hard to believe we've come this far in thirty years.
LikeLike
And I'm not going near and vajayjay jokes, lol. You crack me up Kevin.
LikeLike
I remember when you could smoke on an airplane.
LikeLike
I don't watch Panam because it's bullshit. There was a haze of smoke on every flight back in the day. Nobody smokes on Pan Am, a show set when everybody smoked. I remember smoking in several if my college classes. Ashtrays everywhere. Instructors smoking while teaching. None of that stuff happens anymore.
LikeLike
I'm always wondering how libertarians view the non-smoking laws. Anyone know?
LikeLike
My favorite History professor–Euro: 1848 specialist–stubbed his out in the chalk tray during lectures…must have smoked ten in an hour&1/2 class.I missed an outside-contain tackle against Hamilton and my head coach, smoking while cursing me out at the halftime team talk, chucked an ashtray at my head. We were sitting in a classroom in the athletic complex/field house.I freakin' LOVED those guys.
LikeLike
I'm not a fan, fwiw. I quit smoking a couple of years ago and so I am still pretty cognizant of cigarette smoke within a 5 mile radius. I've left places that were to smokey, even when I smoked. But I chose to do so. I guess though, if single-payer healthcare comes into existence and I gotta pay for everybody's healthcare, don't I get to prevent people from engaging in any risky behavior? Shouldn't I be allowed to force people into exercise and to slap unhealthy food our of their hands?
LikeLike
I think I've said this before but in the Corps I once did a 5 mile run with a Company Gunny who chained smoked Camels the whole way.
LikeLike
Shouldn't I be allowed to force people into exercise and to slap unhealthy food our of their hands?A friend and I are working on this, and when we win the Nobel Prize in Physiology or Medicine you can say you heard it here first. My idea: a pill you can take and *snap* you're in shape! None of that tedious getting in shape, you're there instantaneously. The caveat: it starts wearing off immediately and you can only take the pill twice a year. I figure I'd be in shape year-round if I never had to get in shape.My friend's idea, which she was developing independently but I found out about this summer, is a food patch that you can just slap on and it provides you with a constant infusion of calories, stopping when it reaches the optimum number of calories for a day given your height, weight and activity level.Never say science doesn't work for you!
LikeLike
taoI had an 8th. grade science teacher who used to zing erasers from the chalk board across the room if anyone so much as whispered or passed a not across the aisle. His aim was pretty good too. Kids used to go home with black eyes but no one squealed.McWingI think it's a dilemma regarding health care and bad habits. I'm not too in favor of some of the ideas to curtail the stuff. I suppose taxing makes more sense than anything else but where does it end? I don't smoke and haven't since I tried it in high school but it doesn't really bother me if others want to do it. I'd prefer it wasn't in close proximity and having raised a daughter with really bad asthma, the same one as above, I welcomed the anti-smoking laws for her sake. It's difficult to know where to draw the line though.
LikeLike
A food patch, lol. Imagine how many jobs that would kill.
LikeLike
My friend loves to hike but hates dehydrated and/or camping food. That was her solution–maybe we could create a Libertarian-Socialist paradise and save some of those jobs. You decide whether or not you eat or use the food patch. If you use the patch, your Universal Healthcare premiums are only 10% of what an "eater's" are.:-)
LikeLike
Oh–the jobs come in by creating a Food Patch Enforcement Corps.LOL!
LikeLike
Food Patch Enforcement Corps, sounds like a government job to me. Benefits? It's funny, there are day I really don't care if I eat or not, so I'd probably do the patch then suddenly get a craving for the forbidden fruit (literally) and be carted off to jail with peach juice dripping down my chin. Fruit and buckwheat noodles with soy sauce and sesame oil are two things I don't think I could live without.
LikeLike
Soba noodles! I toss mine with a mix of soy sauce, lime juice, garlic, ginger, EVOO and sesame oil and then topped with green onions and cilantro. Yummy!Now I know what I'm having for dinner tomorrow night. . .Not so big on fruit, but I actually love most vegetables, and have since I was a kid. Go figure.
