Faye Chao (Uninsured 26-year-old):
My rent currently is $475 plus utilities. In total, my cost comes out to about $530 a month.
Stuart Browning:
What’s your average monthly income?
Faye Chao:
On average my monthly income is twenty three hundred. And it’s not taxed. Sometimes, you know, it varies. I save almost a thousand dollars a month.
Stuart Browning:
So why don’t you have health insurance?
Faye Chao:
I’m young right now and currently don’t need health insurance. Probably don’t want to spend $200 a month.
Stuart Browning:
In this state, a 26-year-old non-smoker with no preexisting conditions can get a policy for $96 a month.
Faye Chao:
It’s 96 dollars a month, but that’s twelve hundred dollars a year you’re spending on health insurance. And honestly, I feel it’s ridiculous that we live in a first world country where I have to pay for basic health care.
Stuart Browning (voice over):
We hear a lot these days about 45 million Americans who don’t have health insurance. One commentator has declared that “their ranks are equal to the combined populations of Oklahoma,
Connecticut, Iowa, Mississippi, Kansas, Arkansas, Utah, Nevada, New Mexico, West Virginia, Nebraska, Idaho, Maine, New Hampshire, Hawaii, Rhode Island, Montana, Delaware, North
Dakota, South Dakota, Alaska, Vermont and Wyoming. Would America conceivably turn its back on the citizens of twenty-three states … ?” asks a former Clinton advisor. (1)
In most European countries and Canada, the government pays for and rations health care for all citizens – why not us? Why not outlaw the health insurance industry altogether and have government be responsible for everyone’s medical care?
Stuart Browning:But, before we turn over health care decisions to government bureaucrats – shouldn’t we ask just who are the uninsured in America?
Stuart Browning (voice over):
According to the US Census Bureau, 17 million of those without health insurance live in households having over $50,000 in annual income. That’s 38% of the uninsured in America.(2)
In fact, 9 million – 20% of the uninsured – reside in households pulling down more than $75K a year. (3)
Devon Herrick (National Center for Policy Analysis):Most of us would agree that people like that should probably be able to afford some type of coverage. Essentially, insurance to them is just not a good buy. It’s something that they don’t have a priority for in many cases.
Stuart Browning (voice over):
And then there are the young invincibles. Over 18 million of the uninsured are people between the ages of 18 and 34. (4) They spend more than four times as much on alcohol, tobacco,
entertainment and dining out as they do for out-of-pocket spending on health care.(5) They represent 40% of the uninsured in America.
Stuart Browning (off camera):
What do you think that you spend each month dining out?
Jason Dusek (Uninsured 25-year-old):
I spend about $300 a month on average. I go out to eat about twelve times a month.
I spend three to four hundred dollars a month going out to clubs and bars for entertainment.
Stuart Browning (voice over):
But, what if they get sick or injured and they don’t have any savings? They know that the U.S health care system will still give them medical care.
Faye Chao:
I bike everywhere in the city, so I have gotten hit by drivers twice – and one time I ended up in the hospital. No, I didn’t have health insurance, but I was treated – and billed for it later.
Stuart Browning (off camera):
Umm hmm. How much was the bill for? Do you remember?
Faye Chao:
Honestly I don’t because I didn’t bother to pay for it.
Stuart Browning (voice over):
Since 1965, when Lyndon Johnson signed Medicare and Medicaid into law, many Americans have become accustomed to the idea that someone else should pay for their health care.
These days, federal law requires that any hospital must provide care to anyone who comes within 250 yards of an emergency room – regardless of ability or willingness to pay. (6)
Character in Movie “JohnQ”:
If you don’t have any money, you get a band aid, a foot in the ass and you’re out the door.
Stuart Browning (voice over):
Contrary to Hollywood depictions, the U.S. has a significant health care safety net.
Devon Herrick:
In terms of charity care, we spend more than one thousand dollars for every man, woman and child who’s uninsured in this country. Studies have found that the uninsured tend to get about
50 to 60 percent as much care as say someone who is insured.
Stuart Browning (voice over):
And across the nation there’s an extensive system of low or no cost community health care centers and free health care clinics.
Chandra Nalaani (Uninsured 27-year-old):
One of the things I found is that they have amazing resources for people without insurance here. One of the places I’ve gone is the Lyon-Martin’s Women’s Health Center. And – I got an
annual exam, they tested me for a bunch of things, and I mean as long as you’re within certain income levels and in this case, if you’re a woman – but there are other resources depending
on what you are. And they’re just friendly, they treat you like a person, and they’re like OK – what do you need? What can we do for you?
