grabbing what you can, because you can.

Verizon now carries the iPhone.  Unlike AT&T, they offer unlimited data plans, but there’s a bit of a catch.  If you’re among their top 5% of data users, they reserve the right to throttle your bandwidth for the rest of your billing period (presumably after you’ve reached a certain data download threshold.)

This is an interesting question for those who favor equal access at equal cost for services like healthcare.  If Customer A and Customer B both pay for the “unlimited” data plan, and Customer B uses ten times as much bandwidth as Customer A, is it fair to impose such a limitation on Customer B to make sure Customer A gets his share of the bandwidth?  Conversely, is it fair to Customer A to be paying exactly what Customer B is paying, while only using a tenth of the resources?  Whose interests have precedence here—Customer A’s right to get his fair share of the resources, or Customer B’s right to use the promised “unlimited” data as he sees fit?

Now, Verizon is a private business, and they can set whatever terms they want.  Customers have the choice to either purchase data plans from them, or go to the competition.  Think about your answers to the questions above.  What if it wasn’t a private company, but a public service, bankrolled by tax money?  Is your answer the same?

When you’re talking about stuff like universal health care, you have to sooner or later acknowledge the problem of unequal use of resources.  If we all pay into the tax pot to the same proportional degree, what is to be done about those 5% of users who use a hugely disproportionate slice of the services?  Some may need them, some may just use them because “I ‘m paying for it, and I want to get my money’s worth out of it.”  When you remove the financial penalty associated with frivolous excessive use of a public resource, then there’s no incentive to limit the use of that resource.

A public system of services doesn’t mean you magically have an unlimited supply of a commodity.  Public and private entities alike have to deal with excessive consumption.  In both systems, you have to ultimately put someone in charge to decide what’s excessive and what isn’t, and come up with disincentives for the “getting my money’s worth” customers.  What you’re doing in both cases is rationing the (limited) supply of bandwidth/MRIs/whatever. 

That’s the snag you hit when you look at a finite and limited resource like health care, and you want to put together a system that dispenses that resource equally and fairly.  I dislike the anecdote-driven arguments from the pro-universal health care folks who share stories of people dying because they couldn’t afford to go see a doctor, but who hardly ever acknowledge that yes, even with universal health care, you have to have a pencil pusher deciding who gets that MRI or cancer treatment first…or whether you need it at all.

15 thoughts on “grabbing what you can, because you can.

  1. Ed Skinner says:

    When emusic.com first started, they advertised “unlimited downloads.” Having a fat pipe, I signed up and began downloading, and downloading, and downloading. Before long, I had about 6 Gig of mp3s.
    One day, however, I received an email from them saying they were cutting me off because I was downloading so much.
    I called their customer service department and objected, “But you said unlimited downloads.”
    They replied, “Well, we didn’t mean *that* unlimited!”

  2. Al Terego says:

    The cell service isn’t unlimited; that’s just a marketing blurb. It’s a package with limits set on the curve. Pretty good plan, if mildly deceptive…enough “product” for 95% of customers with a built-in recognition that actual unlimited consumption by the 5% – whether by need or by greed – would be at the expense of the rest, ultimately hurting profit, reducing incentive, and killing the business.

    It’s the same for health care; you either pay to play, or someone else pays for you. Pooling resources, whether by choice (private health insurance), or by force (tax funded services), has merit. But the former has preset spending limits, and so will the latter, whether self-imposed or market-imposed.

    Nothing is unlimited because nothing is free.; if we want to turn the most advanced medical care and research system in the world into a “finite and limited resource” for real, let’s just ignore that simple truth and see what happens.

    AT

  3. Katrina says:

    Being a resident of a place that has universal healthcare, I’ll point out that in my -admittedly anecdotal- experience, I have never heard the phrase “I think I’ll go to the doctor today because I’ve already paid for it”.

    On the flip side, when I need care, I’ve tended to get it, in very reasonable timeframes, and appreciate it, and not worry about going bankrupt because of it.

    • Marko Kloos says:

      I grew up in a country with universal healthcare, and while my experience in the 1980s and 1990s mirrors yours, it has gotten much worse since I moved out of the country (in the mid-1990s.)

      When my grandmother collapsed in her kitchen and couldn’t move, they carted her to the hospital. She didn’t see a doctor for two days because she had been brought in on a Saturday–the admissions staff had determined her condition “not immediately life-threatening”, which according to new cost-saving rules meant no weekend exams by doctors. That’s just one example–anecdotal, for sure–but I hear stories like that quite frequently from my friends and family, which is a good indicator that it’s not all roses and sunshine in Universal Healthcare Land.

