Rossputin.com: Rational Thinking About Our World

[Previously posted on Gang of Four blog]

Nancy, one of the resident liberals at the Gang of Four, issued a short response to my posting about "Slowing the train(wreck) toward socialized medicine" which I posted on these pages yesterday. You can read Nancy's critique here:
http://www.politicswest.com/23859/high_costs_uninsured

Following is my response to her.

Nancy, my main points against socialized medicine were not precisely what you said they were, but even your claims cry out for correction. Because it's such a target-rich environment, this note is a bit long

1. While I didn’t say “people are cheap”, it goes without saying that most people do not want to pay more than they need to for things, and most people (other than liberals) don’t believe they have a responsibility to take care of others before taking care of themselves and their families. The “47 million uninsured” number is one of the biggest intentional deceptions of the socialized medicine crowd. The number makes it sound like there are 47 million permanently or chronically uninsured people in America, which is very far from true.

Here are some basic facts. Keep in mind that some of the groups I mention below may overlap, i.e. a person may be in more than one of these categories:

• 17 million of the uninsured, or about 37% of the total, live in households with over $50,000 annual income. Nearly 9 million, or about one fifth of the total, live in households earning over $75,000 a year. These are people who could afford health insurance if they wanted to.
• An estimated 9.5 million of the uninsured are not American citizens.

Suddenly, the 47 million number drops to 20 million, when you eliminate people who could afford their own insurance or are not entitled to government programs. (This is not to say that non-citizens shouldn’t buy health insurance, but rather that they must not be the subject of any government policy which pays for health insurance with tax dollars.)

• Nearly 14 million of the reported uninsured are either in or eligible for government health programs, like Medicaid and SCHIP. Of these an estimated 9 million are actually enrolled in Medicaid but were categorized as uninsured anyway in the 2004 Census report, leading to an “over-assessment of the uninsured population”, according to Blue Cross/Blue Shield.
• And about 17 million are between the ages of 18 and 24, people who may rationally believe that they are not likely to require expensive medical treatment, and that they (or their families) can afford whatever treatment they may need (and such treatment would likely cost less than high health insurance premiums.) Another 10.4 million of the uninsured are between 25 and 34, another group which generally doesn’t have very large health worries.
• The Census Bureau themselves admit, in the publication which claims 46.6 million uninsured in 2005, that “health insurance coverage is underreported in (their report) for a variety of reasons.”

In total, it seems we end up with a number of uninsured who are not eligible for government programs and who can’t afford insurance which is about ¼ of the reported 47 million. Of these many are not substantial health risks.

And although it seems obvious, it needs to be repeated: Just because someone does not have insurance does not mean they have no access to health care. Many can simply pay for it out of pocket….that was the position I took when I was younger and thought that health insurance was too expensive given my likely limited need for health care.

Different studies show different numbers, but in any case a substantial percentage of people who are uninsured at any given time are uninsured for less than a year, as they are between jobs. Indeed, the largest drop in insurance coverage was among people with insurance through their employer. An obvious solution to this problem is to change the structure of the health insurance market, such as by giving the same tax deductions to people who buy their own insurance as companies get by buying it for them.

In short, the 47 million number that supporters of socialized medicine throw around is partly an outright lie and partly an intentional exaggeration to bolster their claims that we need a massive health care big brother, when the real problem (and I admit that uncompensated care is a real problem) could be solved by much more targeted and less oppressive solutions.

2. Your issue of contributions by a health care lobby are a straw man, and irrelevant. If government does create some massive mandatory program, many health care “interests” stand to benefit, not to lose, such as if people are forced to buy insurance they don’t want. I am not saying that these lobbying efforts are in the interests of American consumers of health care; the companies are almost certainly angling to make sure they profit from whatever the new structure is, just as, for example, the tobacco settlement was one of the best things that ever happened to the tobacco companies even though the American public believes the companies got spanked. Most of the “health care lobby” would have no strong interest in preventing “reform” even if that reform includes turning our system into, or at least in the direction of, the disaster they have in England.

