Morally hazardrous

Health care is the topic of the day.  People seem to agree that 46 million people don't have any at all.  People also tend to forget that having health insurance is not necessarily protection against going into bankruptcy.  For that matter, having health insurance for many does not entail they will get better care than those without, or any care at all.  It is generally agreed, however, that Americans spend more and get less per dollar than their counterparts in other developed nations.  That doesn't worry Robert Samuelson, however.  Nor does he bother to mention that astounding fact.  He writes:

How much healthier today's uninsured would be with that coverage is unclear. They already receive health care — $116 billion worth in 2008, estimates Families USA, an advocacy group. Some is paid by the uninsured themselves (37 percent), some by government and charities (26 percent). The remaining "uncompensated care" is either absorbed by doctors and hospitals or shifted to higher private insurance premiums. Some uninsured would benefit from coverage, but others wouldn't. Either they're healthy (40 percent are between ages 18 and 34) or would get ineffective care

The claim–how much healthier would the uninsured be–is quickly replaced by financial observations on how much care they do receive and who pays (and, oddly, whether this care would be any good).  That, I think, is misleading.  Certainly, uninsured teenagers who never have accidents and don't get sick wouldn't benefit at all from health care, but we're not talking about health care, we're talking about health insurance.  Not having health insurance is different from not having access to health care.  Most Americans, as John Stossel once pointed out (see "Is America Still Number One?"–the answer, would you believe it, was "yes"), have access to the best health care in the world (!!!).  Too bad, however, the question regarded whether they or anyone could pay for it.  To that, the answer is "obviously not."   

Aside from the red-herring like shift in topics, Samuelson abuses the quantifier "some."  Indeed, some–those who don't get hurt–would not benefit from coverage.  For the past three years I was one who benefited not from coverage.  Yet about a week ago, fate had it that I would begin to need to benefit.  You never really know when that will be.  A friend of mine in graduate school was young, healthy and uninsured.  A headache one day cost him 25,000 dollars.  

12 thoughts on “Morally hazardrous”

  1. Even with student insurance from the institution, one often faces something like a $5,000.00 deductible. And even then there is no guarantee that it will actually cover everything.

    I simply gave up on student insurance when I was a grad, and relied exclusively on VA, a position I find myself in once again quite w/o any choice in the matter.

  2. Yes, the school offered “insurance” that was worse than none at all.  It covered only catastrophic stuff (which for grad students is pretty unlikely) and then with a monster deductible and then massive out-of-pocket costs–like you pay 20 percent of anything above a certain amount.  In the end, you pay tons if you end up in the hospital.  And of course it didn’t pay for doctor visits (or anything else), which, if you don’t have insurance, can cost a fortune (especially when your stipend is 7000.00 per year).

  3. If he was poor, wasn’t he eligible for Medicaid?
    My point is that the 46 millions uninsured is a little misleading too. I think that number includes 14 millions that are already eligible for Medicaid or SCHIP, 12 millions illegal immigrants and some few other millions who can afford it but don’t want to buy medical insurance.
    So, I agree with you: “Americans spend more and get less per dollar than their counterparts in other developed nations. “  The real question is why and how are we fixing this. I think Robert starts on the right track, but then derails in the stupid argument that you already highlighted.

    Both of those questions are way over my head.  Samuelson seems to have an answer to why, and he suggests that the Health care Reform will not address the root cause:
    “The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services — and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole. That’s the crux of the health-care dilemma, and Obama hasn’t confronted it

  4. Medicaid eligibility is extremely limited, and is somewhat at the choice of the state. The basic criteria are:

    –Pregnant Women
    –Children and Teenagers
    –Person who is Aged, Blind, and/or Disabled
    –Other Situations

    “Other” is described thusly: Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under age 18 and have limited income and resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under age 18 or over age 65, blind, or disabled).

    So if you’re single, seeing, not-pregnant &/or between the ages of 18 and 65, you do not fall within the basic requirements. Again individual states can exercise a measure of additional latitude.

    http://www.cms.hhs.gov/MedicaidEligibility/02_AreYouEligible_.asp#TopOfPage

  5. Gary,

    I don’t know if those are more guidelines rather than the rules: “In general, you should apply for Medicaid if you have limited income and resources.  You must match one of the descriptions below. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)

    Anyway, the government needs first to fix its messed up programs before it creates a new one. Stories like the one in New York Post: NY Medicaid Mess are becoming more common.

  6. Not especially logical or even relevant, but “I don’t know if those are more guidelines rather than the rules”: Geoffrey Rush moment; time to put Pirates of the Carribean in the DVD player …

  7. Student insurence often isn’t worth the paper the policy is written on.  A friend of mine, now deceased, was a film student at NYU a few years ago.  When she was a child she had a heart condition which the doctors said was cured.   In her late 20’s she suffered a stroke.   Insurance said no way, pre-existing condition.  Too bad, so sad.  She got medicare so the tax payers got to subsidize the insurance company’s profits.  I wonder what the insurance company’s nexecutives’ bonuses were that year?

  8. If he was poor, wasn’t he eligible for Medicaid?

    Because Medicaid *sucks*.

    It barely pays providers cost (if that), and SAGA is even worse. If you think those are bad, check out Charter Oak Health Plan insurance in Connecticut, which is state run (but horribly kneecapped by an insurance industry which demands failure from any state run system to justify its existence).

    Doctors don’t like taking Medicaid, they dislike SAGA, and in Connecticut, you’d be lucky to find two or three doctors in the state for any specialty who accept Charter Oak Health Plan.

    I guess you can look at it one of two ways, the capital oriented way (traditional capitalism) or the person oriented way (traditional socialism). Capitalism dictates that he with the money gets the goods, and screw you if you can’t pay for it. More or less a form of financial Darwinism. Socialism dictates that we have a social obligation to everyone, and those that make the most money (usually by exploiting cheap labor, ie, off the backs of poorer people) put in the most to support it.

    We socialize essential services because they are, indeed, essential services. Our transportation services, fire and police services, and other services which we deem too important to require “pay per diem” costs, are all socialized. Paul Elrich in “The Population Bomb” postulated that every person had the right to health care, regardless of income or social standing, and I’m inclined to agree with him.

    Besides, privatization of essential services *never* decreases their cost. The only fiscal arguments I hear for private insurance are “Medicare wastes money with fraudulent cases” (which is a crock of crap, since its costs are *still* lower than private insurance which denies people who are indeed eligible) and “Government is inefficient” (which is silly, since the profit required for competition in the marketplace pushes any private costs far higher).

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