LikeLike
"I'm always wondering how libertarians view the non-smoking laws. Anyone know? "I oppose them for bars. You ought to be able to smoke in a bar and it should be up to the bar owner whether to permit it.
LikeLike
Michi, I toss mine with leeks and sometimes carrots. I swear I could eat them every night and call it a day. My husband's not too keen on the idea though.That sounds reasonable to me jnc. Just like everything else we tend to go overboard when we decide to be against something. Remember when they used to have smoking and anti-smoking sides of restaurants? I'm probably weird for a non-smoker but I always feel kind of sorry for smokers shivering outside in the rain trying to enjoy a lunch break smoke.
LikeLike
Michi,I bet you have some great MRE recipes.
LikeLike
lms:I'm always wondering how libertarians view the non-smoking laws. Anyone know?I have never smoked. I can't stand smokers being around me. My dad smoked when I was growing up and I hated it. And I will tell you that I find no smoking laws an abomination. It's a total violation of property rights for the government to dictate to a private establishment whether or not they can allow smoking.
LikeLike
What about alcohol licenses, then, jnc?I'd be all for your "rule" on smoking in bars, except that here in Zion the alcohol licensing restrictions are so severe that–until they made all bars non-smoking a few years ago–every single bar in Utah was a smoking zone. So that meant that those of us who like to drink but don't like smelling like ashtrays had no option.I don't mind people smoking as long as they do it downwind of me, but I don't like being in smokey rooms and, while I don't have asthma like lms's daughter, if I'm around cigarette smoke for more than about 30 minutes I end up with swollen eyes and a runny nose like an allergy attack. I don't know if it's possible to be allergic to cigarette smoke, but I look just like someone who's allergic to cats and I feel totally miserable.
LikeLike
20 years ago, after Austin passed its first "no smoking" ordinance, my friend Jimmy and I were eating together on the deck of a restaurant, where smoking was permitted.A fellow from a neighboring table came over and asked Jimmy not to smoke "in consideration of others". We both stood and said quietly "get away from our table now" almost in unison. The guy retreated in semi-terror. I never smoked since 8th grade. Jimmy smoked a lot. He is my friend who is dying now, of lung cancer. I am still glad we chased that pushy bastard off.
LikeLike
scott, somehow I knew you'd say that. When our daughter was young we had to be very careful where we took her because of the smoke. And things like flying were almost impossible. Like I said it's a tough one to figure out. I think it would be difficult to find any indoor privately owned area that would be non-smoking without the laws but I could be wrong. You're such a purist, no compromise?
LikeLike
I agree with you, Mark. As long as the smoke isn't blowing in my face I'd rather have everybody just get along. And I'm sorry about your friend; I lost my grandfather to lung cancer many years ago.
LikeLike
Mich: the alcohol licensing restrictions are so severe that…Classic example of government regulation begetting yet more regulation to "fix" the problems created by the original regulation.lms:You're such a purist, no compromise?I am a purist. As for compromise, do I have a choice? All these whacky laws still exist despite my purist opposition. And I should point out that every step in this direction makes the next one that much easier. And McWing is right about the implications of socialized medicine. If the risks that banks pose to the taxpayer justify regulating the risks the banks can and cannot take, why shouldn't the risks that fat people, or smokers, or non-exercisers, or drinkers, or [fill in the blank] pose to taxpayers justify regulating the risks they can take?
LikeLike
Classic example of government regulation begetting yet more regulation to "fix" the problems created by the original regulation.Well, circle this date in red! Scott and I agree 100% on something!!!I really do have lots of libertarian leanings, Scott, just from the left rather than the right. LOL!
LikeLike
I'm out for the evening–see y'all tomorrow!
LikeLike
I actually have trouble with some of this stuff also. NoVA and I agree all the time on civil liberties issues. The health care risks are a really difficult area because the costs are so high. I just don't see how we can punish all sorts of risky behavior because where do we stop? I'm not a huge fan of airport security either, especially the body scanners. I think that's just weird. That's why I mentioned compromise but I don't know what that would be. I know they tax cigarettes and alcohol ostensibly to cover the extra health care costs but does the money really go toward that? I don't know.
