47 Million Uninsured, Give or Take Several Million

Katherine Mangu-Ward | September 28, 2007

Dick Morris has a few questions for Hillary over at RealClearPolitics, including:

You base your healthcare proposal on the need to cover 47 million "uninsured Americans." Since about a third of them are illegal immigrants and another third are eligible for Medicaid right now and just don't apply for it, aren't you overstating the problem?

Econoblogger Greg Mankiw takes exception to the much repeated 47 million figure as well:

A serious estimate would take out both illegal immigrants and those who are eligible for Medicaid but have not applied. Those eligible for Medicaid can always enroll once they need significant medical care.

In addition, I would exclude those who were offered employer-provided health insurance but declined coverage, and those that are healthy and making more than, say, $50,000 a year. These two groups are choosing to roll the dice. According to estimates I have seen, they make up more than a quarter of the uninsured.

Wow. Even Mankiw's commenters are well-informed:

The Center for Disease Control's National Health Interview survey[PDF] also provides statistics on the uninsured. They report that 41 million Americans did not have health insurance at the time of the survey (Jan-Mar, 2007). One significant statistic was the trend in insurance coverage of Americans under 18:

% of children w/o insurance
1997....13.9
1998....12.8
1999....11.8
2000....12.3
2001....11.0
2002....10.5
2003....10.1
2004.....9.6
2005.....8.9
2006.....9.3
2007.....8.5

More on the stubborn uninsured here.

Comments

|9.28.07 @ 10:09AM|#

A serious estimate of the threat of terrorism would eliminate the number of illegal immigrants killed on 9/11.

A serious estimate of crime rates during the late 80s and early 90s would eliminate crimes against illegal immigrants.

Because that's totally how it works.

|9.28.07 @ 10:15AM|#

yeah I'm one of those poor sad uninsured fuckers. But somehow I don't feel in desperate straits... what's wrong with me?

|9.28.07 @ 10:21AM|#

I would exclude those who were offered employer-provided health insurance but declined coverage

Why would you exclude this group? The point is that not everybody can afford coverage, and that includes people who can't afford the coverage provided by their employers.

|9.28.07 @ 10:22AM|#

yeah I'm one of those poor sad uninsured fuckers. But somehow I don't feel in desperate straits... what's wrong with me?

So what happens if you get very sick or severely injured?

ed|9.28.07 @ 10:23AM|#

So you have no problem with 47 million as an honest estimate, joe?

robc|9.28.07 @ 10:24AM|#

So what happens if you get very sick or severely injured?

He pays cash?

Cal|9.28.07 @ 10:24AM|#

Now we just need Edward to make an appearance in this thread and the troll trifecta would be complete.

|9.28.07 @ 10:25AM|#

It depends on what it's an estimate of, ed.

As an estimate of what it is being offered as - and estimate of the number of people who don't have health insurance - it appears to be accurate.

A Muswell Hillbilly Boy|9.28.07 @ 10:25AM|#

joe --

I see your point ... You can take illegal immigrants out of any statistics about societal trends and significantly alter the outcome. But no one is using that to suggest that illegal immigrants don't count or don't deserve access to health insurance. The point is that illegal immigrants aren't (at least technically) eligible for a lot of things American citizens are, and it's not that surprising that a good deal of them don't have insurance. To group them with American citizens in order to inflate the number of uninsured people in this country is a bit dishonest.

|9.28.07 @ 10:26AM|#

robc,

The ICU runs about $12,000/day. You think he's going to be pulling $20s off of his wad to cover that?

|9.28.07 @ 10:27AM|#

Sixteen MILLION illegals were killed in the Muslim attacks of September 11th? Wow joe.

Or are you confusing 16 million illegals without health insurance (in this country... many have health insurance when they go home) with 1000 illegals killed in the WTC center attacks? (1000 illegals? Really? One third of the people killed on 9/11 were illegals?)

Someone doesn't understand the phrase "serious estimate".

CB

Chucklehead|9.28.07 @ 10:28AM|#

So you have no problem with 47 million as an honest estimate, joe?

Well, as his idol Al Gore has admitted, accurate info doesn't matter as long as folk's are scared into action.

|9.28.07 @ 10:29AM|#

Yes, I pay cash. Worst case scenario, I can get a 40 dollar a month catastrophic plan.

|9.28.07 @ 10:29AM|#

OH MY GOD! There are more than 5 BILLION people on Earth who don't have access to American Health Care!!! Someone should do something!

CB

thoreau|9.28.07 @ 10:29AM|#

Actually, I see two good reasons to exclude illegal immigrants from the estimate:

1) Since they aren't supposed to be "in the system" it's not clear that they would be covered by any proposed health care reform. Or at least it's not clear how many of them would actually take part in the system, and to what extent and in what manner. (Fake ID for full coverage? Just showing up to the ER, as in the status quo? Something else?)

2) It's arguable that a non-trivial percentage of illegal immigrants would find better jobs and get insured if they were allowed full access to the job market, so perhaps the problem that needs fixing here is their employment eligibility (i.e. legalize their status and let them work), not their health care coverage (which will sort itself out once they have work).

On the other side of the coin, if you're economically ignorant and you hate brown people then you can say that their problem isn't a health care problem, but simply a "They're not supposed to be here!" problem, so kick them out. Either way, they are a distinct issue.

So I can see that the health care needs of illegal immigrants are a distinct issue.

robc|9.28.07 @ 10:29AM|#

joe,

I think the question, wrt illegals, is that if we had HillaryCare or some single payer system, what they then be covered? Or would they STILL be uninsured?

Im guessing they would still be uninsured, which means for the discussion at hand, they shouldnt be included. But, if you are talking about the # of people residing in the US who dont have insurance, then they obviously should be included.

But, when Clinton or whoever brings up the 47M number, they are using it to say how many people who arent being covered who NEED to be. They are using them as a reason for change. I dont think that illegals dont have health care is a reason to change.

|9.28.07 @ 10:30AM|#

We trust the market with two things I think are way, way more important and basic than health care--food and housing. But for some reason, when it comes to health care we don't.

|9.28.07 @ 10:30AM|#

The point is that illegal immigrants aren't (at least technically) eligible for a lot of things American citizens are

If the subject of concern was "people who don't have health coverage," than the fact that low-paid illegal immigrants aren't eligible for SCHIP or Mecicaid is a bug, not a feature.

If you accept that this is a society that has, always has had, and always will have a significant population of immigrants coming in at the bottom of the economic ladder, than the fact that a good portion of this generation of said immigrants don't have health insurance is, indeed, part of the cohort of Americans without health insurance. Their legal status is just part of the problem of a lack of health care access.

robc|9.28.07 @ 10:31AM|#

The ICU runs about $12,000/day. You think he's going to be pulling $20s off of his wad to cover that?

I have no idea what Randolph Carter's net worth is. Maybe he can cover it.

Im guessing he COULD have insurance but that he is choosing not to. Depending on his age/health it may be a very risky but profitable gamble.

|9.28.07 @ 10:31AM|#

CB,

Did you take your stupid pills twice again?

|9.28.07 @ 10:34AM|#

Yes, I'm 23 years old and taking a risky and profitable gamble. I could take my company's health care plan for 200 bucks a month, but I would rather have an extra 200 bucks a month than health insurance. And as I said, if I take up any risky hobbies, I'll get a cheap catastrophic plan.

|9.28.07 @ 10:35AM|#

Given the pay scale at which most illegal immigrants work, it seems reasonable to assume that, in the absense of prohibitionist immigration policies, the better part of that 16 million would not be enjoying the Blue Cross/Blue Shield Gold Program.

|9.28.07 @ 10:36AM|#

I have no idea what Randolph Carter's net worth is. Maybe he can cover it.

