Getting health insurance is not about your ideology

Standing in the dimly-lit cave-like radiology reading room, I was looking at a CT scan which was done in the emergency room on a man in his 40s who had a testicular mass — likely a cancer — which had spread through out his body. It wasn’t that the man did not know the mass was present — earlier CT scans from the emergency room clearly showed the mass in the early stages of cancer years earlier. He did not get the necessary care because he did not have health insurance.

Health insurance saves lives. One study in Health Affairs estimated that if all Americans had health insurance, there would be 101,000 fewer deaths each year. Based on population estimates, that would be 300 lives saved in a city of one million each year.

The Affordable Care Act, also known as Obamacare, mandates all Americans to get health insurance. While this provision has no direct impact on those of us who are on Medicare, Medicaid or private insurance, it is a game changer for over millions of uninsured Americans who will have to make a decision: to buy or not to buy health insurance.

My answer is simple. Buy. And here is why.

First, no one can deny you insurance. In the hospital, I saw a diabetic woman who had a foul infection in the pelvis, something which could have been managed at an earlier stage with simple antibiotics and fungal medicine, yet her response to my questions of why she did not have insurance was “I could not get insurance due to my diabetes.” No longer are preexisting illnesses a reason for insurance company to deny you coverage.

Second, illnesses do not look at political preference. It does not matter if you are a Democrat or a Republican, you favor Obamacare or don’t favor Obamacare, getting health insurance is not about your ideology, rather it is about your health.

Third, illnesses and traumas such as a car accident, a cancer, or a skin infection do not do a wallet biopsy to see if you have enough money or an insurance card prior to striking. A young man with a staph infection in an elbow wound at a site of a previous fracture has no insurance. With charity care and a prolonged payment plan — much like a college tuition repayment loan — he is improving.

Fourth, when the uninsured get insured — everyone who have private insurance benefits. Let me explain. There is a common misunderstanding that lack of insurance will lower health care cost and save everyone money. That is not true. By one estimate, those who have insurance pay eight percent or some $1,100 of their premium each year towards the care for those who do not purchase insurance.

Fifth, getting health insurance can help you avoid declaring bankruptcy. One healthy self-employed friend in his 50s with a car and a house decided to stick it out without health insurance, until he began to develop chest pain and needed heart surgery. Each year two million people declare bankruptcy due to medical bills – it is the number one reason for bankruptcies, more than credit card bills and unpaid mortgages.

Sixth, the money spent on health insurance is well spent. A 40-year-old person with an income of $29,000 would have to pay $125 dollars per month for a bronze coverage health insurance or $195 a month for silver coverage with subsidies. This is as much as a pack of cigarettes or two Starbucks tall coffees each day.

Seventh, health insurance even if never used buys you one thing which is priceless: peace of mind. We will not be young and invincible forever, but we don’t want to be old and in poor health.

I don’t know any doctors who would not encourage their patients to get health insurance. I wish the cancer patient, the diabetic patient and the heart disease patient had. If you trust your doctor with your life, you should trust his or her advice. Get insurance and encourage your family, friends, neighbors and acquaintances to get health insurance.

Manoj Jain is an infectious disease physician and contributor to the Washington Post and The Commercial Appeal.  He can be reached at his self-titled site, Dr. Manoj Jain.

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  • Suzi Q 38

    My friend still didn’t have health insurance, until she couldn’t see out of one of her eyes recently. She thought that she would save the money for several years and pay out of pocket. She realized that it may be serious, so she finally signed up and paid for some health insurance.

    She owns two homes, each one with a lavish swimming pool.
    She goes on cruises with her family once a year. They have nice cars.

    My in laws used to think the same way, until a few heart attacks for FIL and metestatic lung cancer for MIL. MIL drove a beautiful Cadillac and FIL only would buy Omega watches.

    My husband and I make PPO insurance a priority until we are old enough for Medicare.

  • Ron Smith

    A Rough Comparison

    101,000 fewer deaths in one year, at $22,000 average health care costs at the present equals 2.22 billion more in end of life health care costs per year or

    $99,990,000,000 ($99,99 billion) saved and

    $10,000,000,000,000 ($10 trillion) more in debt compared to…

    Average of ~$50,000+ per year in contribution (at the current rate) to GDP for 45,000,000 people equals $2.75 X 10(12) or

    $2,250,000,000,000 ( $2.25 trillion ) per year

    or

    $101,250,000,000,000 ( $101.25 trillion )…

    and at 50,000 geniuses in our current population of around 319,000,000, there are 8,620 genius IQs in 45,000,000 people…

    …all gone in 45 years.

    I don’t somehow think that your numbers really tell the whole story. Remember Mark Twain in “Chapters from My Autobiography”?

    “There are three kinds of lies: lies, damned lies, and statistics.”

    It just sounds more like an attempt to throw out numbers to support Obamacare and its politics.

    Respectfully,

    Ron Smith, MD

    www (adot) ronsmithmd (adot) com

    • Martha55

      So you are arguing that it’s OK to let those people die?

