Sunday, December 20, 2009

Another interruption in catching up

Updated Yeah, this catching up stuff is taking longer than I thought 'cause we've been rather distracted of late, particularly in scrambling for new health care coverage after we lost ours when my wife had to leave her job because of her heart condition. But I'm getting there....

But speaking of health coverage and all that, that's what this interruption is about. I actually addressed this earlier this month, but it deserves a loud reprise because what I complained about has continued unabated.

It is a small rant about one aspect of the health care deform "debate" (which is more a debate over how much more can - not even should, but can - be given away to appease the drug and insurance industries and, more recently, the anti-choice crowd and the egomaniacs than it is over actual policy). More specifically, it's about the figure the "suck it up, loser" crowd keeps sticking in the face of those of us who find the Senate bill, let's just call it, less than attractive, the statistic that says "30 million more people will have insurance!" Connected with it is the assertion by some, particularly Ezra Klein, that opposing the Senate bill means you're willing to let people die for lack of coverage. (As a sidebar, in a column he accused people of allowing others to die to express their dislike of Blue Dogs - and a week later in a TV appearance said the exact same thing in virtually the exact same words, except he inserted "Joe Lieberman" in place of "Blue Dogs." Apparently he thinks this is an all-purpose debilitating slammer requiring only the insertion of the villain du jour.)

Time out, gang. In a technical sense, the statement about the number of newly-insured may be true, but it would be more accurately expressed as "30 million people will be forced to buy insurance!" Even if it sucks. Even if it's a plan with high premiums and crappy coverage. Because that's what we're really talking about here. That's what that number actually represents: the amount of additional business for the health insurance industry.

And having health insurance is not even the issue. I mean it. It's not. Having health insurance is not the issue. Having access to adequate health care is the issue. Insurance is merely a means to that end. It's a route (and far from the best one), not the destination. It's the hammer and saw, not the bookshelves. It's - you get the idea.

So here's the question I want answered: How many of that 30 million will as a result of this legal requirement to further fill the coffers of the insurance industry have access to adequate health care in a way they didn't before? Does anyone know? I'm not even thinking here about the sort of major disasters that can (and often enough do) bankrupt even people with insurance, I'm talking about plain old health care, about the ability to go to the doctor, to the dentist, to pay for a mammogram or an EKG or blood work, about getting a cast on a broken arm.

It can't be denied that some among those 30 million are families and individuals who are without insurance by choice, who are either young enough or healthy enough or something enough to have decided that the money they save on premiums is worth the risk of not having insurance. How many of those people there are is unclear; the right tries to maximize them by playing with the numbers while the left often ignores them or assumes the number is insignificant. That may even be true - but again, no one seems to know and the fact that they exist is unquestionable. The point being that they already had access to insurance, they already had access to health care.

A more significant question is how many of those 30 million people could get insurance now, for example through high-risk pools, but don't because that would just leave them paying premiums for insurance they couldn't use because the deductibles are so high - that is, leave them with crap and worse off than they were before? And how many of those newly-insured people will wind up in just that situation? How many of that 30 million will be people who, having been forced to buy insurance, find themselves with low-cost, high-deductible policies that still leave them without access to health care because even as they can afford the premiums, they can't afford the deductibles?

And one more thing: How many still will be left out? How many still will lack insurance-provided access? I haven't seen a figure for the Senate plan, but figure this: The CBO estimated that for the insipid but superior House plan, even after everything was up and running and the maximum impact was reached 10 years from now, there would be 36 million newly insured but 18 million still uninsured. So if the Senate bill would produce 30 million more insured, that would appear to mean that even 10 years from now there would still be 24 million uninsured. Even allowing for some who are uninsured because they prefer the penalties to the premiums, it's only reasonable to think that those 24 million will mostly be people still left out in the cold, lacking access to care. (Would it be fair to propose that Ezra Klein is willing to have those people die for lack of affordable health care in order to express his distaste for the DFHs?)

The blunt bottom line is that presenting the 30 million figure as "the uninsured getting insurance" is not analysis, it's PR. It's sloganeering. It's spin. Presenting it as "the uninsured getting health care" is a lie. And using it in either form to slam people opposed to the Senate bill is - to say the least - offensive.

Health insurance is not the issue. Access to adequate health care is. It's damn well time people remembered that.

Updated with a Footnote: Turns out I was right about the future uninsured. On Tuesday (link via MMFA) the CBO wrote to Harry Reid saying that under present law, 54 million people would be uninsured in 2019 and under the Senate bill, 31 million of those will have insurance - leaving 23 million still uninsured.

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