Im guessing he COULD have insurance but that he is choosing not to. Depending on his age/health it may be a very risky but profitable gamble.

Perhaps. But at least part of it is that he knows that even without health insurance, he'll still get emergency treatment if needed, with the costs passed on to those who do have insurance.

|9.28.07 @ 10:36AM|#

Very few of the people who suffer a serious injury or illness got that way through "risky hobbies."

Timothy|9.28.07 @ 10:37AM|#

On the other side of the coin, if you're economically ignorant and you hate brown people then you can say that their problem isn't a health care problem, but simply a "They're not supposed to be here!" problem, so kick them out. Either way, they are a distinct issue.

Well, I wouldn't guess Mankiw is economically ignorant. And I don't have any evidence that he hates brown people. TLB on the other hand....

|9.28.07 @ 10:38AM|#

We trust the market with two things I think are way, way more important and basic than health care--food and housing. But for some reason, when it comes to health care we don't.

Funny that.

Competition is SO important to the fabric of the economy that it must be enforced through law to prevent abusive monopolies from taking over an indsutry and fleecing consumers.

Unless we're talking health care. Then never mind all that stuff.

|9.28.07 @ 10:39AM|#

joe:

I just can't go with you there. Part of sneaking across the border is the understanding that until you can somehow get legal status, you aren't eligible for much in the way of a safety net.

Believing as I do that you physically can't seal the border at any reasonable cost, you have to make the decision to come across illegally at least something of a risk. I want no incentive to come over and soak the system. Your mat is too thick.

robc|9.28.07 @ 10:39AM|#

Wow, its almost like I remember being healthy and in my early to mid 20s.

Im 2 for 2 on understanding why someone might be uninsured. Its amazing some supposedly smart people cant figure it out.

Randolph - you may want to go ahead and get that $40 a month catastrophic plan. It cuts into your "profit" but cuts the risk WAY down. I think I was 24 or 25 when I bought my cheap cat policy that did me well until I had a job that totally covered my insurance. Of course, I never used it, so maybe I was just throwing money away.

clown|9.28.07 @ 10:41AM|#

Did you take your stupid pills twice again?

Not covered as part of employer-provided prescription coverage.

James|9.28.07 @ 10:41AM|#

The government is not responsible for our healthcare. Government mandated healthcare coverage is going to be just another form of theft. Healthcare is not a right.

robc|9.28.07 @ 10:41AM|#

Dan T,

Perhaps. But at least part of it is that he knows that even without health insurance, he'll still get emergency treatment if needed, with the costs passed on to those who do have insurance.

Wow, its like he is making a rational economic decision. Without the government telling him what to do. Wow!

Episiarch|9.28.07 @ 10:42AM|#

Given the pay scale at which most illegal immigrants work, it seems reasonable to assume that, in the absense of prohibitionist immigration policies, the better part of that 16 million would not be enjoying the Blue Cross/Blue Shield Gold Program.

I know illegals (with fake papers) whose employer bought a health care package for them. How the fuck would Hillary know about that? They're illegals--they don't tell her data collectors about themselves. I bet a lot of employers do this.

If you are reporting numbers on people who...won't tell you about themselves...you are just guessing, which sort of means lying.

|9.28.07 @ 10:43AM|#

Dick Morris decided he liked Hannity cock better. That's how it happened.

At least Greg Mankiw also feels like Dick Morris is just making numbers up. According to Dick, there are only 15 million uninsured. Who knew? Well, Dick, if there are only 15 million Americans uninsured, it won't cost very much to cover them, now will it? What's that? OK, I'll wait until you have Sean's cock out of your mouth.

|9.28.07 @ 10:44AM|#

"CB,

Did you take your stupid pills twice again?"

You're right. I was trying to teach a pig to sing.

CB
Note to self: Stop feeding the troll.

ed|9.28.07 @ 10:46AM|#

Or:

Cynical politicians play hard and fast with the numbers in order to appeal to the emotions of the unthinking electorate so they can get their votes. Is that about right?

|9.28.07 @ 10:46AM|#

robc,

Since it doesn't seem to be clear to you, Dan T.'s comment about sponging off the free care pool was not premised on Randolph's decision being irrational for himself.

There's some other point in there.

|9.28.07 @ 10:47AM|#

Very few of the people who suffer a serious injury or illness got that way through "risky hobbies."

Paging Christopher Reeve...Mr. Reeve...

joe--motorcycling, bicycling, horseback riding, skiiing, skydiving, undersea diving, skateboarding, team sports, unprotected sex (as a hobby...hmmmm), etc.

Lots and lots of people getting hurt.

|9.28.07 @ 10:48AM|#

Episiarch,

I know a dog with three legs. So?

Are you making the point that most or all illegals have health care coverage? Are you making a point?

|9.28.07 @ 10:49AM|#

JW,

John is a man does not equal All men are John.

People with risky hobbies often have major injuries does not equall people with major injuries or illnesses often have risky hobbies.

This is high school stuff here. C'mon.

Episiarch|9.28.07 @ 10:50AM|#

My point is that reporting on people who won't tell you about themselves is dishonest because you have no idea whether they have coverage, or even if they are actually here. All numbers about illegals are "estimates", so using them means your own numbers are "estimates".

|9.28.07 @ 10:51AM|#

OK, they're esitimates. When you see a round number like "47,000,000," it usually is.

|9.28.07 @ 10:51AM|#

well, I'm not sponging off anyone unless it comes to me stuck in an ICU. I guess the point of what I was saying before is that there are probably at least a few million people like me who could afford health insurance, but make the choice (whether it's a good choice or not, I guess I'll find out) not to have it.

There's no moral victory in forcing people to sign up for something they don't want, even if its "for their own good."

|9.28.07 @ 10:54AM|#

There's no moral victory in forcing people to sign up for something they don't want, even if its "for their own good."

Maybe not a moral victory, but a practical one in this case.

|9.28.07 @ 10:54AM|#

And, Episiarch, let's look at the logic of the esteemed (around here) Mr. Mankiw:

A serious estimate would take out both illegal immigrants

Because we can't put a precise figure on the number of illegal immigrants (it might be 15, 567,891, or it might be 13,987,334), we should "take out" that number entirely.

I can't estimate with any accuracy how many yards eash Patriots' reciever will have Monday night. Should I therefore estimate that the Patriots will have 0 receiving yards?

|9.28.07 @ 10:56AM|#

There's no moral victory in forcing people to sign up for something they don't want, even if its "for their own good."

I wonder what tune you would be singing if you came down with bacterial mennningitis, and wish to sign the rest of us up for your hospital bills.

|9.28.07 @ 10:56AM|#

People with risky hobbies often have major injuries does not equall people with major injuries or illnesses often have risky hobbies.

You shittin' me Sherlock? Wait, slow down, I can't follow your dazzling logic.

I believe your words were "very few." I can't grab the stats right now, but it's far from very few. Hell, just talk to the wood shop guys.

robc|9.28.07 @ 10:56AM|#

joe,

There's some other point in there.

Sure, that we should allow hospitals to be hard-assed and turn people who cant pay away, then, people who make rational decisions to not have health care would buy a plan to get the access and the numbers would drop.

There was some state, Jersey maybe?, that changed the law to prevent insurance plans from excluding pre-existing conditions. When they did this, the number of uninsured jumped. People decided that they would just wait until they got a condition to buy health care. Once again, rational decisions.