      • Anne-Marie

        Apparently so. The premise seems to be that it’s cheaper in the long run to let people die early vs incurring huge end-of-life costs as they age.

        Whether the poster is being sarcastic, I have no idea. Nor do I know where these numbers came from or whether they’re even remotely close to accurate.

        There is an enormous amount of spin on both sides. The bottom line is we don’t really know how the ACA is going to play out, so any speculation about it, good or bad, is just that – speculation. Although if someone has a reliable crystal ball, maybe they could share what they know to be factual? I’d like to know what my winning lottery ticket numbers should be.

      • Tiredoc

        I believe he is arguing that the statistics presented are bollocks.

        Insurance is pooled risk of like minded individuals. There is no scientific reason to assume that the primary difference in longevity between the insured group and the uninsured group is due to the presence or absence of insurance. There is every reason to believe that there is a measurable and unmeasurable sample bias that renders any facile conclusion unsupportable.

        Assuming that the researchers could adjust for income, diet, lifestyle, weight, divorce, children, location, religion, genetic background and race, there still is one obvious difference. How do you adjust for risk tolerance and impulsiveness, probably by definition higher in the uninsured group?

        • Martha55

          I hear ads on the radio all the time recruiting participants for clinical studies. These ads are targeted toward people who are uninsured. I guess all these studies are invalid because they don’t control for impulsiveness.

          • Tiredoc

            Those ads don’t target uninsured. They target poor people. Insurance doesn’t pay for clinical studies, drug companies or the government does. Impulsiveness is a major issue in dealing with any behavioral science question.

            As for the insurance question, people on Medicaid routinely do about the same or worse as those without health insurance. Poverty by itself negatively correlates with longevity, even after adjusting for all sorts of variables.

            I have a couple of Medicaid patients with highly treatable cancer that won’t follow their treatment plans. Insurance won’t help stupid and impulsive.

    • Ron Smith

      Let me reply to myself for all. The premise of the poster is that 100,000 lives saved would be a great thing. But we really do not know if that does anything to the overall longevity or quality of life. Certainly the cost is prohibitive.

      I’m not convinced that getting health insurance improves outcomes. I think it is disingenuous then to argue that everyone should have to have insurance just on the basis of 101,000 lives saved.

      As I’ve shown with the rough calculations, the cost per person to get everyone insurance is enormous. The only way to insure everyone it is redistribute wealth.

      We loose 70 to 100 times as many as the 101,000 that the author presents. We consume our children with ravenous endocanabalism yet I never hear anyone talk the its financial facets. The loss in dollars alone dwarf the national debt with astronomically-sized numbers, without even getting into the moral issues there.

      We would be much better off, even more than financially, if we saved the unborn. We are getting older as a nation and struggling to improve and prolong life while disposing of those with brains and productivity who might enrich us and improve the quality of our life.

      I personally believe that the financial losses of abortion pale in comparison to the greater loss of the children themselves.

      Respectfully,

      Ron Smith, MD
      www (adot) ronsmithmd (adot) com

  • EE Smith

    It turns out that the Obamacare estimates are sorely wrong.

    “See Plans Now” on healthcare-dot-gov separates consumers into two groups, those under 49 years of age and those 50 and over. But the application bases all answers for the younger group on what a 27-year-old is likely to pay, while the older group is based on the average 50-year-old. And in both groups, actual insurance costs run significantly higher than the government’s estimate.

    So if you are 40 or 49 and look for an Obamacare estimate of what they’re going to charge you, they just give you the rate for a healthy 27-year old… and that’s NOT the rate you’re actually going to be paying.

  • May Wright

    That sentence stood out to me too. 300,000 people in Florida have just been informed that their individual policies will be cancelled on December 31, 2013. The new policies they’re being offered are anywhere from 20% to 75% more expensive. There’s the possibility that some of them who are on low incomes will qualify for taxpayer subsidies if they buy their new policy through one of the exchanges, but the latest news seems to be that the software for the exchanges won’t be operational until the end of November now. That doesn’t leave those who need to apply by December 15th in order to make sure that they still have insurance come January 1st very much wiggle room.

  • Paul Laband

    I agree with Dr. Jain’s primary point, which is that getting health insurance is not, and should not be made a matter of political ideology. The data supporting the harm caused by lack of health insurance is reliable and peer-reviewed. The purpose of our health care system is to maximize good health outcomes, and everyone benefits from that goal. Letting people die unnecessarily as a cost-saving measure is a grotesque manifestation of free-market thinking, and it bothers me to see that argument being made in response to this article.

    Furthermore, blaming the poor is a common myth, and I see it being advanced in these comments. There is a growing body of research which demonstrates that poverty causes humans to make bad decisions, and those bad decisions perpetuate the cycle of poverty. Blaming the poor as a cause of uncontrolled health care costs is prejudicial and inaccurate.

    For further discussion on this, see my post and the associated discussion:

    http://www.kevinmd.com/blog/2013/11/insurance-wrong-model-health-care.html

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