LikeLike
G'night michi, I'm not far behind you.
LikeLike
scottI don't get the connection to the banks though. Technically, they should have been allowed to fail according to your ideal and yet I think you've agreed it was necessary to bail them out, am I right?I think the best thing to do really for most types of risky behavior is tax it and use that money for either the bailout or health care problems down the road. That makes more sense to me than anything else because it costs the ones engaged in the risky behavior and not others.
LikeLike
"the alcohol licensing restrictions are so severe that…Classic example of government regulation begetting yet more regulation to "fix" the problems created by the original regulation."Agreed. I don't smoke either, but I always prefer to hang with the smokers over the non-smokers at most social functions. "I think the best thing to do really for most types of risky behavior is tax it and use that money for either the bailout or health care problems down the road. That makes more sense to me than anything else because it costs the ones engaged in the risky behavior and not others. "Taxes should exist to raise revenue, not socially engineer behavior. The better solution is to shift from employer based health insurance to individual based health insurance through a plan like Wyden-Bennett so that people bear the costs of their own behavior choices.With single payer, I'm confident that once the government is done with smokers, they will go after other categories of behavior that increase health insurance risk such as drinking, fatty foods, scuba diving and sky diving.
LikeLike
lms:I don't get the connection to the banks though.Well, the justification for regulating the risks banks are allowed to take is that if the taxpayers are on the hook for the consequences of those risks, the government ought to be involved in deciding what those risks will be. The same principle would be applicable to individuals regarding health risks.Technically, they should have been allowed to fail according to your ideal and yet I think you've agreed it was necessary to bail them out, am I right?Yes (sort of…see below), but two points are relevant here. First, in my ideal world the government wouldn't have been involved in guaranteeing or buying mortgages, or blessing the opinions of certain ratings agencies, or any number of other things that helped cause the problems in the first place. Once the government is embedded into the market as an active participant, government action may be necessary to undo the problems government has caused.Second, all that being said, I still am not entirely convinced that the bailout was necessary, at least in the manner in which it was done. There remains to this day many rumors (unconfirmed) that several of the big bailout recipients (notably Chase and Goldman) did not want to take the bailout money, but in meetings with the Fed and the Treasury were essentially forced to do so, so that it looked more like a systemic bailout than a targetted bailout. There is some justification for believing that. If you read reports from early 2009 about banks re-paying TARP funds, you will see many references to whether the banks will be "allowed" to re-pay the money. That is an interesting choice of words. BTW, on a completely different topic mentioned by you above:I know they tax cigarettes and alcohol ostensibly to cover the extra health care costs but does the money really go toward that?It is not at all clear to me that taxing cigarettes and alcohol for the ostensible purpose of covering future medical problems is at all justified or sensible. It is entirely conceivable (and I have seen studies that show) that smokers are net contributers to, not recipients from, government coffers. And it makes sense. If smokers are dying relatively young, they spend a lifetime paying income and payroll tax to the government, but don't get the benefit of getting it back in SS and medicare after retirement.
LikeLike
jnc:Taxes should exist to raise revenue, not socially engineer behavior.I wholeheartedly agree. I think that this is a particularly important difference between liberals (and to a lesser degree conservatives) and libertarians.
LikeLike
And since we are talking about taxes and smoking and alcohol, I highly recommend to everyon Ken Burns' most recent documentary on Prohibition. Really, really interesting. One notable fact that I never appreciated before, and which I learned from the documentary: it was the introdcution of 16th amendment (allowing an income tax) which propelled the final passage of Prohibition. Prior to the income tax, the federal government funded itself primarily via an excise tax, the vast majority of which apparently came from sales of alcohol. According to Burns, at one point prior to the introduction of an income tax, excise taxes on alcohol accounted for up to 70% of federal revenues, obviously rendering any national prohibition impossible. The income tax changed all that.Needless to say, this information decreased my already low opinion of the 16th amendment.