My point, that you seem to have missed, is that part of the reason people are uninsured is that it is rational to be uninsured. Those people arent part of the "health insurance crisis".

|9.28.07 @ 10:57AM|#

"motorcycling, bicycling, horseback riding, skiiing, skydiving, undersea diving, skateboarding, team sports, unprotected sex"

The vast majority required enough money to make me think those folks are insured. Could you imagine rushing an uninsured person from the polo grounds to the ER?

|9.28.07 @ 10:59AM|#

If I came down with bacterial meningitis, I'd be pretty fucked either way. But if that did happen, I would hope that my family and maybe the community of people who I'm close with would help me out. Maybe that's an overly optimistic view of the people who I'm close with, but I wouldn't expect you to pay for it, joe.

robc|9.28.07 @ 11:00AM|#

Randolph Carter,

Even though I dont know you, if you get bacterial meningitis in the next year, I will toss in $100 towards your health care bills.

|9.28.07 @ 11:01AM|#

robc,

As usual, you jump to the policy conclusion you like and think backwards.

No, the point is that there is currently a system in place which allows people like Randolph Carter to engage in that most Repubican of efforts - privatize the profit, socialize the risk.

Now, what to do about that, there are many possible policy prescriptions.

Still, it would reflect well on you to acknowledge that your preferred policy is not the inevitalble logical end here. You're incorporating values-based propositions.

And, as a matter of fact, I got the point that it is rational for Randolph to be uninsured, thanks. I then went beyond this, into thought about the incentive structure that makes such a decision rational.

I didn't realize this was such a mystery.

robc|9.28.07 @ 11:02AM|#

replace "buy health care" with "buy health insurance" in my post at 10:56

|9.28.07 @ 11:02AM|#

The vast majority required enough money to make me think those folks are insured. Could you imagine rushing an uninsured person from the polo grounds to the ER?

I would hope so. But I've known too many a motorcyclist who *knew* it would "never happen to them."

When I rode, I awlays wore a helmet, even before there a helmet law. My best friend didn't. I bugged him once about and that was it. He was a big boy and knew the risks and stakes.

His insurance was minimal.

|9.28.07 @ 11:06AM|#

Randolph,

While you may not be consciously incorporating your awareness of the free-care laws into your decision, you are most certainly making that decsion in the absense of stories of people all over the country dying in the streets and being denied urgent care because of a lack of health insurance.

These stories are not out there, influencing your decision, because of the free-care laws.

robc|9.28.07 @ 11:07AM|#

As usual, you jump to the policy conclusion you like and think backwards.

I dont have a policy conclusion at all. So that would be impossible.

I have a premise that I build up from. Maximizing freedom is good. I think I am working forward from that.

I then went beyond this, into thought about the incentive structure that makes such a decision rational.

So did I. If the hospitals would stop being pussies and would let the uninsured die, the decision making would change.

I dont necessarily support that. Personally, I wouldnt want to force any policy on the hospitals, I would leave it up to them to decide whether to treat uninsured or not.

|9.28.07 @ 11:10AM|#

That's true, joe. I'm not trying to set myself up like some Randian ubermensch, just trying to make the general point that there are plenty of young people in their 20s who choose not to have health coverage. I don't see it as any different than choosing to smoke or choosing to drive a motorcycle, it's just a calculated risk. Also, it's kind of stupid of me. Also, after thinking about all this stuff for the past 2 hours, I might call Aetna and grab the catastrophic plan.

|9.28.07 @ 11:12AM|#

"A serious estimate would take out both illegal immigrants

Because we can't put a precise figure on the number of illegal immigrants (it might be 15, 567,891, or it might be 13,987,334), we should "take out" that number entirely."

Uh, I don't think the uncertainty of the number is Mankiw's problem. He's arguing that illegals shouldn't be eligible.

|9.28.07 @ 11:15AM|#

Regarding mandatory insurance, I wonder how it pans out. I mean, we are adding an expense to the system in the form of insurance premiums for everyone who can't pay their own way. Are we sure that the financial situation improves over having to pay on a one off basis as we do now?

|9.28.07 @ 11:15AM|#

"Defining the key problem in the American health care system as lack of health insurance...."

Is semantic legerdemain; what these guys really want is not health insurance, but unlimited free universal health care. Run by the people who brought you the USPS and the Internal Revenue Service.

|9.28.07 @ 11:17AM|#

"He's arguing that illegals shouldn't be eligible."

But most libertarians are arguing that they should be here, so they should be in the figure in my opinion.

|9.28.07 @ 11:18AM|#

After deducting for illegal aliens, the young and healthy and the wealthy who choose not to get insurance, and the ones who qualify for Medicare, but havn't enrolled, I calculated that there are only 3,000,000 that make less than $50,000 a year but too wealthy for Medicaid or are unhealthy and can't afford insurance. Rather than putting everybody on a socialized system that raises taxes and creates chronically high unemployment and rations services and cuts down on the available funds for research and development, wouldn't it be better to provide tax breaks for the uninsured?

|9.28.07 @ 11:19AM|#

Insurance is not the point, medical care is. This statistic means nothing. I went for a couple of years in the 90s without health insurance. It was when I was in grad school and too old for my parents insurance and too poor to buy my own. I rolled the dice and took my chances. Considering that I was young and healthy and the most likly scenario for me needing serious medical care was being in a car accident and that was covered by my personal injury coverage on my car insurance, it just didn't make any sense to spend money I didn't have on coverage I was unlikely to use. Was I foolish? I don't know but it was informed decision that I made and it nearly cost me a fortune, one month before I started a full time job I cut my hand badly and nearly needed surgery. Had that happened, I would have worked something out with the hospital and paid off the debt over the next few years. It would have sucked but it wouldn't have been the end of the world. I wouldn't consider myself, had that happened, a victim of the system and I sure as hell do not want the government to take away my right to take that risk by demanding that I buy health insurance.

One other point, like poverty statistics, the socialists who want a one payer system never consider mobility. They make it sound like the same 47 million people live without health insurance year after year like something out of a Dickens novel. That is just bullshit. That 47 million changes from year to year. Some of them are like me, young people who chose to take the risk. Some of them are people between jobs. Some of them are rich and want to pay for their own care. The number of "uninsured" tells you nothing. What I would like to know is how many people insured or uninsured in this country are going without medical care they need. That is the question. How many people out there need surgery or treatment for a chronic disease and are not getting or other vital medical services and are not getting it? I never see any statistic on that. My guess is that they are not that bad or we would be hearing about it. Certainly, if people were dying in the streets because they couldn't get medical care, cancer patients not getting chemo, poor people dying because they couldn't get an appendectomy and other things like that, I would think it would make the papers. Yet, it doesn't. Show me some statistics that mean something and then we can talk about the healthcare "crisis" such as it is.

|9.28.07 @ 11:20AM|#

" If the hospitals would stop being pussies and would let the uninsured die, the decision making would change. "

If the hospitals would stop being such pussies and let the insured die, prior to wringing every last penny out of their coverage, aggregate medical costs would be significantly less.

|9.28.07 @ 11:20AM|#

""He's arguing that illegals shouldn't be eligible."

But most libertarians are arguing that they should be here, so they should be in the figure in my opinion."

I don't think that follows. Recall that libertarians don't view the transfer payment as a right. Allowing people to attempt to improve their situation through negotiating labor contracts is one thing. Giving those same people free goodies is something else altogether.

|9.28.07 @ 11:22AM|#

JasonL,

Right you are - Mankiw isn't making Episiarch's "estimate = LIE!" argument. My bad.

|9.28.07 @ 11:23AM|#

"If the hospitals would stop being such pussies and let the insured die, prior to wringing every last penny out of their coverage, aggregate medical costs would be significantly less."

Don't worry in a few years we can Hillarycare and the government bureaucrats making the decision will take care of that problem. The new efficient government system will not be wasting your tax dollars on the old, the weak, the handicapped, and others deemed not worth the effort to save. Hospitals at least have their public image to worry about. Government officials don't have that problem and will be willing to make all the tough calls.

|9.28.07 @ 11:26AM|#

Newb here.
I'm confused. (Maybe those two statements are tautologous).

