On the 47 million people without health insurance point, that too is a statistic where there is less than meets the eye. First, health insurance does not equal health care (there are not just emergency rooms but cash-based clinics, and conversely, a lot of people with insurance don't get good health care). Second, of that 47 million, 14 million are already eligible for existing programs (Medicare, Medicaid, veterans' benefits, SCHIP) yet have not enrolled, 9.7 million are not citizens, 9.1 million have household incomes over $75,000 and could but choose not to purchase insurance, and somewhere between 3 and 5 million are uninsured briefly(<2 months) between jobs. That leaves about 10 million Americans who are chronically without insurance. Needless to say, extending the blanket of coverage to this group should not cost $1.5 trillion and require a wholesale overhaul of all of medicine.
Copyright © 2010 by The Atlantic Monthly Group. All rights reserved.
How much "should" it cost, per year this time, to cover the 15 million (why you'd subtract 3-5 million who are uninsured between jobs is beyond me)?
why you'd subtract 3-5 million who are uninsured between jobs is beyond me
The quoted post expressly used the words "chronically uninsured" -- i.e., people who do not have healthcare coverage and are not obviously endowed with suitable means to obtain it. Someone who forgoes coverage between jobs (presumably, they declined COBRA?) is not in the greatest position, but being in that position for less than two months typically is not a coverage crisis.
These days, being unemployed can last a long time, and not all businesses are large enough to qualify for COBRA. If you're uninsured for more than 2 months, future insurance can refuse coverage for pre-existing conditions or deny coverage entirely based on those conditions. There are some of us for whom a few months without insurance will mess things up for good.
I'm not in favor of the reform (loss of freedom + I don't like positive rights), but I'll do the math for Tim.
1.5 trillion was the 10-year cost (I think before shenanigans got it below 1 trillion). Ignoring interest/growth for simplicity, that's 150 billion / yr.
Assuming 15 million to extend coverage to, that's $10,000 / uninsured / year which is at least not orders of magnitude off what would be expected.
Of course, once that expands to cover everyone, we're looking at a budget of 300 million x 10,000 = 3 trillion / yr.
For comparison, US GDP is 13.84 trillion and health care is 17% of the economy, that would be 2.35 trillion.
So it's more expensive per person by about 27%.
Are we sure about that math?
Call the GDP $14T.
17% of that is around $2.5T, rounding.
And that 17% covers all healthcare related activities, including the manufacture of devices, etc. Even so, if we lump it all in and spread it across 300M people, it comes to about $8,000 per person.
Even if we apply all $8,300 to 15M people, that still only comes to about $125B, plus or minus.
Why, then, does Chauncey keep insisting that he needs TRILLIONS?
Even if it's 30M people, it's still not trillions. This is insane.
Can't he do math?
1.5 Trillion is for 10 years, not 1 year.
Got it. Thanks.
Presumably not $100,000 per person, which is what's quoted as being on the table.
That 47 million figure is for people who are without insurance at any time during a given year. Since they are without insurance for no more than two months, the 3-5 million thus account for 500,000-833,000 person-insurance-years, worst case. Probably much less, since some number of those are uninsured for no more than a few days. Compared to the other numbers involved, these are rounding errors.
Also temporary insurance for
^^^ my comment didn't post all the way for some reason. Anyway: Temporary (or Short Term) Insurance is an existing product available at pretty reasonable prices. I'd bet a substantial number of between-jobbers could afford it. I've bought it several times myself.
Cobra allows you to extend your existing insurance retroactively. So, one strategy is to defer the first month's payment in hopes you don't get sick and get another job. I've used this feature myself.
A modest individual policy costs about $3000 in round numbers. So $45 billion per year, or $500B over 10 years with some inflation. So about 1/3 the $1.5T estimate.
Keep repeating this correction until it sticks to the debate like epoxy. The number of uninsured has been discussed repeatedly in many places including your comments section, with actual numbers of chronically uninsured always coming out somewhere in the 10-20 million range depending on whose figures are used, but in any case always much less than the 47 million number that makes for such an easy media canard.
In spite of that, hardly a week goes by that some Johnny Come Lately doesn't show up and wave it around again.
Too often, we talk about the uninsured; and we fail to discuss the underinsured. There's a lot of expensive junk insurance out there, particularly in the private market.
I CHOOSE not to purchase health insurance - because it's a ripoff. It's costly and doesn't cover the total cost of my care.
I have an excellent doctor whom I see whenever it is required. I pay for it the exact same way I pay for everything else I consume - with my own money. I save money by not having insurance.
Barack Obama wants to FORCE Jews and Christians (but not Muslims) to buy insurance - by making it a legal requirement and fining you if you don't buy it. He thus wants to reduce our freedoms (but not reduce the freedoms of Muslims) and enslave us to insurance companies and HMOs that will have no financial interest in providing me with excellent care.
