Samuelson is clearly reading from the Republican playbook on this issue, as is McCain. The health care problem is that people are paying too little for health coverage. Charge people more for health insurance and care the all of these pesky problems will go away.

When will Obama tie this around McCain's neck and sink him once and for all?

Ezra
Precisely. Not clear why he chose the comparison groups he did--does not register with me.

See latest HA study. Uninsured use less health care before they are sick, and AFTER they are sick, somewhat stilting argument that they cost more in the long run. They still get overlooked by the system.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.5.w399

And we're not even getting into the economic costs that befall families when illness strikes and they don't have coverage to defray the expense or treat the ailment. They go bankrupt.

In some cases, they incur such great debt that they turn to a life of crime. (Note that this guy was insured, but the insurance didn't cover his surgery.)

Do you try to come off as clueless or do you not even realize how little you know about healthcare?

“A person who is uninsured all year will average $1,686 in medical costs, while someone who is privately insured will average $3,915."

Why would that be? Did it ever dawn on you that people without insurance make that decision to be uninsured? If your healthy and decide you don’t need insurance then you will have low expenditures.

From Kaiser; “In a recent paper published by Health Affairs, Dubay, Holahan and Cook estimated that approximately 80 percent of the uninsured are currently eligible for public health insurance coverage or live in families with income below 300% of the federal poverty level (FPL).”

“Of the uninsured, 25% percent are eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP)”

SO why in the world would someone who has free insurance offered to them turn it down? Because they are healthy and don’t need it. It’s not worth the minimal effort it would take to sign up. Insurance agents seldom get calls from healthy people that don’t need insurance. People that are sick or expect to get sick are the ones that seek coverage.

How do you now get such simple logic? Some other common facts you should find useful since you obviously haven’t seen them before and don’t know how to google;

http://news.yahoo.com/s/ibd/20080826/bs_ibd_ibd/20080826general01

The number of uninsured fell to 45.7 million last year from 47 million in 2006

Some 18 million of the uninsured make over $50,000 annually and could probably afford insurance

Another 14 million are eligible for government insurance but don't sign up, he says.

Some 9.7 million, or 21%, of the uninsured aren't U.S. citizens.

I count our uninsured problem to consist of roughly 4 million people. Weird you don’t ever discuss these numbers.

“Samuelson, however, tends to exhibit the opposite dysfunction: He writes to prove his callousness”

Is that any worse then your writing to prove your ignorance?

Do you try to come off as clueless or do you not even realize how little you know about healthcare?

“A person who is uninsured all year will average $1,686 in medical costs, while someone who is privately insured will average $3,915."

Why would that be? Did it ever dawn on you that people without insurance make that decision to be uninsured? If your healthy and decide you don’t need insurance then you will have low expenditures.

From Kaiser; “In a recent paper published by Health Affairs, Dubay, Holahan and Cook estimated that approximately 80 percent of the uninsured are currently eligible for public health insurance coverage or live in families with income below 300% of the federal poverty level (FPL).”

“Of the uninsured, 25% percent are eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP)”

SO why in the world would someone who has free insurance offered to them turn it down? Because they are healthy and don’t need it. It’s not worth the minimal effort it would take to sign up. Insurance agents seldom get calls from healthy people that don’t need insurance. People that are sick or expect to get sick are the ones that seek coverage.

How do you now get such simple logic? Some other common facts you should find useful since you obviously haven’t seen them before and don’t know how to google;

http://news.yahoo.com/s/ibd/20080826/bs_ibd_ibd/20080826general01

The number of uninsured fell to 45.7 million last year from 47 million in 2006

Some 18 million of the uninsured make over $50,000 annually and could probably afford insurance

Another 14 million are eligible for government insurance but don't sign up, he says.

Some 9.7 million, or 21%, of the uninsured aren't U.S. citizens.

I count our uninsured problem to consist of roughly 4 million people. Weird you don’t ever discuss these numbers.

“Samuelson, however, tends to exhibit the opposite dysfunction: He writes to prove his callousness”

Is that any worse then your writing to prove your ignorance?

Great post Ezra, in a perfect world the writers at the Washington Post would worry more about whether what they're writing is true, and worry less about how serious it makes them look.

