The uninsured get good care anyway and the only uninsured people are bad people, so it’s their fault that they get bad care (eh?) pt 1

I once commented on the irony of parts of the pro-life movement apparently believing that life stops at birth – combining a fanatical devotion to the well-being of the foetus and utter indifference to the well-being of poor adults, the inconsistency of which baffled me. I cited the 40+ million Americans without health insurance as an example of this. I received this charming response from someone without the courage to put his name to his comments.

“ the silly yet widespread mistake that if you don't have health insurance, you are denied medical care in the US.Nonsense! There are many ways to get covered medical care, including just walking into an emergency room to getting Medicaid from the federal and/or state government

The statement that these 'uninsured' people have their lives shortened is poppycock, a statement straight from the Democrat talking points, without source and foundation.”

I need to include a disclaimer - these views are not widespread. The majority of Americans do worry about the problems of the uninsured, as many of them are themselves, as the Clintons noted “one pay cheque away from catastrophe”. Nonetheless, I thought this was a revealing insight of the mind of perhaps 10% - and a very vocal 10% - who do much to shape the discourse.

On one level of course this silly little rant should just be ignored, but it is quite revealing of the logical incoherence, and ignorance (or dishonesty) of those who hold these views.

First the logical incoherence is that if it were true that the uninsured were able to get good care, nobody would bother being insured, as having insurance would not provide sufficient advantage to justify its cost. Were this to happen Stephen Levitt would have another chapter for his next book, if nothing else. Of course, this hasn’t happened. Indeed even Health Savings Accounts combined with consumer-directed policies which go a step in this direction have not encouraged this behaviour. (Basically Consumer Directed policies are a misnomer – they’re an exercise in cost-shifting from the insurer to the individual through high-deductibles and co-pays, incentivized by lower premiums and HSAs which allow tax-free savings to cover these potential greater costs). The next post will look at these in much greater detail but suffice to say that take up has been low and people with them are significantly less satisfied than those with conventional health insurance

The response was also, of course, loaded with factual inaccuracy, not least the view that people with Medicaid coverage are included in the population of the uninsured – the problem is the “hole” of the near poor who don’t qualify for Medicaid but can’t afford private insurance, and aren’t offered insurance through their employer. The majority of these people are in working families. Eight to nine million are children.

That the uninsured are likely to receive unacceptably poor care and that this has an effect on their health status seems from the evidence incontrovertible. The uninsured are far less likely to receive recommended screening and preventive care, are likely to delay getting necessary medical care, not fill prescriptions, not get recommended treatment for reasons of cost. The effect of this is estimated by the Institute of Medicine as an excess mortality of 18,000 people a year (or six Iraqs).

So the “uninsured get good healthcare” claim falls flat as soon as one looks at either the evidence or considers the behaviour of Americans in response to having their insurance limited.