When the Patient Protection and Affordable Care Act was passed, we all know by now that Nancy Pelosi famously declared “we have to pass it to see what’s in it.”
But by now, you can see some fallout – most of which was predicted by those against it.
The entire act was billed as the solution to America’s uninsured. The assumption was always that there were 45 (or so) million Americans who were suffering in the streets without healthcare. And naturally, the media never asked the questions, “who are they, and why aren’t they insured?”
According to the Cato Institute, which didn’t have to look much further than the Census Bureau and the Congressional Budget Office, there were about 46 million uninsured as of 2009. But let’s break that down:
46 million uninsured
12 million were eligible for Medicaid and the State Children’s Health Insurance Program (S-CHIP), but didn’t enroll.
That leaves 34 million.
34 million uninsured
10 million (give or take) are not American citizens (ratio of illegal versus legal immigrants can be debated)
That leaves 24 million.
Here’s where it gets blurry, but no less insightful: A study by the Congressional Budget Office (CBO) found that 43% of the uninsured have incomes higher than 250% of the poverty level ($55,125 for a family of four). Slightly more than 33% have incomes in excess of $66,000.
Another study by Mark Pauly of the University of Pennsylvania and Kate Bundorf of Stanford concluded that nearly 75% of the uninsured could afford coverage but chose not to purchase any.
Back to the CBO study: Around 60% of the uninsured are under 35 years of age, and 86% report they are in good or excellent health.
Finally, like those who are laid off of a job or unemployed, we tend to assume that’s a permanent condition. In fact, only about 30% of the uninsured are uninsured for more than a year. This is because most insurance is tied to employment, which was a condition John McCain spoke of solving back during the 2008 presidential race.
The greater point here is this: People hear politicians or media recite a fact like “there are 47 million uninsured,” without asking the question: Why? They don’t ask, “Who are they?”
Based on a quick look into the numbers, it’s clear we could have legislated a solution that dealt specifically with the small number of Americans who needed the help.
Instead, we’ve created a situation where everyone has easier access that they believe is free. This is leading to more demand for doctor time. And with the finite number of doctors, the equation is simple: same number of doctors plus more demand with the same number of hours in a day equals more waiting for doctor appointments and treatment. And it’s happening right now.
Meanwhile, there are movements to cut pay for US doctors. The Medicare Payment Advisory Commission (MPAC), established by the ACA, decided in late 2011 to drastically cut Medicare payments to doctors. This could reportedly cut the salaries of doctors who accept Medicare patients by 50%.
Now, if you were a doctor, and it was going to be less lucrative with more hoops, what would you do? Maybe refuse to accept Medicare patients. And what will private insurance do? They’ll likely slash fees, as well.
And if the pay for the work goes down, there will be less incentive for students to enter medicine – considering the cost and time of attending medical schools.
The new healthcare laws are obviously (and purposefully) complex, and it’s clear most lawmakers have still not read them. But the solution didn’t need to blow up the existing system.
Addressing the small and real number of uninsured and disconnecting insurance from employment would have done the trick quite nicely.
But what troubles me most is how many people sat by and didn’t think through the premise of the problem.