In some cases, they incur such great debt that they turn to a life of crime. (Note that this guy was insured, but the insurance didn't cover his surgery.)

This is not the greatest anecdote, because no form of insurance, including Universal Healthcare or Single-Payer will cover every potential procedure. Folks might still turn to a life of crime to pay for an outrageously expensive new cancer treatment that shows a lot of promise but isn't yet covered by private or public insurance. Which is not an argument against Universal Healthcare so much as it as a caution that, should we get Single Payer or Obamacare, don't expect problems with healthcare coverage to go away.

I didn't have any health insurance in the Hanoi Hilton, you little punks.

Wouldn't it save a lot of health care costs to have seriously injured and chronically ill people volunteered into incinerators? Let's be rational, here, people!

This is not the greatest anecdote

Yah, I wasn't trying to put it forward as an argument -- Ezra's got that covered, with the data -- just as an irony. I usually think of bribe-taking legislators as enjoying some kind of life of Riley, like Duke Cunningham, but this guy really seems to have needed the money to cover his health care. (And it may be that he could've got something adequate in-network; I have know way of knowing.)

I have a question for Ezra Klein's archivist: has EK ever acknowledged the fact that about a quarter of all the uninsured are not Americans? Because, factoring a solution to that into his calculations would seem to be as advisable as, say, a pilot considering wind speed when making a trip.

Also, BHO lied (again) about a similar set of stats:

24ahead.com/blog/archives/007954.html

And, the DNC lied about those stats:

24ahead.com/blog/archives/007898.html

The number of uninsured fell to 45.7 million last year from 47 million in 2006

Unfortunately, that is because government agencies are picking up the slack; the numbers of individuals that receive private insurance have been falling year over year for awhile now. Fewer people on private insurance means there is a smaller pool of people to spread the risk and the price goes up. Over time, more and more people can't afford the premiums and fall off the roles. Since the healthy individuals tend to give up their insurance sooner, the remaining people represent an ever smaller and sicker pool of folks. As I am sure you are aware, this is called adverse selection. It is not sustainable and not that efficient for that matter. I am not sure why you don't see the declining numbers enrolled in the private sector as a problem.

I count our uninsured problem to consist of roughly 4 million people. Weird you don’t ever discuss these numbers.

While your counting could be correct, you are assuming that the categories you cite are mutually exclusive. I see no reason to make that assumption. For example, a person might make more than $50,000 a year AND not be a US citizen AND be eligible for a government program. 300% poverty was $41,070 for a family of 2 in 2007. A larger family could make over $50,000 and still be in this classification. Also, LaCHIP is at least one program I could find through the Google where a non-US citizen could qualify for government health care. The “uninsured problem” that concerns you could very well be larger than 4 million people.

SO why in the world would someone who has free insurance offered to them turn it down?

I'm jumping out on a limb here, but another reason could be that they don't know about the program. Perhaps they missed the commercial with the guy in the glasses and a green suit.

It seems that the overall theme of your comment (besides calling the post clueless) is that people are making the choice to be without health care and that this fact makes everything ok. I think the problem with this is that when people go without health coverage they shift the risk to everyone else. In other words, if they do need to get care later on and cannot afford it (who can these days), then someone has to pay for it (that would be the rest of us). Even if they see the illness coming and are able to jump on private insurance at the last minute, the cost is still born largely by others. That's assuming the insurance company doesn't call them out for having a preexisting condition.

Finally, the 800 pound gorilla in the room is not the uninsured or the costs of ignoring preventative care, but the underinsured. These are people who face some of the same outcomes as the uninsured, but have to pay ever higher premiums for that privilege.

I have a question for Ezra Klein's archivist: has EK ever acknowledged the fact that about a quarter of all the uninsured are not Americans?

Also, BHO lied (again) about a similar set of stats:

24ahead.com/blog/archives/007954.html

And, the DNC lied about those stats:

24ahead.com/blog/archives/007898.html

I wonder if you would support some form of limited care even for illegal aliens. I think immunizations would be a bare minimum since communicable diseases don't often discriminate based on nationality.

