Debunking the 47 million uninsured myth
Toro @ Sat Aug 01, 2009 5:55 pm
Frederick Frederick:
Exactly. And even if, while insured, you were to acquire such a main-floor microwave, and your present insurer said "okay, we'll accept that," there are still risks. If you lose your job and your insurance lapses, your future insurer may not be so accepting. So even if you have insurance, you're not guaranteed coverage forever.
Most insurance policies have a maximum amount one can claim over a lifetime. That figure is usually about a million dollars, but it does vary. There are instances of people with significant chronic conditions running out of insurance coverage in their lifetimes.
Scape @ Sat Aug 01, 2009 6:06 pm
Toro Toro:
Lobbying runs in the tens of millions but not the tens of billions.
http://www.youtube.com/watch?v=Jx9GCJ9h7EQ#t=1m35
Scape @ Sat Aug 01, 2009 6:46 pm
Toro Toro:
For the record, I am in favour of a hybrid system between the private and public sector.
So it would seem the entire GOP...
Toro Toro:
So, yeah, there are problems with a profit-driven model, but those problems must be understood in context.
What's good for the goose...
Dayseed @ Sun Aug 02, 2009 7:45 am
Toro Toro:
Regarding profits, for certain you hear about cases where insurance coverage is denied.
And Sicko was an entire movie about denial of coverage. So far, nobody has sued Michael Moore for a single dime...I wonder why?
$1:
However, consider that generally, Americans receive more tests for conditions than Canadians. Some of this should be self-evident - how easy is it to get an MRI in Canada?
Is this necessarily a good thing designed for the best interest of the patient, or does it also have to do with malpractice lawsuits and doctors covering their asses? Down below you talk about stripping things out of context...look no further than your above point for another example of a lack of context.
$1:
And as I posted above, the American system is generally more aggressive in testing people for cancer. You would think that if profits were what primarily drove the system, there would be less, not more, tests than in a single-payer system.
Again, you're drawing a conclusion out of context. How many of these tests are necessary? How many are done for the purpose of healing the patient or for covering the doctor's ass? Having to explain why a simple test wasn't done which may or may not have saved a patient's life to a jury at court simply blows. Could that be why so many more tests are done?
$1:
But that is generally not the case. In Britain, for some conditions, whether or not you get treated is determined by a lottery.
I don't know anything about the British system.
$1:
The American people would never stand for either shortages of MRIs nor for a lottery system to determine who gets treatment. It is completely antithetical to the American mindset.
But Obama isn't proposing a lottery system for MRIs. He's proposing a government backed health insurance plan available to any and all Americans. It means the federal government (or state government) would pay for the MRI through taxes. That doesn't deprive any American of an MRI.
$1:
So, yeah, there are problems with a profit-driven model, but those problems must be understood in context.
And there's the context comment.
bootlegga @ Sun Aug 02, 2009 8:33 am
Frankly, I'm tired of this whole BS debate.
If Americans are happy with their coverage, then fine, let them pay twice what we pay (per capita) and let's be done with it. I'm at the point where I couldn't care less if they live shorter lives or have a better chance of surviving cancer or whatever.
Just please leave us out of your fucking BS arguments and do whatever the hell you want to.
All I can say is that if they ever try to institute a fucked-up for-profit American-style health care system here, I'll be sending letter bombs like the Unabomber! 
Regina @ Sun Aug 02, 2009 9:03 am
bootlegga bootlegga:
Frankly, I'm tired of this whole BS debate.
![[stupid]](./images/smilies/stupid.gif "With stupid")
Scape @ Sun Aug 02, 2009 1:52 pm
bootlegga bootlegga:
If Americans are happy with their coverage, then fine, let them pay twice what we pay (per capita) and let's be done with it.
That is the key point, they can't. Medical costs are not static, they are spiraling. It's like they got the fast cat BC ferries version of health care. It can't do the job and the job it does is ruining the books. Reform is needed because the costs are out of control not that they can't cover everyone. Coverage for all is a great side argument and it makes for great labeling for the reform movement but the system can not stand as it is running currently as it will bankrupt America and that elephant will roll on us.
