Speaking Of Health Insurance...

by hilzoy

Check out these figures from a new Kaiser poll (Kaiser is a foundation that does incredibly good work on health policy):

"The poll also found that in the past year, 23% of U.S. residents said they or a member of their household had either decided to stay with a current employer, instead of accepting a new job, or had switched jobs because of health insurance coverage. In addition, 7% of respondents said that they, or someone in their household, had decided to get married to obtain health insurance through their spouse. (...)

According to the poll, 37% of U.S. residents reported at least one of six financial troubles over the past five years as a result of medical bills:

20% had difficulties paying other bills;

20% were contacted by a collection agency;

17% had used all or most of their savings;

12% were unable to pay for basic necessities, such as food, heat or housing;

10% had to borrow money; and

3% declared bankruptcy (Kaiser Family Foundation release, 4/29)."

The 17% who used all or most of their savings, the 12% who were unable to pay for basic necessities, and the 3% who declared bankruptcy, are stunning. But I was also appalled by the 7% who said that they or someone in their household got married during the past year to get health insurance. (To be clear: I'm not appalled by those people: under the right circumstances, I might well do the same. I'm appalled that it's necessary. I take marriage seriously, and the idea that people have to marry for health insurance seems awful, in something like the way that having to marry someone to get your family out of debt would.)

I've argued for a while that universal health insurance would free people to change jobs, take risks, and be entrepreneurs in a way they might find it much harder to do if they had to risk not just their money but their health -- or, worse, the health of their kids. But I've always based this on a combination of common sense and anecdotes -- I know people who have stayed with jobs they hated instead of taking great new offers either because those new offers didn't come with health insurance or because they were worried that they wouldn't be insurable because of a preexisting condition. But I wouldn't have imagined that 23% of respondents would say that they or someone in their household had either stuck with an existing job or switched jobs because of health insurance. That's a pretty serious distortion of the labor market.

The most important reason to provide health insurance to everyone is basic decency and fairness. But not providing health insurance has serious costs to our economy and our society. If significant numbers of people are not taking the best jobs they can find, let alone deciding whether or not to marry, because of health insurance, things are badly broken.

Notes: first, here's the actual poll (pdf). And here's a note on the 7% of respondents who say they or someone in their household got married for health insurance (also pdf.) As the Kaiser people note, "substantially fewer" than 7% of the US population got married during the last year, so the figure can't be right; they speculate about it.

Methodology: "A nationally representative random sample of 2,003 adults was interviewed by telephone between April 3 and 13, 2008. The margin of sampling error for the survey is plus or minus 3 percentage points."

Comments

[bc]

That's a pretty serious distortion of the labor market.

Is that "distortion" or "effect?" I mean, no question that if one sticks with an employer due to the health care plan that has an effect, but that IS the market isn't it? You are free to pick the best employer and it happens to be the one with the right plan.

If everyone had access to the same health care than employment decisions would be based on other factors, agreed. In that sense it is a distortion.

I'm putting aside those that stick due to preexisting conditions. I wouldn't mind some HIPAA/COBRA reform that let you stay at current rates if you switched (i.e. a law that requires all group providers to also take incomings if they have been continually insured but without the need to exhaust COBRA first (i.e. pay both the employee and employer's share for 18 months), or some such). I agree that the current preexisting conditions rules make the free transfer of labor much more difficult (although better than before HIPAA/COBRA).

[foolishmortal]

It's a distortion. Health insurance is, by design, much cheaper to obtain as an employee than it is as an individual. So, the various perverse incentives involved with sticking with one's current plan propagate throughout the labor market. Try setting up shop as an independent contractor someday. I was young and healthy and they still ate up my profit.

[Hartmut]

Why should the 7% figure be dubious? I thought that was a general statement (I married for...) not limited to the last year, i.e. it would include all marriages before the time of the study.

[Barbara]

The distortions in the health insurance market are mind boggling. Small employers pay much higher rates than large employers, so even the creation of small businesses, and the willingness of such businesses to hire employees, is affected by health insurance markets. Per BC: there is simply no way to "continue" rates if the indivdiual switches insurers or from one class of product to another. In any event, most employees who elect COBRA coverage are shellshocked when they realize how much their employer was paying, and COBRA is for that reason usually an exercise in adverse selection. HIPAA corrected a few abses, but it was little more than re-arranging deck chairs on the Titanic.

[Steve G]

Health provision in the UK isn't perfect, but it's light-years ahead of this shambles. Why are none of the candidates making real promises on health reform?

[Incertus]

Short answer, Steve, is that the health insurance companies will kill you if you openly advocate for single-payer, and while they may have a limited carrot power, i.e. there's only so much money executives can donate to campaigns, they have a powerful stick in that they can form "advocacy groups" which can advertise against politicians. I think the public tide is turning to the point where we'll get something resembling single-payer in the next 20 years or so.

[FD]

Kaiser also had an article on AIDs. They don't mention the PCV who was fired for getting the disease.

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=51777

Why would I insure people's kids? They will reproduce more.

