Tuesday, August 18, 2009

The uninsured

Clayton Cramer cites a paramedic blogger:

First, I don't see that the problem is as acute as the interests I cited above want us to believe. Which is not to say that there are not some problems, but they don't require the drastic overhaul, restructuring, and ceding control to the federal government that Obamacare would require.

Second, lets talk about the uninsured. Most of the patients I see that are uninsured are young, male, working, and don't think they need insurance. I often see them after they've done something stupid and now need emergency care. A few of them have been reluctant to go to the hospital because they don't have insurance. I don't see a lot of them with chronic or even acute (well not related to alcohol) medical problems. Those few that do have medical problems also seem to have health insurance.

Children, elderly, homeless? Maybe it's just my limited experience, but I have yet to see a kid that didn't have some sort of insurance. For the purposes of this post, Medicaid, whatever name your state uses for it, is insurance. In the real world it's welfare, because the beneficiaries don't pay premiums. Same with the elderly, Medicare may not pay well, but it does pay, and many of the elderly I see have supplemental insurance. NO, Medicare is NOT welfare, since most of the beneficiaries have paid taxes over the years. That includes both my mother and my mother in law. Neither is wealthy, but both have insurance. Same for the patients I see. As to the homeless, my experience is limited to this geographic area, but they seem to have access to health care. Whether they use it or not is a different issue. Every homeless shelter I've responded to (which is a lot) has a clinic available to their clients. Some clinics are better than others, but that's how medicine goes. Nor are the homeless ever turned down at emergency departments, even though the hospital knows that it's highly likely they'll never see a penny of reimbursement.
He has a number of thoughtful suggestions for reforms that seem pretty sensible (such as expanding Medicaid to allow those who can afford insurance, but don't currently have it, to buy into it). Worth reading in full.

UPDATE: To clarify: Medicaid provides coverage for the poor, but there is no option for a person who is employed and above the requisite poverty level, to pay for Medicaid coverage. From what I have read, Medicaid coverage isn't spectacularly wonderful, since it uses the same type of payment schedule as Medicare (although not the exact same schedule)--but it would be better than no coverage at all, and probably less expensive than individual health insurance.

Indeed.  The government has control of medicare, medicaid, and the VA, at the very least.  Why not allow people to pay some amount by way of a premium and obtain coverage that way?

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