Blaming the Uninsured
by Patrick D. HahnLink to article
Marie Antoinette would gasp at the mean-spiritedness of Delegate Peter Hammen’s attempt to blame and punish the uninsured for the train wreck that is our health-care system.
Hammen’s proposal would require anyone earning four times or more the official poverty level ($40,840 a year for an individual) whose employer does not provide health insurance, to purchase coverage at his own expense. Proof of coverage would have to be submitted along with one’s state income tax returns. Individuals failing to purchase health insurance for themselves could be fined as much as $2,000. (Note: this part of Hammen’s bill has been shelved for now, but will be put back on the table for consideration in 2008.)
He didn’t say what the state would do for individuals who were forced to buy health insurance and whose insurance companies refused to pay when they did get sick. (E.g., http://www.usatoday.com/printedition/news/20070129/1a_cover29.art.htm.) This is not a trivial matter. If you want to hear some colorful language, the next time you go to a party, ask the people there what they think of their HMO’s. There is more than a bit of truth to the old joke that the only thing worse than not having health insurance is having health insurance.
But it has become fashionable as of late to blame the uninsured, and why not? They have no expensive lobbyists to speak for them, and most of them are too busy trying to keep a roof over their heads and keep their cars running to do much speaking for themselves. [Disclosure: I have not availed myself of the services of the medical profession for years. I currently pay over six hundred dollars a year for an insurance policy with a $10,000 deductible (not a typo) that I will probably never use.]
The uninsured are maligned as irresponsible carefree grasshoppers, happily fiddling away while those industrious ants, the insured, are footing the bill for their health care.
What utter nonsense. In the first place, the uninsured are, pretty much by definition, working for a living and paying taxes. (Those who are not are covered by either Medicare or Medicaid.) So the uninsured are paying for health care for all those who are on Medicare or Medicaid. They are paying for health care for all the government bureaucrats who keep us waiting in line at the Post Office, who keep us waiting in line at the DMV, and who keep us waiting on hold when we call the IRS and try to find out how much we owe in taxes. They are also paying for health care for Delegate Peter Hammen and his family.
What’s more, who are the uninsured, after all? They are the temps, the contractors, the consultants, the free-lancers, the adjunct faculty members, the “part-time” employees who often work longer hours than the “full-time” ones, usually for less pay and no benefits. They are the ones who are keeping our public and private institutions solvent so they can afford to pay health insurance for their “full-time” employees.
It’s quite true, as the talking heads like to remind us, that if you have a life-threatening condition and lack insurance, all you have to do is go to the emergency room of any hospital and they cannot refuse to treat you. That does not mean you can refuse to pay. The hospital will charge you several times what they charge the insurance companies for the same services and hire bill collectors who will hound you to the grave. Then what they can’t collect from the estate they write off as a tax deduction – and the uninsured foot the bill for that, too, since, as we have already noted, they are pretty much by definition working for a living and paying taxes. So don’t buy the myth that the insured are paying for the uninsured. It’s exactly the other way around. It’s the uninsured who are paying for everyone else’s health care.
We may as well get on with it and move to a single-payer system, as they have in Canada. There is no point in arguing about the merits of the free market versus socialized medicine. That train has already left the station. There is probably no aspect of our economy that is more heavily regulated and subsidized than health care. We already have socialized medicine. It’s just administered in a preposterously inefficient and unfair manner. And please don’t yelp about how, under single payer, we will ration health care. Every economic system is, at bottom, a means of rationing goods and services, because our desires are infinite and our means to satisfy them are not. So we will ration health care, and every other product and service, under any and every conceivable economic system.
Our current health care system wastes resources on an almost unimaginable scale. We spend $4,500 per capita per year on health care – more than any other nation in the world, and almost twice as much as the number-two spender, Canada. And what do we get for our money? In Costa Rica they spend $300 dollars a year per capita on health care, and their life expectancy is just eleven months less than ours.
The typical physician in this country pays in excess of $100,000 a year in malpractice insurance. Out tort system is designed to make tort lawyers rich, not to protect patients. We need to find a better way to weed out incompetent medical practitioners. People also need to accept that much of what physicians do could be done as well by nurses or other lesser-paid professionals.
More generally, we need to fundamentally re-think our approach to disease and health. The era of the great plagues that sweep through the population, carrying away the just and unjust alike, is gone. People need to accept that for most of us, throughout most of our lives, health is a matter of personal choice.
