The Truth About Health Insurance Coverage Since Passage of Obamacare

In recent days the Administration and much of the press have trumpeted the rising percentage of young people, below 26 years old, who now have health insurance coverage.  Specifically, the Department of Health and Human Services press release asserts:

The Affordable Care Act allows children to remain on their parents’ health insurance plans until age 26.  This policy took effect for insurance plan renewals beginning on September 23, 2010, and was designed to address the fact that young adults are the age group least likely to have health insurance.  This is one of the important early provisions in the Affordable Care Act designed to expand insurance coverage to uninsured Americans.
New results released today by the National Center for Health Statistics show that this policy has had a significant impact on improving insurance coverage among young adults. Data from the National Health Interview Survey (NHIS) show that in the first quarter of 2011, the percentage of adults between the ages of 19 and 25 with health insurance increased to 69.6%, from 66.1% in 2010.[1]  This 3.5 percentage-point increase represents approximately one million additional young adults with insurance.

That is true as far as it goes.  However, the same press release provides additional data from the survey that shows that during the same period, health coverage for people ages 26 - 64 has shrunken dramatically.  Here is the chart they provide:

The trends lines are moving together.  The added health support of young people under 26 is likely to have maxed out since most parents were advised of the changes in the law and took advantage of it in the first year.  The only ongoing variable is likely to be the changing number of this age cohort in the population.

In fact, as reported by Gallup itself, although not mentioned in the HHS press release:

The percentage of uninsured 26- to 64-year-olds, however, continues to increase, rising to a high of 19.9% in the second quarter of this year. Among all Americans, 17.4% reported being uninsured in the second quarter of the year.

Another chart accompanying their report shows this drop in the numbers of people reporting that they have health insurance.

So, what we have is a reality in which the much ballyhooed 40 million Americans without health insurance before Obamacare has now become some number north of 40 million.  The net effect of Obamacare to date is therefore to have, arguably, only slowed the continuing shrinkage in the number of Americans with no health insurance.  Not yet worth celebrating.  And given the legal challenges to the mandatory coverage provisions of the law, the future doesn't bode well for improvement in these numbers.

Trouble On The Horizon For Medical "Reform"

"House Speaker Nancy Pelosi is “the mother of health care,” Vice President Joe Biden proclaimed Monday", according to the Washington Post.

 Well, that sort of bravado will no doubt play well on the Democratic chicken dinner circuit.  But sooner or later the realities of the new "Obamacare" legislation will be obvious.  Mostly the chickens will come home to roost by about 2014, well after the next presidential elections.  Until then, those who crafted this budget busting legislation will have to hope that a stiff upper lip will help them survive the next electoral round, which, after all, is the most any of them, regardless of party, ever contemplate.

In a very prescient piece in the Washington Post, Robert Samuelson reports on the findings of an Urban Institute study of the outcomes of the Massachusetts health reform effort, which looks very much like the stew crafted (as in witch crafted) by the President and the Democrats in Congress.

Read it and weep:

People have more access to treatment, though changes are small. In 2006, 87 percent of the non-elderly had a "usual source of care," presumably a doctor or clinic, Long and Stockley note in the journal Health Affairs. By 2009, that was 89.9 percent. In 2006, 70.9 percent received "preventive care"; in 2009, that was 77.7 percent. Out-of-pocket costs were less burdensome.

But much didn't change. Emergency rooms remain as crowded as ever; about a third of the non-elderly go at least once a year, and half their visits involve "non-emergency conditions." As for improvements in health, most probably lie in the future. "Many of the uninsured were young and healthy," writes Long. Their "expected gains in health status" would be mostly long-term. Finally -- and most important -- health costs continue to soar.

Yes, some of the young and healthy who have traditionally been uninsured will possibly seek medical attention that will uncover chronic diseases like hypertension and diabetes.  But will the numbers who avail themselves of this newly available care be so tiny as to have virtually no financial impact on their need for care later in life?  Look at the example of those who use emergency rooms for a form of primary care.  Many of them had Medicaid before yet continued the habits and inclinations of a lifetime.  People tend to act in their own self interest, not in what may in fact be the rational manner viewed as obvious by academics.  They do what offers them the percieved path of least resistance.  This is one of the major realities that will prevent  the anticipated savings from accruing as predicted.

Nor did anyone in the recent debates over medical reform even raise the problem of fee for service medicine.  It is as hot a potato as cutting Medicare benefits for seniors.  It will never happen in the 2 - 4 year life cycles of our politicians.   At least not till we are all staring  over the edge of a massive debt crisis that forces painful cuts and tax increases.

Tread Carefully Into The Morass Of Medical Insurance Reform

One thing I know for a fact about medical reform efforts in America and the world is that they invariably cost more than advertised, produce less benefits than advertised and generate numerous unintended consequences.

Via Memorandum, comes a very well written and documented inquiry into the ten main reasons provided by the Obama administration and other advocates for the necessity of radical reform of our health care system, and the savings and benefits expected. The author is Bruce Kessler at a site called Maggie's Farm.