Seems like including the number of illegals in the total is legitimate if you're trying to deal with health care costs as a societal/economic issue. Maybe those people wouldn't get insurance anyway, but you need to account for them since they will use emergency care etc (the high cost components of the system). Just because you aren't legally here does not mean you have zero impact on the system.

Additionally, while I accept Carter's description of his "rational" decision not to be insured, is not part of the economic decision based on the fact that his big downside risk is being paid for by all of us? It's not like if he goes catastrophic that he'll be turned down at the ER. It's easier to make a bet when you're compensated for your loss, even partially. What is so libertarian about Carter's position other than his stated good intentions?

|9.28.07 @ 11:28AM|#

One other point the illegals should be considered in that statistic regardless of how meaningless it is. It is not like we are going to decide one day that they can no longer visit our hospitals. Healthcare for illegals is part of the cost of them being here. It is stupid to pretend otherwise. The fact is because we have illegals, we have a lot more uninsured people. That is the fact and we shouldn't ignore that.

|9.28.07 @ 11:28AM|#

there's nothing libertarian about it. The point is, it's not right to force people to buy insurance. In a free society you have to be able to make those kind of decisions for yourself.

|9.28.07 @ 11:28AM|#

Insurance is not the point, medical care is.

That's true, John. People who have some, but inadequate, coverage are yet another problem, not accounted for in figures about the uninsured.

How many people out there need surgery or treatment for a chronic disease and are not getting or other vital medical services and are not getting it? I've seen the figure 14,000 additional deaths - just deaths - per annum due to a lack of health care access.

BTW, your "I rolled the dice and took the change" argument and your "People aren't dying in the streets because of free care" argument contradict each other.

|9.28.07 @ 11:29AM|#

My point, that you seem to have missed, is that part of the reason people are uninsured is that it is rational to be uninsured. Those people arent part of the "health insurance crisis".

I agree that if somebody is forced to choose between paying the rent and food bill and paying for health insurance, it probably is rational for them to not have health insurance. But that doesn't mean it's still not a problem if they need health care.

|9.28.07 @ 11:31AM|#

"Additionally, while I accept Carter's description of his "rational" decision not to be insured, is not part of the economic decision based on the fact that his big downside risk is being paid for by all of us?"

It gets paid for by all of us anyway. If I get sick and have insurance be that government or private, all the costs of me being sick are absorbed by the insurance company and passed on to everyone else in the form of taxes or insurance premiums. If I don't have insurance and default on my bill, all of the cost are absorbed by the hospital and passed onto the government and insurance companies in the form of higher prices which are then passed on to the rest of us in the form of higher taxes and higher premiums. What is the difference in the end state? I sure don't see any. It is not like having insurance keeps you from getting sick and incurring medical costs.

|9.28.07 @ 11:31AM|#

Is it right for you to force us to pay for the consequences of your bad decision?

|9.28.07 @ 11:33AM|#

"Seems like including the number of illegals in the total is legitimate if you're trying to deal with health care costs as a societal/economic issue."

The 47 million uninsured argument is not about controlling costs. Just the opposite, it acknowledges that 'society needs to pony up' or some such. Cost containment has to come through other avenues.

I agree that if you are making a fairness or humanitarian argument that everyone needs to be insured, you have to define what 'everyone' you are talking about. The argument here is that the 45 million figure is misleading as an indicator of how broken the system is. I'm guessing that most people don't perceive that an illegal immigrant or a voluntary opt out should be held up as evidence against the system.

|9.28.07 @ 11:34AM|#

Don't worry in a few years we can Hillarycare and the government bureaucrats making the decision will take care of that problem. The new efficient government system will not be wasting your tax dollars on the old, the weak, the handicapped, and others deemed not worth the effort to save. Hospitals at least have their public image to worry about. Government officials don't have that problem and will be willing to make all the tough calls.

But isn't that an advantage of government run health care? If there are limited healthcare resources available, shouldn't they be directed towards where they will be put to good use?

It really doesn't make a whole lot of sense to spend a lot of resources keeping a dying person alive as long as possible, especially since those resources are being kept from those who could gain greater benefit from them.

Usually the complaint is that the government is inefficent. Now the complaint is that the government would be too efficent.

iowan|9.28.07 @ 11:35AM|#

Health insurance would be less of an issue if the basics of health care weren't so tightly regulated and access wasn't so tightly restricted by the AMA.

It's late September, and the ragweed is in full bloom. I have severe allergies so even all the prescriptions I take can't keep up with it. So now I am in the beginning stages of developing sinusitis and/or bronchitus. I know this because it has happened 10 of the last 15 autmuns and just as many times in the spring.

I also know exactly what I need to take to solve the problem but I can't stop at the store on the way home to get the basic anitbiotic that I have used all those other times. I can't even call the nurse and have them call in a script.

I must now take 2 to 3 hours away from work and see the doctor so that he can look at me for less than 5 minutes tell me what I already know. I'll pay my co-pay and the insurance will cover another $100+ payment to the doctor.

And of course all this will get so much better when the federal government tries to level the playing field and make sure that everyone has access to this closed marketplace.

|9.28.07 @ 11:35AM|#

@John:

No, wait. If your argument makes sense then why should anyone have insurance anyway? As you say, there's no difference in the end state. So we all soak off of each other. That seems to me to be saying government-run and private insurance systems are functionally equivalent anyway. If so, why not just go for 1 package? I can't believe that argument.

|9.28.07 @ 11:35AM|#

I don't get it - if you don't have insurance are your bills magically absolved? I thought that you were charged for the services rendered and then payed them back over time or took out a loan to pay them off and then payed back the loan. Is that not what happens?

|9.28.07 @ 11:36AM|#

"BTW, your "I rolled the dice and took the change" argument and your "People aren't dying in the streets because of free care" argument contradict each other."

No they don't. I was rolling the dice with my finances not my health. I got all the care I needed. I just had to pay for it. Hospitals cannot by law refuse medical treatment. I would have gotten my surgery just fine and as it was, I got to see a wonderful hand specialist to find out I didn't need surgery. It just cost me about $1000 that I paid off once I had a job.


"I've seen the figure 14,000 additional deaths - just deaths - per annum due to a lack of health care access."

I would like to see that. First, in a country of 300 million people, 14000 is a pretty small number. Second, what constitutes and additional death? You could define that to be anything.

|9.28.07 @ 11:38AM|#

@JasonL:

Regardless of how the argument is used in this context, the 47 million number can still be relevant to overall health care costs without trying to be humanitarian about it. Uninsured people cost the system money when they get unlucky, legal or not. The total system cost does depend - though the weighting is arguable - on the total number of uninsured using the system. The number does have some merit.

|9.28.07 @ 11:38AM|#

"Is it right for you to force us to pay for the consequences of your bad decision?"

It's not like I invaded Poland.

|9.28.07 @ 11:40AM|#

"No, wait. If your argument makes sense then why should anyone have insurance anyway? As you say, there's no difference in the end state. So we all soak off of each other. That seems to me to be saying government-run and private insurance systems are functionally equivalent anyway. If so, why not just go for 1 package? I can't believe that argument."

Private is better because we can choose how much we want to spend on insurance and insurance companies have to compete with each other. The market always fills the niche better than bureaucrats.

The point of my argument is that unless you personally are paying the entire bill, someone else has to pay for it. That someoen is always society at large be that in the form of insurance premiums or taxes.

|9.28.07 @ 11:40AM|#

@Carter:

No, your costs aren't magically absolved. But some percentage of them are passed on to us. If you don't identify yourself, if you have no fixed address, if you declare bankruptcy, a hospital will still try to prevent you from dying in their ER. Maybe you won't get the best care, or complete care, but you'll get some, and what you can't pay for gets billed to us. It doesn't have to be all-or-nothing; when you go without insurance then you are making the rest of us take some percentage (greater than zero) of your risk as a result of your personal choice.

|9.28.07 @ 11:44AM|#

"How many people out there need surgery or treatment for a chronic disease and are not getting or other vital medical services and are not getting it? I've seen the figure 14,000 additional deaths - just deaths - per annum due to a lack of health care access."