It’s no coincidence that we have an incredibly destructive war on drugs going on at the same time Big Pharma is spending millions of dollars a year on advertising, trying to get us all hooked on some sort of drug(s) or another. Both phenomena are symptoms of a medical-industrial complex that has by and large lost sight of its original mission, which is helping people to healthier lives.
Individuals need to take as much responsibility as they can for their health. We’re not talking anything drastic here, just a few common-sense rules – exercise every day, get lots of rest, eat a sensible diet, refrain from smoking and drinking and drugs, and cultivate a positive mental attitude. Millions of people have been infantilized into believing they can’t function without their “meds.” What ever happened to building character?
We need to accept that we live in a universe of finite resources and that every dollar we spend on health care is a dollar that cannot be spent on education, on infrastructure, on research and development, on plant and equipment – and that all these things have a much greater impact on both quality and duration of life than health care. We need take a good hard look at expensive medical procedures whose contribution to quality and duration of life are questionable. Heart transplants and weight loss surgery come to mind.
Most importantly, people need to accept that death is not some rare and preventable anomaly. It is the natural and inevitable end of life, and there is a huge difference between prolonging life and prolonging dying. Too many of our nation’s best and brightest are working as physicians, hovering over elderly patients hooked up to expensive Japanese machines, when many of these patients would prefer just to have a loved one sit by their bedsides and hold their hands as they slip gently into that good night.
Al this will require a sea change in people’s attitudes towards health and disease, and towards life itself. And every one of the changes proposed here will be vigorously opposed by well-heeled interests. So don’t expect to see any of these changes coming soon. It’s a lot less trouble to blame the latest scapegoat, the uninsured.
Tags: health-care, single-payer, uninsured
March 25th, 2007 at 8:00 am
While I agree with the general drift, I disagree with several of the specifics. I’ll choose this one:
” . . . a medical-industrial complex that has by and large lost sight of its original mission, which is helping people to healthier lives.”
The mission of any modern large corporation, regardless of what they tell you, is not to help “help people” in any way. Their mission is to make money in any legal manner. If it were legal for them to kill people and make money, then you can rely on them doing that. If the management did not use every legal means to make money, they would be either fired or sued by their shareholders.
Our job as citizens and consumers is to control the legal environment within which corporations operate and to terminate the violators. We have the power to do so. We can say that corporations cannot earn money by selling health insurance, for example, which would fling open the doors to single-payer health care.
Corporations exist “at the pleasure of” (as some are so fond of saying these days) the citizens of each and every state.
March 29th, 2007 at 4:20 pm
Damning the Unisured …
For the first time in my life, I have been without a job and health insurance. I have been in this precarious predicament for 10 months now. I spend my days mass-mailing resumes (200+ a month), researching prospects, signing up at worthless, useless employment agencies, going to computer school and trying to find ways to get my ‘due’ until I am employed. This latter part I wish to chat about.
I am a single, middle-aged woman who has worked for the last 41 years paying taxes and being a decent American citizen. I have an IRA but no savings, no collateral, no family to depend on. I support myself. Also, I am a high-risk, breast cancer survivor.
I live in New York, New York. Since I have become unemployed, I have been receiving a meager stipends of $1200 monthly in unemployment benefits which will run out June 2007. I spent weeks applying for food stamps but was told I make too much money to qualify. I spent months researching dozens and dozens of insurance companies who promote themselves as having special deals for those without health insurance only to be told every single time that I make too much money but if I had children, I could be helped.
When I questioned the food stamp office as to why I was rejected and they said I make too much money due to my unemployment checks, I mentioned seeing a prostitute getting out of a chauffeur-driven limousine and picking up her food stamps. My food stamp advisor said “The difference between you and her is that you put your money in the bank and she keeps hers under the pillow.”
Over this last year I have grown totally disgusted with what has become of the USA. My situation has opened my eyes to many aspects of human rights and violations. We are no longer a nation for the people. We have become a nation for the highest bidder. We are becoming a totalitarian state devoid of humanity that operates best for those who are criminals, extremely wealthy, extremely poor, and immigrants. The middle class is disintegrating in disgrace. The health insurance issue is just a small part of a very huge disaster.
March 30th, 2007 at 5:21 pm
I recently relocated to Florida from Connecticut. I’m 48 years old with over 15 years in publishing. Right now I’m working at home for a web site company as a contractor. The pay is extremely low and I have no health insurance.
The subject I wanted to bring up is “bidding” on jobs. Many companies now require us to submit our “salary requirements.” Yesterday I got a call from a promising job opportunity, where the woman asked what I expected to be making. I made the huge mistake of telling her what I made in Conn. (Not a lot by any means, but apparently more than they offer in Florida.)