Key quote:

George Bernard Shaw warned “Beware of false knowledge; it is more dangerous than ignorance.” The major overhaul of American health care pursued by President Obama and his supporters is based on many false premises and is excessive and likely to do more harm than good. Tuning up and improvements already always dynamically occurs. Instead, ObamaCare is aimed at dramatically changing one-sixth of the US economy in ways that are untested or tested and found wanting, primarily involving huge increases in government direction of health care.

The details of ObamaCare are largely being left to Congress, the same body that stuffs the federal budget with earmarks, waste, and other programs that are not requested. ObamaCare is premised on claims for drastic changes in health care and major increases in government programs being necessary. Those claims are largely specious.

Below, the top ten specious premises for ObamaCare are discussed:

1. Comparing US Health Care To Other Developed Countries
2. US Health Care Spending Is More Than We Can Afford
3. Reform Overhaul Will Yield Major Savings
4. Increased Evidence-Based Medicine And Health Information Technology Will Significantly Improve Care and Reduce Costs
5. Present Administrative Costs And Insurer Profits Are Too High
6. US Consumer Dissatisfaction Requires Drastic Health Care Changes
7. Health Care Costs Are So High They Are A Major Cause Of Personal Bankruptcy
8. The Number Of Uninsured Is So Large That Drastic Health Care Changes Are Necessary
9. More Preventive Care Will Better Serve Consumers And Save Costs
10. Health Care Consumers Are Being Served By Drastic Health Care Changes

(More could be added, such as that government restraints on prescription drug prices will not impede incentives for innovations, but they are so transparently false that the list below dwells on other ObamaCare premises more misleading.)

Kessler then proceeds to provide chapter and verse about why each of these sacred given truths just ain't necessarily so. Important reading for the time when the President finally succeeds in appointing Gov. Sibelius as a Secretary of H.H.S. and this effort really gets under way. Let us not go blindly into this massive rescrambling without careful questioning.

Think Michael Moore Makes Sense?

In case there is anyone out there who has just seen Michael Moore's "Sicko" and is all fired up about the wonders of the kind of single payer medical system he advocates, watch this short film (via Andrew Sullivan). It is one man's story about the waiting periods common to all single payer national health systems. The side of the story Mr. Moore didn't tell you about. Or, you could watch Prime Minister's Questions from Britain each week. Not a week goes by that doesn't include tough questions about the status of the National Health Service "Queues", which can be months long.

Americans won't tolerate such effective denials of service, which arise from the government's need to ration the most expensive procedures and equipment. The only way to avoid delays would be for the system to pay whatever it takes to provide the medical industry with the facilities and staffing they think they need. But at what cost?

If anyone tells you it can be done with just some tinkering with the tax code and budget cuts like the space program, ask them to tell you how much Medicare and Medicaid cost increases have been. And those programs ride on the back of the private insurance system at present. That is why MRI's and operations are available so promptly in the US for publicly supported patients.

Health Care: Lies, Damned Lies and Statistics

The headline in the NY Times proclaims, "Most Support U.S. Support of Health Care". But if you look at the pdf document that details the findings the story is not so clear.

At the bottom of page 15 of the details are the following questions:

"27. Do you think the federal government should guarantee health insurance for all Americans, or isn’t this the responsibility of the federal government?"

In the current weeks survey 64% think the government should guarantee health insurance for all. 27% think it is not the Federal government's responsibility and 9% did not respond.

The very next question asks:

"28. IF ANSWERED “SHOULD GUARANTEE”, ASK: What if that meant that the cost of your own health insurance would go up? Then, do you think the federal government should guarantee health insurance for all Americans, or not?"

If their own health insurance costs would go up only 48% continue to support Federal guarantees.

Later, on page 16 the survey asks:

"31. Would you be willing or not willing to pay higher taxes so that all Americans have health insurance that they can't lose no matter what?"

Answering this question, 60% say they are willing to pay higher taxes; 34% are not willing and 6% don't know or have no answer.

The next question provides a little more clarity:

"32. IF ANSWERED “WILLING” TO Q31, ASK: Would you be willing or not willing to pay $500 a year more in taxes so that all Americans have health insurance they can't lose, no matter what?"

Here we find that only 49% of the original 60% remain willing to shell out $500 in taxes to support their notion of universal health equality.

So, instead of a story that asserts "most" Americans are in favor of guaranteed health insurance for all, it really depends on how much it will cost. It turns out that only a minority (48% and 49%) are willing to dip into their own pockets to support the uninsured.

In health insurance, as in all government policies, the devil is in the details. The problem facing advocates of any form of universal insurance, single payer, private payers, whatever, is that the costs are so high. Once the details of any given plan are fleshed out, people realize that the only remaining advocates that will truly matter are the health provider organizations. Those groups will be the only ones with any real power over the future of the program and their interest lies only in maintaining the extraordinary costs of their drugs or services. Anyone who has been hospitalized knows how outrageous those costs are.

The drumbeat marching us forward toward the glories of universal health care are sounding. My prediction is that it is highly likely to end in Hillary Redux, a repeat of the health care efforts of the early Clinton years.