Additionally, I am concerned about the pressure being put on emergency rooms by all those that are uninsured (including illegal aliens). When an emergency room is closed we are all harmed. What type of reform could we implement to solve this problem? Perhaps we need to show our papers when we arrive at the hospital and are denied care if we are not US citizens (or cannot prove that we are)?

I am sensitive to your concern for using US taxpayer money to fund care for non-US citizens. But is this a reason to do nothing? Should we cancel the Joint Strike Figher and F-22 programs since illegal aliens also gain benefits from those? Of course not, that would be a silly reason.

Perhaps we should focus on limiting the number of illegal aliens with other policies rather than allowing this to cross over into the health care debate.

Why has/is employer based coverage declining consistantly? Government regualation. COBRA, HIPAA, small group reform, NY Surcharge, government regulation has been driving up the cost of HC for over a decade. Why are we surprised employer base coverage has declined when that has been the intent of congress for years. They have been trying to take over HC since Ted Kennedy in the easrly 70s.

I certain the number of uninsured who can't get insurance is higher then 4 million, I would guess closer to 8 million now, if people had taken proper action earlier the number wouldn't have been so bad. It's like life insurance, if you wait till you have had cancer you will always have problems getting it. If you buy it early you are covered for life. Even 8 million is far off the 47-50 million those on the left claim can't get insurance. In fact I don't think I have ever seen someone on the left discuss the difference between those that are uninsured by choice and those that can't get it.

the 800 pound gorilla is consumption. The 400 pounder is regualtion and government interferance, and the 200 pounder is personal responsibility, all three of which Ezra refuses to admit exist.

Our two post are a more honest and indepth discussion of the HC problem then anything Ezra has ever posted. If the other side could debate like you do we might actually solve the problem.

You seem very willing to have a logical discussion goDems;

"Perhaps we should focus on limiting the number of illegal aliens with other policies rather than allowing this to cross over into the health care debate."

How about taking a few thousand members of our military and stationing them along the border. It always befuddles me that we have 100s of thousands of soliders sitting back in bases while we are litterlally being invaded.

Hey Nate, maybe if you read Kaiser's studies you would have found that their studies show that half of the unisured do make over 50k but have a prexisting condition and hence can't buy insurance. Way to go douchbag, blame people for getting diabities. They earned it by eating all that candy.

Charlie,

I rather be a douchbag then the stupid douch. Look up HIPAA then tell me why someone with a pre-existing condition can't get coverage. Do you need me to spell HIPAA for you? Then after your done explain further how pre-ex is a hinderous to coverage when almost every state has passed small group reform with guarantee issue and no pre-ex. After that lets tlk about employer based coverage, where most people get their insurance and limited use of pre-ex. Maybe before you go calling people douchbad Charlie your dump ass should get a clue and some education. Why is it the dumbest people feel the most inclined to speak up and parade their ignorance?

the 800 pound gorilla is consumption.

I would argue that the patient does not have enough information to be considered a consumer. For the majority of the health care industry there are no clear prices or information on things such as quality for the various procedures available. Additionally, patients don’t know what they need; they only know what the symptoms are. A doctor is needed to fill in these information gaps. At that point the patient is no longer the consumer, the doctor is.

The market seems to be broken; therefore using standard market arguments, such as claiming too much consumption as the cause for high prices, appears to be ignoring some major parts of the debate.

The 400 pounder is regulation

I don’t know much about the regulations you cite or their impact on prices. A quick read on some of them seems to suggest that they play a role in limited circumstances such as changing jobs. However, I think past experience would suggest that less government regulation leads to lawlessness in the markets which in turn produces excess risk taking which in turn produces market failures. The tax payer is eventually forced to pay for it. There should be clear rules and plenty of information for any market to work efficiently.

There are some other government regulations that I believe could cause limited supplies and thus high health care prices. Protectionism for doctors and patent monopolies for drugs come to mind. Simply allowing negotiation for Med Part D would help. Of course, there are some powerful interests in Washington that do not want to see changes made to these anti-capitalistic practices, so I am not holding my breath.

and government interference

By this I suppose you mean the VA, Medicare and Medicaid. I would only say that if the private industry cannot compete with these programs on cost, then there really is something wrong with private health care. Case: Medicare Advantage costs tax payers more money than Medicare would. I guess conservatives deserve some credit for sticking to their guns (this is a common phrase, I am not making fun of the NRA, also note that I did not use the word “clinging”), even though the evidence seems to be against them.

