BYU pauper babies

[Whistler]

I agree with your assertion that going without life insurance is a foolhardy risk. Even so, some people go without it in order to meet needs for food and shelter.

[Waldorf and Sauron]

For that matter, people also go without shelter. One in five homeless people is employed.

[Tao]

Health insurance is not a luxury.

You.... have never been poor, have you? I mean the 'lets extend our fast another day to help ends meet' poor. Insurance can be a nice thing, but in the end, you're paying someone against the fear that something happens. And what's more, they have nothing to do with it. It'd be like me paying you in hopes that the Russian mafia doesn't come for me. (You have renounced all ties with them by now, right? Except Hobbes, of course, he's family.)

I understand the law of large numbers, and the idea of shared risk. And I will (and do) have insurance that I hope I'll never have to use. Yet when it gets down to brass tacks you are gambling, playing the odds. And although a gambler seeks to constantly heighten risk, and the insured individual (hopefully) reduces them, in the end the house always wins. In a perfect United-Order-esque situation, all could share the risk of all and overhead could be kept at a minimum and the odds of not receiving a deserved claim would be next to none. Dreaming of such a world is a luxury that many of us tap into because we can afford it.

In my eyes, insurance is prioritized by what you can't afford to replace: Catastrophic medical expenses, home insurance, life insurance covering the financial supporter of the family, etc. (Demand for life insurance covering the financial support of the family actually should decrease as you age; as kids grow up and move out, the 'cost' of losing that support is lessened.) Recovering from the loss of any of these things implies expenses that the typical family simply could not cover out-of-pocket, and although you are mathematically 'losing' each and every bet, the regular loss in premiums is not nearly what is avoided if the dice fall against you, so we feel fine losing.

But when situations get to their extremes, things change, helping us see all the better what they are made of. As a family gets wealthier, their pool of 'what they can't replace' gets much smaller, as should their need for insurance. Instead of losing that bet every single month, they can afford to self-insure: have enough assets locked away in a bank to cover the event of a loss and be earning them interest, not losing it. On the other end of the stick, the very poor feel the bite of those premiums much more in relation to the middle-class, and to be honest, their 'what they can't replace' is also much smaller, as their valuation of things tends to be much different.

Again, I'm not against insurance at all. For the middle class, it makes so much sense so as to be a given. It is a small price to pay for the luxury of restful nights, knowing that many of the 'what ifs' are covered. Yet for those living on the edge of their means, worry about the 'what ifs' is minor compared to the worry over 'what is' and exacerbating the latter to assuage the former is foolish at best.

[Marduk]

Right, no one is suggesting going without food, clothes, or shelter in an effort to pay health insurance premiums. What Sauron IS suggesting (at least, how I'm reading it, please correct me if I'm wrong) is that many families go without health insurance, in an effort to put out the biggest fiduciary fire first, so to speak, and do so at their own peril. With life expectancy what it is, and health care in this country what it is, the question isn't IF someone will have some sort of medical issue that will put a financial burden on the family, it is WHEN. And the fact that so many poor simply can't afford to be insured pushes them farther below the poverty line as those issues come up, as they inevitably will.

[Tao]

Oh, aye, I am very much aware that it happens. What I'm endeavoring to show is some of the mindset that may be behind such a decision. Insurance is a luxury, a comfort that costs more than most people will ever get out of it. In the case of privately owned insurance companies, it is that way by definition; they have to turn a profit, which is their due. Opinions on what exactly this should lead us to do differ significantly by way of what one's person aims are. Looking at the impoverished alone, risk sharing prevents the few from being catastrophically hit, at the cost of everyone being held back. Going without insurance is done at the individual family's peril, with a statistically 'better' situation for the majority, balanced by the severe losses incurred by the few.

Nationalized insurance, or subsidized situations where costs and risks are imbalanced in favor of the hard up by an outside source, are a different game altogether. With such available, insurance becomes a mathematically favorably thing for the poor, and in a universal system the average 'loss' incurred by those more fortunate covers it. (Or it comes out of taxes, TANSTAAFL. A mixed-market system simply can't work, as I currently understand it.) I'm OK with that. We are our brother's keeper, after all, and I am more than willing to assist where I can, when I can. Effective implementation of such plans is a different topic altogether, and probably deserves its own thread if enough desire exists to warrant it.