No thanks, pal.
You've made the muslin claim a few times in a few threads. Can you source it in here, at the beginning of what is sure to be a long commented posting.
Will the Old Order Amish be excepted form the insurance requirement?
I think they got out of SS because it was "insurance" and insurance was against their religion.
I was wondering about Christian Scientist, as well.
I can only assume you're a very, very healthy person. Otherwise you would realize the biggest drawback to paying cash for health care is instead of getting a little ripped off by the insurance company you get really, really ripped off by the hospital. In my experience paying cash would have cost me almost five times what my insurance company ended up paying.
That's because the hospital has to post an up-front price in a fashion constrained by medicare price indexes and the various games of insurance negotiation that are played out daily.
If you get the hospital's arbitrator behind a closed door, declare "I have no insurance and here is some basic documentation of my ability to pay," they can and will meet you halfway, up to and including a structured monthly payment plan in some cases.
I'm a fan of of the "bring a wad of twenties and physically wave it at them" school of negotiation. Works for all sorts of things. Really, who pays retail?
movertypeguy, I am no fan of Obama, but I guarantee you that if Obamacare ever passes, Muslims will be just as required to buy insurance as everyone else. There are Christians who won't gamble too, but it won't matter for this, believe me.
Second, if I can offer some personal advice, I think you should look at a catastrophic coverage policy. First, it will get you access to the insurer's network rates for those situations where you can't negotiate your own rate. Second, it will cover most if you end up needing unexpectly large amounts of care.
J Mann, catastrophic coverage, in my neck of the US, cost as much for a family of four as full coverage costs in most areas for the same family.
It's very dependent on where you're purchasing the insurance.
Yep! Cost Is very dependent on where you live.
Unfortunately, none of our great leaders in DC seem to want to address the question of WHY? Why should insurance that covers the same thing cost 2 to 4 times more in one state than another. I live in new York where cost is through the roof. I know that it's because New York handed every special medical interest under the sun a gift - pushing premiums through the roof.
Bush proposed making health insurance a national market - reducing the power of special interests in states to get their goodies. It was dead on arrival.
How many more people could be insured if we could reduce the cost of coverage by simply allowing a national market?
Whether its because of being 'uninsured' or 'underinsured' or whatever, there is a serious lack of health care access in this country (this is well documented). The quote seems to trivialize our health care access problem as nothing more than counting the insured.
The more interesting point, which seems to go amiss, is that theoretical coverage does not necessarily equate to actual health care access.
I don't think this is true (how about a link to some of that "well documented" stuff?), but assume for the sake of argument that it is. The proposed plan does nothing to increase the number of doctors, nurses, hospitals, and clinics. All the doctors I know are very busy. How is it possible that forcing everyone to buy a Government-endorsed insurance policy and adding miles of red tape while doing nothing else will get us more health care?
I wasn't endorsing any particular plan, and was implicitly criticizing the current plans for focusing too heavily on 'coverage'.
The question of whether we even have the capacity to deliver quality health care to all Americans is a separate, but important issue. At first glance, increased health care spending/demand should lead to increased health care capacity in the medium to long term, but life is never that simple.
Health care supply is very dependent on population density. If you live in a major metro area, your supply is usually abundant, sometimes with overcapacity (as is the case with New York City hospitals).
As you move away from major metro areas, supply diminishes due to lack of demand, because the population density cannot support it. That's really no different than any other economic activity. You're not likely to find a giant mall in a semi rural area, nor are you likely to find zillions of car dealers.
As the costs of everything related to medicine have continued to climb, it becomes even less practical to locate facilities (including doctors' offices) in all but the most heavily populated areas.
Huh? That was the whole point of the quote: to take a vague and not very meaningful number (total uninsured) and subtract those who have not accessed an available program, are undocumented non-citizens, have substantial personal means, are temporarily and briefly uninusred due to a job transition, and so forth. The remaining 10-12 million are presumably those among the uninsured who actually lack access.
Wrong.
There's plenty of access. The argument you are searching for is that it is too expensive to walk into an ER for a hangnail.
Plural of anecdotes...
http://forums.studentdoctor.net/showthread.php?t=257985
...is humor?
Punishing doctors, and thereby having less of them, will not ease the access crisis.
Just out of curiosity, do we know none of those categories of uninsured overlap?
I suppose there are probably some illegal aliens making over $75K. Not many, but it's not completely unimaginable for someone with the right job skills.
And how do we count people whose income comes from crime? I don't mean just working off the books at an otherwise normal job. I mean drug dealing, car theft as an economic enterprise, prostitution, illegal gambling, and so on. I doubt they have employer-provided health insurance.
