The talking point
du jour seems to be that young, uninsured people really have enough money to buy insurance but they are selfishly withholding it to buy cell phones, flat screen TVs, and the latest fashions. Seriously. I've gotten this argument from more than one DUer defending mandatory private insurance.
Let's examine the situation regarding uninsured young people, shall we? Per Wikipedia:
Uninsured children and young adults
According to the Census Bureau, in 2007, there were 8.1 million uninsured children in the US. Nearly 8 million young adults (those aged 18-24), were uninsured, representing 28.1% of their population. Young adults make up the largest age segment of the uninsured, are the most likely to be uninsured, and are one of the fastest growing segments of the uninsured population. They often lose coverage under their parents' health insurance policies or public programs when they reach age 19. Others lose coverage when they graduate from college. Many young adults do not have the kind of stable employment that would provide ongoing access to health insurance.<7><8>
So that means that slightly over 70% of 18 to 24 year olds HAVE insurance. Which also means that there's a really good chance that the young person you see with the flashy gadgets and gear either has insurance through his/her job or is still covered by their parents' policy. Which means that people should stop ASSuming things about the uninsured based on the characteristics of some people of a certain age demographic. As for those uninsured young people, honestly, why on earth
would a young healthy person working at a shit job with no benefits, who had a lick of common sense, buy the kind of craptastic catastrophic coverage that's available to them? I mean really? Let's see, you get stuck with a monthly premium of maybe $150 to $200 AND you may be out thousands of dollars before the coverage even kicks in! :wtf: You probably wouldn't get insurance either, and you know it.
While we're at it, why do people hold this fervent, and unfounded, belief that the ONLY thing that is keeping health insurance from being dirt cheap is the fact that a few million healthy young adults haven't been forced to buy it? Let's not forget that the uninsured includes those deemed "uninsurable" for various reasons. 5 million of them, according to the Census. I've been trying to find a study that shows who among the uninsured causes the most costs and haven't been able to locate one. But it seems reasonable to conclude that the people with the "preexisting conditions" - who would tend to be older and sicker - might be causing more costs than the young and healthy ones. Again, I don't know that for sure but it just make sense.
I did find this study from back in 2001 about the uninsured and overall medical costs. It's a bit dated but I don't think things have changed that drastically since then:
We collapsed the sources of payment identified by MEPS into five groups: self (out-of-pocket), private insurance (including Tricare, CHAMPVA, and workers’ compensation), public insurance (Medicare and Medicaid), other public sources (Veterans Affairs, or VA, other federal programs, and other state and local programs), and other sources (other private and other, unknown source).7 Information on insurance coverage is reported on a monthly basis, which enabled us to distinguish full- and part-year uninsured and to identify insurance payments for people with part-year coverage.
We also adjusted the MEPS data to include an estimate of uncompensated care from private providers. (MEPS imputes the cost of uncompensated care provided by public hospitals and clinics.) The estimate was based on the question, “How much would providers have been paid if the uninsured had been covered by private insurance?” The difference between this estimate and the amount providers actually received in payment from explicitly identified sources other than private or public insurance is an estimate of the value of care delivered by private providers with no explicit payment linked to a specific patient.8
We generated the amount of expected payment using MEPS data on total charges for both privately insured and uninsured people. We calculated the ratio of payments to charges for those with full-year private insurance coverage and then applied this ratio to the total charges for care received by people who were uninsured for at least part of the year. (Charge information is provided even if there is no payment.) Overall, payments (from all sources, including out-of-pocket) for care received by the full-year privately insured covered 81.5 percent of providers’ charges for that care.
We applied this ratio to the total charges for care received by the full- and part-year uninsured, excluding care paid for by private insurance, public insurance, or other public sources, to estimate the total payments that providers would have received if the uninsured had been covered by private insurance. This calculation produced an estimated “expected” payment of $54.6 billion. Actual total payments from these sources (self, other private, and unknown) made for the full- and part-year uninsured were $38.8 billion, which implies that $15.8 billion of uncompensated care was delivered by private medical care providers.
Amount of “uncompensated care” provided. Exhibit 1 presents the estimates of medical care spending by insurance status and source of payment. People who were uninsured during any part of the year received $98.9 billion in care, of which $34.5 billion was “uncompensated care” (that is, not paid for either out of pocket or by a private or public insurance source). This represents 35 percent of the care received by the uninsured but only 2.8 percent of total personal health care spending of $1,235 billion in 2001.9 The other 65 percent was paid for out of pocket and, mainly for the part-year uninsured, by private and public insurance sources...
...Uncompensated care accounted for 60 percent of the care received by the full-year uninsured, with almost all of the rest ($14.1 billion, or 35 percent) paid for out of pocket. The part-year uninsured also received a substantial amount of uncompensated care, $9.9 billion, which accounted for 17 percent of their overall care
Even taking uncompensated care into account, the full-year uninsured received about half as much care ($1,253 per person) as the privately insured received ($2,484). While some of this difference is attributable to differences in age and health status between the two groups, research that takes these factors into account still finds about a 50 percent differential.10 Thus, even though uncompensated care is the primary source of care for the full-year uninsured, it does not make up for or offset the effects of being uninsured on access to and use of care.11
http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.66v1/DC1IOW, it looks like the meme that those dirty, rotten, selfish, deadbeat, freeloading uninsured people are to blame for health insurance premiums being so high is not quite fair. They're not even using that much health care, relative the overall population and amount that is spent. Yes, certain areas, like hospitals, are hit hard by the uninsured but it's pretty obvious that the current system - even with most people being covered - is horribly expensive and forcing a few million young and healthy people to buy into it is not going to miraculously transform it. The young and uninsured are not a super-race. Which is not to say that the added costs of the uninsured are insignificant:
When the uninsured cannot pay for the care they receive, health care providers shift costs to Americans with insurance in the form of higher premiums. A new report from The Wonk Room’s Ben Furnas and Peter Harbage concludes that a failure to continuously cover all Americans accounts “for roughly 8 percent of the average health insurance premium“:
This cost-shift amounts to $1,100 per average family premium in 2009 and $410 per average individual premium. By 2013, assuming the cost shift remains the same percentage of premium costs, the cost shift will be approximately $480 for an individual policy and $1,300 for a family policy.
http://thinkprogress.org/2009/03/24/cost-shift-uninsured/So yeah, you might be paying 8% less, on average, if they were mandated to buy insurance (assuming they complied with it). Does that 8% justify spouting "welfare queen" type Freeperisms when talking about people who are uninsured? Really? Can we please cut it out? It's not helping.
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