LikeLike
"Taxes should exist to raise revenue, not socially engineer behavior. The better solution is to shift from employer based health insurance to individual based health insurance through a plan like Wyden-Bennett so that people bear the costs of their own behavior choices."I agree re the Wyden-Bennett plan, I like it also, but you guys have way too much faith in the "free market" for me. And I'm not convinced the insurance industry has any intention of insuring even minimally risky behavior at any cost. At least if we tax it we can still ensure that even people who eat one too many pieces of cake have coverage. And I'm not necessarily convinced taxing is the answer, just throwing ideas out.The problem I have with libertarinism is that the world you guys envision just doesn't exist where the government removes itself from our lives and businesses. How far would we have to go back for that and what would our country look like now if we did? I don't think it would be a very nice place to live personally.
LikeLike
Scott eventually got to the point I was going to make which is that I have seen studies that overweight people and smokers actually cost less in health care dollars because they end of dying younger. That doesn't even take into account the issues Scott raises of SS. So like many other government actions, the law of unintended consequences comes into play. I go back and forth on smoking in bars and restaurants. I really enjoy not having to smell any smoke, but I would simply avoid restaurants that allowed smoking. Just like I generally did before. I would feel bad for the workers at those restaurants, but I don't think protecting them is probably worth the trade off. Restaurant workers tend not to stay at one job too long and, in my experience, 90% of them smoke.
LikeLike
Troll: "I think I've said this before but in the Corps I once did a 5 mile run with a Company Gunny who chained smoked Camels the whole way."You did. And I so totally love that image.
LikeLike
ashot:Scott eventually got to the point…Don't you just love how a single word, "eventually", can make an otherwise unstated point so stark? The use of language is an art form. 😉
LikeLike
I think Tennessee has a pretty good solution to banning public smoking: any establishment that allows smoking cannot allow children. This means that bars, that don't need to be letting folks under 21 in, anyway, can allow smoking. So, if you want to smoke cigarettes are cigars in a public forum, go to a bar. If you're a restaurant with a bar, but you also want to cater to families and children–smoking is banned on your premises. Which is fine with me. Even today, when I go into a restaurant that was constructed before the ban, and the smoking section is still cordoned off (just no one can smoke it anymore), you say to yourself–how in the world is this a non-smoking section? Non-smoking sections were always bs–the smoke goes from one place to another with very little difficulty. It's called diffusion.Although a non-smoker, I enjoyed smoking in the abstract, and have nothing against smokers, and often gaze upon them with envy. I've said before if cigarettes were outlawed, I'd buy a few last packs and smoke it up, for that one last hurrah. Even so, I like having restaurants and airplanes smoke free. When I eat in a restaurant in a state that still allows smoking, it's unpleasant. I can only imagine former-smokers that have turned smoking-haters (I know that happens a lot, but that has never been my experience) and non-smokers often find it even worse . . . so I have a hard time getting worked up about people having limited areas to smoke. When they start passing laws saying people can't smoke in their own houses (as some have attempted) it gets absurd–just ban it, then.
LikeLike
Scott: "It is not at all clear to me that taxing cigarettes and alcohol for the ostensible purpose of covering future medical problems is at all justified or sensible. It is entirely conceivable (and I have seen studies that show) that smokers are net contributers to, not recipients from, government coffers."It also seems to pre-suppose that people who die of natural causes, old age, or spontaneous or genetic forms of cancer not related to smoking or diet, will not incur significant expenses and don't impose a significant burden on the healthcare system. Presumably, every smoker, had they never smoked, will eventually die, and presumably after consuming as much, if not more, healthcare than they would have had they been smokers. I've never understood this argument.
LikeLike
"Presumably, every smoker, had they never smoked, will eventually die, and presumably after consuming as much, if not more, healthcare than they would have had they been smokers. I've never understood this argument"KW — see this: http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.htmlthink of it this way, if I smoke, i will die earlier, possibly after a short and losing battle against cancer. If i'm healthy, i will live much longer, develop more age related conditions, and cost more. it's a short "big" expense for smokers vs. "nickle and dimes" for the healthy, until they hit that last year of life and incur the "big" costs too.
