Health Care Is Not About Numbers

Romney made news today, at least in the left-of-center blogosphere, with the claim that, “[N]o one in this country dies because they don’t have health insurance” (an assertion I’d argue the former Governor of Massachusetts, a smart and informed man and the father of Romneycare, likely knows to be false). But I don’t think it was the most troubling statement from Romney published today about health insurance and preexisting conditions. That came, instead, during an interview with The Columbus Dispatch in which Romney tried to square the circle of his politically toxic support for repealing Obamacare’s protections for those with preexisting conditions:

Romney, in a meeting with The Dispatch’s editorial board, said those who currently don’t carry insurance would have a chance to make a “choice” to be covered without fear of being denied. But he didn’t specify how long Americans would have to make that choice, or what would happen to those who chose not to be covered and later fell sick.

Romney minimized the harm for Americans left without health insurance.

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,’??” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.

For crib notes on why this is a bad idea — assuming one actually cares about helping those with preexisting conditions, present and future — here’s Talking Points Memo’s Sahil Kapur:

What [Romney] didn’t specify: the length of the open-enrollment period. Nor did he say what would happen to sick people who cannot afford the prices set by insurers or those who fall sick — or are born — after the time window lapses.

“If the amnesty ever ends, the problem will just re-emerge,” said Austin Frakt, a health economist at the Boston University School of Public Health. “In part, that will happen because insurance may remain unaffordable without the subsidies that the ACA offers. An individual who can’t afford premiums will cease to have continuous coverage. What’s that person to do after this amnesty ends?”

Tim Jost, a professor of health law at Washington and Lee University, told TPM that covering preexisting conditions isn’t feasible without a mandate to purchase insurance and subsidies for those who can’t afford it — in other words, Obamacare. “If you don’t do those three things [market regulations, subsidies and a mandate] then it’s not going to work,” he said.

A Romney spokesperson did not immediately return a request to elaborate.

There are two explanations I can conjure up in response to Romney’s latest half-baked idea. Neither cast Mitt Romney in a particularly flattering light:

  1. He genuinely hopes to do something like this were he to become president and is unaware of the manifold problems with the idea.
  2. He knows the idea is a rather bad one, but he also knows it sounds good, it makes him sound less callous and uncaring, and what he’s offered is vague and off-hand enough that, even if he doesn’t carry through with it from the White House, few will notice, remember, or care.

As has been the case for Romney throughout his quixotic, half-decade long quest for the presidency, the GOP nominee’s comments are, while less than ideal from a PR perspective, not out-of-step with his party — even its ostensibly more intellectual, policy-oriented wing. For example, I’d point to this (long) post from Avik Roy, a tangential Romney advisor, on why Mitt’s proposed health care plan is superior to Obamacare. The short version of Roy’s argument is that Obamacare, because it involves regulation, will bankrupt us all; and, moreover, the number of people who are suffering from the preexisting condition syndrome is, relatively speaking, very small:

A Congressional Budget Office study found that, of those who are uninsured, only 3.5 percent were uninsured because their health was too poor to qualify. On the other hand, 71 percent blamed the high cost of insurance for their lack of it. 3.5 percent of 55 million is 1.9 million, or 0.6 percent of the U.S. population. It’s both a big number (1.9 million) and a small number (0.6 percent). If the CBO’s numbers are right, the pre-existing condition problem is one that we should pay attention to, and try to fix, but without making things worse for the other 99.4 percent of the population.

In general, Roy’s not wrong. But his blasé approach to a dysfunction that leaves people with the barbaric choice of maintaining their health or their economic livelihood (often losing both) is, to my eyes, disturbing. It’s a reminder that there are some very fundamental differences between the worldview of liberals and conservatives, differences that have little-to-nothing to do with whether or not one reads Breitbart while the other prefers The Huffington Post.

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36 thoughts on “Health Care Is Not About Numbers

  1. There occurs an interesting question would there exist a policy that does not provide current coverage but allows one to buy insurance at regular rates when needed, much like old life insurance policies used to have riders that did that.

    If you made that a catastropic only policy (going in at say 10% of income) and not including routine care what might it cost. That takes care of the cancers etc. In books like Seeking Sickness it is pointed out that the current screen for everything mentality might not make sense, and in some cases such as prostate, it turns out the false positives cost more than the test saves (since most men die with some prostate cancer). If one includes the costs of unneeded treatment caused by screening does it make as much economic sense as the current just look at the avoided cost of treatment by early detection?

