Congressional Democrats are baffled. The universal coverage plan put forward by Sens. Kennedy and Dodd isn’t nearly as universal as they’d hoped:
An analysis released Monday by the nonpartisan Congressional Budget Office raised the hurdles for draft legislation in the Senate just as its Health, Education, Labor and Pensions Committee planned to begin voting on Wednesday. The office concluded that a plan by the committee’s Democratic leaders, Senators Edward M. Kennedy of Massachusetts and Christopher J. Dodd of Connecticut, would reduce the number of uninsured only by a net 16 million people. Even if the bill became law, the budget office said, 36 million people would remain uninsured in 2017.
How can that be? A quick look at the findings on healthcare coverage from the Census Bureau might have told them. It provides a pretty good breakdown of just who is uninsured.
For example, about 8.5% of households with incomes of $75,000 or more have no healthcare insurance. Since family coverage could be purchased for about $15,000 per year, they certainly have enough money. Why don’t they have coverage?
One possibility is simply that they’re free riders. They’ve got other priorities and they’re gambling that they’re healthy enough not to need healthcare insurance.
But another possibility is that they’re noncitizen resident aliens, either legal or illegal. Nearly 44% of those born outside the United States who aren’t naturalized citizens are uninsured. That’s a big chunk of the total uninsured. Unfortunately, the Census Bureau doesn’t provide information on the number of uninsured by income and nativity or citizenship status.
There’s also a big difference based on region. In the Midwest and Northeast only about 11% of the people are uninsured. In the West and South it’s more like 17%. There may be a difference in appetite for risk and predisposition of the state to cover more people among the regions but I suspect that it reflects a larger number of foreign born noncitizens in the regions with higher rates of uninsured.
The uncomfortable truth is that we can’t have universal coverage unless we toughen our immigration practices or offer health coverage to all comers regardless of nativity or citizen status. Is it not self-evident that the latter policy, coupled with our effectively open borders, would be a powerful inducement for every sick person in the world who could get here to do so? And that it’s impossible for us to afford that?
All of this helps to explain why I believe that cost control needs to come first. We can afford to insure a lot more people if the costs are much lower. And if the costs are high enough we won’t be able to insure those we’re insuring now.
“Unfortunately, the Census Bureau doesn’t provide information on the number of uninsured by income and nativity or citizenship status.”
They do – it’s on page 22 of the PDF you linked to, Table 6. Roughly 10 million of the 46 million uninsured are noncitizens.
“For example, about 8.5% of households with incomes of $75,000 or more have no healthcare insurance. Since family coverage could be purchased for about $15,000 per year, they certainly have enough money. Why don’t they have coverage?”
People in that income bracket are almost certainly college graduates. Which means they have student loan debts between $30,000 – $100,000. Which means you’re talking monthly debt payments akin to a mortgage or rent payment. Which means they may not “certainly have enough money.”
Apologies – misread “and” as “or.”
Perhaps what I wrote was misleading. What I meant was that the Census Bureau doesn’t give income within nativity and citizenship breakdowns. For example, I don’t see statistics on how many households headed by foreign-born noncitizens making more than $75,000 have no healthcare insurance.
Alex, I think we’re saying the same thing but you’re saying it as though it’s perfectly okay and you’re saying it angrily.
You pays your money and you takes your choice. Higher education is a bet or an extravagance not a law of nature. If you have education loans of $100,000 and your household income is $75,000, you bet wrong. I’m not saying that $75,000 if rolling in dough. I’m saying that one must prioritize. That is the nature of life and it won’t be legislated away.
Oh, boy.
So let’s posit that a couple pays $15K for 25 years on a family basis, and $8K for 35 years on a couples only, kids out of the nest, basis. That’s age 20 to 80. And its $650K in lifetime premiums. Someone can argue all they want about family size, administrative costs, insurance company profits and so forth. These premiums are outsized to per family expenditure. This is a mess. Suppose we say we had a REAL insurance program, and people paid out of pocket $100K in lifetime routine healthcare costs. And suppose, we had REAL insurance policies of, oh, $4K per year, or $240K for a lifetime to pay for the minority of individuals who suffer real catastrophic health insurance needs. We have arrived at a $340K vs $650K number. Attack my numbers and assumptions all you want. I dare anyone to get to $650K per family on a rational basis. We need REAL insurance, not pay for all health maintenance, and buyer price back in the system.
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“Which means you’re talking monthly debt payments akin to a mortgage or rent payment. Which means they may not “certainly have enough money.â€
LOL Please. I’ve actually been out in the real world. This is pure tripe. They find a way to pay for dinner’s out, plays and concerts, Friday or Saturday night’s bar bender, expensive clothing, tickets and peripherals to absurdely priced professional sporting events, vacations – plane delivered vs cars, beer and liquor, expensive cars and oversized homes, jewelry, dance lessons for the daughter, flat screen TV’s ……I could go on. But they just can’t seem to find the coin for health care expenditures. Balls. The reality is that they have become accustomed to their employer, or some other entity, paying for it. And when that works then they can pay for the baseball ticks, etc. But it didn’t work. The system has become untenable. But don’t tell me they can’t afford it. Wake TFU, people.
As a kid, and my dad was a doctor, we were considered “rich.” But 90% of the activities I cited in my diatribe above we didn’t do. And we were “rich.” We lead a decidedly middle class life. And that was fine. And yet today such expenditures are considered entitlements……and I didn’t even touch cell phones, multiple TV’s, TIVO, On Demand………….
But the poor bastards just can’t pay a health care premium. Gawd…..get a clue.