Even if they reform the system the chances are the single payer option will be so watered down as to be useless meanwhile the horse will be out of the barn as the private insures keep jacking up the rates and kicking the sick off cover for people who do pay. These people will end up going to emergency to get the help they need and that ends up as a state tax in the form of higher costs. The US system (private and public) costs currently run at two and a half trillion annually and it's only going up but the cost to cover emergency care which is only covered by state taxes and benevolent charities costs an additional $300 billion annually. We are talking about $1 trillion white elephant in waste a year simply being thrown out the door with dismal returns as the US ranks 37 in overall health care and 50th in life expectancy.
Bruce_the_vii @ Sun Aug 02, 2009 5:21 pm
Regina Regina:
bootlegga bootlegga:
Frankly, I'm tired of this whole BS debate.
With due regard for the drudgery of moderating opinions this debate wasn't too bad. I even mentioned it to my wife.
BeaverFever @ Sun Aug 02, 2009 6:48 pm
Look, there's no such thing as having "full coverage" in the US as there is in Canada, even if you are a multi-millionaire and paying $1000 + a month for insurance, there are significant out-of-pocket costs and coverage limitations.
The most common health insurance plan in the US is an 80/20 plan, where the insurer pays 80% of the bill once coverage is in effect and you have to pay 20%. Government provided Medicare and Medicaid are 80/20 plans. Well, being liable for 20% of a $120,000 bill is still enough to drive you into bankruptcy and its enough to discourage you from seeing a doctor until its too late. It should also be noted that most health insurance plans also have an annual deductible that you must pay out-of-pocket before the coverage comes into effect. This can be anywhere from $50 to $5000 depending on how much of a monthly premium you can afford.
In addition, some doctors don't work with some insurers and some insurers don't work with some doctors so you have limited choice in who you can see, and the doctor's treatement choices are limited to what treatments the insurance covers. And if you lose your job, you lose your insurance since most of it is employer-provided. I've seen medical coverage for a 4-person family cost $2500 a month! Even if you get a new job, it likely means a new insurer so you will have to change doctors and any pre-existing conditions may not be covered by the new insurer.
Health outcomes in Canada compared to the US are identical or better. Some indicators such as "number of tests performed" are higher in the US, but it's a for-profit system that encourages excessive tests and scans. Some specific ailments may have a better survival rate in the US but many are better in Canada. All in all, the two are cetainly comparable with Canada easily holding its own or even looking better. Lower infant mortality rates, better survival rates for cetain procedures and illnesses, longer life spans, etc.
Also, the orginal article on this thread supposes - but doesn't prove- that anyone who makes over $50,000 a year could easily afford to buy their own health insurance if they wanted to. I make over that amount, and I sure don't have one or two grand lying around for insurance.
The second fallacy of the article is implying that anyone under 18 who doesn't have coverage can just "sign up" for medicare or medicaid. There are millions of americans that make too much money to qualify for the stringent qualifications of these public programs, some of which require your posessions not have a net value over $2,000. THe report states "Current projections by the Congressional Research Service, the Department of Health and Human Services, and the Center on Budget and Policy Priorities indicate that federal funding for SCHIP will not meet current needs in at least 17 states in fiscal year 2007, which starts October 1. These states are projected to face federal funding shortfalls totaling an estimated $800 million to $950 million, an amount equal to the federal share of the cost of insuring about 530,000 children."
For example, if you read the acutal census bureau report, it says "The new census data revealed that those hardest hit in 2006 were families with incomes between $25,000 and $75,000, but even when family income exceeded $75,000, the numbers of uninsured Americans grew by 1.3 million in 2006, suggesting that family premiums are becoming increasingly unaffordable, especially when employers do not provide coverage."
There is also nothing in the report that implies they are surveying illegal immigrants and counting them among their numbers. Non-citizen is not the same as illegal immigrant.
And by the way, illegal immigrants work for like ten or 20 dollars a day, they're hardly "driving up the cost of everything" if anything, they drive down wages and prices.
Latest Census Bureau report (pdf):
http://www.census.gov/prod/2008pubs/p60-235.pdf
Toro @ Sun Aug 02, 2009 7:11 pm
BeaverFeaver
A few things.
