Those of us who have spent a good part of our lives not being rich – or even middle-middle class – have likely spent quite a bit of our lives without health insurance as well. Or with junk insurance that doesn’t actually cover anything but Big Ticket Items such as major accidents and illnesses. And many of us have unfortunately discovered that junk insurance won’t pay for Big Ticket Items either, if ever those happen to accrue.
Thus we have likely been watching the D.C. Street Theater (recently back from nationwide tour over the August recess at Town Hall meetings in every state) with some amazement. Knowing that the truth is that health care is the third leading cause of death, perhaps wondering if greater access for some of the ~50 million Americans without insurance is actually going to “fix” what’s wrong with health care in this country. Which is #37 on the list of 37 industrialized nations in both access and outcomes.
One of the more “important” results of what is now more honestly being called Health Insurance Reform is the promise of government subsities to enroll as many of those ~50 million uninsured Americans in for-profit health care as possible. This is of course a way to compensate for-profit insurers for new regulations that will prevent them from refusing to insure those with pre-existing conditions, rescinding policies when the person gets sick or injured, and other racketeering practices that have 3 of every 4 of the “medically bankrupt” bankrupt despite HAVING insurance.
So I went Googling to find out if the uninsured and underinsured use a lot of health care, since that doesn’t ring true. What Google responded with were various evaluations of how much the uninsured as a CLASS cost the delivery system every year. The best example is a pdf from Health Affairs entitled:
How Much Medical Care Do The Uninsured Use, And Who Pays For It?
Here we can see in black and white that the uninsured use the medical care delivery system far, far less often than anybody else. If we divvy up the total cost of health care in America evenly amongst a rounded 350 million citizens, the cost is $7439 per person every year. But the uninsured – 50 million of the 350 milliion – only cost $1253 per person. That means in real terms the per capita cost to 300 million insured Americans must go up to over $8250 per year!
Wow! Looks like the uninsured are a positive bargain! At least, in actuarial terms, as an insurance hack would view such things. Thus an extremely desirable, low-risk pool of potential patsies to bilk.
Now, we all know that most of overall expenditures reflect people who use way more than an equal share of medical care per year. In addition to the uninsured who use little health care, there are tens of millions more Americans who also don’t use the health care system unless they have to. Co-pays and deductibles have been rising as fast as premiums (at many times the rate of annual inflation), so even the middle class doesn’t have money to go to doctors anymore.
So what we’re looking at (in order of importance for the Congress) in the matter of health insurance reform is that -
1. The for-profit insurance companies are so RICO crooked that they absolutely must be regulated severely.
2. Co-pays and deductibles are completely unreasonable (and getting worse fast), making even expensive insurance these days useless except for Big Ticket items. For which you have to fight hard, threaten to sue, or go bankrupt. Unacceptable for those who have to eat the losses (We The People).
3. In order to get items 1 and 2 accomplished, the insurers must be ‘given’ that pool of ~50 million people who barely use the system at all. They can make good money on these people.
4. The “Public Option” we’ll end up getting will be a subsidy to the insurers to cover the people who seldom use health care, and the minimal pay-out for those who do.
The only way a public option can actually control costs (beyond any limits imposed on the insurers, which will be made up for by the increased pool) is for it to be a government-run single-payer system. One that bargains for prices on everything, and with clout. That is not what we’ll get, so all this is just shine to disguise a bailout of the insurers in exchange for absolutely necessary regulation of their fraudulent tendencies.
The pool of uninsured in this country is very desirable for profit-oriented insurance companies, but most of them cannot afford $3000 apiece a year for premiums. Regulation that limits their ability to refuse pre-existing conditions, drop people for no apparent reason when they get sick, or simply refuse to honor their contracts, is going to cut into the for-profit industry’s bottom line. And that bottom line is and has long been extremely lucrative. They’d love nothing better than to get their hands on all those relatively healthy people, whose premiums will be paid no-questions-asked by the government.
And what does the government get? Coverage of the Big Ticket items for the generally healthy population. They’ll spend about $3000 per capita for the policies with large personal deductibles and co-pays. Then when one of those people has a bad accident or comes down with cancer and costs $50,000 that year, the actual cost of the care is covered. That the difference will likely bankrupt the patient matters not. The bailout here is for the insurers and the government, not for the people.
Health insurance is not health care. It’s a futures market on the suffering of real people. Because health care in this country is more dangerous than not getting health care (unless you’ve got heart disease or cancer), there are tens of millions of people in this country who avoid the system like the plague. Because it IS a plague.
So… wake me up when they start talking about addressing what’s really wrong with health care in this country. Nothing coming out of Congress about insurance reform is going to change the lives of those of us on a Shoestring Budget. The government will buy insurance to protect the system against us if we get hurt or sick. Most of us weren’t worried about them in the first place.