Phew. I thought this was a crisis. So Hillary's plan will cost $110B and we can prevent the deaths of 14,000. What a bargain!

|9.28.07 @ 11:44AM|#

hamilton:

I'm not arguing, nor are most people here arguing, that illegals and opt outs have no bearing on the entire healthcare debate. We are just arguing that to sell a policy based on "47 million uninsured" is at least a tad deceptive.

Indeed, that those categories of people are currently cared for absent insurance should cause eyebrows to be raised. Why does it matter if they are uninsured at all?

|9.28.07 @ 11:44AM|#

"It doesn't have to be all-or-nothing; when you go without insurance then you are making the rest of us take some percentage (greater than zero) of your risk as a result of your personal choice."

True but when you have insurance you are just sharing your risk with everyone else. Granted you are paying for that through premium but you still are sharing the risk and if you get really sick you will get more out of it than everyone else. Granted some people are homeless or just bums who will never pay a dime, but most people pay taxes and are established enough that they cannot just totally duck out on their medical bills.

Iowan|9.28.07 @ 11:45AM|#

I full support Carter's right to refuse to buy health insurance even though he can aford it.

I am also willing to let him die from injuries or illness that could be treated but that he cannot get because he doesn't have insurance or can't prove he can pay for by other means.

I suppose that makes me an immoral bastard, right Dan?

|9.28.07 @ 11:45AM|#

"It's not like I invaded Poland."

Well, no, but if we're going to get all high-and-mighty about durn liberals trying to make our choices for us with their universal health care, let's not ignore that the alternate position also has some kind of impact on other people - and one that wasn't voted on (explicitly).

I'm going to lunch. Damn, how do you people keep going?

|9.28.07 @ 11:49AM|#

Note that for people who can't afford insurance, there still won't be actual insurance. There will be transfers to pay whatever bills they have. When there is no premium and no risk modelling, it isn't insurance anymore. The essential argument here is over how much in the way of medical transfers to people do we want to formally recognize?

|9.28.07 @ 11:50AM|#

"Damn, how do you people keep going?"

It's a pre-existing condition, not covered under the terms of my policy.

|9.28.07 @ 11:50AM|#

I was rolling the dice with my finances not my health. I got all the care I needed. I just had to pay for it. Hospitals cannot by law refuse medical treatment. I would have gotten my surgery just fine and as it was, I got to see a wonderful hand specialist to find out I didn't need surgery. It just cost me about $1000 that I paid off once I had a job.

Does anyone know the extent of what it means when it's stated that hospitals cannot by law refuse medical treatment?

I can see that they must treat the primary complaint if it requires immediate treatment (in John's case his cut hand). Does it also mean that if John were to require surgery to repair a severed tendon, that they must do that surgery too?

|9.28.07 @ 11:57AM|#

"I can see that they must treat the primary complaint if it requires immediate treatment (in John's case his cut hand). Does it also mean that if John were to require surgery to repair a severed tendon, that they must do that surgery too?"

Honestly, I don't know the answer to that, but no one ever acted like if you don't pay for this we won't treat you. I did have to sign an agreement to pay before my doctor would see me, but that was just a few hundred dollars per visit. Also, we have medicade in this country for people who are really poor. I want to see concrete numbers and examples of people who for example lost the use of their hand because they got cut and couldn't afford surgery. I am not saying that is not going on. I don't know to be honest. But those kinds of statistics mean something. Numbers of uninsured doesn't mean anything.

|9.28.07 @ 11:58AM|#

I full support Carter's right to refuse to buy health insurance even though he can aford it.

I am also willing to let him die from injuries or illness that could be treated but that he cannot get because he doesn't have insurance or can't prove he can pay for by other means.

I suppose that makes me an immoral bastard, right Dan?

Forget morals, it just sounds like a lousy way to run a society. And it's annoying to have to step over cold bodies on the sidewalk.

Iowan|9.28.07 @ 12:01PM|#

Forget morals, it just sounds like a lousy way to run a society. And it's annoying to have to step over cold bodies on the sidewalk.

Striving for the best caste system that money can buy (tm)

SP|9.28.07 @ 12:11PM|#

Joe,

You talk a lot about reasoning backwards from a conclusion. I agree with you generally. This forum is full of it. Are you any different?

This conversation has steered away from the point of the original post; that the 47 million figure is being used by those citing it as a means of implying that the existing health care system is failing 47 million people. They may not be saying it in those words, but that is the obvious implication.

That's the part that is deceptive. 47 million people might be uninsured, but 47 million people are not in poor health nor at risk to be without coverage. A health care system that fails people is one that leaves them in poor health or at risk to be. Surely ours is failing some amount of people, but it is an amount fewer than 47 million, perhaps considerably fewer. This much should at least be acknowledged.

Defending the 47 million figure does nothing to boost your credibility as somebody who reasons forward.

|9.28.07 @ 12:12PM|#

"Seems like including the number of illegals in the total is legitimate if you're trying to deal with health care costs as a societal/economic issue. Maybe those people wouldn't get insurance anyway, but you need to account for them since they will use emergency care etc (the high cost components of the system). Just because you aren't legally here does not mean you have zero impact on the system."

I believe in making them all legal citizens, those who want to stay here, and then also give them tax credits for buying insurance.

|9.28.07 @ 12:21PM|#

A health care system that fails people is one that leaves them in poor health or at risk to be.

So there are people out there who are not at risk of developing health problems? I would think we all have about a 100% chance of getting sick or injured.

|9.28.07 @ 12:21PM|#

I'm also one of the 47 million, though my family would probably be willing to help if something catastrophic happened. I'm in the same boat as Randolph--I'm in my mid-20s in good health, normal weight, non-smoker, no history of cancers in my family aside from smoking related ones. So, it will probably turn out to be a profitable gamble.

|9.28.07 @ 12:22PM|#

"Is it right for you to force us to pay for the consequences of your bad decision?"

Is it right to make all of us pay for others' health care through socialized medicine?

|9.28.07 @ 12:31PM|#

"But isn't that an advantage of government run health care? If there are limited healthcare resources available, shouldn't they be directed towards where they will be put to good use?"

At this point there are not limited healthcare resources in America. If we go to socialized medicine, the resources will become limited when people start complaining about their high taxes and the government has to ration services to control costs to keep taxes from going too high. People tend to use more of a service when they think it's free, which causes taxes to rise.

ed|9.28.07 @ 12:32PM|#

Wait a minute. Is Hillary counting Puerto Rico and Guam too? What about Hawaii? Just because it's not a real state doesn't mean the Hawaiians don't get sick.

|9.28.07 @ 12:40PM|#

"those that are healthy and making more than, say, $50,000 a year. These two groups are choosing to roll the dice. "

Right - because it could NEVER happen that someone is, say, earning that much in a company with less than 5 employees which is therefore exempt from being required to offer coverage and so does not, but can't get affordable private coverage because 10 years ago they had a major operation. Especially if they live in LA where 50k basically means you can buy groceries.

statistically insignificant data? probably. but these kind of platitudes are exactly why informed debate is impossible.

|9.28.07 @ 12:43PM|#

John,

What is the difference in the end state?

Incorporating your health care costs into the system through changes to insurance rates/government spending according to what the actuarial tables tell us is much more efficient.

Hospitals cannot by law refuse medical treatment. Yes, that's my point. Your decision to forego insurance was made in the context of there being free-care laws and pools to pick up the costs in case you hade a catastrophic illness.

