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Monday, March 9, 2009

On Health Care

I read this over at, and thought I'd share it with you...

Goverment-Funded Health Care? We're Already Two-Thirds There

By Sara Robinson

My fictitious conservative uncle—let's call him Uncle Con—is at it again.

"Americans don't need socialized medicine!" he bellows, doing his very best Rush Limbaugh impression—which pretty much lets you know where this particular set of talking points came from. (When he whines, you know he's been listening to Bill O'Reilly. If he comes across willfully ignorant and pugnacious, he's been hitting the Hannity hard again. Try it at home: Field ID on right-wing talking points = hours of fun for the whole family!)

You really want to stop Uncle Con in mid-breath? Simple. Just ask him who pays for his health care. If he's over 65, his doctors are being paid by exactly the same kind of God-forsaken Commie single-payer health care that Canadians have. (If he's got a supplemental policy—well, Canadians get those, too.) If he's a veteran, he's even farther gone—the VA, that well-known cadre of fellow travelers, is pretty much the mirror image of the UK's 100 percent socialized medical service. It's fair to ask: If these systems are good enough for him, why aren't they good enough for his kids and his grandkids?

When I started paying attention to this, I was stunned at how many of these anti-"socialized medicine" blowhards are, themselves, fully-vested beneficiaries of government-subsidized health care. In fact, I was so intrigued by this phenomenon that I started keeping count. And then I did some research. And then I ran some numbers. And the conclusions were absolutely staggering.

The inescapable fact of the matter is this:

Only about a third of the country is still dependent on the "dominant" paradigm—private plans paid for by non-government employers. Everybody else in the country—over 200 million of us—gets most or all of their health care via some form of government-subsidized system.

The whole other two-thirds of us. Right now. Today.

When you realize this staggering truth, the entire conversation changes. It's not even a question of whether or not the U.S. government is going to get into the insurance business. We're there. That already happened. The old private-insurer paradigm isn't just failing; the vast majority of Americans left it (or it left them) long ago since, and the government has already taken over where they left off.

This is the kind of fact that most of us know in our bones has to be true somehow. But it turns out there's no "maybe" about it. Let's look at the numbers.

The Fortunate 43 Percent: The Ones We Cover Directly

About 43 percent of all Americans are already getting health care that's directly paid for, one way or another, by some level of government. Here's the breakdown:

32 million government employees and contractors—This group includes 2.7 million federal employees; and 19.3 million state, county, and municipal workers. That's a grand total of 22 million workers who are getting health insurance—usually from privately-contracted insurers—that's been paid for by taxpayers.

In addition, there are an estimated 10 million+ full-time federal contract workers. They're getting their insurance from their own employers; but since these are government contracts, we're still paying their bills in the end.

(Note, however, that this 32 million figure doesn't include these workers' dependents. I made the conservative assumption that most government employees pay an extra out-of-pocket premium for dependent coverage. To the extent that that assumption is wrong, we may also be covering at least some of these workers' spouses and kids.)

58 million recipients of Medicare, Medicaid, and state health care plans -- This includes 47 million Medicare/Medicaid recipients and 11 million mothers and children covered by SCHIP programs.

27.4 million active duty military, reservists, and veterans, plus dependents—This breaks down into 1.4 million active duty troops being served by the military system; and .8 million reservists and 23.6 million veterans who are qualfied to receive care through the VA.

Active duty service members also get free coverage for their dependents. Assuming a ratio of one dependent per active duty service member, that adds another 700,000 Americans getting their care from military doctors.

3 million miscellaneous—This includes 2.3 million Americans in county, state, and federal prisons; 200,000 whose insurance is subsidized by state high-risk pools; and 400,000 Native Americans whose care is provided through tribal health services subsidized by some combination of their own tribal governments and the federal government.

TOTAL: This adds up to about 120,200,000 Americans whose health care coverage is directly paid for by the government. I'm sure there were pockets that were missed by this accounting, and I encourage readers to write and tell me about thtme.

The 25 percent Left Behind: Not Covered, But We're Paying Anyway

The ones above are the lucky ducks: they've got coverage that's backed by the government—the only institution left whose promises are worth a damn. But among our taxpayer liabilities—both tangible and intangible—we need to count another 25 percent of the population who are going without health care, either partially or altogether. This group includes:

50 million uninsured —The last hard numbers that were published put this figure at 45.5 million. But that was last July—just before the financial collapse began stripping jobs out of the economy at the rate of half a million or more per month. As people lose their jobs, they also lose their health insurance. If this number's not at 50 million yet, it will be in another few months.

25 million underinsured—Beyond the vast and growing pool of uninsured, there are another 25 million Americans who are underinsured. That is: they have bare-bones policies that cover catastrophic care, but not routine doctor's visits; or that have deductibles so high that even routine care will drive them into debt; or that exclude so many conditions that they end up paying out-of-pocket much of the time anyway.

