Blue Mass Group

Reality-based commentary on politics.

Profiles of uninsured

By

Globe reporter Alice Dembner has been doing excellent, anecdotal reporting on those likely to be most affected by the state’s personal mandate to buy health insurance. One throughline for each of the folks she interviews in this article: It’s not just that they don’t like being forced to buy insurance (they don’t); it’s that they’re not at all convinced they’ll get good value for what they’re forced to pay.

In negotiating down the price of the plans, the Patrick administration probably did the best it could in the near term, after being dealt a pretty lousy hand by Romney and the legislature. Unfortunately, they’ve only moved the situation from “laughably impossible” to the borderline of “impossible/extremely painful”. Make no mistake, under the world of the personal mandate, this was how it was going to be under the best of circumstances and the best of intentions.

We’ve got several possibilities: Stay the course, and watch an accelerated exodus from the state; raise the income subsidy limit (very expensive to the state); or suspend enforcement for most folks who are just over the subsidized income limit. I just cannot see how $690/month for a family of four making $70,000 is “affordable” — especially considering the cost-sharing that goes on after you’ve paid your premiums.

It’s sad, but it seems the most humane thing to do may well be to let people go uninsured — which the law was supposed to remedy in the first place.

Update: No sooner do I press “save” on this post than A Healthy Blog chimes in:

And thanks to Alice for clarifying that while the requirement to purchase health insurance takes effect on July 1 2007, the penalties for non-purchase do not kick in until December 31 of this year, and perhaps later. And the penalties will not apply to everyone – only to those for whom the purchase of coverage (including deductibles) is deemed affordable. Too many folks are being led to believe penalties kick in on 7/1/07, and it’s not true.

So again, they get the status quo, which is what we were trying to change to begin with. This needs to be addressed, and the choices are very, very difficult for a state running short on cash.

Please share widely!
fb-share-icon
Tweet
0

Comments

  1. I was against this health care policy from the beginning.  Forcing people to do something is not what this country was founded upon.  If a person wants to forgo health coverage it is his/her choice.  However that person shouldn’t come running to the rest of us when they do get hurt. 

    <

    p>
    True healthcare reform would include reducing the regulatory burden on healthcare providers.  Medicare and medicaid have done more to drive up the cost of health insurance than anthing else. 

    <

    p>
    Insurance plans should be catastrophic plans nothing more.  I’d rather pay less in insurance coverage and pay more out of pocket to go to the doctors for routine things.

    <

    p>
    But the long and the short of it is, people should not have been forced to buy health coverage.  And the government shouldn’t be in the healthcare business.

    • If an uninsured person gets hurt or sick, they do indeed come running to the rest of us for help, one way or another. If they’re only using ER care, those costs (huge, huge, fantastically inefficient costs) get passed on to everyone else, either through insurance premiums or through the Free Care Pool, or the hospital eats the costs and has to charge everyone else more.

      <

      p>
      So the idea of getting everyone insured was so that they can get normal, preventative, regular care (relatively cheap) as opposed to crisis care (expensive).

      <

      p>
      EBC, just about every other industrialized country in the world has universal care with a significant government role. And they get better care than us at a fraction of the cost. So please don’t tell me government shouldn’t be in the health care business. By and large, government does a better job than the free market in providing coverage.

      <

      p>
      Read Ezra Klein on this. A lot.

      • My grandmother lives in Canada.  She waits ridiculously long for simple operative procedures. 

        <

        p>
        Also in Canada the Supreme Court, has ruled that it is against the Charter of Rights and Freedoms (their bill of rights) to deny a person to purchase private health care.  If the system was so well run, why would people want to purchase private health care.

        <

        p>
        We have in the United States the best health care in the world.  As is evidenced by the people that come here from all over the world to be treated.  I don’t hear a lot about Americans going to Europe for care, but I do hear an awful lot about Europeans coming here.

        • There are some 44 million people who have no health care at all in the US. How about that for a waiting list? “Never”.

          <

          p>
          I’m not going to tell you Canada’s system is the ideal. But they cover everyone at a fraction of our cost.

