Wednesday, June 14, 2006

American health system and damn stupid users

This is not a post about the American health system, although I think a lot of Finnish people have fairly serious misconceptions about it. It's very good, but it has its problems (genuine problems, not ones caused by dumb users). However, allowing for such a high rate of dumb user failure is a problem in itself. This post is in particularly about the stupid users.

OK, I understand that Finns, Canadians and suchlike who grew up with the idea that the state provides health insurance for everybody may recoil at the idea that one must pay for one's own treatment and if one does not have health insurance one can receive a bill that one is supposed to pay, and that the bill might have a number with many zeroes on it. The morons who do not buy health insurance are, however, mostly American and one could think that they grew up accustommed to how things in America work, but no.

About 15% of Americans don't have health insurance. Most of them can afford it. A lot of them also bitch about the state not providing it. I can understand preferring to have public healthcare, although I do not share the feeling. Healthcare, however, is a very valuable commodity when you need it, and one would think that people would provide for their own within the existing system, but 15% of Americans obviously disagree.

I was raised with the idea that health insurance is the number one priority, approximately on the same level as taxes. You just can't avoid paying it. You pay it, no matter what, and only then you think about the secondary problems, such as having or not having enough money for rent or food.

A lot of people don't share this opinion and prefer to spend the money on something else: rent and food, but also clothes, toys, etc. - some people even save money while not having health insurance. I kind of understand the feeling - paying $250 a month (that's how much my private insurance cost back in 2001) while living on an unemployment check was quite unpleasant indeed, but so is paying taxes, and few people decide to stop paying those.

People's usual explanation for that behavior is that they don't expect to get sick and they have some better use for the money. Some of them even have a backup plan, for example unmarried couples where one person has insurance and the other one doesn't and they figure that if the insurance-less party gets sick they will just get married and the other person's insurance will automatically cover them. This is a perfectly good plan if you get cancer, but a rather unfortunate one if you get into a car accident and run up $50000 in hospital bills before you can even say "I do".

Mind you, if you have some serious medical problem that requires immediate medical attention they will treat you, insurance or not. It's just that you are really not gonna like the bill you'll get afterwards. And in most (all?) big cities there are free clinics available for non-emergency care for the uninsured, but you have to wait in line for hours. Oh, the horror!

The funniest thing is that the very same people who can't be bothered making paying for their health insurance their first priority tend to blame the state, the society and the insurance industry really loudly, demanding that the state provide health insurance to everybody. Just where do they think the state will get the money? That's right, taxes. Their taxes, usually, since most of them are not poor.

I can understand people considering themselves too weak to bother buying insurance for themselves and wanting the state to forcibly buy it for them out of their money. But somehow they never say "I am a silly shmuck who will blow the money on something else anyway, I'd rather the state collect it as taxes and buy the insurance for me", they tend to say "our system is evil and rotten for not providing us with free insurance." Whatever...

I am very curious to find out what will come out of Massachusetts's new health insurance law. Massachusetts is planning to do exactly that: force the people who don't have insurance to buy it. Surprisingly enough, the same people who usually complain about not being forced to buy it were mostly against the new law.

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