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  2. I just had a friend in the bay area turned down by Kaiser because of pre-existing conditions. I haven’t had health insurance the past couple of years (self employed coverage way too high) I am trying to get on my husbands and am worried I will not get on for the same reason. Not that I have anything wrong just in the past have had to have tests that turned out negative but I am afraid they will say that because things repeatedly looked abnormal that that will be a pre-existing condition

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  3. I just started a new job. I am a mechanical engineer, fresh out of college. Prior to that, I was in the US Navy as a nuclear machinist mate.

    My new employer has insurance for me. So I of course, jump at it. In the course of filing out the information, I have to admit that I was born with Spina Bifida. My employers insurance (a major provide in the US) is now fighting with my company, over whether or not I can be insured under their plan.

    This is how stupid this is. I served six years in the @#$ing military, active duty with multiple deployments. Now I am dealing with word around the office that I am some sort of gimp. I have been sat down because my supervisor is afraid for me to do anything that might involve so much as lifting a pencil. I lift weights, run, and pretty much look perfectly fit with the exception that I have a slight limp (again…got into the military with it).

    I’ve actually lost two jobs because of this crap. Where during the hiring process, forms filled out by me about my medical history have resulted in potential employers “closing” an open position. Obviously this is illegal but it comes down to me vs HR and any number of other folks who don’t want the potential liability.

    While I can get medical care in with the Veteran’s Administration, because this isn’t service connected, I have to pay out of pocket. The HILARIOUS thing…I get seizures and migraines infrequently from a head injury in the service. Because that is covered by the VA, this isn’t a problem with insurance companies.

    I don’t think I am a leech. Hell I make good money (around $65K a year). I struggle just getting a insurance company to even run the numbers on me and I have never been to the doctors about my back since I was 12. I don’t even take aspirin for it. How is it, as a country, we cannot afford to cover people? I mean I am pretty conservative I think but it blows me mind that with the size of the US economy, we can’t afford to just give basic coverage.

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    • Wow. And having some idea what it means to be a machinist — even with cranes, loading a CNC with a chunk of metal is physical, this staggers.

      I’m sorry about the seizures and migraine; I get them too (also a head injury, bike accident as a teen). Anything help?

      But more to the point: even people with pre-existing conditions can, with proper medical care, be contributing members to society. Especially with proper medical care. Without, they’re a burden.

      And this, more than any other reason, is why I believe we’ll eventually have a single-payer system; because we already ration care based on who has insurance, and how good that insurance is. (Also based on what the rules are in the state they live in, but that should even out if Obamacare gets fully implemented.)

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      • I sneaked in at the perfect time…around the summer of 2000. Prior to 9-11, when recruiting was at an all time low. I still don’t know how the heck the navy let me in.

        Every time I walk into work, making my way past the group of folks standing outside smoking, I get a bit annoyed knowing that they never have problems getting coverage. Again, I have not been to a doctor about this in almost 20 years.

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    • Not that distracts from your point (it sorta enhances it) I’m surprised they accepted you with a history of Spina Bifida, and particularly in the nuke program. MedMan indicates its normally disqualifying, and back when I was doing nuke recruiting, the docs at Meps would disqualify a nuke over any ol’ thing (Accutane usage was the most common rejection criteria when I was there)

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  4. Elias, this is slightly off topic, but regarding the substance of last Wednesday’s debate, this might be worth looking into. I’m just mystified that the truth has somehow been completely eliminated as a criteria of success in formal debates.

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  5. I’m going way outside my normal way of thinking about this issue but… How is buying health insurance AFTER getting sick different than buying fire insurance AFTER your home is on fire? I can see some ways it’s different but a lot more ways it is the same…

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    • That my major problem (or one of them anyway) with the whole idea. If you are suffering a certain cost you can’t afford, then you have a problem insurance is not designed to solve. What you need is a certain cash flow, not a contingent one. Governments have a tool for this – welfare. Using insurance to deal with pre-existing conditions is simply the wrong tool for the wrong job.

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      • On the other hand, 71 percent blamed the high cost of insurance for their lack of it.

        It’s worth noting that citing cost as a reason for not buying it doesn’t necessarily mean that they can’t afford it. There are lots of things I’d like to have but don’t buy because of cost. It’s not that I don’t have the money. It’s just that I’d prefer to continue having the money, or spend it on something else.

        So it is with many people and health insurance. Some literally can’t afford it, sure. But a lot of people can, but instead opt to spend the money on something else.

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      • Hey, us commie Dem’s would’ve preferred a single-payer kind of plan, but a plan that guaranteed millions of new customers for private insurance companies was called the end of freedom, so we’ve got a way to go over here. Give us another fifty years and we might enter the civilized world on this one. :)

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        • I actually think that would be better than the ACA, though frankly I have no confidence your government could competently administrate something like a single payer system.

