The Great Uninsured -

America has a new persecuted minority. The Great Unwashed have been replaced by the Great Uninsured.

The word “uninsured” has taken on the freighted tonality of “unemployed,” “deadbeat,” “indigent,” and even “homeless.” The next time you hear someone confess to having no health coverage, check out the ever-so-slight pause in his listener’s voice. Watch for the slow blink, the quick wiping clean of alarmed features back to bland American acceptance. We’re good at this; nobody can do the pause-blink-wipe number like an American.

There are as yet no generally known anti-uninsured slurs, but if I know anything about the Greatest Country on the Face of the Earth they are bound to emerge. Maybe we will call them “sickniks”; maybe we will call them “toddies” for the hot lemonade and whiskey they take for double pneumonia; or maybe “branders” after those characters in westerns who cauterize their own wounds.

The slur that comes closest to describing how Americans view the uninsured is “poor white trash,” but we have been so worked over by the goons of political correctness that we are now in the grip of a terrified need to make everything we say sound inclusive, even slurs. “Poor white trash” would have to be tarted up to “poor white trash of all races and classes” before anyone would touch it, so if you want to take out inclusion coverage before you run down the Great Uninsured, it’s best to stick with Marie Antoinette’s “them.”

The uninsured always were “them.” What we are dealing with here are reincarnated attitudes that go further back than most people now alive can remember. But I do remember them, and that’s what got me started on the subject of insurance.

Rest assured that I am not going to write about insurance per se. That requires a natural ear for droning that I lack; a numbers cruncher’s visceral need to drizzle “%” signs all over the page; and, of course, the technical knowledge to criticize HillaryCare and BushCare. I can’t do that. As Samuel Johnson said of the plot of Cymbeline, “It is impossible to criticize unresisting imbecility.”

I leave “deductibles” and “co-payments” and all the rest of it to the panicky-eyed patients milling around the doctor’s checkout desk while his shattered nurse waits on hold to find out who pays for the first three hemorrhoids. What interests me is the place of insurance in the American psyche and how it has affected our health-care crisis.

Back before most people had bank accounts, they had insurance policies. They were always for life insurance — the average man had nothing else to insure — and on them rested his sense of self-worth and his reputation among his peers. Having insurance divided the responsible from the shiftless, the dependable from the flighty. It established a young man as “good husband material,” while an older man who had a paid-up policy was the prototype of steadiness. Their widows and orphans would never end up in what was then called the poorhouse.

Insurance also answered the powerful emotional need for a “decent burial.” This comes out in A Tree Grows in Brooklyn. For years Katie Nolan has paid a dime a week for her own policy and a nickel each for her two children’s. No matter how hard up the Nolans were, she always made sure she had “the insurance money” when the agent came round, keeping it in a tin-can bank hidden in the farthest corner of the closet, nailed to the floor.

But the day comes when Katie is destitute. She tells the agent she can’t pay the premiums; she will have to let the policies lapse. Instead he advises her to cash in the children’s policies so that she can keep up her own, and have a decent burial for their sakes.

She understands. “I wouldn’t want to be buried as a pauper in Potter’s Field. That’s something they could never rise above; neither they, nor their children, nor their children’s children.”

It is not necessary to have known people like this in order to be influenced by them. If you were raised by somebody who was raised by somebody who remembered them, you remember them too. This is why stock characters in movies are perennial favorites. The doctor who made house calls, the lawyer who worshiped justice, and the reliable husbands and decent burials of that old-time insurance live on in our collective national memory long after they have left the stage.

When medical insurance got going after World War Two, it was called “hospitalization,” or, interchangeably, “Blue Cross,” after the pioneer. It was a fortunate name, with a built-in reverent hush, like Prudential. Saying “I have Blue Cross” sounded old and established. Many continued to say it even after coverage was expanded to include doctor bills and the name was changed to Blue Cross & Blue Shield. As competition mounted and other companies got into the business, “group health,” as it was by then known, became America’s new old-time insurance. The decent burial was replaced by the decent complete physical, and the definition of “good husband material” was now a man with “fringe benefits” coming out of his ears. As the matchmakers said, he was “covered.”

It was the Age of the Great Insured. Early group health covered everybody for everything. The premiums were so reasonable they made hardly a dent in your paycheck. When I worked on the Raleigh News & Observer in the ’60s, I paid three dollars a week for such generous coverage that I half-resented being healthy. I used it for the usual tests and shots, but otherwise I made no claims.

Millions of others did. Now that health care was “free,” human nature kicked in. People began running to the doctor for the least little thing. Ask them why and they would recite the usual maxims about an ounce of prevention, but it was never long before the truth compulsively popped out: “I hate to waste my insurance.”

There it was, right out in the open: Eat every mouthful of insurance on that plate! Insurance is good for you. Insurance makes you a better person. If you don’t go to the doctor, people will think you have no insurance. Whatever is wrong with you, insurance will kiss it and make it well.