      Then I read stuff like this about Canada:

      http://www.city-journal.org/html/17_3_canadian_healthcare.html

      It’s kind of worrisome that the Canadian system basically forces everyone into the public system, and that you’re not even *allowed* to go private to speed up treatment.

      Is there a perfect solution? Nope. Is the American system as bad as non-Americans think it is? As someone who has needed medical care on both sides of the universal health care fence, I have to say that I’ve received better and faster treatment in the U.S. than in my old country. More out-of-pocket expenses, and higher health care premiums, sure…but I’ve never had fear of going bankrupt because of medical issues. If you have a job that’s anything but part-time burger flipper, you have access to health insurance here.

      (A lot of non-Americans–and even a lot of U.S. citizens–tend to forget that we already have socialized medicine for the elderly and the poor. It’s called Medicare and Medicaid, and we’re currently spending 40% of our budget on it. And the way those programs are run, I have zero confidence in the public sector’s ability to do better than the private sector when it comes to efficiency, compassion, and cost control.)

      • TimP says:

        Yep, here in Australia with “free” health care and access to private health care if you’d prefer most people who have the option choose private because of the [preception of] better quality and the shorter waiting lists.

        See http://www.aph.gov.au/library/pubs/bn/2007-08/Hospital_waiting_lists.htm for the government statistics on “elective surgery”* wait times. A couple of key quotes:
        “Nationally the AIHW reported that the median waiting time in 2005–06 was 32 days, that is, 50 per cent of all patients waiting for elective surgery were seen in this time. This was slightly longer than in previous reporting periods—in 2001–02 the median waiting time was 27 days. Median waiting times varied across jurisdictions (see figure below); Queensland reported the lowest median time waited (25 days) and the ACT reported the highest (61 days). In 2005–06, 90 per cent of all patients were seen within 237 days, slightly longer than in 2001–02 (when it took 203 days). The proportion of patients waiting longer than a year for their surgery was 4.6 per cent, but this varied across jurisdictions; in Queensland just 2.1 per cent of patients waited more than a year, while in the ACT this figure was 10.3 per cent.”

        “According to the AIHW, the procedure with the lowest median waiting time in 2005–06 was coronary artery bypass graft (15 days); the procedure with the longest wait time was total knee replacement (178 days). There were also variations in waiting times for these procedures across jurisdictions; Queensland patients waited a median time of 41 days for cataract surgery, while those in Tasmania waited a median time of 389 days.”

        Also some patients where removed from the waiting lists “because they were not contactable or had died (1.5 per cent), or because they became emergency admissions (0.9 per cent).” which means that up to 9,000 people (I’m not sure the ration of just “uncontactable” and dead, but it’s probably at least a third dying) are dying each year and an additional 6,000 are having severe complications due to the length of the waiting periods which can be compared to supposed “45,000” people who apparently die each year in the US due to lack of health care. Since the US has 15 times the population of Australia that’s equivalent to 45,000-135,000 deaths and 90,000 serious complications due to waiting times.

        * “[Elective surgery] is surgery that a doctor or health professional believes to be clinically necessary, but which can be delayed for at least 24 hours. Much elective surgery, for example, coronary bypass surgery is therefore important to maintain health and well-being. In contrast, emergency surgery, for example, for critical cases such as a car accident, poisoning or heart attack, is undertaken when the patient’s life or physical integrity is in immediate danger.”

    • perlhaqr says:

      Well, maybe y’all just have better people than we do over here, (possible, there are guaranteed to be cultural differences between countries), or possibly you’re isolated from the sorts of people who say such things (different cultures even locally), but in my admittedly extremely short time working in the American health care industry (doing my time interning working on my EMT-Intermediate license), well… I’ve seen a fair share of “I have a right to be seen” already. People who check in at the ER for a pregnancy test because they won’t spend the $5 themselves at the drugstore to buy their own, at a cost of, oh, thousands of dollars of taxpayer money. (And a serious delay in life, they get put at the absolute tail end of the queue, I’d figure even the most impoverished wretch has better things to do with their time than sit in the ER waiting room for 36 hours to avoid spending $5… and yes, while I understand that there are desperately poor people in the world, my empathy plummets sharply when I see them chatting on a mobile that’s nicer than mine. Yes, I’m aware that this is not a good career-attitude path for someone who hasn’t even made it out of school yet, I’m working on it.)

