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YOUR WORLD IN CHARTS: UNDERINSURED EDITION.
One of the tricky questions in health policy is how to delineate between different types of the insured. We talk a lot about those without any coverage, but a fair portion are hurtling through life with all the protection afforded by a rusted, rattling Kia. In some ways, these underinsured can be worse off than the uninsured, as they think, and even act, like they have coverage, only to find themselves financially ruined or totally betrayed when a medical calamity hits.
Last month, the Commonwealth Fund released a study trying to count the number of underinsured. They chose, as their cutoff point, spending 10 percent of more of income (percent if low-income) on out-of-pocket medical expenses, or having deductibles above 5 percent income. On first read, I was a bit unconvinced by that definition. But it turns out that the experience of folks who fit that description is a whole lot closer to the experience of the uninsured than the insured. Just ask the graph:
The Commonwealth Fund estimates that about 14 percent of the population was underinsured in 2007. That sounds about right, and it's a useful reminder that insurance isn't binary, wherein you have it or you don't. Rather, it exists on a continuum, with some folks being totally insured, some folks being half insured and half uninsured, some folks being totally uninsured but having access to emergency rooms, and so forth. This is how American rationing actually manifests. Canada might have waiting times for non-essential treatments, but we have cost barriers to all manner of treatments. Some can't afford the care, and so they go into debt, or have to sell their home. Others can't afford the care, and so they never get it. We count that waiting time as zero rather than infinity, but that's just a bad faith numbers trick meant to make us feel better.
COMMENTS (8)
I'm stunned by the fact that a third of insured people went without needed care due to costs.
Posted by: DrewSteen | July 3, 2008 9:19 AM
Why are you stunned? Or is that ironic?
I have insurance. It costs me five hundred a month. It covers eighty percent of the cost of maybe sixty percent of the medical expenses in my life -- it does not, for instance, cover vision care, or my spouse's sleep apnea; it did not cover the frenctomy my child's dentist said she needed (that was a thousand dollars out of my pocket). Every January, it does not cover $150 dollars worth of drug costs ($50 deductible per person in my family) or $450.00 of medical costs ($150.00 deductibe per person, etc) not to mention it has a lifetime cap and a yearly cap in some categories -- a ten thousand dollar lifetime cap for mental health services; a thousand dollar per person yearly cap for dental services (it only ays fifty percent on dental to begin with, btw, and has a three hundred dollar deductible there--)...
Well, I could go on. My point is, no, I don't use medical care if I can avoid it, because who can pay for it? I just got my first pair of glasses in three years and only got those because I couldn't see the page anymore. If something hurts I do research on the net and hope it goes away.
I can't do this with my ten year old, though -- every time I take her in, we end up owing the clinic another two or three or five hundred dollars.
And I *have* insurance. Plenty of people around here don't.
Posted by: delagar | July 3, 2008 10:48 AM
Question for Mr. Klein:
Under your preferred health care system, how would care be rationed?
Posted by: Steven Donegal | July 3, 2008 12:40 PM
delagar,
who sold you your policy? Your getting screwed. Only a sucker would purchase a $150 deductible medical plan. Increasing that to even $500 should save you 100-150 a month. Your premium savings would more then pay for the additional out of pocket cost. In fact I guarantee you with what you save you can fully pay the additional deductible and buy vision insurance.
Ezra,
nice half of a study. To mean anything you would need to see where their money is going. I know plenty of people who have unpaid medical bills on their credit. That doesn't stop them from driving a hummer or going out to the bar after work.
Are we supposed to feel bad someone decided to have an $800 a month car payment instead of buying better insurance or paying off their debt?
Every morning on the way to work I stop and buy bottled water at 7-11, every day someone with all the appearances of being lower income is buying their cigs or double douce.
Why should I feel bad that in their life they prioritize smoking and drinking over their health, both of which actually decreases their health and makes them more likely to incur expenses they can't afford.
Do a study of how many non smoking non drinking public transportation riders have unpaid medical bills or skip treatment and then I'll care. Until then it's just BS propoganda.
Posted by: Nate | July 3, 2008 1:04 PM
Underinsured is to vague a word. Use of the word underinsured makes debate impossible.
Delagar for most people a $500.00 is not a big problem. Many people have a monthly auto payments that approach that. It would be a problem for low income people though.
Posted by: Floccina | July 3, 2008 1:22 PM
delagar,
Who wants insurance that covers eye glasses and dental care?
Not me.
Posted by: Floccina | July 3, 2008 1:28 PM
Shorter Flocky: "I can make fatuous excuses for anything, because I expect the world to revolve around me."
I'd like to know those members of the 'uninsured by choice' group who are uninsured because they don't have a fucking clue what's appropriate for them. Coinsurance or not? Deductible for prescription coverage or not?
The cellphone-plan-like structure they use is designed to ensure you'll feed the beast one way or the other.
Every morning on the way to work I stop and buy bottled water at 7-11, every day someone with all the appearances of being lower income is buying their cigs or double douce.
Bottled water: selfish yuppie juice. At least you can't get cigarettes from a tap. But please, keep blaming those straw wastrels.
Posted by: pseudonymous in nc | July 4, 2008 2:25 AM
so-- I have a car payment that approaches 500 dollars. I am not in the low-income bracket. Right now, I am having a dental emergency, but no dental insurance is offered to us. We have to pay an additional 400 dollars PER MONTH on top of our already outrageous health insurance, just to get dental. My son's teeth are going to cost 200 PER-- He has a genetic enamel problem that must be fixed and we were holding out hope that it could wait and open enrollment is right around the corner. Just because we have a new car does not by any means, mean that we can afford 10k a year denal insurance that we may not use. Good for you if you have it- but dont judge me because I dont have 12 kids and live on welfare. If I did, my kids would be at the dentist every six months and YOU'D be paying for it!!!
Posted by: nunya | July 14, 2008 2:34 AM