          <

          p>
          You need to back up your ideas, rather than just give talking points. In fact, health care quality is “really, really mediocre across the board” in the US.

          <

          p>

          “The rate at which health care produces really serious defects would drive a for-profit business out of town in about six months,” says Mark Chassin, chairman of the department of health policy at Mt.Sinai School of Medicine in New York and a leader in the movement to bring quality improvements to US health care.”Quality is really, really mediocre, across the board, so simply putting the care back into the hands of the doctors won’t do the trick.”

          <

          p>
          More here.

        • at Mass General and see how many Americans are in the waiting room.It’s a league of nations. People flock to USA from the entire world for medical care.

          • they have to wait around to get it.  Perhaps if more people had access to affordable preventative care, they wouldn’t end up in the ER waiting room with the League of Nations.

    • I worked in medicine. Half of my day was documenting repititive and redundant patient information for medicare/medicaid. Nursing homes and hospitals have well known for a while how to mapipulate the system to increase patient acuity to increase reimbursement. Hospitals are forced into this because they are required to provide incredible amounts of free care for our “immigrants, and underserved” (read those unwilling to assume financial responsibility).

      <

      p>
      Personally I have a medical program that I pay a lot for an MD visit but I max out on catastophic injury/illness. I see an MD when something is really wrong, otherwise I stay away from from any medical practioner because they have to justify the visit with a diagnosis that just may be BS. There are also many, many people in our society that feel the need to visit ER’s, medical offices for a panoply of reasons most being unrelated to any physical ailment (most psychiatric, drug seeking , or lonely)We are talking three grand a week for frequent flyers! The system is broke. Having to pay something out of pocket keeps the lid on to a certain degree.

      <

      p>
      I don’t see how Romney is the fall guy for this. Kennedy has been railing about this for years: Free care for everyone. Well nothing is “Free” and if you want to see the system collapse under it’s own weight, just watch.

      <

      p>
      People need to have and incentive to carefully manage their own health care and be provided decent, affordable care as a reward. When I say affordable, I mean folks are not driven into bankruptcy, but people have to pay a significant amount.

      • Consumer-driven health care — that’s what we need!

        <

        p>
        Oops.

        <

        p>

        Survey findings indicate:

        * Lower satisfaction with consumer-driven plans…
        * Higher out-of-pocket costs…
        * More missed health care…
        * More cost-conscious consumers… [Not altogether good — click the link.] 
        * Lack of information…

        <

        p>
        Other than all that, damn, you’re right. People just eat that stuff up.

        <

        p>
        See, there’s a problem when you apply the same economics arguments to life-and-death stuff like health care, the same way you would for SUV’s or Oreos. People need health care. They don’t need Oreos.

    • Romney’s original bill called for the individual mandate, but let people get out of it if they posted a $10,000 bond (presumably so they wouldn’t become a charge to the uncompensated care pool). Legislators working on the final version of the bill felt a) it discriminated against the poor; and (and perhaps more to the point) b) $10,000 isn’t enough to cover 2 days in a hospital, so it wouldn’t address the problem of uncompensated hospital charges anyway. So, I’m curious: would you have endorsed the bond exemption, or would that have been worse?

  2. #1
    I actually am from Canada. Many of the negative aspects of the Canadian system are blown out of proportion here in the United States. To myself and my Canadian friends, it actually becomes almost humorous. For any critical procedure there is no wait-list. For non-critical procedures, yes, there are wait lists. And sometimes they can be a few months. So the system isn’t perfect. I personally think that it is a much better system than the system here in the US, but I’m also open to the prospect of new innovative systems that may work even better than the Canadian system, and that may be more appropriate for the United States given its current health infrastructure.

    A couple of years ago a major national poll was taken asking Canadians who they deemed the greatest Canadian of all time. The winner was the father of the Canadian Healthcare System, proving how much Canadians appreciate and value their system. He was ranked ahead of all Prime Ministers, Athletes, Nobel Prize winners, and Entertainers, etc. If this poll was taken here in the US, where would the father of the US Healthcare System fit? It probably wouldn’t even be ranked. Here is the link the story:
    —
    #2
    Every Canadian I have asked (several dozen now, although most are from the Toronto area) has said that they have never had any trouble with health care.  No wait, super-easy.  I have good insurance here, and I usually have trouble making an appointment inside of four weeks.

