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July 13, 2009
Who Isn't Covered?
Here's an interesting paragraph from a Mark Steyn piece in the current print edition of National Review:
There have been two trends in U.S. health care over the last decade. On one hand, a lot of Americans have become, by any rational standard, overinsured: They get tested for things they'll never get. On the other, there has been an abandonment of health insurance by the rich. If you peel the Census Bureau and DHHS figures, of those alleged "45 million uninsured Americans," one-fifth aren't Americans; another fifth aren't uninsured but are covered by Medicare; another two-fifths are the young and mobile (they don't have health insurance, but they don't have life insurance or home insurance, either — they're 22 and immortal and life's a party); and the remaining fifth are wealthier than the insured population. Really. According to a 2006 Census Bureau report, 19 percent of the uninsured have household income of over $75,000. Since the last round of government "reform" in the Nineties, wealthy Americans have been fleeing insurance and opting to bring health care back to being a normal market transaction. And if you look at the "uninsured discount" offered by doctors, one can appreciate that, for everything but chronic disability, it's not an irrational decision to say I'll get a better deal on my broken leg or my colonoscopy or my heavy cold if I just write a check for it.
That last fifth points in the direction that we ought to head: insurance for catastrophe, and a pay-as-you-go system for regular care. No employer involvement. No broad-based "public option," except to assist those who cannot afford catastrophic coverage.
The entire structure of the industry would change. Consider, for example, that the majority of procedures and expenses would no longer be tied to negotiated pools, because the emphasis would no longer be on distributing risk for the great bulk of procedures. Those with preexisting conditions would have less fear of losing their coverage, because their conditions would be partly what the catastrophic coverage is for (and independent from unrelated aspects of life, such as employment) and partly under the umbrella of regular care.
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Interesting stats. It seems that they totally ignore the large number of people who are uninsured because premiums are too expensive or because they cannot get coverage due to pre-existing conditions.
In my experience working in the health care industry for 20 years, the vast majority of people fall into this category. It isn't even necessary to have a medical condition to be excluded from coverage by carriers. In many states, it is virtually impossible for a healthy woman of childbearing years to get an individual health insurance plan AT ANY COST - EVEN a plan that excludes maternity coverage.
And, yes, insurers are indeed allowed to exclude maternity coverage in quite a few states.
Before Republicans go and talk about market-driven solutions, someone needs to explain why the states in which Republicans have held power are exactly the same states where insurers are allowed to exclude pre-existing conditions, refuse coverage outright, and limit coverage to the point where even the insured risk bankruptcy if they get sick.
Texas, Louisiana, Mississippi, etc. are some of the worst examples of these issues.
Posted by: Ken M at July 13, 2009 5:47 PM"In many states, it is virtually impossible for a healthy woman of childbearing years to get an individual health insurance plan AT ANY COST - EVEN a plan that excludes maternity coverage."
Do you have a link, Ken?
"It seems that they totally ignore the large number of people who are uninsured because premiums are too expensive or because they cannot get coverage due to pre-existing conditions."
Really? Steyn's breakdown seems pretty comprehensive. Do you have an estimate on how many people that is?
Posted by: Monique at July 13, 2009 9:46 PMOn the bigger picture, Ken, what puzzles me is why we need to destroy our current health care system, which takes care of 80% (or more, from what Steyn and others are saying) of the population to accommodate those who do not have coverage. Isn't there some other way of getting that group of people coverage without ruining it for everyone?
My wife and I have been following your catastrophic
Posted by: justasking at July 14, 2009 10:00 AMinsurance suggestion since 1991. We got a return of premium rider so when turning 65 over $240,000 was
returned to us! Paid all doctor visits and tests out of pocket and used $11,000 on a gall bladder operation.
Staying healthy is of course key to this.....