          I think a better idea would be to let the insurance industry do its thing (without being crippled by the mandates that are currently in place) and then use welfare to fill in the gaps.

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          • Medicare and VA are both administrated fairly well, all things considered. Yes, there’s the usual problems with fraud and such, but that’s going to happen in any large system. The incompetence of the federal government is quite frankly, overblown.

            I disagree with the notion that companies should be allowed to sell junk health insurance and profit off it, but if the conservative/Republican/etc. response to the ACA or single-payer health care was, “remove mandates and regulations on insurance companies, but greatly increase funding to Medicaid to fill the gaps”, I could at least understand that. But, instead, it’s “remove mandates and regulations and cut Medicaid.”

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            • My big concern on the administration side is that, like Medicare, political pressure will make the system so generous it rapidly becomes unaffordable. Medicare has this problem already without making things worse by expanding it.

              As for “junk insurance”, my concern is that your current regulatory structure prohibits insurance at all. I don’t know what I’d call what you actually have, but it’s not insurance.

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      • Because c-sections and major depressive episodes continue to cause problems 20 years later.
        Yeah, sure. Seems like you don’t understand preexisting conditions much.
        [note: C-sections are pre-existing conditions for well over 10% of the American tax-paying populace]

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        • Actually, the way insurance currently’s been working in many states, a woman’s fertility is a pre-existing condition. That’s why most insurance wouldn’t, until Obama’s executive order, cover contraception.

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  6. One way it could work is after the transition period you have 1 year to sign up after reaching say 26 If you don’t sign up it could then work like medicare part B where delaying signing up at 65 raises the premium some each year. Also could provide that if you drop coverage you can’t re-sign up for 5 years.
    As Kazzy points out the term insurance does not exactly cover what we have here. In addition buying insurance against something that is sure to happen is just a way of loosing money on the deal. So for example if you took the median spending on healthcare and set that as the deductible then you would be closer to an insurance model. The Health Care Savings accounts in principle are the right idea for sure things, you save to pay them. It is the catastrophes that are the issue than need the insurance.

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  7. My husband is a cancer survivor. That pre-existing condition meant that for over 7 years I lived in fear of losing my job (he was under my coverage when diagnosed – and a good thing too since his job disappeared when his company reorganized) and I was essentially an indentured servant in terms of not being able to explore any other job options until he was past that magic 7 year-cancer-free mark. Turning down calls from headhunters at a time when in my career when taking them would have been the smart thing was painful, and definitely hurt us economically since my employer knew they had me and didn’t need to offer much to keep me.

    Btw, DH worked for all but 6 months of the time that he was a healthcare pariah and came up with a patent worth a lot $$$ for his next employer. Their insurance still wouldn’t have accepted him.

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    • God. Now, picture all the women with C-sections, who never get off that pre-existing condition list. Or all the people diagnosed with Major Depression (yes, Chris, I’m not using the right term. chime in if you like, elsewise i’m close enough), who also never get off the pre-existing condition list.

      These folks just don’t want to pay out anything, and collect premiums while doing it.

      Just another fucking open-jaw.

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    • bookdragon-

      Every time I’ve taken a new job (4 times in the past 8 years), I was offered health insurance and never needed to complete a physical. There were no questions about pre-existing conditions. Is this not the norm with employer-supplied health insurance?

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      • It is not the norm. You aren’t asked to complete a physical in most places (mileage may vary – I had to pass a physical before being hired for my first job). In many places you won’t be *asked* about pre-existing conditions, but if you read the fine print, you’ll see that if anything relating to that condition crops up (and after chemo nearly any health issue can count as related), you won’t be covered.

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        • Gotcha. Thanks for clarifying. That makes sense. And I assume that the insurance company puts the onus on YOU to prove that a new condition isn’t caused by a pre-existing condition.

          It seems sort of like how, after a massive rainstorm, flood insurance insists the damage was storm related and homeowners’ insurance (which covers storm damage) insists the damage was flood related.

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        • Way back in 1976 I did have to take a physical, and because of it was denied long term disability coverage at the time. Of course it may well depend on the job, if there is a possibility of exposure to dangerous chemicals federal law may require the phyisical. (Of course back in 1976 insurance was cheap, and to boot the companies insurance only covered pregnancy at 50% since it was not an involuntary condition in their mind.

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  8. The comments here illustrate why I am coming to question whether the existance of health insurance serves the interest of the American people.

    Health care is radically different than a consumer good like a toaster. Mainly that it is the one good that in most cases no one wants, and strives to avoid needing. In other cases like pregnancy, it isn’t a “loss” like having your car stolen or house burn down; but it is an essential part of normal life.

    Delivering health care via insurance doesn’t serve the needs of the republic; so why do we insist on retaining it?

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