First, when I came down to America after living in Toronto, my after-tax income jumped substantially comparative to what I would have made in Toronto. I actually went through both a Canadian and American income tax form and was surprised at the difference. And I never came down here making a six figure salary. Far from it. At $50k and over, I could easily afford health insurance. But that was just me. I wasn't driving a brand new car either, which, BTW, you will see many young people driving down here.
Could you please link to me which survival rates are better in Canada. I would very much be interested in knowing what they are as I imagine there are at least some. (Gunshot wounds don't count.)
Finally, the US Census makes an estimate of the number of illegal immigrants in the US. Most of those illegals work under the table for cash and few have a social security number. You are correct in that the census survey does not specifically say how many illegals do not have coverage but you do not have to make a giant leap in logic that most illegals do not.
Here is another analysis of the breakdown of the uninsured.
$1:
* There were 45.7 million uninsured people in the U.S. in 2007.
* Of that amount, 6.4 million are the Medicaid undercount. These are people who are on one of two government health insurance programs, Medicaid or S-CHIP, but mistakenly (intentionally or not) tell the Census taker that they are uninsured. There is disagreement about the size of the Medicaid undercount. This figure is based on a 2005 analysis from the Department of Health and Human Services.
* Another 4.3 million are eligible for free or heavily subsidized government health insurance (again, either Medcaid or SCHIP), but have not yet signed up. While these people are not pre-enrolled in a health insurance program and are therefore counted as uninsured, if they were to go to an emergency room (or a free clinic), they would be automatically enrolled in that program by the provider after receiving medical care. There’s an interesting philosophical question that I will skip about whether they are, in fact, uninsured, if technically they are protected from risk.
* Another 9.3 million are non-citizens. I cannot break that down into documented vs. undocumented citizens.
* Another 10.1 million do not fit into any of the above categories, and they have incomes more than 3X the poverty level. For a single person that means their income exceeded $30,600 in 2007, when the median income for a single male was $33,200 and for a female, $21,000. For a family of four, if your income was more than 3X the poverty level in 2007, you had $62,000 of income or more, and you were above the national median.
* Of the remaining 15.6 million uninsured, 5 million are adults between ages 18 and 34 and without kids.
* The remaining 10.6 million do not fit into any of the above categories, so they are:
o U.S. citizens;
o with income below 300% of poverty;
o not on or eligible for a taxpayer-subsidized health insurance program;
o and not a childless adult between age 18 and 34.
* Of that amount, 6.4 million are the Medicaid undercount. These are people who are on one of two government health insurance programs, Medicaid or S-CHIP, but mistakenly (intentionally or not) tell the Census taker that they are uninsured. There is disagreement about the size of the Medicaid undercount. This figure is based on a 2005 analysis from the Department of Health and Human Services.
* Another 4.3 million are eligible for free or heavily subsidized government health insurance (again, either Medcaid or SCHIP), but have not yet signed up. While these people are not pre-enrolled in a health insurance program and are therefore counted as uninsured, if they were to go to an emergency room (or a free clinic), they would be automatically enrolled in that program by the provider after receiving medical care. There’s an interesting philosophical question that I will skip about whether they are, in fact, uninsured, if technically they are protected from risk.
* Another 9.3 million are non-citizens. I cannot break that down into documented vs. undocumented citizens.
* Another 10.1 million do not fit into any of the above categories, and they have incomes more than 3X the poverty level. For a single person that means their income exceeded $30,600 in 2007, when the median income for a single male was $33,200 and for a female, $21,000. For a family of four, if your income was more than 3X the poverty level in 2007, you had $62,000 of income or more, and you were above the national median.
* Of the remaining 15.6 million uninsured, 5 million are adults between ages 18 and 34 and without kids.
* The remaining 10.6 million do not fit into any of the above categories, so they are:
o U.S. citizens;
o with income below 300% of poverty;
o not on or eligible for a taxpayer-subsidized health insurance program;
o and not a childless adult between age 18 and 34.
http://keithhennessey.com/2009/04/09/ho ... taxpayers/
Robair @ Sun Aug 02, 2009 9:49 pm
Toro Toro:
At $50k and over, I could easily afford health insurance.
