Posted on 04/08/2006 12:31:47 PM PDT by UnklGene
The Great Uninsured -
A meditation on the covereds and the uncovereds, and other things
FLORENCE KING
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 The Great Unwashed have been replaced by the Great Uninsured.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.
You're talking about Health Savings Accounts (HSA's). They do exist, and GWB would like to extend their availability to more of us. (I wish he could!)
The way they work is that you buy a catastrophic care policy (the amount where they start to pay - say, $5,000 or $10,000 is up to you). The price is cheap.
And you get to save something like $5,000/yr. tax free to spend on medical care.
People will shop around for care, and will be judicious in their use of medical care if it's their own money. That's just human nature.
And the versions of HSA's that let you keep the money you don't spend in one year to cover costs in following years make it even better. After a healthy year or two, you can increase your deductible, pay less for the policy, and still be covered if you have a real problem.
I can't imagine why people aren't pushing hard to get HSA's for all of us.
Because most people pay very little for gold plated insurance through there employer. Why get an HSA and a $5,000.00 Deductible when family coverage only costs you $3,000.00 per year through your employer and maybe an additional $1,000.00 in small co pays. People just don't realize really how expensive there insurance is. If they were to get an HSA and catastrophic policy on there own most employers would give an extra 10% in salary to there employee's in which would pay the small premium for the policy and probably leave a few thousand to stick into the HSA every year.
Bush and congress could make them more appealing by eliminating caps on contributions and maybe a tax credit to low income individuals if they open an HSA.
You are so right. Our biggest problem is that many Americans are just not informed. I have no idea how to fix that problem.
btt
The hospitals I've worked for only charge a self-insured patient the same as they would be reimbursed from an insurance company (usually Medicare rates). If they are to be reimbursed $1200 from Medicare, that is the rate the self-insured/self-paying is billed. I'm sure every hospital system may be different, but it may be helpful to check with the hospital prior to receiving services if possible.
"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."
The difference is probably due to the many different insurance plans the physician is enrolled in and covers all possible payments.
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.
While doing my taxes, I had the chance to check over some medical bills. I had arthroscopic knee surgury, and the bill was a bit over $3000 for the surgeon. The "write off" was about $2200, and the surgeon was paid about $800 by the insurance company.
Mark
For a single it is $140.00 per month, which includes prescription drug coverage. That is what my son pays.
Is he self insured, or is that through a group policy where he works? When I was employed by a previous employer, I had a similar insurance payment, which was subsidized by my employer. When they let me go, I was able to keep the same coverage through COBRA, but had to pay the full $560 a month premium. Many people who have insurance have never had to price it for themselves, and don't realize just how expensive it can be.
Mark
Catastrophic coverage is true medical insurance. Unfortunately what many people call "health insurance" is really a health maintainance payment plan. The idea of having a catastrophic plan plus setting aside a separate account for periodic medical costs is a good one, and doesn't need a law for people to do it. The law would provide tax incentives, which would certainly encourage the behavior. The problem with tax incentives, like the one's employers have had since WWII, is that it encourages more money to flow into health care. This is one of the reasons (in addition to 3rd party payers and increasing demand) that health care costs inflate.
Ideally, health care would be treated like any other commodity. People would leverage risk with catastrophic insurance, and shop around for more routine health services which they would pay out of pocket.
Putting healthcare squarely back into the market economy could be a natural result of replacing the income tax with a simple consumption tax. The initial result of dropping tax deductions would be that health care would be more difficult to afford. Over time, however, healthcare inflation would decrease and a market balance would be achieved. Out-of-pocket payments would be more affordable.
Ironically, the most likely healthcare reform is nationalized care. This would hugely amplify the third party payer inflation problem. It would also simultaneously amplify the inflation currently associated with tax deductions, by completely severing all choice in how the income is channelled. On top of that, it establishes a coercive monopoly--wiping out all competition in third party payers. Demand would skyrocket, and the eventual cost-cutting measures would cut supply of phyicians and other healthcare goods and services. It is the worst conceivable "cure" for rising healthcare costs, as has been demonstrated everywhere it has been tried. In fact, it is an idealized model for healthcare cost inflation in this country.
Anyone interested in the topic can find more at:
http://www.hospitalpricegouging.org/main.html
I have personal knowledge of an incident where a self-insured patient was billed more than $50,000 for a heart stent procedure that took about 15 minutes ... and would have been billed to an insurance company at $10-15,000. It was non-negotiable and the hospital, the major hospital in the particular area, would not accept anything other than full and immediate payment.
Not likely. Stossel produces pieces that are popular with the audience. Most Americans today are more interested in gov't based medical care than in making their own choices. That's why there's so much fuss about the Medicare drug coverage - it's making people choose private plans instead of having a "one plan fits all" gov't solution.
No, Americans want what they *think* Canadian style health care is. They mostly don't know about the long waiting lines (Canadians can wait 6 mos. or more for procedures we'd get within a week); or that people as young as their 60's can be declared "too old" for expensive care; or that Canadians with money are spending a lot of it in medical clinics on our side of the border.
If you really want to turn your health care costs over to someone else (be it gov't, your employer, an HMO, etc.) they will be the ones deciding what care you get.
If you want to make your own health care decisions, you have to also be responsible for the costs.
Why is that so hard for people to comprehend?
The 800 bill is customarily "bartered" down to something near where the doctor can still make money. The rest of the "unbillable" is written off as a loss....makes the taxes the doctor/hospital owe at the end of the year less.......
It's not that people are gullible. They are badly informed. The MSM is still most people's source of information, and they have a liberal agenda to push. Even the Internet isn't a complete help, because some people use it to read major newspapers like the NYT and the WaPost.
This is just one issue of many where the MSM basically lies to their readers/viewers.
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