    Where do these stories about the trouble with Canada’s system come from?  I am genuinely curious.
    —
    #3
    It’s interesting, this whole wait list thing.  I think it comes from the promulgation of a few anecdotes that have come up along the years (similar to the grotesque waitlist/treatment rejection anecdotes we have plenty of in the US).  When bad stories come out of Canada, there are those who will quickly throw it up into headlines in the US in order to promote a certain agenda – i.e. “private health insurance is good, look at what those commie Canadians are doing to their citizens”.  Also, similar attention isn’t given to the same problems in the US, even though we ALL know what it’s really like here.  So in the end, it’s very successful PR – something along the lines of ‘the neighbor’s grass is always greener’, but in self-congratulatory reverse.  The fact the almost everyone you talk to in the US – who has not done any background reading on the issue – believes these exaggerations is a testament to their success.

    Take a look at this brief on waiting lists prepared by a past American Medical Student Association (AMSA) Jack Rutledge Fellow: Health policy brief on waiting lists

    Finally, one of the best ways to respond to the waiting list argument is simply to point out that we have more money than the Canadians and we spend much more money per capita on healthcare than they do (almost twice as much!).  Per capita, they have been underfunding their system for a long time.  We have a different problem – we spend alot, but we put it in the  wrong places (i.e. 30 cents of every HC dollar does not get spent healthcare at all-diverted away to admin., marketing, profit). If we managed our system like they do, but per capita keep spending the same level, we would eliminate much of the waste and direct more money into providing better healthcare to all Americans, without the crazy waiting lists everyone is so scared of.

    <

    p>
    To learn about ongoing work to achieve needed health system reforms in the U.S., reforms that truly seek to address the interrelated sytem issues of ACCESS, QUALITY & COST, here are a few sites to visit: the Amercian Medical Students Ass’n Issues page, the Alliance to Defend Health Care (the Alliance is here in Boston and does statewide work as well as national movement building for Univ. HC reform), MassCare for starters.  Each site has many links to other resources and groups.

    <

    p>
    If you feel overwhelmed trying to get your brain around this issue as many of us do, a few themes that many use can help to stay focused on the core issues. These include:
    1. Health care should primarily be for people not for profit-making.
    2. For any proposed hc reform, try to follow the money trail  and identify who wins and who loses under a proposed reform. (ie the insurance industry vs. the average person/taxpayer)
    3. Access, cost and quality issues are inherently interrelated so all hc system reforms must respect this dynamic.
    4. It can be useful to seperate out hc delivery issues from hc financing issues when analyzing a problem and its proposed solution.
    Hope these are helpful.

    • a univ. hc forum on Thurs. April 12, 6-8 pm at Simmons College in The Fenway, Boston, organized by a consortium of students from various schools-see below. And I also meant to say to Charley, please don’t give in to the thinking “maybe the most humane thing is to leave people uninsured”!!!!  Let’s use this hc reform momentum in MA and across the U.S. (with the Pres. race) to create a winning movement for real univ. coverage.

      <

      p>
      BTW we are THE ONLY industrialized country in the world that lacks some form of a national health insurance program that guarantees coverage to all.  It used to be 2 countries: the U.S. and South Africa, but when they did the right thing and abolished apartheid and re-wrote their constitution they included a right to health care and created a national program. So now it’s just the U.S..

      <

      p>
      As US citizens we have the dual distinction of tacitly accepting the fact that ~44 Million people are left without the most essential safeguard for their physical security and dignity out while we get soaked spend, BY FAR, the most money in “the hc system”. What a disgrace and an outrage.

      <

      p>

      <

      blockquote>The upcoming free forum is titled Universal Health Care: Paving the way toward a healthy society. Thurs. April 12, 6pm at Simmons College Library, Kotzen Room. Event details and link to flyer on Alliance website-scroll down homepage to Events

Archives