[Sock Puppet of the Great Satan]

" But I was also appalled by the 7% who said that they or someone in their household got married during the past year to get health insurance."

Which is why we should make sure Teh Gay can't marry. To protect the sanctity of Holy Matrimony.

[shelleybear]

To Barbara.
Want to know why?
http://www.huffingtonpost.com/david-sirota/hill-dc-dems-back-off-hea_b_98386.html

[FD]

Wall Street journal has an article on foreign law and the first amendment.

[redterror]

Our perverse health care system is a disgrace and an economic dead weight. Last year I stayed in a small family-owned hotel in Florence. The owners were fantastic hosts and the hotel was outstanding. And they were able to exist as a profitable small business because they could afford it, primarily because their profits were not consumed by health insurance premiums. Yes, their taxes are higher, and Italian politics are ridiculous in so many ways. But the Italian people live well, without the crushing fear that they are just one illness or serious injury away from financial devastation. And that is why one of the younger children in that family of hoteliers will be able to open another small hotel should he have that desire. In the good ol' USA? Not so much.

[Barbara]

shelleybear, I already noted this "development." This is why I initially supported Edwards, as the candidate least likely to lose himself in political expediency related to the health care industry. I also think he happened to have exactly the right plan. Although Obama has not taken PAC contributions, the same cannot be said for the gutless wonders in Congress. Overall, I do not believe that we could transition very rapidly or happily to a total single payer system. It would happen over time, and that's how the Edwards plan worked.

[publius]

i think yglesias noted this a while back, but the biggest overlooked health care controversy is not so much being uninsured, but having to stay at a job you hate for health care reasons. thanks for providing the numbers.

on the political front, i think focusing on this aspect would be a powerful political attack. lots of people who just don't care about the uninsured certainly do care about the restrictions on their freedom.

and I have a wonky question. i agree that the best part of edwards plan was the ability for it to develop into a single-payer system if people opt for the government option (whatever it's called). my understanding is that Clinton's plan has the same thing, but that Obama's is significnatly limited in this respect. Is that right?

[Brick Oven Bill]

As the rationing begins, the following things will be at first highly taxed and then restricted:

1. Alcohol
2. Tobacco (makes no sense; smokers have a lower life-cycle cost to governments than non-smokers)
3. Fatty Foods
4. TVs

Not too far down the line, the Duty-to-Die provisions will kick in.

After the good doctors move to the Caribbean and take their Clients with them, we’ll end up eating cabbage and chocolate that is dull-brown, crumbly stuff that tastes, as nearly as one could describe it, like the smoke of a rubbish fire.

Socialism does not work. Hey look! 1-year Treasury Bills.

[OCSteve]

Hilzoy: But I was also appalled by the 7% who said that they or someone in their household got married during the past year to get health insurance.

Oh man – you guys are going to leave it to the wingnut in the group to bring this up? Domestic Partnership. This ties into a few points here. Concerning those stuck in their current jobs, this is an even larger factor in their life. More and more companies are offering domestic partnership coverage, but it’s still pretty limited across the country. If you are in such a relationship and you have that coverage now you have even fewer options.

The flip side of that – companies that do offer domestic partnership coverage often limit it to same-sex partners. They exclude unmarried heterosexuals, even if they otherwise qualify as a common-law marriage. Their logic is that the heterosexual couple can always get married if they want that coverage while the same-sex couple does not have that option.

Back to the 7% - I’ll bet it’s not a primary motivation to tie the knot. More like, “we plan to get married someday anyway and we could save a lot of money if we just go ahead and do it now”. I say that because that is what my wife and I did even a long time ago.

[Kathe Burt]

I have one of the best insurance plans in the country, the Federal Employees Plan (actually a whole family of plans), but a prolonged period of ill-health several years ago left me deeply in debt, from which I fear I will never recover.

[Kathe Burt]

I have one of the best insurance plans in the country, the Federal Employees Plan (actually a whole family of plans), but a prolonged period of ill-health several years ago left me deeply in debt, from which I fear I will never recover.

[JillA]

Brick Oven Bill,

You are wilfully ignoring the many countries who have some form of universal health insurance where it works well (or, at least, much better than the US system) - Canada for one. Yes, alcohol and tobacco are more heavily taxed than in the States, but they are still affordable, and there isn't any of the stigma that exists in some areas of the US (where 'dry' areas still exist for some odd reason). You are taking the argument to its unlikely extremes. Please provide examples of countries with universal health care where tobacco and/or alcohol (let's leave aside the fatty foods and TV for now) are highly restricted to back up your assertion.

[gwangung]

Brick Oven Bill,

You are wilfully ignoring the many countries who have some form of universal health insurance where it works well (or, at least, much better than the US system) - Canada for one.

And that bastion of dirty socialists, Taiwan....

[Loneoak]

" But I was also appalled by the 7% who said that they or someone in their household got married during the past year to get health insurance."

Which is why we should make sure Teh Gay can't marry. To protect the sanctity of Holy Matrimony.

Actually ... one of my good male friends is in a sham marriage to a lesbian in the military to provide her cover and to provide him health insurance. How's that for distortion!

