According to the U.S. Census Bureau, the number of Americans without health coverage has fallen for the first time in 20 years—to 45.7 million in 2007 from 47 million in 2006.
At the same time, the percentage of Americans with private health insurance fell from 67.9% in 2006 to 67.5% in 2007. An additional 1.3 million Americans went on Medicaid, 1 million were added to Medicare, and 400,000 to military health care programs.
States with budgetary problems are, however, trying to cut back on Medicaid enrollment—although the American Enterprise Institute estimates that the poverty rate now is half a percentage point higher than in June 2007 (Wall St J 8/27/08).
The way to enable more Americans to obtain private coverage is to reduce the cost. According to a new study by Stephen Parente and Roger Feldman of the University of Minnesota, Congress could boost the number of privately insured by permitting people to buy health insurance across state lines (Grace-Marie Turner, Wall St J 8/27/08).
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Unfortunately, we are going to see more Medicaid, as hospitals push for this kind of “coverage”. Hospitals are compensated quite well via Medicaid, in spite of their claims to the contrary. As the process continues and the government dependent population increases, physicians will be squeezed out, since Medicaid compensation is so low. Hospitals, on the other hand, are quite flush, and will come to the “rescue” by hiring physicians and thus exercise total control over the practice of medicine. Hospitals’ definition of “quality” will likely be quite different from physicians’ definition. Finally, hospitals will be utilizing physician assistants, nurse practitioners, residents, and para-medical personnel to perform the work of physicians. Unfortunately, it’s not just hospitals. Three weeks ago, I saw a young lady with a serious complication following a surgical procedure performed in a physcian’s office by a physician’s assistant, evidently without direct physician supervision. She told me that this was the only physician’s office that would accept her “insurance”, which was Medicaid.
I and husband Paul (ages 63 and 70, respectively) do not have health insurance by choice. However, we take a very active role in maintaining our excellent health – high nutrition calorie restriction with intermittent fasting, regular vigorous exercise, restful sleep, assortment of supplements, specific researched chemicals, regular in-home health parameter monitoring and a battery of lab tests every 12 to 18 months. We pay directly for those very infrequent physician office visits we have had reason to make since we were married in 2000 (mosly to only obtain “gatekeeper” services) and are prepared to use our savings if an unexpected incident occurs – like the ureteral stone I had 5 years ago. (Measures taken for prevention of repeat calculi have been quite successful – not even any UTI in the past 2 years, although I had 3-4 yearly in the previous 20 years.)
We would like to have catastrophic health insurance with a large deductible ($25,000) just for the possibility of some disorder/injury that would be *extremely* expensive. But the highest deductible available, when looking online just for me (in Arizona) is $5000 and the lowest monthly premium for that is $228! That’s $2736 per year! This is far more than we think is warranted by our excellent health and preventative measures. From what I have seen, the health insurance coverage choices are *very* limited for those who take active measures to (get and) remain healthy. And insurance company health policies that I have seen do not at all consider anything more than a person’s gender, age, where s/he lives and whether or not s/he is currently a smoker. Actual current and recent health status is not even a part of premium determination – the fact of not being a smoker (length of time not asked) is not definitive of a person’s overall health. (I haven’t smoked in over 40 year – and Paul has never smoked – but I am viewed the same as someone who stopped recently.) Current major medical (euphemism for catastrophic coverage only) insurance policies – at least in Arizona – treats everyone of the same age, gender, current smoking status and in the same general location the same – which they definitely are not.
I find it hard to believe that some insurance company would not offer the kind of catastrophic medical expense coverage that I would seriously consider – if there were not some government regulation, state or federal, against doing so. It appears that once again government regulation has caused certain choices to be unavailable and has thwarted desired voluntary exchanges.
Lastly, in Fall 2007 I had to seek the services of an otolaryngologist outside of Casa Grande AZ, where I live, when the only one in that medium size town would not see me because I did not have insurance. It did not matter that I was willing and able to pay for the visit with cash in advance – I actually showed up at the office with a sizable amount of cash in hand. In comparison, the only urologist in that town has been extraordinarily acceptable of me and Paul as self-pay patients for years. For a more lengthy description of another of our experiences with a physician, actually a hospital employee but never advertised or known to us as such until after the first visit, see “Health Care Provision Responsibility and Social Preferencing – A Personal Example” – http://selfsip.org/focus/healthcareexample.html
Kitty Antonik Wakfer
Casa Grande Arizona