In either case, though, such things don't make it impossible to provide for one's family, just more or less work. With a proper work ethic and priorities, I just don't see a point where having a child is financially 'impossible' in the States. (And I do mean financial impossibility. I am fully aware that other impossibilities occur; congenital conditions that lead to infertility or inability to hold a job can bring individual complexities to such a discussion that it becomes impossible to address.)

[Waldorf and Sauron]

What I'm saying is that basic health insurance is a necessary part of providing for one's family.

We can argue about the other little things or definitions or whatever, but poor people thinking of having children need to plan to have health insurance for themselves and for their children. If they want to get help doing that from the church or the government, in my opinion that is fine and great. If they don't want to do that, they can't view health insurance as something unnecessary that can be cut out of the budget in "sacrifice" to cut down to the most essential things, just as they shouldn't cut shelter out of the budget.

Now in hard times, yes people go without lots of things to make ends meet. To all those poor prospective parents out there, it is possible to be poor and have children. But you've got to be realistic. Don't just think that you can work a minimum wage job, go without health insurance, and you'll just be able to make it on your own and everything will be fine. If you have a child (without resorting to medicare) even with catastrophic medical insurance, you'll be paying at least $5-6,000 maternity deductible for the delivery. That's not in Tao's budget.

The good news for poor people is that for many public programs exist to help. In my opinion, these should be taken advantage of if needed. But you should also strive to become self-sufficient, to get training in a field that pays above the poverty level, and to get a job at your own level.

And, Tao, you're ignoring the fact that insurance companies not only pool risk but collectively bargain on behalf of their patients, securing lower rates for medical services for their clients.

[Tao]

What I'm saying is that basic health insurance is a necessary part of providing for one's family.

Yes, because until the implementation of health insurance in the late 19th century, no one was able to provide for their families. Forget the young earth theorists and all those crackpots that claim that families existed prior to the 1850s, after all, how could they have possibly managed without the fundamental necessity that is health insurance?

I begin to wonder if some of those 'little definitions' we may be viewing in different light are those of Necessity and Impossibility. You largely summed up my thoughts with your line "To all those poor prospective parents out there, it is possible to be poor and have children." Is it possible? Yes. Will it be hard? Yes. But unless your personal work ethic equates 'hard' with 'impossible' the latter does nothing to abrogate the former.

The good news for poor people is that for many public programs exist to help. In my opinion, these should be taken advantage of if needed. But you should also strive to become self-sufficient, to get training in a field that pays above the poverty level, and to get a job at your own level.

Agreed. While the poverty level is an imaginary line in an imaginary field, seeking training to improve your situation is always desirable.

And, Tao, you're ignoring the fact that insurance companies not only pool risk but collectively bargain on behalf of their patients, securing lower rates for medical services for their clients.

Hardly. Having been on the other side of that haggling, I think I can safely say that insurance companies collectively bargain on behalf of their pocketbooks, only taking into consideration the patients health or well-being when it aids their bottom line. And unfortunately, to counter that pressure, many medical practitioners have resorted to standard haggling techniques: artificially inflating their 'base' price. While this helps them counter the effects of the professional palterers, any without or with incomplete insurance are left with exorbitant medical bills, wondering what hit them. Without referring to any concrete numbers, I wouldn't be surprised if over half of the catastrophic medical bills that health insurance claims to protect against are due to the insurance system itself.

[Imogen]

Tao, you're forgetting something. Back in *~YE GOODE OLDE DAYSE~* most doctors were local, single practice types. They weren't housed in offices connected to hospitals. They were lone wolves. So if I needed to see the doctor because I was in labor or had a broken leg 1)he'd probably be a decently close friend and 2)I could probably pay him in trade.

