Debbie says:

As readers of this weblog know, both Laurie and I are generally fans of Sandy Szwarc’s blog, Junk Food Science. No one does a better job on reporting on issues of fat and health.

The blog’s general high quality makes today’s entry on health insurance in the U.S particularly disturbing. The initial facts are informative: Szwarc uses her statistical good sense to take apart the studies on how many Americans are uninsured, and exposes some fascinating (and more than slightly horrifying) discrepancies in the numbers.

As she says, “every interest picks the survey with the data most favorable to its agenda.” Having said that, she then proceeds to analyze every piece of data from the perspective of minimizing the numbers of uninsured, and defending the proposition that many if not most uninsured Americans have made a conscious decision to forego insurance which they could have. In doing this, she seems to be using some of the tactics that she is best known for exposing.

Her first point is that many people who count as uninsured are not uninsured for an entire year. This is only important if they stay healthy during the uninsured period. A friend of mine knows that her health insurance will kick in in October … so all she has to do is decide whether to have the expensive biopsy now for the condition that probably isn’t cancer, or wait until October. If it isn’t cancer, then waiting is not only economically thrifty, but also medically smart. If it is cancer, the several-month wait could theoretically cost her life. So do I care if she is statistically not “uninsured for the whole calendar year”? No, I do not. And neither does she.

Her next point is that many uninsured people could afford private health insurance.

Of the 46.6 million Americans they cited as uninsured in 2005, 17.04 million without health insurance live in households making more than $50,000 a year. That’s 37% of the uninsured in the U.S. Nearly 9 million of those make more than $75,000.

Well. When I was last paying for my own health insurance, for my healthy self and my healthy partner, in 2002 (both of us are fat but neither of us have any of the theoretically associated health issues), the cost was over $600 per month. That’s $7200 per year, or one-tenth of the pre-tax higher income level that she references. We have extremely low housing costs, which is how we could afford it. If we were paying average housing costs in the San Francisco Bay Area, it would have really cut in to our budgets.

Szwarc makes the unsupported assumption that most people who are making “enough” money and don’t pay for their own health insurance “prefer to self-insure for whatever reason, perhaps to keep their healthcare decisions out of the hands of their employer or government.” While I’m sure that that represents some portion of the non-poor uninsured, she never mentions, however, that many people (fat people very much included) either cannot get private health insurance for any amount of money, or can only get private health insurance at a truly astronomical cost. Way back in 1989, I was quoted almost $1500 per month for private insurance, and those numbers have certainly not gone down.

She also never mentions that private health insurance plans often have huge deductibles and significant copayments, so their nominal cost can be half or less than half of what you spend to be sick. She ignores the fact that customers of private health plans have no protections: if you are paying for private health insurance and have a heart attack or are diagnosed with Crohn’s disease, your health insurance company can drop you or triple your premiums after paying for only 60% of one or two months of your illness costs.

I have to wonder what percentage of the voluntarily uninsured would be insured if they could get the same coverage that corporate employees get at roughly the same price. This is not because I think corporate employee health insurance is either affordable or adequate–it’s just so much better than private coverage.

I don’t understand her brief point about “not Americans,” unless it is pure and simple xenophobia. She says that 20% of the uninsured in this country are not citizens. This should affect their access to health care exactly how? I imagine that most of them are taxpayers.

Next, she says that a lot of the uninsured are “young and healthy.” Sure, it’s easier to live without health insurance at 25 than at 55, and statistically safer. Unless you’re the one with the brain tumor, or antibiotic-resistant tuberculosis, or clinical depression.

Finally, she points out that many people eligible for government programs such as Medicaid don’t sign up for them. She seems to think that the “preventive health care and free immunizations” for children that come with certain welfare programs are equivalent to health insurance (asthma in low-income children, anyone?). She also glides right over “access barriers, cultural views, socioeconomic factors and parent education needs,” somehow implying that if people don’t have health insurance because of these issues, they don’t actually count as uninsured.

Her final conclusion:

So how many have actually fallen through the cracks through no fault of their own, are unable to find affordable insurance and are in need of our help? Dr. David Gratzer, M.D., a doctor with licenses in both Canada and the U.S. and author of The Cure and Blue Code, believes the number is closer to 7%.

Who is this man? Why should we take him seriously? She never mentions him in the article until the conclusion. How did she come up with a number lower than any of the numbers cited in the studies she quotes earlier in her article?

I have no idea why it is important to Szwarc to minimize the number of uninsured people in the U.S., or to promote the concept that most uninsured people are affluent, healthy, and have made a conscious choice to pay for their own health care. (Remember “the survey with the data most favorable to its agenda”?)

All I know is:

1) this is a specious and skewed article from a normally careful writer;
2) maybe my “uninsurable” friends and acquaintances are the only people that the U.S. health care system leaves behind, and everyone else is doing just fine, thank you. Maybe. But I don’t believe it.

Thanks to Stef for the pointer and some of the reasoning.

health insurance, health policy, United States, statistics, Body Impolitic