Want To Help The Uninsured? Just Give Them Insurance Already!
In my prior post on why I though the current health reform bill would fail to help most people, SteveK linked to a study by the Kaiser Family Foundation with an outrageous claim:
Myth 10: Expanding health insurance coverage to all, or even a large share of the uninsured, will cost far more than the country currently spends on health care.
FACT: Because both the uninsured and government subsidies pay for a good share of their health care costs already, the amount of additional health spending to cover all of the uninsured is relatively small.
Most proposals to expand health insurance do not account for the tax dollars currently being used for the care of the uninsured.
Assuming their health care use would increase once the uninsured gained coverage, that the uninsured would continue to pay for a share of their care, and that current tax dollars could be fully redirected towards insurance — the additional health care spending to cover ALL of the uninsured in 2004 has been estimated to be $48 billion. However, this does not include any administrative costs associated with reforming the system. These new dollars represent only a 3% increase in personal health care spending (which totaled $1.4 trillion in 2003).
This sounds like blasphemy, but I think it’s completely accurate. In fact I’m glad he saved me time, because I was going to write a post that argued precisely this. The conclusion is simple: we just need to give people insurance to those that don’t have it.
OK obviously it’s not that simple, because then it gets into questions about fairness and the like, but the points still stands that the uninsured problem is relatively easy to fix and would have extremely marginal costs once you take into account the money that will be saved by people acting differently since they have insurance.
Even though the currently proposed health care reform is projected to help only a fraction of the uninsured (if at all, the Senate bill may not), that is the main reason people are arguing for it. I’d really like to see proponents explain why the CBO is wrong in their projections instead of just touting the talking point about how bad it is that tens of millions of people are uninsured.
No, the current bill isn’t a bill to help the uninsured, and even if we did cover all of them, that wouldn’t solve the health care crisis. The corollary to the statement above (and the conclusion of my prior post) is that health care inflation is the primary threat, and that will only grow bigger. This is something that the current bill does nothing to solve (again according to the official analyses) and therefore isn’t true reform. We have to be honest: it’s more of a bandaid to keep people from revolting for a few more years. You can argue that it is a noble goal in order for us to come up with a reasonable solution later (just like you can for the economic stimulus and financial bailout that didn’t fix any of the root problems — of which I could slap down twenty graphs and quotes from top officials to show we haven’t made any long term progress) but it’s not being sold that way at all.
I hate to sound like a broken record, but regulatory reform, covering the uninsured and tackling long term price inflation are three separate (although overlapping) issues that I’d like to see tackled independently. That will never happen of course, but the current way is just leading to a squandering of opportunity.
11 Responses to “Want To Help The Uninsured? Just Give Them Insurance Already!”
The thing is that even if the opportunity is squandered, it doesn't mean any reform that doesn't worsen the problem or provides little bang for the buck is worth fighting for.
It's like with cap-and-trade: It's nothing that makes anyone do the running man out of joy, but no bill would be worse because a) the side opposing reform is partially made up of people who in good faith want something better or nothing, but also people who – for various reasons – want nothing to happen and would get energized if they succeeded. This leads into -
b) Waiting to even take the first step will only make the problem more costly and without a first step the inertia will be just as prominent because now the actual solution is not only more sorely needed, it will also be costlier. This will decrease the chances of a finely tuned and therefore cheap bill, and this will augment issue a) and I think people can see where this goes.
c) the party of the people who oppose both these reforms is *at best* no better than the other party when it comes to providing decent, reality-based solutions to the matters at hand.
Flawed now or plain bad much later. The current GOP in a majority would not provide a good soil for even flawed health-care or energy bills. After the GOP picks up a few seats in the midterms they're going to blather even more about what the “real, center-right America” wants and how their closing the gap means they have a mandate. If health-care reform fails, then reform will be taking the backseat for longer still.
I dunno, they say don't let the perfect be the enemy of the good and I agree with your points in theory. But…
I think politically speaking, people in general (and our country in particular) just veers wildly when something isn't working. If they pass this plan and it plays out the way that it's projected, then what do you think the chances of getting something that does cover the uninsured or has some government role in tamping down costs are?
I believe that you have to look at opportunity cost when determining whether something is worth it. The cap and trade bill costs money, won't have a real impact on the climate and gives a decade of cover for us to say that we're doing something.
To me that is “worsening the problem.”
Ditto this if the projections are correct. I'd rather that they have a bill that simply brings individual insurance up to HIPAA standards and allows for nonprofit insurance cooperatives that can operate across state borders (two things which the Republicans supposedly support I believe) and leave out the rest because they would have an immediate and noticeable impact.
Similarly, they should pass a bill that rewards companies that make things more efficient as the first step to cutting costs. They could even tie it in with receiving government money: the uninsured would be made apart of some government covered program initially, but if a company meets certain coverage and operational efficiency standards then they will enroll an amount of people in their program that scales the better the coverage/cost ratio is.
In general I feel like if a problem is too big to tackle all at once the “right way” (whether because of inertia or just because it's unclear what the right way is) then instead of having piecemeal and flawed reforms, there should be very targeted reforms that aim to help solve a particular subset of the problem.