LikeLike
"it's a short "big" expense for smokers vs. "nickle and dimes" for the healthy, until they hit that last year of life and incur the "big" costs too."That's my point. The argument that smokers (or the obese) are a greater burden on the healthcare system seems to have an implicit assumption that healthy people don't incur big costs in that last year of life. It seems reasonable to me that *everybody* who doesn't die immediately from a fatal heart attack or some other fatal trauma will end up being a burden on the healthcare system, whether or not they had a healthy lifestyle, and whether or not they smoked.
LikeLike
oops. misread what you wrote. take comfort in the fact that this is somewhat of a dirty secret in policy circles. "jeeze, if we keep people alive, how are we going to pay for it."
LikeLike
Well, that's all good then, we don't need to worry about extra costs existing along side bad habits. Why does the insurance industry tread these as more expensive costs then?
LikeLike
"Why does the insurance industry tread these as more expensive costs then?"are you talking about higher premiums and the like for bad habits like smoking? part of it is employer demand and concerns about lost productivity from bad habits. smokers might not cost more in direct health care costs over their shorter lifespans, but they're more likely to take sick days and the like from their employers. and it's easier to shift some of the increasing overall costs to those engaging in frowned upon activities, namely smoking and weight issues.
LikeLike
lmsinca- If I could hazard a couple of guesses:1) Because they can; 2) Because they can get away with it;3) The costs at the end of life are mostly covered by Medicare whereas smoking increases your risk of getting cancer earlier in life which insurance companies have to pay for. So what NoVa is saying is that if the government really wants to save money on health care they should give us our tax returns in the form of cigarettes as opposed to a check. Also, efforts to protect the environment from pollutions that would lead to us developing cancer both increase costs as businesses have to comply with them and increase governmental costs because we live longer. Why or why do Democrats hate America so much?
LikeLike
What would happen do you think if we did away with employer based health insurance? I guess I'm trying to figure out if those bad habits over a life time actually save health care dollars, because of earlier death rates, what would happen in a truly free market? Is there any incentive for the insurance industry to cover everyone at basically the same rate just adjusted for age if employers are kept out of the mix?
LikeLike
lms:Why does the insurance industry tread these as more expensive costs then?Because in the short term they are. Insurance premiums are determined based on expected costs over the coming year, not expected costs over a lifetime. And people with risky habits are more likely to cost more money sooner, even if their expected lifetime costs are equal to or even less than more risk-averse people.
LikeLike
In other words, assume for a minute that we all want universal coverage, I know some of you don't find that compelling but if you did, what is the best way to get there without government intervention? I don't think there is a way but does anyone think there might be?
LikeLike
I get the point about risk aversion over the short term but in some ways it makes the case for cradle to grave single payer coverage doesn't it? Long term it saves money, as you guys are claiming, so spread the cost over a lifetime instead. I'm not sure I'm explaining this adequately.
LikeLike
lms:What would happen do you think if we did away with employer based health insurance?Employer based insurance is strictly an artifact of the tax code. If you recall, back during our old pre-ACA health care debates, I repeatedly argued for changing the tax code to eliminate the disparity between getting insurance via one's employer and getting it elsewhere. I was never able to convince you to agree. Is there any incentive for the insurance industry to cover everyone at basically the same rate just adjusted for age if employers are kept out of the mix?No, because insurance companies have no ability to compel people to maintain insurance with the same company for the whole of their life.
LikeLike
lms:Universal coverage…what is the best way to get there without government intervention?I don't want to sound pedantic, but it really does depend on what you mean by "universal coverage". Even people who have insurance don't all have the same coverage. Some policies cover more than others. If by universal coverage you mean some basic level of care for everyone, we pretty much have that now (albeit with some government intervention). If you mean all contingencies will be covered regardless of cost, then sadly it simply cannot exist, even with government intervention.