      But, well, this is still more anecdotes. *shrug*

      • KD5NRH says:

        $5? The local Dollar Tree almost always has a few on the shelf for $1. Maybe ERs should find some surplus deals like that and keep them behind the admissions desk.

        “You can sit over there in that uncomfortable chair until we’re bored enough to deal with you, or you can pay $1 and go away now.”

  4. farmist says:

    Here in the good ol USofA, in 2001, my wait for elective cardiac bypass surgery was much closer to 15 hours than 15 days.

  5. Mike Dodson says:

    So-called “public utilities” (gas, water, sewer, electric, etc.) are often run by non-governmental organizations (NGO’s). The rate plans, not shared unless requested, gives higher end users a rate break based on high usage. For example, my electric company charges 10.8 cents/kWh for under 2000 kWh/month for a residential plan. An industrial plan, for over 2000 kWh up to 10000 kWh/month, is charged only 6.9 cents/kWh. The rates are proposed by the company and approved by the public utilities commission (or whatever they’re called in your state).

    Your question about whether this is “fair” or not doesn’t make a lot of sense to me. How do you determine what is fair and what is not. These types of rate plans have been challenged in court many times and have always been upheld. It’s kinda like, “The Universe is what the Universe is.”

    From an “equity” point of view, I don’t believe I’m receiving all of my moneysworth, and that I’m underwriting the industrial use of the commodity. Until someone convinces their public utility commission to change rate plans, or for someone to win a case in court, it will remain (in my view) inequitable.

    JMO, ICBW.

  6. abnormalist says:

    See, this is where I really like the idea of socialism, from each as their abilities, to each as their needs. Sadly that never really works outside a family.

    The new system in America I think actually has some real promise, and addresses some of your concerns, since insurance remains private, you will continue to have varying levels of service, coverage, out of pocket costs, etc.

    I like the idea of universal health care mainly for when I have to switch employers, and lose my existing coverage until I’m covered by the next one. One of those jumps came four weeks after the birth of my oldest daughter. I had both mama and baby in good health and good shape, but it was an expensive month while we waited for health care to kick in at the new job.

    • LittleRed1 says:

      You don’t have to have employer-provided insurance. I have a self-paid plan and have had it for over 10 years now. It goes with me as I ‘ve moved across country. It is not inexpensive, but I’ve kept it because 1) most employers in my field(s) don’t provide insurance and 2) the new tax codes, if enacted, will make your employer-provided benefits part of your overall taxable income. I pay up front for all my medical exams (some of which I can take as a business expense) and save up for things like eye-glasses and vaccinations. I prefer this to an employer-provided package, because I don’t have to worry about losing my coverage when my employer says “our budget got cut. Good luck with the job search.”

      • abnormalist says:

        Honestly, until I had a wife and kids, (for some reason the addition of the wife, and the addition of kids to my life were only about 13 month apart, but hey it bests 6 months right?🙂 ) I never gave a second thought to health insurance and health care.

        I was early 20s, employed in IT, and in great shape. Once I got married, and she got pregnant, it quickly rose to near the top of my list of concerns.

        In my experience, the larger the business you work for, the better the health coverage. I’m currently working for the largest place I ever have, and am enjoying the 2nd best health insurance from my employer. Best was at a non profit, but they pay stank.

        littlered1 Do you have children? I only ask because of how drastically that event changed my outlook on insurance.

        • LittleRed1 says:

          No kids at Festung Kleinrot: I’ve been cautioned against trying to have any and adoption isn’t really an option just now. I certainly understand how insurance becomes a lot more important when you have children. I think the company I get my insurance from has pediatric policies, but I’ve never looked into the costs and benefits available.

  7. og says:

    Having a Canadian wife, and having been a recipient victim of Canadian healthcare myself, I can tell you, it’s not worth the paper they print the money on.

    Sure, you can go to the doctor practically for free every time you have a hangnail and a fart crosswise. If you have anything more serious, it’s a crapshoot. Plus, the entire country has the population of the New York metro area.

    The healthcare system in this country has some serious issues. Making it suck for everyone but the ruling elite is not the solution to any of those issues.

  8. TBeck says:

    I prefer ATT’s method; if I exceed my bandwidth limit I get charged a fixed amount for another gigabyte. I pay for what I use and everybody agrees up front to the plan.

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