America's border flooded by foreigners seeking better medical care

There is no right to expose others to your untreated illness. If you lack the will or the means to satisfy your obligation to avoid endangering your neighbors, then you surrender the freedom to live among them.

Welcome back!

So how is that different from saying you don't have the freedom to opt out of minimal health insurance? Both kinds of regulation assume that there are limits to your freedom arising from an "obligation to avoid endangering your neighbors". Why is forced exile a better means of enforcing that than mandatory minimal insurance? It's obvious that forced exile will be more costly and less effective, so what's the advantage?

Exile also neglects to consider that one of one's fellow exiles may be carrying a disease that has not yet evidenced symptoms and, with neither party immunized, the chances of their dying of the disease before spreading it to others are enhanced.

Worst case scenario, the exile ends up paying hospital costs out of pocket to be treated for the disease he might have avoided, or dying horribly in a country not his own. But at least he didn't have to pay for health insurance...

Bottom line, freedom of choice who those who manage to provide for themselves without government interferance, and the preemption of another scheme to redistribute wealth.

If all you want to do is require people to carry a minimum amount of health insurance (or just prove they have some financial means of paying for medical care) as a condition of citizenship, we're closer to agreement. But we part ways again the second you force someone other than the individual to pay for his insurance.

That would be there in my scheme as well (see above). The difference is that your scheme only punishes those who risk theri neighbours' health when they actually get ill, thus encouraging everyone to bet it won't happen to them, and rewarding those without the will to fulfil their obligation for pure luck.

How is forcing someone to take out insurance a redistribution of wealth? If you assume that it is their obligation to protect their neighbours' health from their illnesses, they already owe that money. Redistribution, then, is allowing them to go without paying, as your plan does.

Clarify your terms, here. Would you have me pay for someone else's health insurance, or not?

Well, the basic actuarial fact is this: 20% of patients require 80% of care.

Now, there are ways to alter those figures long term, but in the meantime, that's the baseline that health insurance, just like life insurance, starts with.

So, essentially, if you're young and healthy and you have health insurance, you're already paying some of the costs for the kid with cystic fibrosis and the couch potato with congestive heart failure.

But that's only part of the problem. The real problem is decades of insurers' monkeying with this basic structure at the expense of *all* consumers, healthy ones as well as sick ones.

Emphatically no, if "have me" means "force". I'd want at least one of the many insurers available on an open market to set rates not by medical conditions, but by income, so that whoever chooses that insurer among the many deals available will pay more if they earn a lot, and less if they earn less, with their advantage being that they know their rates won't become unaffordable if they get a chronical illness, or if they lose their job. But that's their choice. If they want a different deal, every company should be free to offer it to them.

In the interest of full disclosure, an extreme scenario (the kind the US hasn't seen in at least 80 years) with a massive and lethal epidemic sweeping the country would very likely eventually necessitate state interference, costing tax payers' money. But so would your forceful exile, and yours would cost tax payers' money on a much more regular basis and in much more normal circumstances, and still cost proportionally more in the extreme scenario.

Cost effectiveness is not the final measure to me, and you'll never sell me on something with a required proportionality to income. If such a scheme would be so great, offer it among the options and see which one people choose.

Not that there's any mystery to how that would play out.

That's exactly what I just said.

In Germany, 80% choose that option.

How hard is it to switch? What's to stop someone from taking a flat rate when they are making bank, and then switching to income based once they lose their money?

Is Germany's National/Federal/whatever you call the income based insurance company having to eat into it's reserves this recession?

Really? Wealthier people knowingly choose to pay more, while there are other providers that don't set their rates based on income?

I'm thinking there are some other factors involved here.

Nicer decor and shorter waiting times? Bragging rights? "Well, *I* see Dr. So-and-So. He's very exclusive."

Just guessing.

Yes, me, for instance (and many, many more). For at least three reasons.

One, I (and probably many others) actually agree with such a system, which I assume is my privilege even in your eyes.

Two, if they or one of their dependents falls ill, a different insurer might raise their rates, based on their medical situation.

Three, if they fall on financial hard times, they know they don't have to worry about no longer being able to afford healthcare.

But this is just some interesting data on the side. For all I know, most Americans might make a completely different choice. That wouldn't bother me at all, nor would it change my argument.

Indeed, it is very hard to switch to such a service if you first choose a different one. And indeed why not? If someone else wants to offer the same conditions AND make it easy to switch, they're free to do so. But I don't think anybody does.

I don't think we know yet, but probably. As I said earlier, this whole system went wrong when the insurance company was made to pay for Germany's (not at all health-related) reunification costs. If anyone wants to adopt our system, they should make sure to truly separate insurance and state, as was the original intention but not the practice under Kohl's government.

So at what age do you have to make a decision of which plan you choose? I mean I assume children get their own plan or are they covered by their parents? What about kids that work? I know I started working at 14 and IIRC Vera starting working at her swimming club in Moenchengladbach at around the same age.

If the history of SS is any indicator that shouldn't be a problem at all.

Kids are covered with their parents under most, not all plans; if they're not, it is still the parents' responsibility to cover them when they're small. At what point it becomes the kid's responsibility depends heavily on when the kid starts earning for real (not counting summer jobs and the like) -- that could be at 14, or at 27 if they go for a full university degree. 14 and 27 are the two cut-offs, however; younger, and you're definitely your parents' concern, older, and you're definitely your own.