First, in a country of 300 million people, 14000 is a pretty small number. It's 5.5 9/11s annually. It's about 40% of the total number of traffic fatalities. It is not a small number.

Second, what constitutes and additional death? Rates of mortality above what they would otherwise be.

|9.28.07 @ 12:45PM|#

sixstring,

So Hillary's plan will cost $110B and we can prevent the deaths of 14,000. What a bargain! Now you get the substract the total amount of money being spent on health insurance plans from that $110 billion, since that spending would replace it.

And then you can extrapolate days lost to illnesses, working lives shortened, and all of the other costs associated with debilitating disease, but not deaths, associated with a lack of access.

|9.28.07 @ 12:48PM|#

"Second, what constitutes and additional death? Rates of mortality above what they would otherwise be."

Joe mortality rates say nothing about the status of the healthcare system. No amount of healthcare coverage is going to change the homicide rate, the accidental death rate and the deaths that result from smoking, obesity, and other lifestyle choices that lower people's life expectancy. Thank you for clearing up that your 14,000 a year figure is meaningless.

|9.28.07 @ 12:50PM|#

SP,

I guess it depends on what the 47 million is claimed to represent.

As for my credibility, I'd say that would actually depend on what claims I have made about the figure. Are there any specific claims you take exception to, or am I just completely lacking in credibility because I raised counter-criticisms to the criticisms of the figure, and the validity of my points is irrelevant?

As for the figure itself not representing those being failed by the health care system, that works both ways. Plenty of people within the current, broken, 30-40% overhead and profit medical system are getting a lousy deal, too.

|9.28.07 @ 12:52PM|#

"So Hillary's plan will cost $110B and we can prevent the deaths of 14,000. What a bargain! Now you get the substract the total amount of money being spent on health insurance plans from that $110 billion, since that spending would replace it."

1. If the 108 billion figure is accurate, it will be the only spending figure in the history of the government that did not grossly underestimate the cost of a social welfare program.

2. You can't just subtract the two numbers. What about how efficiently the money is used? What evidence is there that Hillary's plan will not like every other government run system be less efficent than the market.

3. Health care coverage does nothing about the real drivers of mortality rates which is homicides and lifestyles. So, there is no reason to beleive that any healthcare reform that doesn't involve draconian controls on the way people live will do anything to increase life expectancy.

|9.28.07 @ 12:52PM|#

John,

Mortality rates as a whole tell us nothing about the state of the health care system.

A comparison of mortality rates among the insured and unisured tells us something.

Think, then post, genius.

|9.28.07 @ 12:55PM|#

What evidence is there that Hillary's plan will not like every other government run system be less efficent than the market.

Every government-run health care system on the planet is more - not less, more - efficient than ours. This has been studied. Is this one of those gut things you do?

Health care coverage does nothing about the real drivers of mortality rates which is homicides and lifestyles.

The 14,000 figure was arrived at through a methodology designed to eliminate other influences on mortality rates - which doesn't make it wholly accurate, but probably in the ballpark.

|9.28.07 @ 12:56PM|#

Oh, wait, the studies you've never heard of are all invalid. All of 'em. Even though they all keep coming up with the same conclusion.

That just shows how deep the conspiracy goes.

|9.28.07 @ 1:03PM|#

"A comparison of mortality rates among the insured and unisured tells us something.

Think, then post, genius."

No it doesn't dumb ass. Not unless you do some serious accounting for outside factors like the increased instances of violent death and obesity among the poor and that is assuming that mortality rates are only the result of bad care and not just statistical quark. Further, you have no proof or link to this mythical "study" that shows that that was done correctly and wasn't just a number thrown out by some politically motivated group. Moreover, even if the results were done properly, statistical blips do happen, not every statistically significant correlation is the result of the hypothesized cause. Even then, as you finally admit in you last post, you think they might do that and that the figure "might be in the ballpark". "In the ballpark" I feel a lot better about that now. It is a meaningless statistic Joe, just admit and move on.

|9.28.07 @ 1:04PM|#

"Every government-run health care system on the planet is more - not less, more - efficient than ours. This has been studied. Is this one of those gut things you do?"

Oh really, who thinks that? If that were true, why do people come here for health care not the other way around. Moreover, what about the horrible conditions that have been documented in British and Canadian hospitals? That doesn't look very efficient. What about thousands who died during the 2003 heatwave in Europe due to bad medical care? That doesn't happen in this country.

|9.28.07 @ 1:05PM|#

"A comparison of mortality rates among the insured and unisured tells us something."

I'd like to see the study. Controlling for income, environment, lifestyle, crime rates, and so forth, you get a measurable difference? I'm actually very surprised by that. If true, it is the first piece of actual evidence to support the notion that insurance matters.

Again, we have to be careful here, because the new plan would be tipping the apple cart through a ton of variables. There could be a lot of secondary effects to the new system. Just as an example, what we mean by insurance completely changes.

|9.28.07 @ 1:08PM|#

No it doesn't dumb ass. Not unless you do some serious accounting for outside factors like the increased instances of violent death and obesity among the poor

Yup.

and that is assuming that mortality rates are only the result of bad care and not just statistical quark.

Nope, it's assuming that SOME of the additional mortality is from bad or absent care, and trying to pin that down.

statistical blips do happen

Pathetic. But, sadly, completely in character for you.

|9.28.07 @ 1:13PM|#

"statistical blips do happen

Pathetic. But, sadly, completely in character for you."

Translation, "Yes John all my bases belong to you and I have no response." JasonL makes the point quit well above. If your "study" really exists and is valid, it would be the first piece of evidence ever found that shows insurance matters. The chances of that happening are right up there with finding bigfoot.

|9.28.07 @ 1:14PM|#

Every government-run health care system on the planet is more - not less, more - efficient than ours. This has been studied.

The 14,000 figure was arrived at through a methodology designed to eliminate other influences on mortality rates - which doesn't make it wholly accurate, but probably in the ballpark.

Well, joe, you're no HTML dummy. Provide some studies or links or evidence or something

|9.28.07 @ 1:16PM|#

Oh really, who thinks that?

Pretty much everyone who has ever done a study of the issue.

If that were true, why do people come here for health care not the other way around.

Because they're not seeking the most efficient use of their health-care dollars across the entire population (the claim you were making about government inefficiency), but the most effective treatment for their particular case.

Efficiency and quality at the top of the market are two differen issues.

Moreover, what about the horrible conditions that have been documented in British and Canadian hospitals? That doesn't look very efficient. John, do you know what the word "efficiency" means? Because you aren't showing any evidence that you do.

What about thousands who died during the 2003 heatwave in Europe due to bad medical care? OK, now I'm laughing at you.

You just posed as a deep thinker by noting that there can be other factors besides the quality of health care that influences mortality rates, and now you're pointing to the presense of an extreme weather event that happened once as proof of our health care system's efficiency.

'kay, dude.

|9.28.07 @ 1:17PM|#

Gotta work.

Find it yourself.

Or you can do what John does, and conclude it must be wrong, because you want it to be.

Meh|9.28.07 @ 1:29PM|#

People talk about how everyone should have health care, and how important it is. Yet they vote for (i.e. pay for) cell phones, cable TV, designer clothing, cars they can't afford and other luxury items ahead of health insurance. That is a choice being made, and if your health insurance is not a priority for you, why the fuck should it be a priority for me?

robc|9.28.07 @ 1:29PM|#

you are making the rest of us take some percentage (greater than zero) of your risk as a result of your personal choice.

He is not making you take it on. The hospitals are choosing (although the law may be making that choice for them, in which case it is the government doing the forcing) to treat him and pass the cost on to you.

Theoretically, a hospital that just let people without insurance die would have lower rates and get increased business.

|9.28.07 @ 1:31PM|#

Gotta work.

