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 2
The unstated point here of course is that there is mindset of the “deserving” and “undeserving” which equates material wealth with virtue. And the failure to be able to afford insurance makes you a bad person who therefore doesn’t deserve healthcare. The following are comments from a conservative American talkboard. Some are pretty repellent, and looking at this stuff requires you to take a shower afterwards, but it’s sometimes worth it as, like children being naughty when no-one’s watching them, they reveal their true beliefs when they think the only people who agree with them are listening.
“people are too stupid to shop around for the best insurance
You liberals stupidly think health care is a right [Actually 85% of Americans do believe healthcare is a right ]
Couldn't we solve the uninsured problem by deporting illegal aliens?
[Speaking of the California plan for universal insurance] Of the 4.2 million, 4.19999 million are illegal aliens that Perata would love to be able to get their votes. The State of Confusion is already screwed enough, not to insure all the bums and scumbag illegals that have invaded us. Perata talks of mostly the working poor. I think he meant the welfare receiving illegal poor.”
Yeah, what lovely people. And these views are not widely held. The illegal immigrant lie is particularly egregious (and I think we can see where these commentators are coming from, from the tone of their comments) and I will turn to this in a later entry, but suffice to say that the total cost of healthcare for undocument workers is vanishingly small (by the best estimates I could find perhaps between 0.1 and 0.2% of total US healthcare expenditure, even by the worst case scenarios made out by anti-immigration groups this climbs to 0.3%), and at least three quarters of the uninsured are not undocumented workers.
However, expressed less offensively this idea of “deserving and undeserving” mentality is widespread, both in American health policy, and in voter attitudes to healthcare. The morality of dividing groups into deserving and undeserving (which certainly could not be done by wealth, but perhaps could be on grounds of health related behaviours) is profoundly complex and we could debate for years without ever quite resolving it. This is perhaps why when health authorities were seriously considering explicit rationing in the UK in the 1990s it was very difficult to get further in what should be excluded for public purchase than tattoo removal.
So let’s consider the practical consequences, instead. This simplistic division creates massive extra costs. Obviously if some are excluded, then the included must prove their inclusion – this creates bureaucracy and cost around the transaction of proving inclusion, hence filling in 5 forms a the doctors before being seen.
More fundamentally though, the question remains of what does one do with the excluded, those without insurance. The logic of the undeserving position is to let them die in the street – but that’s very difficult to live with. The alternative is to treat those in extremis via emergency care. But this leads to worse outcomes and is incredibly expensive. If this was a sensible way of organizing healthcare – all healthcare would be organized like that. And someone has to pay for it – and that is of course those with insurance. Insurance premiums are more expensive to cover the free-rider problem caused by the uninsured having to get very expensive emergency care because they don’t get adequate preventive care up front.
The American College of Physicians calculated the costs of healthcare to the uninsured in 2001 as juts shy of $100bn, of which $35bn was not borne by the uninsured- increasing costs elsewhere. They also estimated that each hospital stay by an uninsured person was 13% or $650 per stay more than for insured individuals.
Given the real public concern about the unacceptable costs of uninsurance, rather than the philosophical problems of maintaining the idea of an undeserving population should be the focus of those wishing to challenge the first convenient untruth.
“people are too stupid to shop around for the best insurance
You liberals stupidly think health care is a right [Actually 85% of Americans do believe healthcare is a right ]
Couldn't we solve the uninsured problem by deporting illegal aliens?
[Speaking of the California plan for universal insurance] Of the 4.2 million, 4.19999 million are illegal aliens that Perata would love to be able to get their votes. The State of Confusion is already screwed enough, not to insure all the bums and scumbag illegals that have invaded us. Perata talks of mostly the working poor. I think he meant the welfare receiving illegal poor.”
Yeah, what lovely people. And these views are not widely held. The illegal immigrant lie is particularly egregious (and I think we can see where these commentators are coming from, from the tone of their comments) and I will turn to this in a later entry, but suffice to say that the total cost of healthcare for undocument workers is vanishingly small (by the best estimates I could find perhaps between 0.1 and 0.2% of total US healthcare expenditure, even by the worst case scenarios made out by anti-immigration groups this climbs to 0.3%), and at least three quarters of the uninsured are not undocumented workers.
However, expressed less offensively this idea of “deserving and undeserving” mentality is widespread, both in American health policy, and in voter attitudes to healthcare. The morality of dividing groups into deserving and undeserving (which certainly could not be done by wealth, but perhaps could be on grounds of health related behaviours) is profoundly complex and we could debate for years without ever quite resolving it. This is perhaps why when health authorities were seriously considering explicit rationing in the UK in the 1990s it was very difficult to get further in what should be excluded for public purchase than tattoo removal.