200 pounder is personal responsibility

Here I agree with you. When someone who can afford health insurance chooses to shift the risk and cost to the rest of society by not getting it, then they are forsaking personal responsibility. Also, obesity is up, exercise is down and prevention seems to be a dirty word. How can we solve these issues? Maybe we could provide some sort of credit for those that get regular checkups with additional credits for those that score well on body fat, blood pressure, etc. This could be like when your car insurance goes down if you don’t speed.

I’ll keep the answers short so you get the gist of the idea. I’ll gladly expand on any of them if someone wishes to discuss the merits in detail.

800 Pound gorilla is consumption – no one is asking consumers to be an expert on rather to have open heart surgery or not. That is not were the majority of inflation is. Asking your doctor for a generic instead of brand is well within reason. When your doctor schedules a office visit to give you simple test results instead of over the phone the average person can question it. In 1960 50% of health care was paid out of pocket. Today that is down to 17%. Consumers don’t care because it is not seen as their money. They take medicine, allow test, and show up for visits they never would if they had to contribute meaningful to the payment.

400 pounder regulation – the road to hell is paved with good intentions. It’s not the intent of the laws that are a problem, it’s the fact they were written by dumb asses that don’t understand healthcare. COBRA has a 2% acceptance rate meaning 98% of notices mailed are never returned. Instead of requiring employers to mail notices what of individuals wishing to take COBRA were responsible for asking. Hardly an imposition but it would save hundreds of millions just being wasted. Additionally the liability on small employers forced them to drop efficient self funded plans and move to insurance companies. If your HR person loses a change of address form and you mail the COBRA letter to an old address the company can be forced to cover the individual years later when they get sick. Numerous small employers have been bankrupted by honest clerical errors.

NY needed to raise revenue and decided to tax the revenue of a couple hundred hospitals and ancillary facilities. No problem except NY is ran by a bunch of liberals with their head up their ass. Instead of taxing 200 facilities they decided to tax a hundred thousand health plans and employers. Every single health plan and employer with SF benefits had to send monthly reports to NY, even if you were in NV and didn’t have employees in NY. Liberals would be hard pressed to find a more inefficient method to collect revenue from 200 facilities.

I could go on all day about inefficient government regulation. None of them have anything to do with protecting members or the system, it’s pure government stupidity. Which makes it all the more ironic/moronic when the left claims government is more efficient.

Government interference I mean Ted Kennedy passing a law saying every employer with more then 25 employees had to offer an HMO. He then subsidized HMOs so they could undercut other plans. I’m talking about state laws that say only certain employers can self fund and they must carry certain levels of coverage, those levels being chosen only to limit self funding not for any legitimate business reason. I’m talking about poorly designed small group reform like CalChoice.

No need to suppose what I mean I can articulate my own arguments. I hope you’re aware that Medicare Advantage has much richer benefits then Medicare, you are adjusting for those correct?

200 pound gorilla – I personally like the idea of a personal mandate. Every American must carry catastrophic coverage. Maximum 5-10K deductible. If you take care of yourself insurance cost you less, if you don’t care about your health then your going to pay out the nose for it. This is the simple answer, no government sponsored plans, anyone that smokes can’t get subsidized care from the tax payers, must have minimum 10 carriers per market. On and on, at least we found some common ground.

Does anyone know the source of the study Samuelson cites on chronic illness among the insured and uninsured? It doesn't appear on a Google or Medline search. It would be interesting to know what the study actually said.

Perhaps Nate should take a look at what the must-issue coverage costs before blathering. A policy that costs, say, $1k-plus a month with $10K deductible and $25k out-of-pocket may exist, but it's not going to do most people with pre-existing conditions a lot of good.

The law in its majesty permits both the rich and the poor to spend $20k a year for medical care...

The game is too early for any player to really develop any guide that can contain that valuable of information that another can offer considering the game has yet to even be released. Why pay for information when many sites even provide that information for free. Majority of the information these paid for guides are scraped off other sites, blogs and forums and combined, compacted and reworded to become their own guide.