3. As Mark Twain said (although he said he was quoting Benjamin Disraeli), “There are three kinds of lies: Lies, Damned Lies, and Statistics.” Claiming that someone died because of not having insurance is quite a stretch and quite hard to prove. I do not have data on it because I think such data is essentially impossible to acquire, and I believe that the Kaiser Family Foundation, whom you quote on the subject, has a noticeable bias toward a big-government solution and therefore toward finding a way to create a “statistic” like that. You also can not pin lost productivity from “diminished health” simply on not having insurance. Someone who is obese or smokes too much is going to be a less productive worker and need more sick days regardless of insured status.

Your point about infant mortality is also highly misleading. There are two major reasons why the US infant mortality rate looks higher than in many other countries. First, because our health care is so good, American obstetricians and pediatricians will attempt to deliver and save infants who are very premature or have very low birth weight, the biggest single risk to an infant’s survival. American doctors will use all measures they can to save a baby who is born not breathing, for example. In other countries, most these babies would simply die.

Furthermore, in America if such an intervention were attempted but the baby died anyway, that counts as an infant mortality. However, in many other countries, including in Europe, that outcome would be recorded as a death of the fetus, and not in the infant mortality statistics.

There is no doubt that we have a real issue in this country with the infant mortality rate among African-Americans. According to the CDC, “Non-Hispanic black women had the highest infant mortality rate in the United States in 2004 – 13.60 per 1,000 live births compared to 5.66 per 1,000 births among non-Hispanic white women.” Furthermore, nearly half of infant deaths to non-Hispanic black women were “due to preterm-related causes of death”, more than 3 times the non-Hispanic white preterm mortality rate.

This huge disparity is troublesome, and points to problems within the Black community that might range from behavior to diet to stresses from there being such a high percentage of single mothers. It is an issue I am not saying we should ignore. My point, as far as the statistics go, is that it (in addition to the items mentioned above) skew up the infant mortality rates in a way which makes for unfair comparisons between US and foreign infant mortality rates, and which is used for unfair criticism of the US medical system overall.

I maintain my position that our system is indeed far superior to Canada or Great Britain, two places often talked about as comparisons when Democrats bring up the idea of creating government-run health care. In Britain, over a million people are on medical care waiting lists. In Canada, it’s estimated at 800,000. Of those, some will die waiting and some will be unable to be treated because of the progress of their disease while waiting. Canada is also much slower than (the already intolerably slow) US in approving new drugs. There are many statistics, not just the cancer survival rates which I mentioned in my original note, which prove the superiority of our health care system which is far more independent of the dead hand of government than are Britain or Canada.

There’s a reason that British and Canadians who can afford to come here for care for serious issues do come here, and there’s a reason that the Supreme Court of Canada was forced to take a case in which his government told him it was illegal for him to pay for a hip replacement privately; he was told he had to wait a year, living in pain, for a government procedure. The Court ruled (by a disappointing one vote, 4-3, margin) that “Access to a waiting list is not access to health care."

4. I already showed you that only about ¼ of the so-called 47 million uninsured are unable to afford insurance and not eligible for government programs. I do not claim that of the 12 million who are left, they will all be able to afford insurance if the health insurance market is somewhat deregulated, such as with auto insurance. But I am certain that many of them will, as the competition would drive prices down substantially, as it does with car insurance.

In summary, America has a clear problem with uncompensated health care costs, but the extent of the number of uninsured in America is massively overstated by supporters of socialized medicine. If government wants to do something to help the 10 million or so people who are “chronically uninsured” (and I’m not saying I believe that’s a legitimate function of government), we most certainly do not need to attack a system that provides the world’s best quality health care. Instead of burdening our system with more government, more bureaucracy, more costs, less creativity, and less incentive for the best people to go into medicine, we should free the health insurance market from burdensome regulations such as state-based mandates for coverages people don’t want, and we should tackle the narrower issues specifically, such as African-American infant mortality and the clear problem of tying health insurance to a person’s job.