Humor will not be tolerated!! -Portia

http://theboard.byu.edu/questions/64372/

Just a response to obstreperous's comment. (S)he seems pretty dismissive of critiques toward health care. The socialism claim on medicaid is a bit overblown, but simply saying, "Access to health care is a good thing even when you're paying for someone else to have it," seems equally overblown. Both ignore the intricate realities of what the system does.

As an aside, questions like this one are one of the primary reasons I am for medicaid reform and reduction. There are perverse incentives for people to take risks and engage in behavior (e.g. having a child) that they wouldn't engage in if the system weren't there. I know quite a few people who say something along the lines of, "Well, we might as well have children now because it costs us next to nothing since we're students." I am not saying they shouldn't engage in that behavior (it is the completely rational thing to do), I am saying that we should reform the system so that people will change their behavior to be more fiscally optimal.

To be clear, I am NOT saying any of the following:
-It is immoral to use medicaid.
-People who use medicaid are lazy.
-Church members shouldn't use medicaid.
-Medicaid is evil or socialist.
-We should have no system in place for people who have no access to health care.

wired, I'm curious of your opinion, then, of the couple asking the question. They're not saying, "Well, we might as well have children now because it costs us next to nothing since we're students." but rather saying, "We'd really like to have children, but do not have the insurance to do so. Perhaps we can use Medicaid to make this dream possible?" Both types of people are using medicaid to have children, and you don't like the first example because they're abusing the system, but what about the second group? a) do you agree with that reasoning? b) in your ideal medicaid reform and reduction, would you have a way to help out the second group?

I think people assume if you can't afford to birth a baby you can't afford to take care of a baby, but I don't think that's true. Having a baby (in a hospital with a doctor present) is so expensive it's ridiculous, and that's what's stopping a lot of nice, responsible people who could take care of a child from having one.

Well, you're asking hard questions now. I'd much rather complain about the current system then tell anyone how to fix it.

Really though, those are tough questions that I probably haven't thought through enough. I will think about them so more. I'll give you my gut reaction Question A right now though.

Whenever having children comes up, my disclaimer is "pray about it." I am quite confident that the Lord knows their situation (and the permissibility of them using Medicaid) better than any set rule will. That would be my first response.

Then, my default answer (if God doesn't say anything) is that it is up to you to determine if you have any personal moral opprobrium to voluntarily putting yourself in a situation where you will take government money to have children. If you don't, then by all means do it. If you do have any sort of moral opprobrium to it, then you need to balance whether other options costs (going to family for loans, putting off children until you are able to financially support them on your own, etc.) outweigh your moral opprobrium to it. This is a fairly sanitized, economical way of looking at it, but that's what I think the decision calls for. I much prefer the first answer.

Personally, my wife and I have waited while we are in grad school to have children at a point where we will be able to avoid Medicaid or food stamps. I am in a much shorter program (law school is only three years) so I by no means think I'm a paragon of virtue. Had I been in med school or in a PhD program, it is quite possible we would have used medicaid. But my distaste for taking free money has led us to push off having children for a few years. It has been quite hard seeing others have children and wanting to have children now, but for us, personally, we felt like we could wait until we were in a position to support ourselves. I don't look down on anyone who does use medicaid (that accounts for about 80% of the grad students at my school who have children), but for my wife and I, it just hasn't been right.

Thinking it out, one modification I might make is that one parent must be seeking full-time employment. This would cut out college couples who have a mother stay at home while the husband goes to school. If the family does not have a full-time job seeker, they can receive a government loan (not sure on subsidized or not....) to act as a co-pay for medical insurance. If they opt not to insure, they're in the same position as anyone else who decides not to insure - they bear their own costs.

To be sure, this isn't a perfect solution. But I think it addresses my individual concerns about the system (perverse incentives primarily).

wired wrote: If you do have any sort of moral opprobrium to it, then you need to balance whether other options costs (going to family for loans, putting off children until you are able to financially support them on your own, etc.) outweigh your moral opprobrium to it.

A) Opprobrium? Really?
B) Once again, you're assuming that having a child using medicaid automatically means not being able to support that child.

A) Care to elaborate beyond being incredulous?
B) Where have I assumed anything outside of medicaid? All of my comments have been confined to the use of medicaid and I haven't said anything about subsequent care. (To be sure though, many people who utilize medicaid also utilize food stamps and WIC. If I had made comments about subsequent care, there would be strong grounds for assuming that people in the questioner's position would rely on government resources for subsequent care.)