Stuart Browning (off camera):
And what do they charge?
It’s sliding scale … in my case, because I wasn’t making much at the time, it was free.
Stuart Browning (voice over):
14 million people without health insurance are eligible for government health care programs like Medicaid and S-CHIP but choose not to enroll. (7) They represent %31 – nearly one third – of
the uninsured in America.
At Parkland Hospital in Dallas where President Kennedy was rushed after after being shot, the ER is a primary source of health care for the poor. Many Parkland patients have Medicaid while others have no health insurance. Yet, they’re treated the same. They get identical care from the same doctors – regardless of ability to pay.(8)
Devon Herrick:
And whenever someone goes into Parkland Memorial, seeking care, quite often they are uninsured. And, of course, it’s to the advantage of the hospital staff to try to sign people up for
coverage if they qualify. But they tend to fail about half the time. And the reason is that people are getting the same care regardless of whether they have coverage for Medicaid or S-CHIP
or not.
Stuart Browning (voice over):
The U.S. has 12 million illegal immigrants who don’t buy health insurance but still get health care.
Devon Herrick:
There are estimates that about maybe ten million – possibly more – of the uninsured are in fact undocumented workers or at least people who are foreign born. The rates of un-insurance for
people that are foreign born is much higher than native born Americans and so – that will always be a problem. And, of course, if you can get something for free, why would you buy
insurance? We create a disincentive – to have people walk through the ER and try to get charity care simply because they can.
Stuart Browning (voice over):
In fact, the U.S. even provides free medical care to people who still live inside Mexico. Residents of Mexican border towns like Naco, Sonora are able to request “Compassionate Entry” at
the border crossing where they are picked up by American ambulances and taken to emergency rooms like the one at the Copper Queen Hospital in Bizbee, AZ.(9) In 2004, The Copper
Queen had uncompensated care costs of nearly half a million dollars due to compassionate entry patients.(10)
So, how many are truly uninsured? Around eight million. Just 18% of the 45 million that we hear about so often. (11)
A small minority of people slip through the cracks through no fault of their own – however in any nation there is a group of people who refuse to participate in society or take responsibility for their own well-being. Even if our government attempted to force them to receive regular health care, many wouldn’t comply.
So, why do we keep hearing about a crisis of 45 million uninsured?
Maybe, it’s because the problem of Americans without health insurance is exaggerated and used as a smokescreen by many reformers who advocate socialized health care financing.
But with so much at stake – our lives, our liberties, our health …
Stuart Browning:
… is it too much to expect politicians and the media to tell the truth about the U.S. health care system?
Notes:
(1) Matthew Miller, The Two Percent Solution: Fixing America’s Problems in Ways Liberals and Conservatives Can Love (New York: Public Affairs Books, 2003),pp. 112-13.
(2) See Carmen DeNavas-Walt, Bernadette D. Proctor and Cheryl Hill Lee, “Income, Poverty, and Health Insurance Coverage in the United States: 2005,” U.S. Census Bureau, Department of Commerce, P60-231, August 2006, Table 8 (sub heading Household Income), page 22 ( http://www.census.gov/prod/2006pubs/p60-231.pdf)
(5) Bureau of Labor Statistics Consumer Expenditure Survey, It has spending for age 25 to 34. Unfortunately, it does not break down age 18 to 24 – but we can reasonably infer that spending for people in their early 20s is similar to mid-20s. (http://www.bls.gov/cex/2005/CrossTabs/agebyinc/x25to34.pdf)
(6) Emergency Medical Treatment and Active Labor Act (EMTALA) FAQ, (http://www.emtala.com/faq.htm)
(7) The Blue Cross Blue Shield Association estimates that nearly one-third of the uninsured already qualify for public coverage such as Medicaid or S-CHIP. See “The Uninsured in America,” BlueCrossBlueShield Association, excerpt available at: http://www.bcbs.com/issues/uninsured/who-are-the-uninsured/uninsured_sec1.pdf
(8) John Goodman, Five Myths of Socialized Medicine, Cato’s Letter Winter 2005, page 1 (http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf)
(9) “Catastrophe in Care”, June 2, 2005 Leo W. Banks, Tucson Weekly, (http://www.tucsonweekly.com/gbase/Currents/Content?oid=oid:69346)
(11) David Gratzer, The Cure: How Capitalism Can Save American Health Care (New York: Encounter Books, 2006), page 87.