This, to me, amounts to bidding on a job. The lowest bidder will get the interview. In other words, the person who has the lowest regard for their own abilities will be the one who gets the job. I would like to know what other people think about this, as I haven’t seen it mentioned anywhere, and this is definitely a new phenomenon. Shouldn’t we be valued according to our abilities and willingness to learn the job?
April 18th, 2007 at 4:30 am
…Blaming the Uninsured
Dr. Hahn, you’re the best
May 10th, 2007 at 1:59 pm
RRUA: You sound like me. Only I’m doing this for the second time in five years.
Health insurance? Right. What unemployed person can afford it?
The retraining programs are a joke. Our unemployment office has $$ to train young people in HVAC, and when they get out, they can make $9.00, if they’re lucky.
Temp. agencies are not much better. “What is the lowest pay you will accept?”
Yes, it is a bidding war.
“Land of the free, home of the brave,” what is the least that you can live on?
June 8th, 2007 at 3:38 pm
Patrick Hahn may be right about the “train having already left the station” but we cannot accept the current situation. Pat has mentioned that the system is extremely wasteful. This can only lead to ever greater rationing and longer waiting times.
This is the case in Canada. Canadians are forced to come to the U.S. and pay for better care at their own cost. Sweden, long known for cradle to grave care, is now backtraking on some of the benefits!
The U.S. went down this road beginning in the early part of 20th century when government
interference caused businesses to start offering “benefits” without paying attention to
keeping “beneficiaries” aware of the costs of options and services. Because of this, the
market dynamics were severly distorted. Now we are forced into the position of pre-paying
for overly expensive medical care without being able to inject accountability on the part of
providers. This has caused costs to continue to skyrocket out of control.
We have to break the yoke of this insanity, demolish the current system, and return to free
market efficiency and accountability for both the customer and the provider. The indigent
can get far better care from private charities. Keep government out! The Law of Unintended
Consequences inevitably lead government to ever greater heavy-handed bureaucracies and
maddening restrictions.
Just in case you feel I am a heartless Republican, you must think again. I am a middle-aged programmer that lost his job two years ago and my family has been living without health
insurance for the last 18 months.
The Constitutional form of government still is a precious gift to the world. But if people
continue to tax others to get “freebies” for themselves, they are going to end up in a
totalitarian system that will be far worse than the darkest days of the former Soviet Union
or the Cambodian Nightmare.
June 11th, 2007 at 1:07 pm
To Brian:
I don’t disagree with anything you’ve said. My main point was that it is fatuous to blame the unisured for our nation’s health-care system woes. As I explained, the uninsured are already paying for everyone else’s insurance. My second point was that we already have socialized medicine in this country — it’s just administered in a preposterously inefficient manner. Anything would be better than the chimera we now have, which combines the worst features of socialism and the free market. My third point was that people expect way too much from medicine. I read recently that the annual per capita expenditure on health care in this country is seven thousand dollars. I’m 46 years old and my expenditure on health care in an average year is zero dollars. I wonder what the Hell all these people who are running up the average are doing.
June 12th, 2007 at 10:09 am
I’d also like to add that if we ever do make the switch to single payer, it’ll be because the insurance industry got too greedy and killed the goose that laid the golden eggs.
An essential element of free-market economics is a government which is willing and able to protect people against force and fraud. That element is missing from today’s health-care situation.
Let’s say you buy health insurance out of your own pocket and pay your premiums in good faith every month. If you get sick and file a claim, the insurance company can just refuse to pay. If you have to hire a lawyer to sue your health insurance company to make them pay you what they promised to pay you if you got sick, you can collect only the money they promised to pay you in the first place. You can’t collect even legal fees, let alone interest, let alone punitive damages. So denying legitimate claims is basically a no-lose proposition for the insurance companies.
Fighting a multi-billion-dollar company is difficult under the best of circumstances, but especially when you’re sick. The insurance companies even have a cute little name for this tactic: “starving them out. ”
For more information, see Sick: the Untold Story of Amrica’s Health Care Crisis (http://www.amazon.com/Sick-Untold-Americas-Health-Crisis/dp/0060580453/ref=pd_bbs_sr_1/103-8931507-7660607?ie=UTF8&s=books&qid=1181664394&sr=8-1) and Uninsured in America (http://www.amazon.com/Uninsured-America-Life-Death-Opportunity/dp/0520250060/ref=pd_bbs_sr_1/103-8931507-7660607?ie=UTF8&s=books&qid=1181664474&sr=1-1).