These were the cultural hypochondriacs. Others, with a dormant tendency toward the real thing, blossomed into full-flowering nightshade in the rich soil of full coverage. Anyone who worked in an office during these halcyon years probably remembers a monster of self-diagnosis just down the hall. He would have been perfectly all right if he had not overdosed on health insurance, but now he kept a blood-pressure cuff in his desk and believed that the pothole he drove over jarred loose his pancreas, causing what he christened “Errant Gland” during his coffee-break phone call to the doctor.

HalcyonCare couldn’t possibly last. Whenever we insure something its price goes up, as do waste and fraudulent claims. Medical science kept devising new and increasingly expensive treatments, technology, and pharmaceuticals, forcing Halcyon to raise premiums even more, until companies could no longer afford to provide HalcyonCare to their employees. And the employees, languishing now in their HMOs, could not believe what had happened: Insurance, once a symbol of stability, was now a symbol of chaos.

The honeymoon was over but the honeymoon mindset remained. “It worked fine at first,” people said, reminiscing about HalcyonCare while filling out their stack of forms in the doctor’s waiting room. Of course it did. Everything works fine at first — credit cards, public schools, feminism — because human nature has not been kicking in long enough. The trouble starts when we try to make a basically good idea work for everybody, everywhere, all the time, until the good idea crumbles under the weight put on it and becomes a bad idea.

In the years before World War One, Henry Ford astounded the nation when he announced that he would pay his workers five dollars a day, a munificent wage for the time. His intention was to attract and keep the cream of loyal hard workers. It worked fine at first, until the unions reasoned that if bosses would volunteer to pay high wages, think what could be gotten out of them by force. To that end they upped their demands to outrageous levels over the years; more and more raises, benefits, overtime, holidays, rest periods, and bonuses, until the American autoworker was the envy of the blue-collar world. Now he works at Wal-Mart because he priced himself out of the market.

So now we are going to “fix Health Care,” as the current locution has it. We always seem to be “fixing” something — Social Security, the border, levees — but fix is an unfortunate choice of words for the tasks at hand. Too cavalier, too likely to be in the same sentence as “a lick and a promise,” or “a little dab’ll do ya.”

Fix is Dagwood with a hammer and a mouthful of nails, trotting off to do what Blondie has been nagging him to do for ages. We all know how that’s going to turn out, so don’t be surprised if, some day in the not too distant future, the Statue of Liberty’s torch is replaced with a sign reading “It Worked Fine at First.”

Florence King’s National Review columns are collected in STET, Damnit!: The Misanthrope’s Corner, 1991 to 2002.

As I saw this woman last week in a convenience store where I had stopped to get gas. She told the clerk that she could not afford health insurance because it cost too much but she bought two cartons of cigs and two cases of beer and I said that was enough to pay for health insurance and almost got my head handed to me. Most are uninsured because they want to be and there is NO hospital that will turn away a patient whether they have insurance or not. So we have a vast number who are riding the horse of the tax paying public for their medical care. There are NO uninsured in the United States.

I don't pretend to know to know what the answer is, but I worry for my children's sake. I do not want a government run bureaucracy, but when I was hospitalized for abdominal surgery, there must have been 20 illegals, with no insurance in the ER. Somehow, some way we have to get the freeloaders out of the system. If I sound harsh, sorry, but I am sick of paying for the deadbeats of the world.

I don't have insurance because it cost 1200 bucks a month for me to be insured. I also pay my own bills which come to less monthly than would insurance payments for my "pre-existing" condition. No one picks up my tab except me and I resent your implications that everyone without insurance is a deadbeat, some of us can't afford insurance and two cartons of cigs and a case of beer won't cover the cost either. There are MANY uninsured in this country who pay their own way or just simply do without care.

Yes, many ILLEGALs and others use the ER for health care but many other people who don't have insurance pay their own way. Get your facts straight and stop using your emotions and "heresay" when you post.

There really are a few, wealthy folks who are in good health and choose not to waste their money on health insurance ... just in case. They really fall into a categoy of being "self insured" ... i.e. they pay their own way.

Do you know how hospitals gouge them? They will charge $5,000 for a simple procedure ... the same procedure they will bill an insurer a couple of hundred dollars for ... so that one paying customer ends up paying for dozens of other uninsured folks to end up having the procedure for free.

This should be criminalized. The hospitals know they cannot turn away indigent patients and that those patients will not pay them. So they extort it from the folks who do pay their own way.

I am sure this will only grow worse in time.

That's true for most young people who are healthy, a decent catastrophic plan will only run you about what your cable bill costs. However there are a decent amount of people who do work full time and make about 100-150% the FPL who happen to have developed an illness like say diabetes. Now there premium just went from around the cable bill to around say the rent. For about at least 1 in 5 of the uninsured the choice is rent or insurance. The other 75% are either twenty and thirty somethings who think nothing bad will ever happen to them so why piss $80 bucks down the drain or they are children of parents who are to cheap or irresponsible to buy them coverage in which children are the cheapest to insure.