Did you ever have to use it?
fifeboy @ Sun Aug 02, 2009 10:08 pm
Toro Toro:
Could you please link to me which survival rates are better in Canada. I would very much be interested in knowing what they are as I imagine there are at least some.
Done it already:
moi moi:
Horsemanure!
If Canada has such terrible health care than why do the statistics show our results being better than in the U.S. cheque out http://www.who.int/whosis/en/ and go to customized search and look up Cancer Mortality rate, Cardiovascular disease Mortality rate, Infant Mortality rate, Healthy Life expectancy, Life expectancy at birth, Under 5 mortality rate, HIV infection rate, etc. As I am sure some will point out, the U.S. has the best cancer survival rate in the world and a lower cancer death rate than Canada. That is true. In Canada the rate is 138/100 000 where in the U.S. it's 134/100 000. But when we look at other diseases, take CV disease, in the U.S. the death rate is 188/100 000 and in Canada it is 141/ 100 000. I would maintain that the differences in cancer rates is not significant, while the CV death rate difference is. I'm not a statistics guy, but it seems quite clear. The other statistics don't bode well for private health care either. Like I said before the election in the U.S., we need to gird our loins for an onslaught of anecdotal information about every Canadian who has had a hangnail operation go wrong. It is BS.
And Robair, you are exactly right.
If Canada has such terrible health care than why do the statistics show our results being better than in the U.S. cheque out http://www.who.int/whosis/en/ and go to customized search and look up Cancer Mortality rate, Cardiovascular disease Mortality rate, Infant Mortality rate, Healthy Life expectancy, Life expectancy at birth, Under 5 mortality rate, HIV infection rate, etc. As I am sure some will point out, the U.S. has the best cancer survival rate in the world and a lower cancer death rate than Canada. That is true. In Canada the rate is 138/100 000 where in the U.S. it's 134/100 000. But when we look at other diseases, take CV disease, in the U.S. the death rate is 188/100 000 and in Canada it is 141/ 100 000. I would maintain that the differences in cancer rates is not significant, while the CV death rate difference is. I'm not a statistics guy, but it seems quite clear. The other statistics don't bode well for private health care either. Like I said before the election in the U.S., we need to gird our loins for an onslaught of anecdotal information about every Canadian who has had a hangnail operation go wrong. It is BS.
And Robair, you are exactly right.
DerbyX @ Sun Aug 02, 2009 10:19 pm
http://www.sadlyno.com/archives/23404.html
Circulatory disease deaths per 100,000:
Canada: 219
United States: 265
Child maltreatment deaths per 100,000:
Canada: 0.7
United States: 2.2
Digestive disease deaths per 100,000:
Canada: 17.4
United States: 20.5
Infant mortality rate per 1,000 live births
Canada: 5.08
United States: 6.3
Intestinal diseases death rate
Canada: 0.3%
United States: 7.3%
Proability of not reaching age 60:
Canada: 9.5%
United States: 12.8%
Respiratory disease child death rate per 100,000
Canada: 0.62
United States: 40.43
Heart disease deaths per 100,000:
Canada: 94.9
United States: 106.5
HIV deaths per million people:
Canada: 47.423
United States: 48.141
BeaverFever @ Sun Aug 02, 2009 10:46 pm
There are many studies comparing Canada/US health outcomes that have been conducted over the years, but the most comprehensive to date is a summary of them all
$1:
A systematic review of studies comparing health outcomes in Canada and the United States
http://www.openmedicine.ca/article/view/8/1
Of the 38 studies included in the analysis, 10 were considered to be of the highest quality because they enrolled broad populations and included extensive statistical adjustments. Results of five of those favoured Canada, two favoured the United States and three showed equivalent or mixed results.
Of the 28 remaining studies that did not meet one of the criteria, nine favoured Canada, three favoured the United States and 16 showed equivalent or mixed results.
The only specific medical condition in which medical results consistently favoured one country was end-stage renal disease. Canadian patients fared better in those cases.
When all the studies were combined, the 17 doctors and researchers involved in the meta-analysis found Canadians had a five per cent lower death rate than people in the United States."
After adjustment for the case mix and treatment variables, the mortality rate for end-stage renal
disease was 47% higher in the U.S. than in Canada.