Wow Megan, you're really doubling down on "everything's fine", eh?
I hope everyone goes and reads the entire article that Megan linked to. It was quite informative and this guy (a doctor) has some pretty good ideas, many of which people of all political stripes could agree with.
It is worth reading. It's interesting how doctors from certain medical fields (like opthalmology, in the case of Dr. Ambati, private practice, etc..) have very different views of how 'broken' the system is than doctors in other medical fields (pediatrics, public health clinics, etc..). But its more striking, that on so many points, they all agree.
We must destroy American Health Care System in order to save American Health Care System. When you look at things in that perspective, it makes perfect sense.
"Needless to say, extending the blanket of coverage to this group should not cost $1.5 trillion and require a wholesale overhaul of all of medicine."
Then DO IT. I'm all ears. Extend coverage to the many millions of chronically uninsured in a way that they can actually afford it and don't get their plans cancelled and their claims denied. We've been waiting for months to hear an actual, serious plan from Republicans as to how they could accomplish this. They can't, and they know it, so they don't bother.
We all know single-payer is by far the cheapest way to achieve what the author states is his shared goal of universal coverage. Followed by the public option. Every other modern country does one of these and does them well. But hey, if there's another way, I'd be more than happy to listen. Because it all boils down to the fact that you're not going to make private insurance companies stop denying coverage, cancelling coverage, refusing claims, and constantly raising premiums without government interference. So either you admit that, or you admit that you don't have the goal of universal coverage at all. Which I rather doubt the author does, but he knows he can't admit that either.
Oh, and of course the $1.5 trillion figure is completely made up. It's been well-documented how the AP spread that meme completely out of nowhere based on an "anonymous aide" instead of the actual CBO report. The actual House plan is deficit-neutral and by no means a complete overhaul. Keep spinning.
single-payer is by far the cheapest way to achieve what the author states is his shared goal of universal coverage
When a monospony is motivated by profit, this would be expected. But there are already other government monosponies in the US, like the Defense Department of the $500 toilet seats which lead me to think that maybe profit (or cost reduction) is the dominant consideration for government monosponies.
The actual House plan is deficit-neutral
While I'm at it, that a plan is deficit neutral says nothing about the cost. It merely says that new taxes + cuts elsewhere will equal the new costs. So "deficit neutral" is a non sequitir on the question of "does it cost 1.5 trillion?"
"We all know single-payer is by far the cheapest way to achieve what the author states is his shared goal of universal coverage."
That might be true but only if you limit your focus to out of pocket costs and only if you assume some sort of price controls are imposed to cope with added demand and, if that occurs, you have to ignore the costs that such price controls would inflict, in terms of treatment denied and delayed, and any instance in which people choose not to invest either their time or money in pursuing a healthcare advance because they conclude that the rewards no longer justify the investment and its risks.
There is no free lunch. Demand for physical goods and skilled services cannot be expanded without paying a price somewhere in the system.
Or, in cartoon form:
http://mjperry.blogspot.com/2009/07/cartoon-of-day_24.html
The categories in the post are probably not additively separable; there will be overlaps. For example, the noncitizen population may aso be among those who are eligible for, say, SCHIP but have not enrolled. Thus the total number of "deserving" uninsured is probably a fair bit higher than 10 million. (Although still much less than 47 million).
One small correction, Adam - to the best of my knowledge, the Germans, Dutch, and Swiss achieve something close to universal coverage without a public plan. However, and this is a big thing, their equivalents of our private insurance companies are tightly regulated by highly efficient civil services.
Of course I agree with you on your main point. Very, very few opponents of the health plans making their way through Congress have any interest in achieving universal coverage. It's just a talking point.
Very, very few opponents of the health plans making their way through Congress have any interest in achieving universal coverage. It's just a talking point.
So in your point of view, in order for someone to oppose a plan to distribute raw sewage on a field that might feasibly drain into a drinking water supply, said opponent must have his own plan for fertilizing the same field waiting in the wings, otherwise it's nothing but "talking points".
Shenanigans.
That's the most twisted, inapplicable analogy I've seen from you yet.
I'm glad you support conservative efforts to kill health care reform so openly. Next time you complain about deficit spending, I'll remind you of your own support of deficit spending -- because that's the status quo.
Judging by the howl of pain it generated, I think that the analogy cut right to the truth of the matter. Regardless, I'm not glad to see you adopting this new debate tactic. You don't even know what kinds of plans or modifications I might support, other than the fact that they are not these plans and modifications.
Good intensions and goals are irrelevant in determining whether a thing will work as promised once installed and flipped on. One does not have to be offering an alternative good policy in order to call a bad policy a bad policy, and while it would be nice to see a bad policy substituted with a good policy, seeing a bad policy quashed is a good start.