Mikkel, Though your conclusion appears simple, stopping there would IMO solve nothing while allowing big pharma, big health care, and big health insurance to continue to rake in obscene profits while still allowing middle class consumers to lose everything and forced into bankruptcy when major medical crisis strikes and they run out of money… lose a job… or become unable to work.
The Kaiser Family Foundation report “Ten Myths about the Uninsured” was about TEN MYTHS… not one. Without looking at all ten of them together the point the report can easily be lost or misrepresented.
Individual parts of the report may seem to support compromised solutions but when you look at all of them together it’s easy to see just how nonproductive and unmanageable compromised solutions would be.
As many may not be able (or desire) to open Mikkel's link here are the Ten Myths and facts debunking them are:
Myth 2: Most of the uninsured do not have health insurance because they are not working and so don’t have access to health benefits through an employer.
FACT: Most of the uninsured are either working full-time or have someone in their immediate family who does — the problem is that the majority of the uninsured are not offered benefits through their employers.
Myth 3: Most of the growth in the uninsured has been among those with higher incomes.
FACT: The majority of the growth in the uninsured since 2000 has been among people earning less than $38,000 a year for a family of four (commonly considered low-income).
Myth 4: Most of the uninsured are new immigrants who are not U.S. citizens.
FACT: The large majority of the uninsured (79%) are American citizens.
Myth 5: The uninsured often receive health services for free or at reduced charge.
FACT: Free or even discounted health services are not common and when the uninsured are unable to pay the full costs, the unpaid medical bills add to their providers’ costs.
Myth 6: The uninsured can get the care they need when they really need it and are able to avoid serious health problems.
FACT: The uninsured are more likely to postpone and forgo care with serious consequences that increase their chances of preventable health problems, disability, and premature death.
Myth 7: Buying health insurance coverage on your own is always an option.
FACT: Individually purchased policies — vs. job-based group policies with similar benefits — are more expensive and coverage can be limited or even denied to persons in less than good health.
Myth 8: We don’t really know how large the uninsured problem is and many are only uninsured for brief periods.
FACT: Depending on whether we count the number of people who are uninsured during a specific month, for an entire year, or just for short periods, the numbers will differ; and all measures are useful.
Myth 9: The health care the uninsured receive, but do not pay for, results in higher insurance premiums.
FACT: The large majority of uncompensated care is subsidized through a mix of federal and state government dollars not cost-shifts to private payers.
Myth 10: Expanding health insurance coverage to all, or even a large share of the uninsured, will cost far more than the country currently spends on health care.
FACT: Because both the uninsured and government subsidies pay for a good share of their health care costs already, the amount of additional health spending to cover all of the uninsured is relatively small.
Open Mikkel's link to see the details.
Steve, I thought I made it clear that besides being slightly tongue in cheek about how easy it would be to give people it even if we wanted to, that I didn't believe it was the root cause of the health crisis. I think it is extremely perverse about how many people are in peril because of not having insurance (not to mention certain hospitals that serve those demographics more) and that myth 10 is entirely true, then it would be a good first step to address that while figuring out how to tackle the far more damaging and long term problems.
Similarly, it's been stated that there is enough consensus to get individual plans to be regulated more like HIPAA, even if it means allowing individuals to join collectives.
My prior post was an argument that it will do little to address those problems and not help many uninsured.
You did make it clear Mikkel, my comment was not directed at you or in opposition to your post. I just wanting to emphasis the importance of the Kaiser “Ten Myth” report in it's entirety. It's my belief that anything short of major, MAJOR health care reform will ONLY reinforce the status quo… protect big business… and create more (not less) burden on middle America.
off topic – it sure would be nice if disqus allowed <underline> as it would be nice to have something stronger than italic but not as in your face as bold that we could use for emphasis.
Alright. I do really appreciate the report and it's a shame that it's not being cited to the hills.
Does this underline work?
Yesit worked just fine… Maybe it was strikethrough < s > < / s > and < strike > < / strike > that gave me trouble in the past. I dare not try them now… once was quite enough
THANKS
Obsidian Wings points out how little the current system does for entire classes of people.
Mikkel–
You've been making reference to the number of people who would be covered by this. I wonder if you could point me to your source.
I've read some widely divergent numbers over the last few months, none of which has had very dependable sourcing.
I'm not saying you're wrong or complaining or anything like that. And if you've already made it clear, sorry to have missed it. I just want to know what the numbers are.
If it's in that PDF from the KFF, could you tell me which page it's on?
Thanks.
The number is referred to in the links I had in the previous post that it came from the congressional budget office…but I went to the site and looked for myself. Apparently if they expand Medicaid then it may cover 15-20 million people and cut it in half. If they don't then it [the House bill, not the Senate] will cover about 10 million and leave 33 million uninsured. According to the PNHP site, the Senate bill won't increase any. It should be noted that the $600 billion to $1 trillion doesn't cover the Medicaid increase.
To me the cbo is the most authoritative source, but I'd be open to reading objections if there are any (I haven't seen them).
Thanks. I guess this is the relevant passage:
I presume the difficulty finding numbers comes from the fact that there is no solid bill yet, only proposals?