Medicare as means of coercion: as long as I pay your bills, you will obey my rules!

How many people’s parents used to say something equivalent to this:

“As long as you live under my roof, you will obey my rules!”

For those whose parents supported them while they studied in another city, this might be a more familiar version of the expression:

“As long as I pay your bills, you will do as I say!”

It is a rather reasonable expression of the parents’ role: as long as their son or daughter lives under the parents’ roof or as long as the parents are financially responsible (even partially) for the offspring, that offspring (whether chronologically an adult or not) is not truly emancipated.   As long as one is a dependent, one cannot expect to have their independence!

OK – so what if the adult child’s medical costs (say a University or College student) are covered by the parent: would that parent would be within their rights to insist that their son or daughter (adult or not) not indulge in, say, ultimate fighting?

After all, we know that some activities are,  statistically speaking, much more likely to result in higher medical bills than others. So, if someone else is paying a person’s medical bill, that someone else would be justified in putting in some limits on dangerous behaviour.


So, what about a situation where a group of friends get together to purchase a medical insurance in order to get a ‘group rate’? It is inevitable that not every member of the group will necessarily have a slightly different ‘benefit’ at any given point in time – and most will accept that going into the deal. But…

What if one of these people – let’s call him ‘Bill’ (pun intended) – takes up the hobby of getting a little tipsy and, on a dare, nailing his hand to ‘stuff’. Whenever he does it, Bill gets rushed to a hospital, his hand has to be surgically separated from whatever he had nailed it to this time, Bill then has to get shots… You get the picture. Bill incurs a sizeable bill.

And he does it again.  And again.  And everyone’s group-insurance costs go up!

In this situation, do Bill’s friends have the right to tell him to stop nailing his hand to stuff?

Do they have the right to force him to stop?

The next time he does it, do they have the right to tell him that he is not allowed to use their group insurance to cover the cost of the medical treatment?

Perhaps we can agree that this particular Bill is an idiot. But – where exactly does his right to be an idiot stop and the rights of his friends not to have Bill’s idiocy ruin them financially begin?

Obviously, I picked an extreme example. So, let’s pick another one…

What if, instead of nailing his hand to stuff, Bill chose to get piercings?  It’s sort of similar – just a bit more socially acceptable.  And, what if Bill’s piercings got infected, he needed to be hospitalized, and all that.

And then he got another piercing.

And another.

And they kept on getting infected or having other complications, and Bill’s friend’s medical insurance rates kept rising and rising… Would they have the right to tell him to stop getting any more piercings? Or do they have the right to tell him that any future piercing-related costs will not be covered by the common insurance plan?

All right – what if Bill did stop getting piercings… but one of his existing rings gets caught on something, tears the skin, and Bill has to go to the hospital again. It’s the piercings which are causing the cost to go up – again! Should the group insurance cover it?

And what about if Bill were not an idiot – but his friends were. What if they thought that regular exercise and a good diet was bad for you, because they heard about a lot of athletes getting arthritis? What if these friends believed (truly and honestly) that regular exercise was an unreasonably high-risk behaviour, much like nailing one’s hand to stuff would be. And, what if Bill liked to do yoga – and he pulled something that required medical help…a few times?

Who gets to decide who is ‘the idiot’ and who is ‘reasonable’?

Or what if Bill were a Billie – and she had 16 kids, while nobody else in the group had more than 2: should her choices in fertility affect her friends’ medical rates?

Should only her first 2 births be covered by the group’s insurance?

Or should the whole group be responsible for paying for Billie’s hospital bills if she got into an accident because she was speeding? What about the bills of her 16 kids, who were in the vehicle, too?

Who gets to decide?

Before, or after the treatment?

Would any of your answers change if, instead of choosing to enter into this group insurance arrangement, all the friends were forced into it by law, with no means of opting out? You know, like all Canadians are?

These are not easy answers: I certainly don’t know where the balance lies. All I am trying to do is to make sure that people understand that the ‘benefits’ of being ‘one of a group’ come with the cost of allowing the group some control over one’s behaviour. There is no such thing as a ‘free lunch’ – or a free ‘medical care’!

Someone always has to bear the costs: and the one who bears the costs will want to have a say in how you behave (and incur the cost)!

In the UK, this is the reality: people ARE being denied medical treatment because they are deemed to have too high a body-mass-index (which actually penalizes muscular people, as muscle is heavier than fat), as are smokers or dare to get old. Their treatment them just does not seem cost-effective or fair to the rest of society that has to pay for it….

And, with my own eyes, the last time I went to renew one of my kids’ health cards at the Ontario Ministry of Health office (it is downtown – nearest public parking is about a 10-minute walk from the office), I actually saw a guy there, with a broken leg….trying to get some problem with his health-card straightened out, because the people at the hospital’s emergency room refused to treat him until the problem was straightened out. He offered to pay – but the law forbids the hospital to let him pay first and get reimbursed later…as it forbids the hospital to set one’s broken leg (or provide any treatment – even a triage assessment) until one has a working health card.

Think about it.