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Tuesday, March 21st 2006

Uninsured By "Choice"

I found this link on this weeks Grand Rounds (@ Healthyconcerns.com). The question is how many people are uninsured by choice, as presented by InsureBlog, which I may start reading more often. Estimates and figures on those who lack health insurance and truly cannot afford it are extremely controversial and subjective.

Take the poverty line for example, an oft quoted figure in any debate concerning government welfare. It likely grossly overestimates true “poverty”.

While as the story points out what is a necessity varies over time, it is only fringe arguments that will recognize a television (which 91% of those in the poorest 10% own) or a stereo (42%) as a necessity in my lifetime. Many of the same truths concerning “poverty” naturally concern the debate over the uninsured as well.

For example, as with the poverty figures a closer look at the uninsured shows that many are transients, briefly passing through as uninsured over a matter of a few months, which I will admit is still significant if not as emergent as some of those for a right to health coverage would have us believe. As I’ve commented on before, this along with other errors (some of which the Bureau has admitted and corrected) make the most cited figure of 40+ million highly dubious.

But this is a post over different numbers. Cases certainly vary and specifics need to be known, but as InsureBlog points out imagining a scenario where an average family brining in ~50,000 dollars, even with several children, could not find and afford minimal health insurance, and thus dissipate at least a good chunk of their healthcare costs, with at least a little effort is unlikely.

I don’t know what it would be like to be poor and the correct assault on my piece here is certainly that it is easy from my position (in front of my expensive computer and high definition television) to claim that certain items are “luxuries” and that the vast majority of the uninsured are choosing such items over insurance. But, really, when you step back from the shock of the medical bills, from the upset families on 60 minutes, that is what it looks like.

This is one of the greediest, consumption driven civilizations in the history of the world and it extends from top to bottom. The drive for luxury goods, not just William – Sonoma as in the story but non-necessities, certainly extends down into the lower classes. Does the fact that everyone else has a television, has a dishwasher, has two cars mean that this large group of the uninsured deserves (I use this word very intentionally) them as well?

I find that hard to buy, and I’m sure most do as well, as it reeks of notions of economic equality.

The numbers will always be debatable, and I’m sure plenty can be cited against me, as it is simply too subjective to try to define what is “enough”, yet, often times I feel that proponents of universal health coverage approach the problem with their heart on their sleeve and ignore the real possibility that the large majority of the uninsured in this country might be choosing their condition in exchange for immediate quality of life improvements.

Of note, the conservatives who make the arguments like I have above, well, they were the whiny insecure kids. Meanwhile the self-reliant, confident kids grew up to become smart, free thinking liberals who fight for the rights of the poorest Americans. Of course, the study was done in Berkeley (boy, I hate Cal…but that is a PAC 10 thing).

Even if the figures fall in my favor, and I’m not claiming the book is closed as this post is merely part of a debate, the question may be: so what? So the number is 7 million (I pulled that out of thin air) that truly cannot afford health insurance instead of 30 or 40 million, but the situation may be, as some people view it, that even 1 person without the healthcare, and insurance to pay for it, that they need is unacceptable. I can respect that argument even as I don’t agree with it.

H/T Slate