LikeLike
"albeit with some government intervention"Some? Some? It was a government takeover, didn't you hear? Glad to see you got it….eventually. 😉
LikeLike
Scott raises a good point — the annual nature of coverage, which i neglected to mention. Ash's points are valid too. Nobody really objects to charging the smokers more (or viewing them as a tax revenue source). "What would happen do you think if we did away with employer based health insurance?"Unicorns and rainbows all around. You'd be eliminating one of the players whose sole concern is expenses and controlling and/or shifting them. my two problems with the current system is employer involvement and larded up benefit plans. we pay in premiums what we should be saving and/or paying directly to providers for routine and non-catastrophic care. It's add to Scott's point — insurers would have to compete for customers. right now, i either take or decline my employer-sponsored coverage. if I'm shopping for my own i can see an insurer offering a age adjusted premium to attract and retain customers.
LikeLike
ashot:Some? Some? It was a government takeover, didn't you hear?Actaully I had in mind our pre-ACA system.eventuallyAh, You did see my post. I was hoping you did.
LikeLike
Scott, yes I remember our conversations regarding the tax code and employer subsidies. I think I was arguing, if I remember correctly that it gave an unfair advantage to large group employers over small ones or the individual in the market. I don't mind if we eliminate employer coverage altogether. I just think if we do that, we need some form of "basic" coverage for everyone, and no we still don't have that really, although I think ACA got us closer. I agree we can't cover everything which is why I think we still need a system similar to medicare which means most people will also purchase an additional policy that covers more, based on their needs or ability to pay. I'm just trying to figure out a way to get there that works for everyone. I think a cradle to grave "basic" coverage through either a premium payment or through tax policy gets us that much and then the rest is up to the individual and the insurance industry or maybe community oriented medical groups that you join and pay an added premium. I don't know, I'm just thinking out loud mostly.
LikeLike
"or viewing them as a tax revenue source"We've already established they are going to die early so we better get our money out of them now. Over the line?So NoVa- what do you think about HSAs? They seem like a good idea, but as long as the prices you end up paying for a given service are "larded up" so I don't know that they really make much of a difference. But do you see them as a step in the right direction.
LikeLike
"Nobody really objects to charging the smokers more (or viewing them as a tax revenue source)."Except when I suggested that perhaps taxing bad habits might be the way to cover the added health cost of bad habits……………
LikeLike
NoVA:up benefit plans. we pay in premiums what we should be saving and/or paying directly to providers for routine and non-catastrophic care.Yes! Another point I repeatedly made back in the day before ACA. One of the main problems is that what we now call "insurance" is not, in fact, insurance. We call it that in order to take advantage of the tax code, but it isn't insurance in the proper sense of the term…ie protection against the crushing cost of an unknown and uncertain future event.The income tax…the source of so many of our ills. We should go back to financing the government via an excise tax on alcohol, I tell you! First round is on me when the 16th amendment is repealed.
LikeLike
lms:Except when I suggested that perhaps taxing bad habits might be the way to cover the added health cost of bad habits…………… My objection was to the notion that they had "added health costs".
LikeLike
"So NoVa- what do you think about HSAs?"On paper and ideologically, i'm 100% behind them. build up assets over time for when you are more likely to have higher costs. But they are so divorced from the system as it currently stands that I think the are a tough sell. But if we are truly doing to control costs and make them transparent, you have to be able to compete on price and quality. our current system does neither. the response is that you don't shop for health care. i think if the conditions are right, you can. Example, i had my benefits meeting last week. The HSA+Catastrophic plan included "free prevention coverage" — the typical list of things that will be provided without cost sharing. (I think this is an ACA requirement). *facepalm.* totally defeats the purpose. as a result, the premiums were not significantly less than the PPO. the benefits manager didn't understand the groans from the health policy practice.
LikeLike
"Ah, You did see my post. I was hoping you did."I absolutely did not mean it in the way it ended up sounding. It was the first thing that popped into my head. I think it was over at the WaPo that somebody raised this issue and called to my attention that obesity and smoking doesn't actually increase health costs on the whole. I was dubious so I took a look at the numbers and they were right. It's one of the reasons I participate on blogs like this. You do actually learn things. Even you have taught me a thing or two…eventually.
