A Few Facts About the Uninsured

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I really don’t understand the animosity conservatives have against the uninsured now being eligible for subsidized insurance through the Affordable Care Act. Their hatred seems to be based on a few misconceptions.

  1. The uninsured are lazy and don’t work
  2. If they are working, they should have gotten a job with benefits
  3. I don’t want to pay for someone else’s health care

The Institute of Medicine of the National Academies published several monographs on the uninsured between 2001 and 2004. The Kaiser Family Foundation (KFF) publishes the Employer Health Benefit Survey every year or two.  Their findings are sobering.

Eighty-two percent of the uninsured either work or live in a household with someone who works.  Part-time workers generally aren’t eligible for benefits. Neither are independent contractors like me.  People in minimum-wage jobs often don’t get insurance, either because their employers don’t offer it or the workers can’t afford the premiums.  Wal-Mart appears to have the largest number of employees on Medicaid and food stamps.

63% of workers don’t have insurance because their employers don’t offer it; another 16% are ineligible as new hires.  Remember Andy Harris, the anti-Obamacare Republican Congressman from Maryland who, in 2010, complained that he’d have to wait 28 days for his taxpayer-funded health insurance?

Only 57% of all employers offer benefits.  Larger companies are more likely to provide insurance. Only 45% of companies with 3-9 workers offer benefits compared to 93% of companies with 50 employees or more.

Prior to the ACA, some people couldn’t get insurance at any price.  Insurers don’t want to underwrite people with expensive pre-existing conditions, like depression, diabetes, heart disease, AIDS and old age. The last one is why we have Medicare.

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Having insurance doesn’t guarantee you will keep it. Your insurance will disappear if you lose your job or the spouse providing your insurance dies or divorces you. You can continue the insurance under COBRA, but you’ll pay the full premium cost plus a 2% administrative fee.  We paid about $950/month when my wife lost her job. So, you can become uninsured in a heartbeat, despite working.

Having health insurance won’t necessarily protect you from financial ruin. More than 60% of bankruptcies in 2007 were due to medical debt and more than three-quarters of those people had health insurance.

Being able to afford health insurance is relative. The average costs of single and family policies in 2013 were $5,884 and $16,351. That comes to $490/month for an individual and $1363—more than my mortgage payment—for a family. And those are just averages.

Someone else IS paying for YOUR insurance. Employers heavily subsidize health insurance premiums (which they write off as a business expense). Employees pay an average of 18% of an individual plan premium and 29% of family plan premiums, often with pre-tax dollars, and they aren’t taxed on those benefits. That means they get around a 75% subsidy. The uninsured have had to pay sticker price for policies on the individual market, if they could even get insurance, with after-tax dollars.

So if you’ve had great health insurance, stop being so smug. Be grateful for what you have, because it could have disappeared in a heartbeat.

Freedom’s Just Another Word For Everything To Lose

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September 27, 2013

Ted Cruz’s phony filibuster on September 24, 2013, was ostensibly about “freedom.” Tony Perkins of the Family Research Council said, “… the greatest threat to our faith, our families and our freedom is Obamacare”  And one internet troll complained, “Thanks to Obamacare, I’m losing all my choices?

Oh, really? And what freedoms are you losing?

The freedom to let other people absorb that $79 billion a year in uncompensated care for the uninsured?

The freedom to wait several hours in someone’s emergency room for routine care because you are uninsured and none of the doctors in town will see you?

The freedom to go bankrupt because the cost of the care for your catastrophic illness exceeded your insurance policy’s lifetime cap?

The freedom to be uninsurable because you developed cancer, lost your job and then lost your insurance?

The freedom to put a pickle jar on the local convenience store counter asking for donations for your child’s surgery because you make too much to qualify for Medicaid but can’t afford insurance on the individual market?

The freedom to stay in a soul-crushing job under a boss you hate and you would leave in a heartbeat if it wasn’t for the the health insurance benefits you desperately need?

If you are fortunate enough to have heavily subsidized health insurance through the generosity of your employer you can keep it. Thanks to Obamacare, you have additional proctections – insurance companies can’t drop you because you actually needed your insurance. So stop complaining that 30 million people will now get something you’ve taken for granted.

The Sky Is Falling! Obamacare is Coming!

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A physician shortage is one of the many catastrophes conservatives claim will befall the country if Obamacare isn’t repealed.  Alyene Senger, in a Heritage Foundation Issue Brief, thinks declining Medicare and Medicaid reimbursement rates combined with obnoxious bureaucratic oversight will cause already dissatisfied physicians to retire in droves and dissuade younger people from becoming doctors. Jeff Tangney, CEO of the physician social media site Doximity, Inc., predicts we’ll be short 90,000 to 150,000 physicians by 2025 as 30 million people obtain health insurance.  The unstated implication is “You’re screwed because some undeserving, lazy moocher is getting the health care you worked so hard for, and YOU’RE paying for it.”

This is wrong on so many levels I’m not sure where to start.

 Overwhelming the system?

The uninsured have always been there but now they will have health insurance. Barring an unexpected pandemic, thirty million people aren’t going to become sick on October 1, 2014. People won’t be trampling each other in a Black Friday-like rush to the doctor’s office. More may now seek preventative care, but not necessarily.  My well-insured sister-in-law hasn’t had a Pap smear in 24 years.

 The scourge of Medicare and Medicaid?

Physicians were predicting disaster before Medicare was enacted in 1965. Ronald Reagan railed against “socialized medicine” in 1961. Now, they love it because it pays them for taking care of old people. My late father-in-law’s internist got a hundred bucks for each five minute visit.

More people on insurance means more revenue for physicians and hospitals instead of bad debt write-offs.  The same holds for Medicaid. Many physicians refuse to see Medicaid patients; those that do accept those patients out of necessity or a sense of moral obligation. More people will be eligible for Medicaid but the Feds will be throwing more money into the pot, so what’s not to like?

 Doctors leaving in droves?  I don’t think so.

The independent, solo practitioner is almost extinct. More than half of all physicians are employed by a hospital or a healthcare system and don’t have to worry about the bureaucratic headaches of private practice. Younger physicians find this attractive because they want a life outside of practice.  Employers like them because their young minds can be molded into the corporate way. Established physicians like the idea of a guaranteed salary and potential productivity bonuses.  And many, if not most, physicians will shut up and endure for the right price. Those of us nearing retirement may get out early because we’re tired, but Obamacare provides a convenient excuse for the complainers.

For the past thirty years I’ve heard physicians complain that “the practice of medicine isn’t fun anymore.” But they are also bound by the golden handcuffs. The average physician income is $259,000/year and even primary care physicians average a healthy $189,000/year.  It’s hard to walk away from all that money. Trust me; I still see a lot of luxury cars in doctors’ parking lots, including one Tesla Model S.

You will still get the medical care you need.  Everyone should.

 

Welcome!

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Welcome to my blog! After four years of procrastination, trepidation and lame excuses like “I don’t understand WordPress,” Peg has dragged me kicking and screaming into social media.  I’ll give it a shot and see what happens.