TOTAL: 75 million at-risk Americans who can't depend on either the government or an employer for care. But even though we're not paying their bills (or, more accurately: because we're not paying their bills) the tremendous risks they live with do eventually end up on the public balance sheets, one way or another. According to CAF health care reform expert Mike Elk, "A recent study by Families USA showed that 1 out of 3 Americans under 65 (people over 65 automatically qualify for Medicare) lacked health care for some or all of 2007-2008. The biggest irony is that that of that group, 4 out of 5 were in a household with a full time worker and still could not afford health care."

The first-level effects of this malign neglect are obvious. Because they often delay routine care that catches things while they're small and easy to treat, these are the people may not get seen until they end up in front of an ER doctor in a public hospital. Not only do taxpayers end up paying far more for this high-end service; the patients themselves get less effective care for our money, because the ER system was never designed to provide preventative or follow-up care. This is a colossal waste of time, money, and resources for everyone concerned. (And God help us all of there's ever a major pandemic: this group could spread the bug far and wide before they're finally sick enough to get to a doctor.) In fact, if you were going to design a system to deliver the minimum amount of effective care for the maximum cost, it's hard to imagine how you could possibly do it better than this.

But it's the second-order effects that really come around to bite us on the backside. A recent Harvard study found that over half of all home foreclosures in the US are due to the financial stress of medical bills. Other studies have found that medical debt drives the majority of personal bankruptcies, too. Therefore, the people most at risk for bankruptcy and foreclosure are the ones who fall into this 25 percent.

Too many of these people are just one bad health event—a car accident, a case of pneumonia, a heart condition—away from a complete family breakdown. If the worker gets fired because recovery took too long to suit her employer, she's now sitting at home with a pile of hospital bills, no income, and no insurance. Bankruptcy and foreclosure follow quickly. So do domestic violence, delinquency, and drug abuse—all of which eventually end up costing the whole community, both in tax dollars and lost social capital. And "family values" conservatives are perfectly content to stand by and let it all happen.

Then there's the fact that nobody reaches the age of 50 without developing some kind of "pre-existing condition." A large subset of these uninsured folks are well-educated middle-aged professionals—many of whom are self-employed, or own their own companies—who are simply uninsurable at a price they can afford. Medicare is starting to pay attention to these people, because they've done the math. It turns out that the little problems that these people can't afford to treat properly while they're in their 50s—the creeping blood sugar and the angina and the joint problems—grow into big hairy monster problems by the time these people turn 65. These very expensive deferred-care messes are now devouring a disproportionate amount of its Medicare's entire budget.

Nobody's counting the costs of all this—but anyone who argues that we can afford to have a quarter of the country living on the edge of disaster isn't thinking clearly about how much it costs us all when they finally fall through the cracks.

The Last 32%: Still Getting Employer-Paid Insurance—But For How Long?

Add together the 43 percent who already have access to government-funded coverage, and the 25 percent whose lack of access to reliable care eventually ends up on our bill one way or another, and you get a stunning figure: 68 percent of Americans are, effectively, already depending on taxpayers to pick up the tab for their health care—or for the aftereffects of their lack of it.

Which leaves just 32 percent—under a third of the country—still dependent on traditional employer-based private insurance plans. With everybody else decamped into government-funded plans or the vast limbo of the non-insured, this little slice of the market is all that's left—the prize that insurance companies are fighting so hard right now to hold onto.

The percentage of Americans who already receive some form of

publicly supported health care; 43 percent directly; 25 percent indurectly because they are uninsured and thus the cost of their care is subsidized.

The percentage of Americans who receive employer-based insurance.

And anybody who's seen Michael Moore's "Sicko" knows how it is for those folks, too. They may have insurance right now; but if they lose their jobs or sustain a permanent injury or the insurance company decides to jerk them around, that guarantee (which costs them and their employers dearly to maintain) could evaporate overnight. With the economy on pace to lose over six million jobs this year—and perhaps many more—this group is shrinking fast.

The numbers make it clear.

Thirty-two percent. If private employer-based insurance plans aren't even serving a third of the country any more, why on earth should Congress put the least bit of time or money into preserving them? And as long as so many of us now depend on this broad patchwork of federal, state, local, single-payer, socialized, private-insurer based plans—all paid for, one way or another, with our tax dollars—how much money could we save by simply putting everyone on Medicare, and calling it good?

Sixty-eight percent. Government-funded care is already working well for 43 percent of us, and could be working far better (on much less money) for the other 25 percent.

When Uncle Con starts yelling about "socialized medicine," you can tell him, in all seriousness, that we're already two-thirds there. From here, the only question remaining is how we're going to make sure we're getting the most for the money we're already spending.

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