The medical field is structured in such a way now that I can't trade my doctor a home cooked dinner for services rendered. I have to pay him because he has to pay other people like insurance companies, hospitals, and landlords. Not to mention, we're no longer a barter society, so even if he DID accept, say, an iPhone, for setting my broken leg, he can't necessarily use that iPhone to purchase services or good of his own.

Insurance is necessary in our modern society because of how the medical field is now set up. Sure, you don't HAVE to have medical insurance, but you'll almost inevitably end up in debt because of it. I had insurance, and STILL ended up in debt because of an unexpected knee dislocation that required an ambulance ride to the emergency room. But, my debt was FAR less than it would have been if I hadn't been insured.

[Waldorf and Sauron]

Good old 1850, when the average life expectancy was 39 years, where the infant mortality rate was only 21% (34 if you were black), and when maternal mortality was just more than 100 times what it is today.

[Yarjka]

The medical field is structured in such a way now that I can't trade my doctor a home cooked dinner for services rendered. I have to pay him because he has to pay other people like insurance companies, hospitals, and landlords.

You'd have difficulty finding a doctor who could afford to have the equipment necessary to perform a $20,000 heart surgery in exchange for a homecooked meal.

In the good old days, you didn't go into debt in the case of a serious illness or injury, you just died. If the worst case scenario is a broken leg, then you can probably get by without insurance.

[Tao]

Good old 1850, when the average life expectancy was 39 years, where the infant mortality rate was only 21% (34 if you were black), and when maternal mortality was just more than 100 times what it is today.

And good old modern understanding of pathogens, when hospitals have the same mortality rates as homebirths. I really do feel that much of our different outlooks simply differ on what exactly a necessity is.

[Katya]

Good old 1850, when the average life expectancy was 39 years, where the infant mortality rate was only 21% (34 if you were black), and when maternal mortality was just more than 100 times what it is today.

And good old modern understanding of pathogens, when hospitals have the same mortality rates as homebirths. I really do feel that much of our different outlooks simply differ on what exactly a necessity is.

Hospitals handle a much higher proportion of high-risk deliveries than homes do.

[Dragon Lady]

you'll be paying at least $5-6,000 maternity deductible for the delivery.

Not necessarily. I've been looking at a birthing center for whenever baby #2 comes along (and the point is now moot since I'm moving and won't be near this birthing center) and I could birth there for $2,000 or $1,800 at home (both are including pre-natal and post-natal visits). Total. That doesn't include any insurance payments at all. So you may have to spend more time learning how to birth naturally, and it's possible you'll end up transferring to a hospital in case of emergency (but the numbers there are quite low) and have a bigger bill. But my point is that saying having a baby costs at least $5k is simply wrong if you're willing to look at alternatives. (Please note that I'm not suggesting unassisted home birth, which is essentially free, but the risks are probably not worth it.) Heck, many (not all) midwives and doulas believe that everyone deserves a safe and quiet birth, even if they're poor, and are often willing to work for cheaper, trade, and sometimes even free.

[Waldorf and Sauron]

DL: You're right on all counts, I'm just speaking from our own experience. And, like you said, you should still have insurance in case you have to be transferred to a hospital. Our first child could not have been born at a birthing center, and the C-section cost $16,000. Our deductible was $5,000. Either way, you need to have thousands of dollars in the budget.

Katya is right on the money.

Tao: Maybe so. I think surviving health problems is a necessity.

[Tao]

I think surviving health problems is a necessity.

Oh, I think steps should always be taken to reduce risk, I just feel that such steps must inevitably vary due to circumstance: always the odds are weighed against the costs.

Silly example follows.

Fact: Falling bullets are a potentially fatal health problem.
Assumption: Surviving health problems is a necessity.
Conclusion: Bullet-proof umbrellas are necessities.

[Marduk]

Tao, I think you're vastly underestimating both the potential health risks of going uninsured as a family as well as the cost of those health problems when they happen.

Let's put some things in perspective of what is a necessity, and what is a luxury:

Is potable water free of contaminants and bacteria/viruses a necessity for a family, or a luxury?
How about eating food that isn't spoiled?
How about a shelter that protects from the elements sufficient to prevent severe health problems as a result of exposure?