Compared with their American counterparts, low-income Canadians had a significant survival
advantage for 13 of the 15 kinds of cancer studied.
One-year mortality rates following myocardial infarction were virtually identical for both countries (34.3% U.S. vs. 34.4% Canada) however:
• U.S. patients were far more likely to undergo expensive and invasive treatments such as coronary angiography (34.9% U.S. vs. 6.7% Canada); percutaneous transluminal coronary angioplasty (11.7% U.S. vs. 1.5% Canada); and coronary-artery bypass surgery (10.6% U.S. vs. 1.4% Canada).
Canadians had lower rates of unadjusted in-hospital mortality (1.4% Canada vs. 2.2% U.S.). There
was no difference between the countries after controlling for demographic and clinical differences.
• The average length of a hospital stay in Canada was 16.8% longer
• Adjusted costs of CABG in the U.S. were 82% higher than in Canada
• Average in-hospital treatment costs were nearly twice as much in the U.S. ($20,673 U.S. vs. $10,373
Canada / Median: $16,036 U.S. vs. $7,880 Canada).
• Administrative costs consumed more of the total cost of treatment in the U.S.
Manitoba had lower mortality rates for patients 65 and older three years after both low-mortality
(18.52% U.S. vs. 15.31% Canada) and moderate-mortality (19.19% U.S. vs. 16.63% Canada)
procedures. There was no difference on high-mortality procedures (41.50% U.S. vs. 41.82%
Canada).
On seven diseases / procedures for which data are available for both countries, Canada survival
rates were superior to the U.S. for four (colorectal cancer: 113 Canada vs. 108 U.S.; childhood
leukemia: 118 vs.110; kidney transplants 113 vs. 100; and liver transplants 123 vs. 102), about the
same on two (cervical cancer: 106 Canada vs. 108 U.S.; and non-Hodgkins lymphoma: 107 vs.
109), and worse on one (breast cancer: 104 Canada vs. 114 U.S.).
3
http://www.openmedicine.ca/article/view/8/1
Of the 38 studies included in the analysis, 10 were considered to be of the highest quality because they enrolled broad populations and included extensive statistical adjustments. Results of five of those favoured Canada, two favoured the United States and three showed equivalent or mixed results.
Of the 28 remaining studies that did not meet one of the criteria, nine favoured Canada, three favoured the United States and 16 showed equivalent or mixed results.
The only specific medical condition in which medical results consistently favoured one country was end-stage renal disease. Canadian patients fared better in those cases.
When all the studies were combined, the 17 doctors and researchers involved in the meta-analysis found Canadians had a five per cent lower death rate than people in the United States."
After adjustment for the case mix and treatment variables, the mortality rate for end-stage renal
disease was 47% higher in the U.S. than in Canada.
Compared with their American counterparts, low-income Canadians had a significant survival
advantage for 13 of the 15 kinds of cancer studied.
One-year mortality rates following myocardial infarction were virtually identical for both countries (34.3% U.S. vs. 34.4% Canada) however:
• U.S. patients were far more likely to undergo expensive and invasive treatments such as coronary angiography (34.9% U.S. vs. 6.7% Canada); percutaneous transluminal coronary angioplasty (11.7% U.S. vs. 1.5% Canada); and coronary-artery bypass surgery (10.6% U.S. vs. 1.4% Canada).
Canadians had lower rates of unadjusted in-hospital mortality (1.4% Canada vs. 2.2% U.S.). There
was no difference between the countries after controlling for demographic and clinical differences.
• The average length of a hospital stay in Canada was 16.8% longer
• Adjusted costs of CABG in the U.S. were 82% higher than in Canada
• Average in-hospital treatment costs were nearly twice as much in the U.S. ($20,673 U.S. vs. $10,373
Canada / Median: $16,036 U.S. vs. $7,880 Canada).
• Administrative costs consumed more of the total cost of treatment in the U.S.
Manitoba had lower mortality rates for patients 65 and older three years after both low-mortality
(18.52% U.S. vs. 15.31% Canada) and moderate-mortality (19.19% U.S. vs. 16.63% Canada)
procedures. There was no difference on high-mortality procedures (41.50% U.S. vs. 41.82%
Canada).