Hey Bill: if national health care is going to result in alcohol, tobacco, and fatty foods being taxed out of existence, then how do you explain France?! Do you really expect us to believe that France, the land of wine, cigarettes, fatty sauces, and frickin home-visit doctors simply doesn't exist? I think you hate America for not believing that we can outdo the French in smoking, drinking, fat-eating, and healthcaring. (We already kick their butt in TV-watching.)

[Anarch]

And that bastion of dirty socialists, Taiwan....

Is it a coincidence that KMT and HMO both have middle initial 'M'? I don't think so!

[gwangung]

Is it a coincidence that KMT and HMO both have middle initial 'M'? I don't think so!

On the other hand, perhaps we're overestimating BIll and his friends..perhaps they're not familiar with anything outside the US borders....

[Hartmut]

(parts of) Scandinavia have (or had) rather strict rules on the sale of alcohol. In Norway for example wine and booze sale was (or is) a state monopol http://en.wikipedia.org/wiki/Vinmonopolet>link and the taxes very high. One undesired effect is holiday alcoholism (i.e. Scandinavians travelling abroad getting heavily drunk on the much cheaper alcohol).
I think Scandinavians are on average healthier than US citizens but I do not believe that this is connected to limited access to alcohol.

[Avram]

I know at least two couples among my circle of friends who got married for health insurance, but in both cases the couples were in long-term, living-together relationships that would probably have been considered common-law marriages in a state that recognized such.

[Martial]

When asked, my wife and I say we got married for the health insurance. We had been living together for eight years previous and certainly expected to live together for the next eighty. Then she got a job with great benefits AND her employer laughed her out of the room when she applied for a domestic partnership policy - which they did offer to homosexual couples. America is a very strange place.

[Platosearwax]

Norway for example wine and booze sale was (or is) a state monopol link and the taxes very high.
American living in Norway here. This is true. Beer is available in grocery stores, wine and booze available in the state run shops. It'll cost you about 40 bucks to buy a bottle of vodka. Wine, however, is affordable. We always bring back our quota when we travel abroad.
Norwegians are healthy because of things like decent health care, the fact that they walk much more than Americans, they normally eat a couple of slices of bread for lunch, fresh food, 37.5 hour work week and 5 weeks of vacation. Sure taxes are high(er) but I get paid more, have more time off and don't have to worry, financially, about getting sick.

[Morat20]

Want to make Americans healthier, outside of actually making sure every sick American can see a doctor, not just the ones with insurance or spare cash?

Get rid of corn subsidies, and some of the stupid tariffs and barriers on sugarcane.

When you have to use several times as much corn syrup instead of cane sugar to get something to the same sweetness, all you're doing is loading it with extra calories.

Americans would still probably have a serious weight problem, but I suspect we could cut calorie intake by 10% just by going back to actual sugar and not "high fructose corn-syrup".

[Brick Oven Bill]

Sorry, a truck just took out my phone line…

Socialism is possible in disciplined societies with intelligent people and negligible immigration. I’m not too familiar with Taiwan, but I think that’s the case there. Socialism worked in Sweden up until a decade or so ago and is on the way out. Google Malmo. Check emigration rates.

Tax rates on wealthy Frenchmen can now exceed their income (there are ‘wealth’ taxes in France). Guess what? Frenchmen of means are leaving and being replaced with North Africans.

200,000 young British professionals left the Island last year. They were replaced with 500,000 immigrants.

Europe is probably ahead of us in learning that the combination of a socialist form of government, without draconian immigration controls in the era of air travel and boats, is really, really attractive to those in the world who are used to living on a few dollars a day, if that. The productive people being asked to pick up the bill are… leaving. Globalism is a two-way street; taxes redistribute people too.

There will be no democratic solution to the budget collapse. It’s really a shame. Lots of people have had a few decades to feel good about themselves though. I hope it was fun.

[david kilmer]

I used to think that my situation was unusual, but now I think that that's just one of the things that makes it typical.

I work remotely (in upstate NY) for a company based in Pennsylvania. It's useless for me to get health coverage through them because I couldn't see doctors in my area. I checked out ways to get insurance as a self-employed person, and the cheapest I could come up with was about $4000 per year (not counting co-pays, deductibles, etc.). Nothing I found covered mental health care at all, and that's most of my medical costs (I'm BP).

My girlfriend is a brilliant woman with a master's degree in Linguistics. She works as a barista at Starbucks. I joke that she stays there because we would go bankrupt without the free beans, but there's no doubt at all that it's the health coverage. They're willing to cover both of us because we live together, and they only require her to work about 20 hours a week to get coverage. The mental health coverage is reasonable, and I also have dental and optical for the first time in my life. All for less than a grand a year (for me - hers is much less).

[bemused]

Brick Oven Bill -- you may want to check this out. As usual you have the wrong end of the stick

[Gary Farber]

"As usual you have the wrong end of the stick"

If you don't mind my asking, Bill, do you listen to any internet political "radio"?

What sites, in general, do you get most of your political/social tidbits from, may I ask?

Thanks.