How to Talk About Universal Health Care Insurance: Part 1

A few weeks ago I posted a diary titled How to Talk to Small Business People . So many of the comments were about health care issues that it become apparent that this was a topic in desperate need of further conversation. So instead of "How to Talk To..", today it is "How to Talk About..."

Usually you will see this subject discussed using the short hand of "Universal Health Care" as if that were the issue. That is not the issue. As we will see below the fold, we already have Universal Health Care. What we do not have is Universal Health Care insurance.

So follow along and we'll see what can be done about this situation.

We need to make one thing perfectly clear right from the start. That is that we do not have a health care crisis in this country. We do have a health care insurance crisis. No one in need of care who presents themselves for treatment is denied treatment. Ok, almost no one. But the general rule is that if you present yourself for health care, you will receive it. From VOANews.com:

Karen Davenport, executive director of health care policy for the Centerfor American Progress:"The ones that are probably of greatest concern would be the people who areuninsured who delay care and who end up using not just emergency room services,but more complex, more complicated, more intensive services when they do getcare," she said.

Since they are uninsured, these patients run up bills that they are unable to pay. More from VOANews:

"I think that we provide a high amount of uncompensated care here at Children's National Medical Center, anywhere from $28 and $30 million a year that we report that is provided as uncompensated care," noted Chavanu. "And that's really approximately eight to ten percent of our population."
According to the American Hospital Association, hospitals doled out $27 billion in uncompensated care in 2004.

Like any other business, hospitals pass along the cost of bad debts to their other customers in the form of higher prices. Unlike other businesses, hospitals are not able to control their credit risk. They treat whoever shows up. We all wind up paying for this in the form of higher hospital bills which ultimately turn into higher health care insurance premiums. So what can be done to alleviate this situation?

MALCOLM GLADWELL lays out some of the facts about our current health care system in this article in the New Yorker:

Americans spend $5,267 per capita on health care every year, almost two andhalf times the industrialized world’s median of $2,193; the extra spending comesto hundreds of billions of dollars a year.

<snip>

The United States spends more than a thousand dollars per capita peryear—or close to four hundred billion dollars—on health-care-related paperworkand administration.

Other countries pay around 30% of what we spend on health care related adminstrative overhead. Between the uncompensated service hospitals provide and the excess cost of administration, there is about $300 billion needless spending in our current health care system. That comes to more than $1,000 per year for every man, woman and child in this country.
So we have plenty of room for improvemnt in the administration of our health care delivery system. There is one other myth to bust about health care in this country. We already have a working model for a single payer health care system up and running in the United States. It is called Medicare.

So who are the uninsured? The Census Bureau provides us with this information:

• In 2004, 45.8 million people were without health insurance coverage, up from 45.0 million people in 2003.
• The percentage and number of children (people under 18 years old) without health insurance in 2004 was 11.2 percent and 8.3 million.
• With a 2004 uninsured rate at 18.9 percent, children in poverty were more likely to be uninsured than all children.
• The uninsured rate and number of uninsured in 2004 was:
• 11.3 percent and 22.0 million for non-Hispanic Whites, and
• 19.7 percent and 7.2 million for Blacks.
• The number of uninsured increased in 2004 for Hispanics from 13.2 million in 2003 to 13.7 million; their uninsured rate was 32.7 percent.

These figures show us that an undue burden is placed on people of color, who also tend to be at the lower levels of the socio-economic ladder. Blacks and Hispanics make up 46% of the uninsured population. They account for only 19% of the total population.
How about some characteristics of the uninsured? Again, from the Census Bureau :

• 73% of the uninsured in the workforce worked sometime during the year.
• 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.
• 62% of the uninsured in the workforce had a high school diploma or less.

It turns out that the uninsured are not only the unemployed. In fact, nearly 3 out of 4 uninsured in the workforce had been employed during the year. Of this group, nearly 2 out of 3 worked for small businesses (less than 100 employees.) And nearly 2 out of 3 uninsured in the workforce had only a high school diploma or less.

Some of the issues and makeup of the health insurance problem have been laid out. This is the first step. In Part 2, we will talk about some proposed solutions and how to talk about them.

In the meantime, talk amongst yourselves. But be gentle.