Last week the Census Bureau released new numbers showing that 5.6 percent of the population in Massachusetts remained without health insurance coverage. That’s a 42 percent drop in the number of the state’s uninsured since the law took effect in 2006. A new study by the Cambridge Health Alliance, one of the state’s safety net providers, showed who was left out, putting a human face on those without insurance. The findings are illuminating given that the Bay State’s health law is the model for the national law, which takes full effect in 2014, and the Romney-Perry feud often flares up around the topic of health reform in the state.
The local press, primarily the Boston Globe and WBUR, covered the story; the national media whiffed on its implications for federal reform. If reform in Massachusetts cut the number of uninsured roughly in half, the same is likely to happen nationally, according to government data. The latest Census Bureau numbers show that nearly fifty million people have no health coverage; the Congressional Budget Office estimates about twenty-three million will be still be uninsured later in the decade. It was as if the national media has forgotten that Massachusetts is a harbinger of what will happen nationally. Or perhaps it’s easier for the national media to cover the he said/he said back and forth between Perry and Romney.
Writing on WBUR’s CommonHealth blog, Carey Goldberg started with an intriguing lead that showed she could sniff out a story—and showed why others should, too.
You figure that when a press release comes in from Physicians for a National Health Program, it has an agenda. But that doesn’t negate the value of the research it highlights—which, in this case, was a paper from Harvard Medical School researchers just out in the Journal of General Internal Medicine.Researchers surveyed 431 patients who sought care in the emergency department of the Cambridge Health Alliance and conducted in-person interviews with 189 who were uninsured. Their results show that fragmentation still exists in a system built on employer-sponsored coverage. Gobs of paperwork also still exist, and private insurance remains unaffordable for many—even with government tax subsidies. The key points from the study are these:• Finding affordable coverage is hard. One third of the respondents said they were uninsured because they could not buy affordable coverage. Half the sample said that the mandate to buy coverage prompted them to look for insurance, but they couldn’t find any they could afford.
• Two-thirds of the uninsured were working, but only one-quarter of them had employer coverage.
• Some declined employer coverage because of its cost. The state requires an employer to cover only 20 percent of the annual family premium and 33 percent of an individual premium. The authors suggest that if the trend continues that requires employees to pay more out-of-pocket, even fewer employees will take their employers’ coverage.
• One third of the respondents said they were uninsured because they lost their coverage. People receiving subsidized coverage must re-enroll every year. If they don’t get the paperwork sent in within ten days, they lose coverage.
• Eighty-five percent of the uninsured qualified for state-subsidized insurance, but still one-third were without coverage, suggesting, the authors say, “that for some working poor, even heavily subsidized insurance premiums may be unaffordable.”
• Only about six percent said they were uninsured because they didn’t think they needed coverage; in other words, there were few “free riders.” That’s an important point to remember next time the candidates declare that people like to take risks by being uninsured.
Several months ago, a group called PHI, which works to improve conditions for workers who provide long-term care, released a study that meshes with the Cambridge Health Alliance findings. PHI found that while many employers offered coverage, workers were not taking it. About half of the workers surveyed were not eligible for employer coverage because they worked part time or had to satisfy a waiting period for coverage. About one-third of employers raised the level of cost-sharing for their workers. The media showed little interest in this study as well.
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Trudy wrote: "...fragmentation still exists in a system built on employer-sponsored coverage".
padikiller responds: Of course it does.
Why shift the responsibility to paying insuring premiums to employers? I mean, aside from furthering the commie/liberal "wealth redistribution" agenda? Why is this a good health idea? Or a good financial idea? Or a good social policy?
Any system wherein the consumer does not pay for the product will become fragmented, inefficient, expensive and downright crappy.
When people paid their own doctor's bills out of their own pockets, there was no problem. Costs were reasonable and care was good. When health insurance rolled around (as a result of wartime interference with the free market) then things started getting worse.
When the government got into the health care equation through Medicare and Medicaid, then the system became a pure boondoggle. Medicare wastes many times more money in fraud and abuse than the combined profits of all of the health insurance companies.
When "somebody else" is paying the bill, who gives a crap about costs? What motivation does the consumer have to reduce costs? What motivation does a provider have to reduce costs? The system becomes corrupted - transformed from a free market system where costs are moderated by market forces into a system built to circumvent or exploit policies - a system wherein the providers game the loopholes and surf the regulations to squeeze as much money as they can from "somebody else" while providing services to consumers who don't give a rat's ass about costs.
The commie thing just doesn't work. As Margaret Thatcher said, the problem with socialism that socialists always run out of other people's money.
#1 Posted by padikiller, CJR on Wed 28 Sep 2011 at 06:38 PM
Furthermore...
Having "somebody else" pay the medical bill is inherently less efficient and more expensive than having consumers pay expenses directly. It's just another bureaucracy and another regulatory authority added into the mix to be paid for.
If I were able to craft an insurance law it would be this:
Every family would be entitled to purchase a family catastrophic insurance plan with a $10,000 family deductible. This plan would cover $10 million in lifetime benefits and would require insurers to pay every single penny of medically necessary treatment over the $10,000 deductible. Regulated insurers who want to do business in the state would have to offer high-risk policies under an assigned risk program. Low income families who can't afford the plan would qualify for subsidized premiums on a sliding scale (ultimately obviated by Medicaid for the truly indigent)
Such a plan would cost about $200-$300 per month (I have a similar plan and that's what it costs me).
After this... Do what you want.
You want to run the risk of bankruptcy without coverage? Go for it. You want Cadillac insurance to beat the $10,000 deductible? Buy it. Your employer offers such insurance? Take it if you want. Or don't. Whatever.
Worst case scenario for those insured in my proposed system - two family members get really sick and need expensive treatment - the family's covered. The most they will pay is $10,000 a year in the deductible plus another $3600 in premiums. $13,600 total.
In a good year where everyone is healthy, they'll pay the $3600 in premiums plus the cost of routine visits (for my family, under $1200 last year). Around $5000 total.
Compare that to what we have under Obamacare -where premiums on family plans just jumped NINE PERCENT to more that $15,000 on average! (so much for the commie/liberal "Obamacare will reduce premium costs by $2500 per year" lie).
My proposal would provide voluntary universal coverage that would be available to cover every single person who wants it, regardless of preexisting conditions, the maximum cost of this plan would be less than than the current average cost of more restrictive health plans and the average cost of my proposed plan would be less than half of the current cost of the average family plan.
The plan works by making consumers responsible for out-of-pocket expenses for routine treatment.
You implement a plan like this, and the system will fix itself immediately.
#2 Posted by padikiller, CJR on Wed 28 Sep 2011 at 07:14 PM
Interesting article. However, your conclusion that there are relatively few 'free riders' (6%) is based on a biased sample. Since the survey was done in the ER department of a safety net hospital, the individuals surveyed are likely low income and have health issues. If the same survey of the uninsured was done at a Patriot's game, I am sure the results would be significantly different, and likely skewed in the other direction.
#3 Posted by observer, CJR on Fri 30 Sep 2011 at 07:58 AM