Remember when McCain economic adviser Phil Gramm said that the U.S.’s economic woes are “a mental recession” and called the United States “a nation of whiners”? I thought at the time that was the most callous statement we’d see from a McCain adviser this year, but I was so wrong.
But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)
“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.
“So, there you have it. Voila! Problem solved.”
Do I have to explain how incredibly stupid this is?
Go on, try. I bet you can’t do it. I know I can’t. That kind of stupid utterly defies explanation.
So, aside from the heaping gobs of stupid that are dripping off this quote the way mayonnaise drips off a Carl’s Junior Six Dollar Burger…
Where does the guy get the idea that the GOVERNMENT picks up the tab when poor people go to the ER? As I understand it, if someone can’t pay, the HOSPITAL picks up the tab. Talk about unfunded mandates…
And in his version of a more perfect world, poor people would die in the street. But don’t worry, he’ll work for it to come to be.
No.
Wow, that’s really loopy! We can solve our health care finance system simply by averting our eyes? Ha ha! Ha ha ha!
That was fun. Now, to be fair, please go read Goodman’s comments here.
Goodman’s point, however insensitively expressed, is that the simple term “uninsured” lumps together people in rather different circumstances, and efforts to devise policies to deal with them might benefit from more refined analysis. Goodman argues, among other things, that our method of categorization distorts our ability to compare our system to the health care systems of other nations.
Goodman favors disaggregating the data into at least four groups:
1. People who would rely on emergency rooms + out-of-pocket + charity to obtain care. Emergency rooms must provide care regardless of ability to pay. Anyone can afford health care up to the extent of her net worth. And, according to Goodman, uninsured people receive an average of $1000 – $1500/yr in charity care.
2. People who are eligible for Medicaid/SCHIP; an estimated 25% of the uninsured are eligible, but haven’t signed up yet.
3. People who would rely on out-of-pocket, including the ability to buy private insurance out-of-pocket. According to Goodman, lots of uninsured live in households earning enough ($50,000) to afford health care/insurance. Many laws bar insurers from withholding policies, and some even have mechanisms to keep premium costs low.
4. People who would sign up for insurance with their employer. Goodman asserts that anyone who has a job could get a job with health benefits (albeit perhaps at a lower salary), and that many employed people simply decline to pay for insurance via their employer.
I have little knowledge about the facts Goodman alleges, but I suspect there are many dynamics Goodman overlooks: As an insured guy, I can get my kids vaccinated so they can go to school. I don’t think emergency rooms provide this kind of “routine maintenance” kinds of services. Moreover, public health analysis suggests that many people are discouraged from seeking routine maintenance due to price, but that this is precisely the kind of services that has the biggest pay-off to society. Thus, the fact that someone COULD afford a measles shot does not tell the whole story; I’d also like to collect data regarding extent to which people actually DO get those shots.
Nevertheless, Goodman hints at relevant distinctions: Is the health care problem a matter of access, or of cost? What percentage of the uninsured regard themselves as too poor to afford insurance? What percentage regard themselves as are too healthy to worry about insurance? Should we require affluent people to buy insurance, or is it sufficient to leave them to their own devises? Disaggregating the data might help illuminate these issues.
The most important health care you get is the routine type you don’t think about. By the time most people realize they need specific care, it’s already too late, and in many cases all you’re getting is dressed up palliative care. It’s like waving off education by saying “if you really wanted, public libraries and wikipedia exist”.
Not that I’m putting this past people like Goodman. After all, a society that truly valued freedom wouldn’t educate children for free.
Re: vaccinations:
Health departments offer vaccinations for free. Perhaps a bad choice of comparison?
Regardless, insurance is a hot-button issue, particularly for folks with chronic illnesses or conditions. “Nearly 1 in 2 people in the USA has a chronic condition…” That’s a lot of people. And everyone needs something to rely on when they get seriously ill. Changing the way people are categorized isn’t going to help that.