I think most of us here would agree these things are necessary, and not really a luxury. Yet, right now, there are billions that go without these things. And there were millions a hundred years ago, even in this country.

Is health insurance a necessity? Absolutely, if one expects to be fiscally solvent enough to provide even the things I just listed (although, fortunately, in this country, clean potable water is practically free) one MUST include calamitous health insurance. Think about it, under your basically subsistance living, any of the following mean instant indigency:

Diabetes. Heart Disease. Organ Failure. Cancer. Broken bones. Delivering a baby. Pre-natal care. Anything that requires surgery. The list goes on and on. Are you telling me a family can survive twenty plus years until a child is able to care for itself without any family member having any of these things? And once any of them happen, that's easily over a thousand dollars in costs, most likely over 3000. A number of these very likely scenarios will result in needing continual care for the rest of their lives. A family with your budget simply cannot incur these kinds of costs without throwing it into bankruptcy.

[Tao]

Are you telling me a family can survive twenty plus years until a child is able to care for itself without any family member having any of these things?

Not at all. Are you assuming that a couple looking at starting a family in indigent circumstances will never improve their financial situation?

Is potable water free of contaminants and bacteria/viruses a necessity for a family, or a luxury?

Water is a necessity, "free of contaminants" is a luxury. If billions of people are living without something, and manage to survive, thrive, propagate, and educate their progeny to follow in their footsteps, then it can hardly be considered necessary.

I am reminded of a conversation I had with a young woman wherein she quite adamantly stated that nothing would stop her from being a working mother, as she "wasn't about to let her children starve on one income." When pressed further, she claimed she didn't know what they would do if her mother wasn't working, as her father "only made ninety thousand a year". She had no clue what living under the 100,000/year benchmark was like, and presumed that starvation would soon follow. Nothing I could do or say could open her eyes to the avenues that are available for us po' folk. This conversation seems to bear the same hall-marks, albeit with less Escalades and jetboats.

Heh, check out Babies. See if it affects your thoughts on necessity and luxury.

[Emiliana]

Is potable water free of contaminants and bacteria/viruses a necessity for a family, or a luxury?

Water is a necessity, "free of contaminants" is a luxury. If billions of people are living without something, and manage to survive, thrive, propagate, and educate their progeny to follow in their footsteps, then it can hardly be considered necessary.

Considering that more than 2 million children die of diarrhea each year, most because they don't have clean water, I would have to disagree with you.

[Katya]

Heh, check out Babies. See if it affects your thoughts on necessity and luxury.

The infant mortality rate in Namibia is over ten times as high as the infant mortality rate in Japan. But a more accurate portrayal of those sorts of statistics probably wouldn't have made for such a warm fuzzy documentary.

[Tao]

The infant mortality rate in Namibia is over ten times as high as the infant mortality rate in Japan. But a more accurate portrayal of those sorts of statistics probably wouldn't have made for such a warm fuzzy documentary.

You wish a more accurate film? As in, we'll bring ninety film crews in and film ninety different kids in order to get a 95% probability that one of them will die on camera? Then again, we have to show equal footage from all ninety films, for to show just the one unfortunate one would be inaccurately saying that all Namibian children die. You are right, warm and fuzzy tends to get drowned in the countless hours of very similar footage and the buried glimpses of tragedy.

Am I OK with a 33.6 permil infant mortality rate? No. I would wish to see that much much lower. Yet it only reinforces the idea that necessary conditions are being met for the vast majority of infants in a country with far lower education and far higher AIDS incidence than the US. (according to UNICEF assumptions, by 2005 ~48% of Namibian child deaths under 5 were AIDS related) If so, then roughly half of that 33.6 permil is due to the endemic AIDS, and thus has only tangential correlation with insufficient financial needs being met in the States. If anything, it reinforces the idea that the level of indigencey required to reach the "impossible to raise a child" benchmark is at most 18permil of Namibian babies. What number of US families are at or below that threshold?

Unless you want a 100% safety-assured birth, in which case all the world is too poor to have babies, and we'd best be living up our last years on Earth.