Tuesday, August 25, 2009

True Health Care Facts! (I want what my mom has!): Updated

As the intelligence and tone of public discourse devolves into apoplectic frothing, gun toting, and absolutely inane claims from the extreme right, the primary victims, other than the millions of Americans lacking health coverage, have been the facts.

At the town hall in Valdosta, GA, Representative Jack Kingston, to his credit, spoke in favor of what Sarah Palin has famously called "Death Panels," and he spoke with sincerity (tough for most politicians) about how the end of life issue touched his own family, and he called the provision, accurately, "counseling for living wills" instead of "death panels." He's spoken up against the rhetoric, and pointed out on his "Health Care Checkup" that end-of-life preparation could save Medicare $77 million dollars, not a big chunk of change in these trillion-dollar times, but that would fund a few neighborhood clinics. I applaud him for his clarity on that point.

However, in many of the other bullet points, Kingston presents facts that dissemble the problems families face with our current health care system. Among the most egregious is his assertion that, whereas consumers once paid 47 cents on the dollar out of pocket for health care, now we pay only 13 cents. This misleads because it suggests that we're actually getting a bargain and we should be grateful that employer- and public-funded insurance is so generous, and that's perhaps not surprising for someone whose largest campaign contributer is AFLAC, and three of the top five funding categories are insurance, lobbyists, and health care professionals (opensecrets.org).

The more important figure is how much of one's income is going out for health care, and how much larger a burden that 13 cents is on families today. Donning my old Forest Service statistical clerk hat and using figures from US Dept. of Health and Human Services Excel spreadsheets and US Census data, I could very quickly see that the burden for US families is growing astronomically. Since Jack compared 1960 with today, I did too (or as close to today as the spreadsheets and census data would take me--2006).

In 1960, the annual consumer burden, per capita, for health care was $101. That seems tiny, but the average male income* was only $4080. Still, that's only about ~2.5% of his annual income.

In 2006, the annual consumer burden, per capita, was $2256 for the same male who earned $32,265. The burden for health care for that individual has jumped to about 7%.

To put that in some perspective, if incomes had risen as fast as health care cost, the male in 2006 would have had to earn $91,336 to enjoy the same health-care-cost-to-income ratio as the male in 1960.

And it's only worse for women. In 2006 the average woman earned only $20,014, but her health care burden was the same, so her consumer burden is over 11% today. Marry the average man and average woman and add a child or two and you can see why the consumer burden for families approaches 20%. Employers have helped with some of the burden, but more and more employers are eliminating or reducing health care coverage for their employees. Still, if I added my own health insurance contribution and the average out-of-pocket amount, I would come in a little over the average listed above. But average itself is a misleading word.

Realize that half the country earns less than average, and you can see why so many are increasingly unable to afford health care.

Then realize that the averages also spread the burden across the full spectrum of the population regardless of health. Most people don't get really sick, and so the averages mask the astronomical burden faced by the seriously ill, the chronically ill, people with insurance and good jobs who go bankrupt when the co-pays begin to add up to the tens of thousands of dollars. People like my sister.

We haven't even begun talking about rescission, the act of canceling policies for preexisting conditions uncovered when someone becomes seriously ill (i.e. expensive). I can speak personally about this, because my first job out of college was to sell life and health insurance. Agents aren't trained medical professionals, and offices want premiums sold, so we were encouraged to check "no" whenever customers said "I don't know" to a health question. I was 22 (i.e. naive) and simply didn't consider that a company could behave so unethically as to cancel a policy after someone had paid into it for years. But writing premiums gets money flowing into the company, and, to keep it from flowing back out, companies don't expend the effort to check up on their customers unless, heaven forbid, they should become seriously ill (i.e. a liability).

Outlawing rescission and eliminating the practice of refusing customers with preexisting conditions, which would be the right thing to do, will make health care more expensive in the current setup, too expensive for millions more Americans. But these millions are at the mercy of tens of millions who like what they have mainly because they haven't used it much. Comes out of the check before they see it, co-pay's 20 bucks, most prescriptions are covered, no worries. To the majority, especially to those making more than the average, it still feels like a pretty good deal even if that number on the check keeps getting bigger every year. So, all those people out there with signs, many on Medicare, are essentially saying, "Screw the millions," and, as Kingston did elaborately on his Checkup, claim that it's fewer millions than the media is reporting. Fewer millions equals less guilt I guess.

At any rate, after doing my own math, I have questions about some of his other bullet points. He touts medical tourism as proof that our system is the best (40% of the world's medical tourists come to the US). First, boob jobs aren't real medical procedures, but I doubt such procedures were excluded (he has no citation for this figure, so I can't check it), and no one disputes that, for the very wealthy, we do have the best health care system in the world.

For everyone else, our infant mortality rate is a better measure of how we aren't taking care of the millions. According to the CIA fact sheet, we rank 45th, just behind Cuba.

But these are facts, and it's clear that, in this debate, the facts don't seem to matter. And the 45,000* adults under 65 who die each year (according to Harvard research published in American Journal of Public Health, more than die from breast cancer, by the way) for lack of adequate health coverage? They're the facts that seem to matter least in this debate.

Me? I don't see why I can't have what my mom has. She's on Medicare, with a supplemental policy. I pay into Medicare. I'm OK with people keeping what they have, but I want what my mom has, and I want you, Jack Kingston, I want you, Congress, to do your job and figure out how we are all going to pay for it.

(Psst. I think it would help Medicare, btw, to have an influx of younger, healthier clientele. You know, actuarilly speaking. Just sayin'.)

*Why male? The census in 1960 doesn't break things down into median household incomes, so we have to cobble together a bit to get a sense of the burden to families. *2 The original figure of 18,000 cited from a radio broadcast earlier has been replaced by this more authoritative figure.


George said...

You're thinking is far too well-reasoned and calm to be believable, Marty.

John Guzlowski said...

Marty, a thoughtful posting. You bring reason and charity to a discussion that needs it. You should be running for Kingston's job.

Andrea said...


Just kidding. I enjoyed this and I agree with you.

Anonymous said...

I would make the point that America's infant mortality is more an indictment of crack addicted mothers, than any failing in America's Healthcare system. Youths in America most often die when they are killed by other youths in America. It is unfair to criticize doctors for their inability to cure children with multiple gun shot wounds.

John Guzlowski said...

I think Anonymous suggests something important. We need to factor out homicides (19,000 a year?) and crack infanticides (I couldn't find any stats)when we talk about health care. Perhaps we can get a bi-partisan resolution about this out of our representatives in Washington. :)

Marty said...

No, John. Anonymous is promulgating a thinly veiled talking point derived from racist assumptions (which is not to say that anonymous is racist--I don't know the person--, but that the commonly repeated talking point comes out of that milieu). Facts follow.

ICD 10 category X mortality by "Assault" is not a significant source of infant mortality (e.g. 68 in 2001 out of 27,523) according to CDC statistics.

"In the United States, about two-thirds of infant deaths occur in the first month after birth and are due mostly to health problems of the infant or the pregnancy, such as preterm delivery or birth defects. About one-third of infant deaths occur after the first month and are influenced greatly by social or environmental factors, such as exposure to cigarette smoke or problems with access to health care."

Medicinenet.com (Sources US ChildStats Health)

John Guzlowski said...

Hi, Marty, thanks for the note. I'm with you. My response to Anonymous was supposed to be ironic but reading it over I can see that it doesn't come across that way.

Marty said...

Yeah, I didn't notice the smiley face until after I posted. My bad.