How convenient - 20+ comments starting at 10AM and ending (ostensibly) at almost 1:30 in the afternoon, and you suddenly don't have the time to find your prime pieces of evidence.

Or you can do what John does, and conclude it must be wrong, because you want it to be.

Well, I don't think the Easter Bunny and the tooth Fairy are wrong, because non-existent entities don't have attributes like that...much like your vaunted "studies" you suddenly don't have time to find.

|9.28.07 @ 1:44PM|#

Won't someone think of the illegal children?

robc|9.28.07 @ 1:45PM|#

In case joe comes back, I am going to define efficiency in a very correct way that he will disagree with.

The efficiency of a product delivery system (which is what we are talking about) is what percent of the people who want a product and can afford it are able to purchase and consume said product.

For example, using a product I know more about than health care, lets talk about efficiency of beer.

A-B is efficient - the laws prevent some people from buying Bud (dry counties) but ignoring that, they are near 100% efficient.
Coors too, although they didnt used to be efficient, which is why we had Smokey and The Bandit inflicted upon us.
Goose Island, on the other hand, isnt efficient. I can both afford and buy their beers, but many people, especially on the coasts, cant. Their distribution is inefficient (although it should be getting better due to the minority ownership/distribution agreements with A-B).

The US health care market is fairly efficient. People can generally buy the products they can afford, via insurance or cash. It isnt near 100%, but pretty good.

Canada, for example, isnt as efficient, especially if you consider convenience. I could drive to Denver and buy New Belgium beers - I could wait for 3 months to get a MRI in Canada too. The fact that Canadians come to the US to buy products they wnat speaks to its inefficiency. Their system fails to deliver products people want and can afford.

|9.28.07 @ 1:55PM|#

Ayn Randian,

I doubt numbers would convince you anyway, since 1) you obviously haven't spent much time learning about the numbers, and 2) your beliefs are not based on how the numbers work out, but your values, regardless of outcomes.

robc,

Fine, our system is very efficient at allowing people to buy what they can afford.

It is the most inefficient in the industrialized world at health-care outcomes per dollar spent on health care.

That I consider the latter more important, and you the former, is the consquence of our different values - not, as some would like to pretend, one or other of us having a better understanding of objective outcomes.

|9.28.07 @ 1:58PM|#

"You just posed as a deep thinker by noting that there can be other factors besides the quality of health care that influences mortality rates, and now you're pointing to the presense of an extreme weather event that happened once as proof of our health care system's efficiency."

There are other factors besides the quality of health care that influences mortality rates such as diet, genetics, drug use including cigarettes and excessive alcohol, sendentary lifestyle, murder and suicide rates, accidents, etc. There is nothing about America's health care system that contributes to a lower life expectancy in the US.

|9.28.07 @ 2:05PM|#

"It is the most inefficient in the industrialized world at health-care outcomes per dollar spent on health care."

There is nothing superior about the quality of health care in countries with socialized medicine. Their lower costs are due to rationing. What would be the state of medical care in the world if it weren't for all the medicines and medical technology that we have created in this country? We have been able to develop it because our medical dollars aren't rationed like they are in countries with socialized medicine.

|9.28.07 @ 2:24PM|#

"If that were true, why do people come here for health care not the other way around."

"Because they're not seeking the most efficient use of their health-care dollars across the entire population (the claim you were making about government inefficiency), but the most effective treatment for their particular case."

They're coming here from Canada because they don't have to wait for the tests and operations they need because our health care isn't rationed like it is in Canada.

|9.28.07 @ 2:27PM|#

Health care is rationed here all the time by HMOs and insurance companies.

|9.28.07 @ 2:31PM|#

your beliefs are not based on how the numbers work out, but your values, regardless of outcomes.

joe, keep your day job (provided that you know, you actually work instead of posting here all day)...prognostication is not your forte.

|9.28.07 @ 2:32PM|#

I doubt numbers would convince you anyway, since 1) you obviously haven't spent much time learning about the numbers, and 2) your beliefs are not based on how the numbers work out, but your values, regardless of outcomes.

And yet, still no links. Hmmm.

chris|9.28.07 @ 2:40PM|#

I hate to admit this, but I will.

I spent 17 years in the military... so my family will have health insurance. I kind of resent my level of benefits being given away to people who would rather have premium cable TV than pay insurance premiums.

The truly poor have Medicaid.

|9.28.07 @ 2:55PM|#

"Health care is rationed here all the time by HMOs and insurance companies."

HMO's were a creation of the government in 1973. HMO's were originally designed under the concept that they provided preemptive care that would save costs in the long run. When you eat at a buffet, you tend to eat more than you would otherwise eat because you want to get your money's worth if you pay a lump sum for your food. When you pay for each item, you are careful of what you buy so you don't go over your budget. Before HMO's, insurance usually paid for only catastrophic care and routine expenses were paid out of pocket. When people started getting all the services they wanted for the cost of their premiums, they started overbuying which helped drive costs higher. Since big insurance companies, HMO's, Medicare, and Medicaid were paying the bills and not the patients, doctors had the perverse incentive to charge more since they felt big insurance companies, HMO's, Medicare, and Medicaid could better afford the higher costs than patients. This led big insurance companies, HMO's, Medicare, and Medicaid to start rationing to control costs. All of this is the result of big government's meddling in health care. These perverse incentives would not have come about in a free market health care system.

|9.28.07 @ 3:00PM|#

There are other factors besides the quality of health care that influences mortality rates such as diet, genetics, drug use including cigarettes and excessive alcohol, sendentary lifestyle, murder and suicide rates, accidents, etc. Yes.

There is nothing about America's health care system that contributes to a lower life expectancy in the US. No. Does not follow, is not supported by the evidence.

|9.28.07 @ 3:14PM|#

"What about thousands who died during the 2003 heatwave in Europe due to bad medical care? That doesn't happen in this country."

That happened in France, which is touted as having the best health care system in the world according to WHO.

|9.28.07 @ 3:18PM|#

"Does not follow, is not supported by the evidence."

After these other factors affecting mortality rates have been corrected for, it was found that the life span in the US is comparable to the life span of people in Western Europe and Canada.

|9.28.07 @ 3:20PM|#

RJ,

There is nothing superior about the quality of health care in countries with socialized medicine. No, just the distribution.

Their lower costs are due to rationing. We have rationing, too. Market-based rationing. No way to pay, no (or less, or inferior) health care. Hasn't reduced our costs below theirs. As a matter of fact, we have vastly greater amounts of "health care" dollars spent on things like overhead, corporate profits, and advertising.

|9.28.07 @ 3:20PM|#

J sub D,

God came down and told me the 14,000 figure.

I could be convinced otherwise, but you'll have to show me some evidence.

Tick, tock. Tick, tock.

|9.28.07 @ 3:29PM|#

"So Hillary's plan will cost $110B and we can prevent the deaths of 14,000. What a bargain! Now you get the substract the total amount of money being spent on health insurance plans from that $110 billion, since that spending would replace it."

Some economists believe that $110 billion is highly understated.

|9.28.07 @ 3:31PM|#

"God came down and told me the 14,000 figure."

"I could be convinced otherwise, but you'll have to show me some evidence."

"Tick, tock. Tick, tock."

The burden of proof is on you, Joe, to give us the source, not on us to disprove it when we don't even know how that figure was arrived at.

|9.28.07 @ 3:35PM|#

This led big insurance companies, HMO's, Medicare, and Medicaid to start rationing to control costs. All of this is the result of big government's meddling in health care. These perverse incentives would not have come about in a free market health care system.

Any system that incorporates insurance (even only catastrophic coverage insurance) will have rationing.

|9.28.07 @ 3:39PM|#

J sub D,

"God came down and told me the 14,000 figure."

