Wednesday, June 17, 2009


Health care: cover everyone

Not wanting to worry about burying the lede, I’ll put it right out here: I’ve been saying for a long time that when we reform health insurance in the U.S., we need to make sure that everyone is covered. Not that everyone can afford it, not that everyone can buy it if they want to... because those result in not everyone being covered.

Like other first-world countries, like Canada and Japan and the United Kingdom and Sweden and France and Germany and the Netherlands, we just need to take care of our people. We need universal health coverage that people don’t have to think about. You need to see a doctor, you see a doctor... and it’s covered. You never see a bill. You don’t have to argue with someone about the treatment your doctor recommended.

That said, let’s back up and listen to NPRs report on Tuesday afternoon about Healthy Howard, a plan in Howard County, Maryland, which is meant to provide cheap coverage for all the uninsured residents of the county.

What a great idea! If the country won’t do it, the state can. If the state doesn’t, well... the county is giving it a shot. For a very small payment — between $50 and $85 per person per month, they’ll give you a whole bunch of medical coverage. It’s a wonderful deal.

But here’s the thing: out of around 10,000 adults who ought to be getting this, fewer than 600 have applied for it.


They attribute some of this to lack of awareness, and they’re working on that. But they cite two other reasons:

Reason 1:

Beilenson attributes the low numbers to the "young invincibles" in their 20s and 30s who think they’re going to live forever.

Reason 2:

“The costs are somewhat problematic, even though it’s very reasonable: $50 to $85 per person per month — far less than insurance,” Beilenson says. “Nonetheless, it is something, and for a lot of people who are having trouble holding jobs during this recession or have lost their jobs, economics plays some part of it.”

Even the cheapest health care program will strike some low-income working families as too costly.

And there it is, in black and white: some people don’t think they need it, and some aren’t willing (or able) to pay for it, however “affordable” it may be.

And when those people get sick, they’re in trouble, because they lack preventive care, and because they turn to hospital emergency departments instead of using the health-care system the way it was designed to be used. And the rest of us are affected too.

Now, when I first heard the item on NPR, I thought that Dr Beilenson, Howard County’s health commissioner, was heading there:

But the paltry enrollment figures have also confirmed Beilenson’s belief in the need for a reform that isn’t even on the table in Washington.

Indeed: universal coverage is not anything that any politicians are discussing. None of the front-runners in the 2008 election talked about it. No one working on legislation now is talking about it. Everyone’s afraid of considering it, afraid that someone will accuse them of supporting socialized medicine, as though that were a fate worse than... well, worse than not being covered. Having doctors work for the state is one way to achieve this, but it isn’t the only way.

But Dr Beilenson was about to cross that line, yes, and suggest universal coverage?

Well, no:

“I am 100 percent convinced that if we are going to have comprehensive affordable quality coverage for all and spread the risk amongst the entire population, you have to have individual mandates,” he says.

That means people would be required by law to have health insurance, something President Obama campaigned against.

We aren’t learning anything from this stuff, we really aren’t. The answer isn’t to require people to buy health insurance. The answer is to provide it for them, as part of the package of benefits they get from living in the United States. Howard County is proving that, right there on NPR.


Ray said...

It appears to me that this is the classic example of how years of brainwashing can become a prime inhibitor to meaningful progress, and yet again it is those who stand to benefit the most who appear to be the ones who are dead set against it. The words stupid and ignorant spring to mind (as they seem to do with depressing regularity these days).

I grew up in the UK, and thus became accustomed to health care simply being there whenever I needed it. All my records were kept in one place, and would follow me if I moved somewhere else. In the US, however, it continues to baffle me that at least once a year I'm required to fill in one or more forms with my medical history. It irks me no end that I'm presented with an avalanche of bills whenever I have the temerity to seek specialist treatment. And it truly ticks me off when I see the amount of money charged for some items that I can buy elsewhere for a small fraction of the price these medical scam companies charge my insurance company.

Now, I would never dream of arguing that any existing universal health coverage system is ideal - that would be ridiculous. There are always going to be problems, and there will always be examples of those who have suffered as a result of errors in the system - these systems are run by humans, after all. However, the acid test would be trying to do away with universal coverage in any country where it exists - it simply wouldn't be tolerated (in the same way that trying to do away with Social Security in the US would never be tolerated. And why is it that we can have social security but not social health care?).

I don't know what it will take to get meaningful universal coverage here in the US. A sea-change in public attitudes is required, not to mention large numbers of politicians with backbones, and frankly, I just can't see that happening.

Sue VanHattum said...

>Howard County is proving that, right there on NPR.

But they don't believe their own proof. Yikes!

I heard Obama on the radio yesterday, saying he doesn't want to redesign one-sixth of the economy (health care sector), and that's why he doesn't want to go single-payer. He said it would be great if we'd started out that way, but here we are, and it's too big to change.


The Ridger, FCD said...

People should be required to have health insurance, yes, absolutely. But the mechanism is requiring the state to provide it.


The fact is simple - too simple for people to see it, I guess: insurance companies are for-profit businesses, and they don't pay off their stockholders and make profits by actually paying for your health care.