I'll address your comment to my question later, but as a followup to the next statement: B) You can utilize Medicaid to have a baby because it is EXPENSIVE. Without insurance, we're easily talking $10k plus if you go the normal route and use an OB and have a hospital birth. More if you also have an epidural and even more if you have a c-section. Even with insurance, we paid $2k+ for my pregnancy with Dragon Baby. That did not include an epidural or a c-section. Let me just say that we have NOT spent that much money on her since then and she's now 2 years old. And that's including a nice, brand new crib. Because, let's be honest, raising a child doesn't have to be as expensive as public opinion makes it out to be. (Neither does the birth, for that matter, but that's a totally different story.)

Genuine, didn't you hear the part where he said he was in law school? That's the answer to A.

As an aside, I think the systemic problems with healthcare in this country in general are what necessitates a reliance on a government program in the first place. Not to be insured simply is not an option in this country; the medical costs are so exhorbitant for childbirth and prenatal care as to financially hamper any couple many years into the future. I think it myopic to the point of flippancy to suggest that anyone who is not insured ought to bear their own costs. The system we have is designed around insurance.

As to the thought of purchasing one's own insurance, yes, that's a thought. However, the time constraints put you practically out of school by the time that insurance would cover anything; else, its price barely beats (if it does) the cost of paying out of pocket. Buying insurance without an employer's subsidy is tantamount to simply bearing the costs oneself.

As to your recommended answer here (after your standard Christian default is exausted) I think that's an honest consideration for anyone in this situation, but we should consider that moral decisions aren't made in an autonomous vacuum; one's "moral opprobrium" in a given situation is far more complex than a given visceral reaction. It takes into account the zeitgeist of one's particular evironment, and this isn't so easily handled.

Tangentially, I think that Christian default must presuppose (at least, in an LDS context) the second recommendation, as well as more thoughtful analysis of one's current (or rather, the couple's current) situation, financially, spiritually, physically, and emotionally. God simply doesn't tell us things, we go to Him with suggestions that are the fruit of an intense reasoning and thought process. To do otherwise is to close that conduit of revelation. (This isn't necessarily directed specifically at you, Wired, simply that the way you phrased that ignited a pet peeve of mine.)

The thing in the question that stood out to me was this quote: "I am currently a first year medical student, my wife is still looking for work, and the loans are barely covering our needs."

If LOANS are barely covering their needs, maybe they should wait for the wife to find a job and get them on insurance, even if it means waiting longer than they want. They're already in debt and barely making it. Why make things worse right now?

My friend waited seven years before he and his wife had a child because they wanted to be debt free, out of school, and own a home first. She's told me how hard it was to wait, but they knew it would be worth it because she wanted to stay home with their kids. She wouldn't have been able to stay home when he was only substitute teaching or when he was still in school. They lived in small apartments to save up for their home. Now that he's got a full time teaching job, they are able to afford to live on his salary (though I don't know how they do it because I make the same salary and barely make ends meet. But I'm also terrible with money. Anyway...)

Is it really so bad to wait just a while longer? I'd tell them to give the wife's job search another year and then reassess their situation. If she finds a job with benefits, great! If not, THEN look at Medicaid.

Dragon Lady wrote:I'll address your comment to my question later, but as a followup to the next statement: B) You can utilize Medicaid to have a baby because it is EXPENSIVE. Without insurance, we're easily talking $10k plus if you go the normal route and use an OB and have a hospital birth. More if you also have an epidural and even more if you have a c-section. Even with insurance, we paid $2k+ for my pregnancy with Dragon Baby. That did not include an epidural or a c-section. Let me just say that we have NOT spent that much money on her since then and she's now 2 years old. And that's including a nice, brand new crib. Because, let's be honest, raising a child doesn't have to be as expensive as public opinion makes it out to be. (Neither does the birth, for that matter, but that's a totally different story.)

@Dragon Lady: I feel like I must have mis-expressed myself somewhere. I hope I haven't been conveying any thoughts about post-delivery care. Rather, all of my comments have been aimed at use of Medicaid for pregnancy and delivery. I agree that the biggest cost in having a child is the initial outlay for the pregnancy and birth.

At one point I did mention "putting off children until you are able to financially support them" but that is in the context of paying for the birth. Indeed, that's the point I am agreeing with above - having a baby is a HUGE financial cost. If you can't pay for the insurance to cover the birth, in my view, you can't support a child financially. Some families may be able to care for children post-birth, but are unable to cover the labor and delivery expenses. I think that is still relevant for the Medicaid discussion.

My later parenthetical comment about food stamps and WIC is meant to be a tangential comment stating that while I am not addressing post-delivery care, there's number of people who use medicaid who will also utilize those programs and that it would be fair to critique those programs on similar grounds.

