Health Insurance in the U.S.: The Devil in the Details

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

6 thoughts on “Health Insurance in the U.S.: The Devil in the Details

  1. I think you misinterpreted what I was trying to say, especially given the body of my work for years. Fat people very much ARE being denied AFFORDABLE health insurance and this does not negate that problem at all. Most of the people in the highest income brackets have insurance available through employers, such as it is. This article is not looking the problems with the insurance industry, of which I could cite chapter and verse far more than most, but simply with the statistics being given by the government about the numbers of Americans without insurance, in their efforts to create a crisis and make it mandatory for everyone to purchase health insurance.

    The fact that young people do not buy insurance while many admit they can afford it and statistics show they can, does not make their choice as contributing to a crisis for which we should force them or anyone to buy it.

    This piece was simply to help get a picture of who are the uninsured in the U.S. and if there really are 43 million who are suffering from lack of access to care as many want us to fear. It was to bring down the level of hysteric rhetoric and start to try to get a better handle on what problems we need to fix.

  2. Thanks!

    I think Sandy changed the post slightly since I originally blogged about it and our conversation in the comments of my post.

  3. At the end, to clarify I added a second link to an article linked earlier that wasn’t being read, which explained why the insurance industry is pushing an uninsured crisis and wanting to force everyone to buy their insurance, while creating a second tier level of people they don’t want to cover to be in public-funded plans (have and have not system).

    There is no need to address most of your comments which concern the health insurance industry as I made it clear that was not what my post was about. But your comment “I don’t understand her brief point about “not Americans,” unless it is pure and simple xenophobia.” is offensive. Ask the CDC why they added these numbers to their stats on uninsured AMERICANS — their deception was all that was being noted.

  4. Sandy, I’m sorry that you feel misinterpreted. In my experience, it’s not just that fat people (and all kinds of people with perceived or real pre-existing conditions) are denied affordable insurance; many are denied any insurance at all.

    As for “Americans,” the term is ambiguous. It can mean “citizens,” “taxpayers,” or “residents.” I have no idea how the CDC is using it here; my limited experience with government statistics (much inferior to yours) leads me to believe that most of the CDC users of the term may not know either, and that the usage may not be consistent from person to person or study to study.

    As you say, we all choose the data that suit our agenda. One of my agendas is that everyone living here is somehow or other “American” and entitled to the benefits of being here, just as my American-citizen niece gets inexpensive, quick, and efficient health care in Sweden, where she is currently living, without having to somehow present herself as Swedish. That’s the position that underlies the remark you found offensive.

  5. Sandy, a “household income of $50,000 a year” might sound like a lot of money to you. And for a young, single person with no dependents who isn’t living in a screamingly expensive city like New York or San Francisco, perhaps it is.

    But in many cases, that pretax $50K a year is the combined income of two spouses and all of their dependent children, and if you live anywhere near a major city these days — especially New York, Los Angeles, Boston or San Francisco where housing prices are astronomical anywhere within striking distance — those are barely subsistence wages in that situation.

    In New York, for example, $50,000 could be what two non-Star**cks coffeehouse baristas or buspeople or cashiers or child-care workers earn before taxes. In Portland, where I live, that would be great money for “low-wage” work, but apartments cost about a fourth here what they do in New York.

    So it’s not like anyone with that household income should automatically be written off as simply “not wanting insurance.” I’m sure in many cases it’s desperately wanted, but did you realize that many of these lower-income people insure their children and not themselves because they simply can’t afford to cover everyone? Not at a monthly nut of $2000 and higher.

    Now, if you want to say some people pass up health insurance they could buy because all kinds of preexisting conditions are excluded and thus it’s not worth it to them to have to pay double for their care? Yeah, maybe.

  6. re the product report in Comment #6 [a penis-enlarger spam since removed], I’m waiting for the Consumer Reports on this subject–not to mention my next incarnation. There was a time when I thought that the accessory most associated with Y-chomosome-bearing entities (I dare not speak its name for fear of spam) might help me achieve certain life goals and I was seriously planning on a male incarnation next time… But having observed the mental effects of testosterone poisoning, I’ve changed that goal. Of course, none of this has to do with insurance. The abrupt hijacking of subject matter just got my attention.

    Sometimes the action of spam engines in putting placing “ad” blog postings makes me think of that cut-up-fragment ransom-note style William Burroughs poetry.

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