The Uninsured

http://www.nytimes.com/2009/08/23/opinion/23sun1.html?emc=eta1

We have said in prior posts that, when you try to do too many things at once, you end up getting nothing done - we specifically applied that observation to the Obama administration's plans to solve the problems of the economy, health care, and climate (plus countless "sub goals" - is "carbon" climate? I get confused) simultaneously. Fortunately for me, I have Paul Krugman, Maureen Dowd and others to help me thru the vast and confusing mess of the administration's priorities.

As to health care, we have said before that delegating to congress the task of creating a comprehensive approach is ridiculous. Too many people with too many "agendas." Sadly, the people who are still suffering are the losers. And the "choosers" can be losers too - if you're 24 years old and have "chosen" not to buy medical insurance, you're in a tough situation when you find out next week that you have a form of cancer.

The theme of our 7/14 post ("45 Million") was: do something. Start with the basics like nobody can be dropped from health coverage because they cost too much and nobody can be denied coverage because of prior medical conditions. Simple concepts. Build from there. Our "Health Care Flowchart" post (8/17) gave us, thanks to Krugman referencing us to Nick Beaudrot's brilliant simplicity (Medicare: 78 million people, employer provided: 122 million people, etc., "people" who have coverage), a perspective on who has "coverage" and who needs it.

The generally accepted number for the "uninsured" is 45.7 million, a number that the NY Times Editorial Board pointed out yesterday (attached) is from 2007 census data. The insurance industry hacks away at that guesstimate by pointing out that many of those people are "temporary" losers of coverage because they are between jobs or the insurance cost too much. And, does anyone think that the unemployment rate is going to drop anytime soon - so some of those "temporaries" probably need to be called something else.

Now, the Department of Health and Human Services estimates that 28 million people were uninsured for all of 2005 and 2006 and that 18.5 million of them were uninsured for at least 4 straight years. Does that sound temporary?

Here are the "uninsured":

THE WORKING POOR - The Kaiser Family Foundation estimates that two-thirds of the uninsured - 30 million people - earn less than twice the poverty level, or about $44,000 for a family of four. 80% of these are full-time or part-time workers. They cannot afford coverage!

THE BETTER OFF - About 9 million uninsured people come from households earning $75,000 or more. While the mix of this group is complex, buying some form of medical insurance lessens the possibility that a serious accident or illness might turn them into charity cases. Compelled to buy (perhaps with a subsidy) somewhat along the lines of Social Security deductions sounds reasonable here because the "insured" will pay for them one way or the other unless they can be "compelled" (I dislike that word) to make a more rational decision.

YOUNG ADULTS - 13 million young adults between the ages of 19 and 29 lack coverage.

ALREADY ELIGIBLE - 11 million of the poorest people, mostly low income children and their parents, are thought to be eligible for public insurance programs but have failed to enroll.

THE UNDERINSURED - The Commonwealth Fund estimates that 25 million people who had health insurance in 2007 had inadequate policies with high deductibles and restrictions that stuck them with large amounts of uncovered expenses.

NON-CITIZENS - 9.7 million of the uninsured are not citizens. 6 million of those are estimated to be illegal immigrants. None of the pending bills cover them.

However one wishes to count the total of those who are uninsured (plus the "under-insured"), if something is not done, it will get worse. Quoting here, "That would be a personal tragedy for many and a moral disgrace for the nation ... Any nation as rich as ours ought to guarantee health coverage for all its residents."

My impression is that we are having "town hall meetings" where members of congress are being shouted down by "citizens" (there is a suspicion that some of those people are "planted") who feel their coverage is threatened. So, we've gone from delegating to congress to adding town hall meetings to the design process. Thinking this out, congress + town hall meetings = impossible health care reform. How inept, politically insensitive and irresponsible we are.