LikeLike
scottBecause of the risings costs of both premiums and health care most people are sharing more of the costs of both already. It's funny but we had a snafu with our insurance, and I went in for my annual check up and discovered that the cost of a regular office visit for cash paying customers was $32 versus what my co-pay would have been which was $30, I paid more because it was a physical ($90) to see my regular doctor. We just renewed and added even more cost sharing to our coverage in order to save on the premium ($800/mo each vs. $950/mo each) but now my co-pay is $40. I'm wondering if I can just pay the cash customer fee instead? I don't think the system we have is going to keep working for the majority of Americans for much longer.
LikeLike
My objection was to the notion that they had "added health costs".And people with risky habits are more likely to cost more money sooner, even if their expected lifetime costs are equal to or even less than more risk-averse people.So sooner or later they do cost more, according to you. Now I'm even more confused about why or why not or when or when not we should or shouldn't tax tobacco.
LikeLike
"I don't think the system we have is going to keep working for the majority of Americans for much longer"Above all else, i think this is 100% right. There's one other point I'd like to make before have to run. Say I have an HSA+Catastrophic plan. I have assets that are mine and I can choose how to spend them. Compared to gold-plated health insurance that pays only for the care you consume. what if you opt not to continue treatment? your gold plan in now essentially worthless. say you have 6-months to live and you would rather spend that time spoiling the grand-kids than sitting in the ICU? you want pain management and a DNR. you have some assests with that HSA. take the tax penalty hit and go to disney world. with the gold-plated plan, i'm sure the insurer will be more than happy to collect premiums and not return them if you decline treatment. But you have to come up with the cash for Disney elsewhere. Critics of HSA say it's put to much onus on the individual. that's a fair criticism in part, but it really hurts come end of life decision time.
LikeLike
ashot:I absolutely did not mean it in the way it ended up sounding.I didn't think so, but it would have been amusing if you had (I can be verbose, I know, and there are times when I have made what seems to me spectacular points, only to get bewildered looks and a "so what?"). And I thought it was a great example of how a single word can pack in so much meaning.
LikeLike
"I'm wondering if I can just pay the cash customer fee instead? I don't think the system we have is going to keep working for the majority of Americans for much longer"I wonder if sometimes I wouldn't be better off saying I don't have insurance. Not only may I actually end up paying less, but I would bet I would be referred to fewer doctors which leads to unnecessary co-pays. NoVa- That's a great story. So maybe your HR department should have…you know asked the Health Care policy experts about what plans they should offer. Insurance companies have to know that they are defeating the purpose of the HSA + catastrophic plan, right?
LikeLike
"insurance companies have to know that they are defeating the purpose of the HSA + catastrophic plan, right?"it's actually an ACA requirement. all plans have to offer the free prevention coverage. so this makes HSA much less attractive.
LikeLike
lms:So sooner or later they do cost more, according to you.No. They have a higher risk of costing more in the immediate future, but in the long run they cost the same or less.
LikeLike
"Critics of HSA say it's put to much onus on the individual. that's a fair criticism in part, but it really hurts come end of life decision time"This is where all this gets hard. On one hand saying, it puts too much onus on the individual is basically saying, we're afraid the individual will make a bad choice. That's awfully paternalistic and despite (or because of) my liberal leanings I'm not too keen on the idea of the government preventing from making decisions, bad or good. On the other hand, as a society we have basically decided that we don't want people to die in the streets or to go without care if the care is available. This leads to bad debt for hospitals, increased costs to others and so on down the line. Anyway, as you and lmsinca point out (I know Scott agrees), the system is broken. However, in addition to changing the system, we need to change our mindset on health care.
LikeLike
"it's actually an ACA requirement. all plans have to offer the free prevention coverage. so this makes HSA much less attractive."facepalm- you said that already and I just missed it. Yeah for more unintended consequences.
LikeLike
"Yeah for more unintended consequences."Have to disagree there. I think this was foreseeable and, therefore, i submit, intended. (and i'm totally not doing what i should be write now. which is lms' medpac post)
LikeLike
scottWhen I said sooner or later, I meant sooner or later as either or. You agree with sooner and so do I. My point was then this doesn't make much sense to me.My objection was to the notion that they had "added health costs".