Zic -
I openly support the need to kill major health care or health insurance overhaul right now, besides a few key things. The economy needs stability and not discussion about completely overhauling 15-20% of GDP.
It needs 1-2 years of that type of stability before we can re-introduce major economy-wide overhauls, of which many are needed.
In the meantime, the federal government could take steps to help remove the state-by-state infringements to public health insurance options, the state-by-state variations in healthcare costs, the cost overruns of medicare and the various problems in medicare, help reduce the cost of current and future pharmaceutical and medical devices by doing new things with patents or even FDA requirements, tort reform, and other things that would have very widespread and substantial (in aggregate) improvements to our healthcare system.
Without actually trying to re-build the system. And almost all changes that would be appropriate under either a multi-party or single-payer system.
It would be a far more effective use of time to bring these things up one by one as simple bills that can be easily discussed and voted upon in short order.
There is no reason, none, for any American to support these obscene omnibus bills that are brought out of committee within days of a vote.
So I'll openly say I want to kill this effort.
Joe
Why were the liberals in congress so opposed to Bush's very simple plan to allow a national market for health insurance? That would certainly have allowed for more affordable coverage in states with high medical insurance rates.
That was a "conservative" plan that would not cost one dime of taxpayer money and could have lowered insurance premiums, thus opening up coverage to many more. It was also a plan supported by any number of multi-state companies that have to deal with myriad health insurance requirements in every state they operate in.
How much would it have saved? How many more could afford insurance? Nobody knows because it was shot down immediately - especially driven by special interests like powerful hospital workers unions in states like NY.
So a simple, "try it - it sure can't hurt" plan was unceremoniously dumped.
By the way, does Obama/Pelosi care help in any way with the vastly disparate costs of insurance among the states? Is an employer in NY supposed to come up with an extra grand to 1500 every month for every single employee while an employer in Kansas has to come up with 2 or 3 hundred? Is a self employed person supposed to come up with that kind of money? As far as I know, nobody has answered that.
Mouse, we're all eyes to read what you have to offer, what you'd support.
Otherwise, you're just spreading raw sewage on the field.
If one firmly believes that it's not an enumerated power of the federal government to provide health care to the populace, then why should it be incumbent on one to provide alternatives?
If the proposal on the table was to create a national program of putting RFID tags in everyone's necks so that Homeland Security could keep track of all of us "for our safety," would you seriously accept the argument that you should keep your mouth shut until you had a workable alternative plan for government tracking of citizens?
Health care is important, and lack of quality health care is a problem. That doesn't mean that the Founders intended for Washington DC to make health care decisions on behalf of the electorate. Since the advocates of Obamacare are the ones proposing a terribly expensive, terribly disruptive, and arguably unconstitutional change, I think the rules of argument require the advocates to make a convincing argument. "I'm not convinced" is a perfectly acceptable retort in this context.
In the meantime, I'll stick with "My state government does an excellent job of screwing up health care already. I have trouble seeing how the feds could do a better job."
Mouse, we're all eyes to read what you have to offer, what you'd support. Otherwise, you're just spreading raw sewage on the field.
First, speak for yourself only; I am confident there are plenty of fine people who have no interest whatsoever in what I have to offer.
Second, what I have to offer doesn't matter, since the Democrats -- the Democrats and their omnibus bill, which control both the executive and legislative branches, remember? -- aren't proposing anything like it, nor are they soliciting suggestions for improvement. They've simply mashed together a phonebook-sized maze of bureucratic landmines and cost controls that is essentially a 500-pound gorilla version of Medicare/caid to be forced down the collective throat, and told the American public to like it, or shut up. It so happens that I don't like it, and my programming doesn't include an option for shutting up, so here we are.
Maybe you can do better than me by explaining your own stake in the bill: Why do you want to see yourself under this type of healthcare system?
Health insurance doesn't have anything to do with health care.
The arithmetic seems wrong on this. It assumes all the categories are mutually exclusive. Going the other way (also not a good assumption but at least it gives us boundaries) and assuming each category is potentially inclusive of every other category, the number of "real" uninsured should be around 19 million.
I'm thinking Megan subscribes to Winterspeak...
IIRC, Megan and Winterspeak were Co-bloggers back on Assymetrical Information. So yes, she probably reads it.
A pretty devastating rebuttal to Megan's post:
http://voices.washingtonpost.com/ezra-klein/2009/07/on_megan_mcardles_case_againt.html#more
The rote "govt involvement = kills innovation" argument is bs, and only evidences blind libertarianism. You can't hold these views and acknowledge how markets for services like healthcare actually work in practice.
Its arguing against reality from a position of fantasy.