Finally, a new point that does extend into the post-delivery care are the follow-up doctor visits for the newborn. I know that the majority of the students with kids use medicaid to cover those follow up trips. Assuming that occurs more broadly, I don't think its fair to say that parents can't just afford the delivery and they're fine with the post-birth care. The insurance is a significant part of the post-delivery care that ought to be incorporated into a family's budget.

@Marduk: Fair point on revelation. Agreed.

For the environment and visceral reaction comment, am I correct in interpreting that as you saying something similar to this: The standards of the community in part define our moral opposition or acceptance to certain practices. Thus, we must assume any moral reaction to the acceptance of Medicaid will be influenced by that context.

Finally, I didn't understand this comment:

However, the time constraints put you practically out of school by the time that insurance would cover anything; else, its price barely beats (if it does) the cost of paying out of pocket.

Do you mind giving me an example so I can understand better? (I don't think it's a failure on your part, I think I'm just not getting the extension of inference of this.)


And for the love of everything holy, please don't let me become too long-winded or uneven about my responses that I begin to resemble previous posters who have been too ideological.

Imogen wrote:The thing in the question that stood out to me was this quote: "I am currently a first year medical student, my wife is still looking for work, and the loans are barely covering our needs."

If LOANS are barely covering their needs, maybe they should wait for the wife to find a job and get them on insurance, even if it means waiting longer than they want. They're already in debt and barely making it. Why make things worse right now?

Imogen: I like your overall point (surprise, because it matches mine). I did want to point out that in some states, having a child would actually make things BETTER for them then worse. Without a child, they may not qualify for food stamps or for WIC. But if she becomes pregnant, they may then qualify and receive a significant subsidy for their grocery bill each month. This is what I mean about perverse incentives. Not only do they not have to internalize the cost of the pregnancy and care, in some cases it is a net positive for them to impose expenses on others.

EDIT: To be clear, this is addressing Imogen's point directly and not meaning to extend any of my previous arguments out further.

Wired, let me just say that you haven't been particularly obtuse here, so I wouldn't worry too much about that. Second, I think it is awesome that you're starting up a political discussion here (which I've sorely missed) and people are willing to comment. I've been quite happy with the discussion thus far.

To clarify on my point; I just did a quick health insurance search online to get some price ideas. After discarding all those with a 10k or higher deductible (I'm just using 10k because that was one estimate given for birth, as we've pointed out, the price can easily get much higher) they run the gamut for anywhere around 150 per month for a 5k deductible to 400 per month for a 500 deductible. These plans also have 20-30% coinsurance, typically.

Most of these plans require you to wait a year plus before charging these kind of expenses to them; that, or require you to sign up for long term plans. So take the top end of that spectrum, $5000 deductible, leaving 5k left, they will pay 80% of that, so there's another 1k you have to pay, and 150 per month times twelve months is 1800. $7,800 is your bill for what would have originally been 10k. A savings, yes, but not a significant one. At the other end, we've got a $500 deductible, leaving 9,500 which 80% would be paid, leaving you with 1900. Add to that 2400 twelve months times 350, which is 4200, and that puts you at 6100. A lot better than the first one, but still a massive expense. This is what I mean by not being much better than simply bearing the costs. Also, depending on how it is calculated, when they split certain costs it can be even more expensive than my estimates. You could easily wind up paying more for having insurance than not having it.

We had our baby in Canada and didn't spend a dime on medical costs during the whole pregnancy--and still the only thing we pay for at her doctor visits are certain immunizations. But as I look around, I don't see a huge rush of Canadians having babies just because it's free. In fact, I jokingly told my wife that we should have another baby before we leave Canada, just so we could save money, and she was offended that I even proposed the idea.

I don't see adult, married reproduction as a vice that we ought to discourage, like smoking. What I was absolutely shocked at was that she's on her parents' medical insurance. I don't care if my kid marries an impoverished medical student, you're your own adult and family now! I'm honestly surprised that's even legal. Everything else you are considered part of your husband's household, from taxation to education to custody issues.

Actually, it's a part of the new healthcare reform. All children under the age of 26, married or not, are by law allowed on their parent's insurance. At some companys, such as my dad's, they are actually requiring the information of these children so that they can be insured.

Portia wrote:I don't see adult, married reproduction as a vice that we ought to discourage, like smoking.

Can't respond to all of the other comments (school has started to get VERY busy) I just want to say there's a difference between discouraging behavior through taxes, criminal penalties, etc. and encouraging behavior through subsidies. I am saying we shouldn't subsidize having children by paying for procedures and awarding money in other areas.