LikeLike
I think it's really interesting that we always come back to health care costs and coverage as a topic. It's obviously something many of us are worried about going forward. I think we should be.
LikeLike
lms and scott: here's the new england journal of medicine on the health care costs associated with smoking:http://www.nejm.org/doi/full/10.1056/NEJM199710093371506Conclusions: If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.
LikeLike
and here's the CDC on lost productivity and smoking. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htmso it's clear. give up cigarettes for new years, but don't give up smoking.
LikeLike
lmsinca- An insurer only knows you are going to be their insured for a given year so they calculate the risk for that year and don't worry about the next. For any given year, a smoker is probably going to cost more than your average insured who does not smoke. At some point, as we get old, that no longer is true. However, by that time, people are probably covered by medicare and it's way down the line, so it's not the concern of the insurance company. However on aggregate, smokers and overweight people probably cost less in health care dollars.
LikeLike
lms:My point was then this doesn't make much sense to me.If product A costs $100 today, but then nothing ever again, while product B costs $5 a year for the next 20 years, which product has an "added cost" relative to the other one? (Ignoring for the moment the time value of money.)It is fair to say that product A costs more right now, but over time the costs of the two are equal. There is no "added cost" to choosing A over B.
LikeLike
Haaaaaaaahaaaaaaaaaa, I get it now you're all making the case for single payer so the cost is amortized in one central plan over the life of smokers and non-smokers alike………good plan, I like it. We'll all save money in the long run.
LikeLike
"We'll all save money in the long run."Yes, but I thought we saved money by killing off the old people? We save money both ways? Jackpot!While I agree with many of the points Scott and NoVa make, I, like you lmsinca, lack the trust in the free market. So that's why I'm with you on the single payer.
LikeLike
lms:I get it now you're all making the case for single payer Nope. I'm making the case that your assumption regarding the "added costs" of risky behavior, and therefore the need to charge for that behavior, is in error. And certainly the knowledge that, say smokers on average do not incur greater lifetime health care costs than non-smokers bears no relevance at all to the question of how health care costs should be paid or who should pay them. It is odd if you think it does.
LikeLike
"lack the trust in the free market. So that's why I'm with you on the single payer."got to run, but we can pick up this later. I'd say that there's nothing at all free market about the current system.
LikeLike
"I'd say that there's nothing at all free market about the current system."I don't disagree with that at all. Scott- I have to assume lmsinca was mostly kidding.
LikeLike
Well, if I could get Scott to agree that single payer is the best way to go for numerous reasons I wouldn't be kidding at all…………but yeah I was. It's a nonsense conversation IMO because he doesn't agree with the premise in the first place that a goal of universal "basic" coverage is legitimate so how to get there is meaningless. I do think though if we eliminated all incentives for employer provided insurance the conversation would change completely once people see how the insurance industry would operate in a free market environment. And that's something I'm very serious about.
LikeLike
And btw scott, in general I believe we should all pay our own health care costs or insurance premiums and I think only those truly living in poverty should receive some sort of basic health care via the government. I don't really care if it's a government program such as medicare or a non-profit type of insurance program that delivers it, but I do think single payer which spreads the costs over a life time regardless of inevitable or non-inevitable health issues is where we will eventually end up. Nothing else makes any sense to me.
LikeLike
"And btw scott, in general I believe we should all pay our own health care costs or insurance premiums and I think only those truly living in poverty should receive some sort of basic health care via the government"I'm more liberal than lmsinca! I actually like the idea of basic universal healthcare (that we accept is basic, and rationed) and a market for private supplemental health insurance that the government doesn't mess with, mandate, or order around. I'm also not opposed to expanding medicare to cover established treatments for all–like, say, basic radiation and chemotherapy and the necessary imaging that goes a long with it. Medicare isn't going to cover every 20 year old's mono or cold, but will cover leukemia . . . sort of the approach taken for Medicare's coverage of dialysis. Although hopefully better as lots of people who receive coverage for dialysis under Medicare think it sucks (but, of course!).
LikeLike