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Cutting Out the Middleman in the Triage Tent

piny

Publius at Obsidian Wings wrote a post about high-risk pools:

Here’s the nickel version. McCain’s proposal seeks to push more people into individual plans (rather than employer plans). The problem, however, is that lots of people would be disqualified on the individual market on the basis of, say, pre-existing conditions. In response, some states have established programs where the government subsidizes insurance companies to take on these higher-risk, high-cost individuals. McCain has made these pools a lynchpin of his larger plan – indeed, he has to, given that he’s otherwise doing literally nothing for people with pre-existing conditions. (Jonathan Cohn has a more extensive background on these programs here).

(You should read the whole thing, which discusses high-risk pools both as they are and as they fit into the proposal.)

Everything Publius says about high-risk pools is true. They are a very thin veneer over the worst failure of the market solution.

Instead of writing people off completely, high risk pools offer less care at a higher price. Thus, better than absolutely nothing, which is what the industry is otherwise prepared to offer them. But they’re not a solution, especially for people who can’t pay several thousand or several hundred thousand dollars for treatment. These people–the sickest, the poorest, the most vulnerable–are cut off from the rest of the population and forced to accept a much greater burden. Kinda like now.

And that’s the quick point I wanted to make: This isn’t just the problem with McCain’s proposal. It’s the healthcare crisis. It’s the problem his proposal is supposed to solve.

It isn’t that “high-risk” candidates would be fucked on the individual market. They already are fucked on the individual market and have always been fucked on the individual market. It’s not profitable to provide healthcare to them, so they get no healthcare, so they suffer and die.

High-risk pools are a slightly less severe version of this same toxic dynamic: those who need most pay most and still receive the least help. The extra cost is prohibitive; the deficiencies are basic and torturous. (Also–“high risk” is a very broad category. It doesn’t just mean people who are very sick or sick right now. And as most of you probably already know, out-of-pocket is so costly that it becomes prohibitive at a very basic level.)

The high-risk arrangement doesn’t just expose one segment of the population to disease and death, either. It means that health ceases to have social worth right around the time an illness becomes serious enough to require social assistance. It means that the system incorporates a lack of interest in providing treatment to people who need it.

If we use the insurance industry as a rubric–and like Publius says, that’s exactly what McCain wants to do–that line really does creep downward to problems most people would not define as life-threatening or incapacitating–or uncommon–let alone terminal. So cooperative healthcare is itself protection worth paying for on a community level, and high-risk pools aren’t.

7 thoughts on Cutting Out the Middleman in the Triage Tent

  1. Amen, hallelujah!

    Speaking as one of those persons who isn’t terribly ill but has a lot of health problems that require regular medication, I’d be one of those forced onto a high risk plan under McCain’s plan. And with the salary I currently make, I couldn’t afford the out of pocket costs.

    Which means, of course, I’d have to pick and choose which medications to take. At least until I become disabled. Then at least I’ll have medical coverage, but it’d be too late then.

    I’m in the situation now of having to cobra my health care. I’m lucky that it’s only 308 a month, but even that’s a lot and seriously straining the budget. But I can’t afford to let it lapse because then I’ll get hit with pre-exisiting conditions when I finally do get a job with health insurance.

    I always live in terror of losing my job, because it means losing my health insurance. Even voluntarily changing jobs is fraught with risks for folks like me. At this point in my life, I’m mostly able to work, and I want to work. But sometimes I get tired of fighting and think I should just give up and apply for disability. I’d be poor, but at least I’d have some healthcare coverage.

    It’s a shame that people like myself have to even have thoughts like that.

  2. The more I read about McCain’s healthcare plan the more I want to scream. It also makes me sick how his plan would allow insurance companies to sell their plans in any state essentially eliminating all state imposed regulations (like, say, requiring companies to cover pap smears and mammograms–not something all states require!!). This means a company in Utah (which I believe doesn’t require mamograms to be covered) can sell it’s health plan all over the country, and since it’s so much cheaper, may be all some people can afford (again better than nothing but still shitty). So much for state’s rights! Women are already be charged outrageously higher rates than men in individual insurance plans!!!

    http://www.nytimes.com/2008/10/30/us/30insure.html?em

    And not just because of reproductive health issues! ARRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRGGGGGGGGGGGGGGGGGGGGGGGGGGGAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

  4. And as most of you probably already know, out-of-pocket is so costly that it becomes prohibitive at a very basic level.

    As someone who, for the last month and into the indefinite future, is without health insurance for the first time in her life, I hear ya. I’ve already had to give up two prescription medications that I’m not going to die without or anything, but would certainly be a hell of a lot better off with. It’s not even a nightmare, and that’s not even counting the constant nagging at the back of your mind about “what if someone gets sick, what if there’s an accident. . . “

  5. Unfortunately, a large percentage of the people in power in this country have never had the experience of being uninsured. Because of that, I think it is very, very difficult for them to understand what it’s like.

    Shortly after my husband and I became engaged, I had a conversation with my mother-in-law where she asserted, vehemently, that if you were too poor to afford health insurance, there was always Medicaid. Needless to say, I had to count to ten before responding to her, as I was uninsured for 6+ years because my mother worked for a non-profit and my father worked for a small business, and my parents couldn’t even afford to put us on their employer plans (both passed the ENTIRE cost of family coverage on to the employee, and since they didn’t have the purchasing power of a large corporation, it was prohibitively high). I then informed her that many lower-middle class working people who can’t afford to private pay for health insurance make too much to qualify for Medicaid, and even if they don’t, unless you’re under 18, over 65, pregnant, or permanently disabled, you’re still SOL. She didn’t believe me, and basically thought I was full of crap, but that’s a whole other issue.

    My point is that I think many people who’ve never had to navigate the waters of trying to purchase private health insurance or trying to qualify for Medicaid have an unrealistic view of how things really work. Unfortunately, I don’t know how to change that, nor do I know how to convince people that guaranteeing a basic standard of medical care for everyone will actually save money in the long run, since by the time people get sick enough to qualify for Medicaid, or to have to go to the doctor anyway (and then aren’t able to pay their bills), it costs a heck of a lot more than it would have had the problem been treated/prevented from the get-go.

  6. My understanding of individual health policies is that almost anything reasonably affordable specifically excludes coverage of maternity care.

    Am I the only one who wonders what it would do to the abortion rate to have all of America’s reproductive age women out there buying insurance on an open market?

    Just speaking for myself, I am married and hope to have children in the next few years but one thing I am quite sure of is that I am not pushing out no baby without health insurance. No way, no how. Under McCain’s plan I am much more likely to personally have an abortion and I bet I am not the only one.

  7. It doesn’t take much to be denied health insurance and pushed into the high-risk pool, either. Someone close to me has a chronic illness that is not life-threatening and most of the time is under control with only occasional flare-ups. She is self-employed and had to turn to the “high-risk” pool in her state because the regular plans denied her. The costs of this plan were so expensive and went up every year that eventually she could not afford it.

    It is so ridiculous to have people making a profit off of our health (or lack thereof). Health care is a basic human right and it is horrifying that our government does not ensure that every person in this country has access to good health care. McCain’s proposal truly terrifies me.

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