I wish a company would come out with a catastrophic coverage policy that kicked in when medical bills exceeded 20,25, or 30% of the policy holders income. That would mean everything outside of Hospitalization and Surgeries would be paid out of pocket but bankrupting sized incidents like heart problems or cancer would be covered. I cant imagine a policy like that would be awfully expensive and it would be IMO a responsible level of coverage. Someone on here posted a similar Idea the other day and it has been bouncing around my head ever since.

I've found the opposite.

For the same exact procedure (a non-cosmetic laser treatment for my daughter, which is covered by my insurance), the dermatologist charges me $200 if I pay in cash but charges the insurance company $800.

I'm not sure what the insurance actually pays him though; perhaps also $200. The $600 difference in the actual charge is so interesting though.

. . .there is NO hospital that will turn away a patient whether they have insurance or not.

True. But after they admit him, then they will bill him for the full price of his treatment. All the doctors who treated him at the hospital (even those he never saw, like the pathologist, the radiologist, and the CRNA) will send him ginormous bills too. And if he can't pay them they will all take him to court and obtain a six-figure judgment against him. Of course, if he has a pre-existing condition he might not have been able to obtain health insurance at any price prior to this disaster, and he certainly won't be able to afterward.

About the woman in the convenience store-it could be two cartons of cigs and two cases of beer would not pay for her insurance. If she could even get it in the first place. Insurance is extremely high.

I am shocked that you say most are uninsured because they want to be. Maybe you are right. Yesterday someone commented that most are unemployed because they want to be. Maybe it is me that is living in another world.

More and More I hear Big D thoughts on this forum. First of all if the person needed 50K worth of care, which is an unusual situation then they would have to arrange payment or do without. They may refinance their house or negotiate the rate down. Rare is the case that someone needs 50 k worth of treatment. It is an individual personal right to decide on the amount of risk they wish to engage. Going without insurance is a risk analysis. Like why pay $1300/mo which is a typical COBRA premium or pay out of pocket? Rarely do we go to the doctor and pay $1300/mo. Perhaps they bank a few thousand for a possible hospitalization.

I had a bladder surgery done and had insurance but the cost about $6000 was for an in/out procedure. I did not stay the night. Expensive but not beyond what a family can pay for. This was elective and I did have insurance.

But my insurance does not pay for braces for my son and I had to wait for 2 years to get the money available to pay for it.
Funny thing I had braces 30 years ago and it cost my father out of pocket $2000. I negotiated $4500. The amount of increase over 30 years was not that high. But doctor and hospital stays have gone up more than 130% in 30 years. Perhaps it is because people have insurance and since a 3rd party pays they don't price shop and the hospital increases the price. If the hospital has to keep with the price people can afford they won't overcharge as much.

My brother,who is uninsured, had a shunt for his heart. It was a one day procedure. He had prenegotiated the amount to a lump sum and paid upfront. The hospital did not know what to do. But his cost was lower than what the insurance company would pay.

Please do not assume that we personally pay for a responsible uninsured person. I will agree that our insurance companies does pay an inflated amount for the poor people who use the hospital for visits that would normally go to the doctor.

"unemployed because they want to be"

At 5% unemployment it is (loosely, lol) as if a job seeker is in a foot race with 99 other people and all he/she needs to do is finish not worse than 95th place. At 20% unemployment one need only finish in the top 80. If one doesn't place, they can run the race again and again until they do.

Fat pickings for someone who wants to work.

I guess I should have elaborated more. The way it's set up now I have to pay for the health care costs of twenty year olds having babies. I have to pay for psychological counseling for drug addicts. I have to pay for lots of things that I will never use.

The 50,000 dollar situation is what I should buy my insurance for, not all the routine visits. But I can't. I can buy a 50,000 dollar life insurance policy that likely will never be used because I may cash it out when I retire. But if I get hit by a truck I have to have it. I have to have automobile insurance that I may never use.

Health insurance is nothing more than a method of political control. All this HMO, PPO crap and state and federally subsidized medical centers is costing us a hell of a lot more than a pay as you go - insure castastrophe system would.

she bought two cartons of cigs and two cases of beer and I said that was enough to pay for health insurance and almost got my head handed to me.

And rightly so, I might add.

Last time I checked (about four years ago), it would cost me over $1000 a month to insure me and my family (wife & 1 child).

I know the price of cigarettes has gone up, but I doubt it's THAT much.

In the four years I've been self-employed, I've saved about $50,000.

When my wife needed wrist surgery, we found the price to be around $5000. When the bill came, they found out we were paying cash, they knocked it down to about $3000.

Don't assume that just because you check off the 30 bucks a month on your pay stub, that everyone is in the same boat.

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