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March 15, 2006



I'm afraid, Kate, you're as wrong about "skin" in the health care "game" as is Ezra.

For so long as employees do not realize the costs of health care because their employers are paying for it (even if the employees' incomes are lessened thereby) there will be little call for significant change and none for UHC.

Employers should be required to compete for employees with salary offers, and employees should pay for their own health care insurance. As soon as they are, the presented muted calls for UHC will become loud and forceful -- but not until then.


Ellen1910 thinks your general opinions are 'wrong', but that is merely Ellen1910's opinion.

HOWEVER, you are absolutely, objectively wrong here...

"Something else I've been pondering is the flawed way HSAs are being introduced into the market. If they're supposed to introduce more risk then the employee should feel like it's their money they will have to spend in order to get care. But if their employer is putting in money up to the deductible (in the case of several companies), doesn't that erase the incentive to be "cost-conscious"? Isn't their skin not really in the game?"

If employers contribute to employees' HSAs, the contributed amount then belongs to the employee. It rolls over from year to year and it is transportable from job to job. It certainly counts as "skin-in-the-game" as Ezra defines it. Your objection looks silly.


Outside of the random and wrong anti-HSA memes, your posts raises some excellent questions.

Regarding the libertarian Utopia and the risk of disease we face before we are even born, you need to look up John Rawls's "Theory of Justice".


I think someone should apply it to health insurance. That would be way cool.


Kate, Grant,
The question of how much skin Americans ought to have in the game has been comprehensively addressed through our elected representatives. You say you missed that debate? Well, not really. It was in the bankruptcy law overhaul that was passed last year (and truth to tell in our bankruptcy laws generally).

The bottom line is this: you and I are each obligated to pay everything we have in this world, plus everything we may ever earn. We already know that about 50% of bankruptcies are caused by medical costs -- that was before the laws were tightened.

Grant mentions the "ownership" of the HSA as if this was in any way responsive to the issue, the issue being the insurmountable cost of serious health care to all but the wealthiest individuals. In a world of negative-savings rates those HSAs aren't going to be funded by individuals -- and employers are under no obligation to fund them either. Quite simply, people will be flying bare until they hit their deductibles, so warm-up that VISA card!

I jokingly said to a friend that we can look for the emegence of pawnshop windows coming soon to a hospital lobby near you. Rolled-up stel slats, bullet-proof glass, the works.

Rawls and his theory of justice be damned. Thanks to moral idiots like Trapier we will soon have the privilage of signing-away the title to our car before the ER will work on our kids.

Martha Grant

Medical care is such a neccesity I can't imagine it being only provided to those families that can afford it. It seems by Ellen's standards only people that work decent paying jobs should be off Medicaid.

(Note: in NY state the Working Families Party is working on getting corporations with over 100 employees to provide healthcare, for details/a petition go here)


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