On seven diseases / procedures for which data are available for both countries, Canada survival
rates were superior to the U.S. for four (colorectal cancer: 113 Canada vs. 108 U.S.; childhood
leukemia: 118 vs.110; kidney transplants 113 vs. 100; and liver transplants 123 vs. 102), about the
same on two (cervical cancer: 106 Canada vs. 108 U.S.; and non-Hodgkins lymphoma: 107 vs.
109), and worse on one (breast cancer: 104 Canada vs. 114 U.S.).
3
This one is a joint Canadian/US patient satisfaction survey conducted by the US CDC and Stats Canada:
$1:
Joint Canada/United States Survey of Health: Findings and public-use microdata file
http://www.statcan.gc.ca/pub/82m0022x/82m0022x2003001-eng.htm
Overall, more Canadians reported having a regular medical doctor compared with Americans (85% versus 80%) - Canadians were similar to insured Americans in terms of having a regular medical doctor.
Overall, more Americans reported that they had experienced an unmet health care need in the previous year compared with Canadians (13% versus 11%). There was no difference in the proportion who reported unmet health care needs between Canadians and insured Americans.
http://www.statcan.gc.ca/pub/82m0022x/82m0022x2003001-eng.htm
Overall, more Canadians reported having a regular medical doctor compared with Americans (85% versus 80%) - Canadians were similar to insured Americans in terms of having a regular medical doctor.
Overall, more Americans reported that they had experienced an unmet health care need in the previous year compared with Canadians (13% versus 11%). There was no difference in the proportion who reported unmet health care needs between Canadians and insured Americans.
As for the cost of US health insurance, check this out this report and its synopsis from the below links:
http://healthinsurance.about.com/od/faqs/f/avgpremium.htm
http://www.ahipresearch.org/pdfs/Individual_Market_Survey_December_2007.pdf
$1:
Most recent figures are from 2005, and indicate that the average individual's job-based premiums were $3,991 that year, while families spent an average of $10,728.
$1:
Nationwide, annual premiums averaged $2,613 for single coverage and $5,799 for family plans in the 2006-2007 period.
For single policies, annual premiums ranged from $1,163 for persons under age 18 to $5,090 for persons aged 60-64. For
family policies, premiums ranged from $2,325 for policies covering children under age 18 to $9,201 for families headed by
persons aged 60-64.
The average deductible for single PPO/POS plans
purchased was approximately $1,700. Among the single
PPO/POS plans purchased, nearly one-third had deductibles
under $1,000; just over one-third had deductibles in the
$1,000-$2,499 range; and nearly one-third had deductibles
of $2,500 or more.
The average deductible for single HSA/MSA products
purchased was approximately $2,900 for single plans and
$5,300 for family plans. For HSAs, the minimum deductible
required by law for 2007 is $1,050 for single policies and
$2,100 for families. By law, HSA plans have a unified family
deductible — there are no separate deductibles for family
members.
Almost all single HMO/EPO plans purchased had either no
deductible or a deductible in the $1,500 to $2,499 range.
For single policies, annual premiums ranged from $1,163 for persons under age 18 to $5,090 for persons aged 60-64. For
family policies, premiums ranged from $2,325 for policies covering children under age 18 to $9,201 for families headed by
persons aged 60-64.
The average deductible for single PPO/POS plans
purchased was approximately $1,700. Among the single
PPO/POS plans purchased, nearly one-third had deductibles
under $1,000; just over one-third had deductibles in the
$1,000-$2,499 range; and nearly one-third had deductibles
of $2,500 or more.
The average deductible for single HSA/MSA products
purchased was approximately $2,900 for single plans and
$5,300 for family plans. For HSAs, the minimum deductible
required by law for 2007 is $1,050 for single policies and
$2,100 for families. By law, HSA plans have a unified family
deductible — there are no separate deductibles for family
members.
Almost all single HMO/EPO plans purchased had either no
deductible or a deductible in the $1,500 to $2,499 range.
Bruce_the_vii @ Mon Aug 03, 2009 2:31 am
Interesting data. Some actual numbers; I cut and saved them. Thanks for the post.