So let’s consider the practical consequences, instead. This simplistic division creates massive extra costs. Obviously if some are excluded, then the included must prove their inclusion – this creates bureaucracy and cost around the transaction of proving inclusion, hence filling in 5 forms a the doctors before being seen.
More fundamentally though, the question remains of what does one do with the excluded, those without insurance. The logic of the undeserving position is to let them die in the street – but that’s very difficult to live with. The alternative is to treat those in extremis via emergency care. But this leads to worse outcomes and is incredibly expensive. If this was a sensible way of organizing healthcare – all healthcare would be organized like that. And someone has to pay for it – and that is of course those with insurance. Insurance premiums are more expensive to cover the free-rider problem caused by the uninsured having to get very expensive emergency care because they don’t get adequate preventive care up front.
The American College of Physicians calculated the costs of healthcare to the uninsured in 2001 as juts shy of $100bn, of which $35bn was not borne by the uninsured- increasing costs elsewhere. They also estimated that each hospital stay by an uninsured person was 13% or $650 per stay more than for insured individuals.
Given the real public concern about the unacceptable costs of uninsurance, rather than the philosophical problems of maintaining the idea of an undeserving population should be the focus of those wishing to challenge the first convenient untruth.
posted by Exiled in mainstream at 1:05 PM
3 Comments:
I think you underestimate the problem of the illegals. First, they have a greater need of healthcare than similarly aged workers who are indigenous Americans (or UK citizens for that matter). Granted they will mostly be young and won't have the problems of old age, but young workers barely impinge on the healthcare system at all (maternity and violence, mainly). Immingrants show the disbenefits of their previous abode: infectious diseases (TB and HIV, of course, but also parasites and wierd fungi), poor diet etc, and in addition often have an excess of quite costly congenital diseases like sickle cell disease.
Second, because of their illegal status and because of their poor English they present late when the disease is much more costly to treat.
Third, and this is especially true among Pakistani immigrants, there is a 6 fold higher incidence of congenital disease because of consanguinous marriage.
Judging by Karen Davis' figures, the NHS doesn't deal with the problem very well either. On the other hand France does. I'm not sure why. Unless the figures are crook.
Calculating the exact proportion of expenditure is tricky, because different people do it in different ways and they are working from different sets of years. There's a lot of issues about age groups one should measure - as you say most will be young. I'm willing to concede that the figures could be higher than I've calculated here - but not hugely.
Even the anti-immigration group can't get much over 1% of total expenditure from a totally opaque methodology, so my basic point remains - the cost of undocumented workers is chump change in the scheme of American healthcare costs. When you are twice the price of everyone else, taking 1% off by sending the Mexicans back makes no difference at all.
It was interesting to read some of your commentators on your similar posting, and I see your delightful anonymouse has reappeared to throw in his usual bile; but Jim, I think as ever, is insightful on the point about the cost of the uninsured being borne by everyone else.
My argument here is rather more that the idea of an undeserving poor is paradoxically worsening the situation for Americans because they have to pay for the costs of these people which are more than they should be (regardless of the human cost). It seems to me you have to either decide to live with the logic of deciding some people don't deserve care and let them die, or give them effective care which doesn't cost you the earth.
This is not the real reason for the crazy costs, but it is why 9 million children don't have access to good care, and explains why middle-class people we know here worry about paying off medical bills.
No, I agree with you that the actual added cost of illegals is trivial in the American system, but they make running the system that they have got very much more difficult and unwieldy. As I said the British system is similarly handicapped and has a hard job keeping up even without the ER chaos. Head-for-head illegals are more expensive when they come into contact with the healthcare system, but much cheaper when they don't because they don't speak the lingo or understand the system or are hiding from the authorities. Far better that we knew who they were and provided a proper service for them on a weighted capitation basis. Otherwise they distort the local allocations.
By the way, the doctors like the illegals because they give them the opportunity to do the spectacular. Most of the GOSH gene therapy work is being done on the offspring of consanguinous marriages.
The costs billed to the American Insurers are much higher than even private hospitals charge in the UK. If the insurers would pay, most Americans could fly teh Atlantic first class and purchace their medicine here and still make a profit. In some cases they would be better off coming to England and paying for the whole of their care rather than paying the the patient's contribution to the American costs.
This sounds to me like profiteering and many people think that that is at the bottom of teh problem.
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