"I could be convinced otherwise, but you'll have to show me some evidence."


You made the claim, smartass, you back it up!

|9.28.07 @ 3:40PM|#

"There is nothing superior about the quality of health care in countries with socialized medicine. No, just the distribution."

What about the people who are rationed out of the system? Where is the distribution of medical care for them?

"We have rationing, too. Market-based rationing. No way to pay, no (or less, or inferior) health care."

People in this country who aren't on Medicaid and can't afford insurance can always get charity care. And as I've said before, why put everybody under socialised medicine when what we are really concerned about are those without insurance? All we need are tax credits for those people to buy insurance.

|9.28.07 @ 3:42PM|#

There is a huge population of people who could afford health insurance but would rather spend their extra money on beer and cigarettes.
I figure that's about 15-20 million right there.

|9.28.07 @ 3:43PM|#

"Any system that incorporates insurance (even only catastrophic coverage insurance) will have rationing."

Then, why wasn't that the case to any great extent before the creation of HMO's in this country?

|9.28.07 @ 3:43PM|#

And as I've said before, why put everybody under socialised medicine when what we are really concerned about are those without insurance?

Well, as Michael Moore illustrated in Sicko, having insurance doesn't always mean you get to keep all our fingers either. Now, make sure you pre-approve any emergency ambulance rides!

|9.28.07 @ 3:47PM|#

No, RJ, it is not on me.

The burden of proof lies on those making the most extraordinary claim, and that would be the people asserting that there is little or no detectable lack of health access in the United States.

|9.28.07 @ 3:47PM|#

Dan T., I hope you lose your goddamn fingers so we wouldn't have to put up with your assholiness and hyperbole.

|9.28.07 @ 3:50PM|#

Jake,

The people too poor to afford insurance don't pay enough in income taxes to cover the cost of a health plan. Good instinct, but the numbers just don't work.

And no one is "rationed out of the system." Some individual treatments may be in shorter supply, but these people you are talking about, who are "out of the system," just don't exist.

robc|9.28.07 @ 4:02PM|#

Fine, our system is very efficient at allowing people to buy what they can afford.

So, we are good at distribution.

There is nothing superior about the quality of health care in countries with socialized medicine.
No, just the distribution.

So, we are bad at distribution.

Either we are efficient at distibuting the product or we arent. Pick one. And before you try to point out a subtle distinction, no one has any right to any product they cant afford, so that doesnt enter the picture.

|9.28.07 @ 4:03PM|#

My question is how many people die in countries with socialized medicine while waiting on operations.

robc|9.28.07 @ 4:04PM|#

I think all the arguments about efficiency and quality are just bullshit. There is really only one issue that underlies all of this:

Should people be given a product they cant afford?

|9.28.07 @ 4:08PM|#

"It is the most inefficient in the industrialized world at health-care outcomes per dollar spent on health care."

There are two ways to "improve" that ratio. Either increase the number of "health-care outcomes" (whatever that is) or decrease the number of dollars spent on health care.

Who, joe, is more likely to be "efficient" at reducing costs? Private enterprise, or the Federal Government?

CB

|9.28.07 @ 4:10PM|#

"no one is "rationed out of the system." Some individual treatments may be in shorter supply,"

Like MRI's that detect that malignant tumor that will kill you before the supply equals the demand.

You're dead, but you weren't "rationed out of the system" so that's a victory for socialist medicine.

CB

|9.28.07 @ 4:16PM|#

"The people too poor to afford insurance don't pay enough in income taxes to cover the cost of a health plan. Good instinct, but the numbers just don't work."

Have you not heard of a negative income tax? They will get more money back than they paid in. It's true that isn't free market, it involves money transfers from some to others, but it's better to provide insurance to these people who want insurance, but can't afford it and need it than putting the whole population under socialized medicine.

"And no one is "rationed out of the system." Some individual treatments may be in shorter supply, but these people you are talking about, who are "out of the system," just don't exist."

Tell that to this friend of my wife's from Holland who said elderly people are rationed out of the system. I have heard about this happening in other countries with socialized medicine as well. Elderly are sometimes put at the bottom of the queue. Because there is not enough money to provide for everybodys' health care needs, some people are rationed out of the system. Since the elderly have lived their lives, they're the ones who get rationed out of the system.

If you die while waiting on an operation, for all intents and purposes, you have been in effect been rationed out.

|9.28.07 @ 4:24PM|#

"Who, joe, is more likely to be "efficient" at reducing costs? Private enterprise, or the Federal Government?"

In the case of health care, the government because they do it through rationing services and apparently moreso than does the private sector.

|9.28.07 @ 4:24PM|#

joe | September 28, 2007, 11:28am | #

...I've seen the figure 14,000 additional deaths - just deaths - per annum due to a lack of health care access...

joe | September 28, 2007, 3:47pm | #


The burden of proof lies on those making the most extraordinary claim,..

I say again, You made the claim, smartass, you back it up!

|9.28.07 @ 4:28PM|#

"The burden of proof lies on those making the most extraordinary claim, and that would be the people asserting that there is little or no detectable lack of health access in the United States."

But, that isn't true. People can always get charity care at charity hospitals and charity clinics. There simply is no reason for anybody to die in this country because of a lack of insurance, so the more incredible claim is the one you're making, joe.

|9.28.07 @ 4:34PM|#

"Now, make sure you pre-approve any emergency ambulance rides!"

You're still on that argument, Dan, even though on another thread, an EMT told you that ambulance rides don't require pre-approval.

JBinMO|9.28.07 @ 5:33PM|#

"A serious estimate of crime rates during the late 80s and early 90s would eliminate crimes against illegal immigrants".

Does anyone have a problem with this?

|9.28.07 @ 6:20PM|#

A serious estimate of the threat of terrorism would eliminate the number of illegal immigrants killed on 9/11.

Because there's no difference at all between victims of a terror attack and people who should have access to massive state entitlements.

None at all.

Does anyone know the extent of what it means when it's stated that hospitals cannot by law refuse medical treatment?

Hospitals are prohibited by federal law from refusing care to people in emergencies.

And, once a patient is in the hospital's care via the ER, the hospital can't discharge the patient until the patient is either healed or has a place to go for further care.

MRW|9.28.07 @ 6:59PM|#

What will it take before people just ignore joe? How many times does he have to pull this bullcrap "I'm not doing your homework for you" move when he's asked for evidence before people just stop responding to him?

Paul|9.28.07 @ 7:20PM|#

Oh good god, I don't have the energy for this one, today.

Paul|9.28.07 @ 7:28PM|#

Every government-run health care system on the planet is more - not less, more - efficient than ours. This has been studied.

**trying not to respond**gritting teeth**must not get involved**cuba**grrrr*zimbabwe**"universal 'access'" to services that don't exist**

Aaaahhh... Aaaaarrrghggaaaaaaahhh!

|9.28.07 @ 7:36PM|#

Is it just me or does that Times cover look like it was riped from a south park episode?

|9.30.07 @ 2:41PM|#

I agree with the premise that the 47M uninsured number is "truly" about a third of that because of those who should not be in that category. As to the Illegal Alien contingent in that 47M...

...The new President of Mexico, addressing his legislature recently, said a Mexican anywhere in the world is a Mexican, and he planned to do all he could he could to ensure their rights, elaborating that he wanted them covered in America by any social service offered Americans and would try and see to it.

Maybe the new President of Mexico ought to back that up by taking care of his 12M citizens here illegally, and cover their insurance at the cost American healthcare charges Americans, insurers, or US employers. Or maybe the new President of Mexico ought to pay to bring his 12M citizens back to Mexico. Or maybe he ought to just STFU.

John Elert
Chicago
And why do blogs allow people to post anonymously, cowards....