Why do the uninsured want to stay uninsured? They won’t say

Why do the uninsured want to stay uninsured? They won’t say


Picture 3 Two uninsured people who insist on their right to remain uninsured have joined 20 states and the National Federation of Independent Business in suing to overturn the new federal law requiring all Americans to obtain health insurance or else pay a tax penalty.

The lawsuit, filed in U.S. District Court in Pensacola, Fla., claims the government is exceeding its constitutional authority to regulate interstate commerce.

The states added the two individuals as plaintiffs because the government is likely to argue that the states lack legal standing to challenge the individual insurance mandate, given that it only affects individuals, not the states.

But the public can’t find out why the two new individual plaintiffs — an auto repair shop owner in Panama City, Fla. and a retired lawyer/Wall Street banker living in Port Angeles, Wa. – oppose the insurance requirement because the lawyer spearheading the suit says they aren’t speaking to the news media.

I particularly wanted to know how these two uninsured people have paid for health care for themselves and their families in the past and how they plan to pay for it in the future. So I asked David Rivkin, a partner at Baker Hostetler in Washington, D.C., who is representing them and the NFIB and serves as outside counsel for the states, if he could put me in touch with them.

“They aren’t public persons and don’t want to give up their privacy,” said Rivkin. He did say they are both around 50 years old – an age when most Americans are anxious to have good health insurance. That made me even more curious about their motives for joining the suit. I also found it funny that two people jumping into one of the country’s biggest political controversies expect to maintain their privacy.

Rivkin’s privacy claim may or may not be true for Mary Brown, the repair shop owner. She initially told me in a brief conversation that the attorneys didn’t want her to talk to the media. Then, after calling Rivkin’s office, she called back and said she’s so busy with her business that she doesn’t have time to talk to reporters. She very courteously indicated she actually would like to talk to me, perhaps at a later date.

But the assertion of privacy doesn’t seem to fit Kaj Ahlburg, a Harvard University law graduate and Clallam County Republican Party leader who recently was appointed to the Harbor-Works Development Authority board in Port Angeles.

Described by Rivkin as a “person of means,” Ahlburg is no shrinking violet. He’s often quoted in the local press commenting on controversial issues such as the U.S. Supreme Court’s eminent domain ruling in Kelo v. New London. And he recently has given public talks on the Islamic religion and on al Qaeda. In December, he spoke to a county GOP gathering on how to mitigate the threat of electromagnetic pulses caused by nuclear explosions high above the atmosphere. Hmm, who knew?

According to an announcement advertising Ahlburg’s January 2009 al Qaeda speech at the Bremerton-Olympic Peninsula Navy League, Ahlburg practiced law and investment banking for 19 years in New York City, is a member of the International Assn. for Counterterrorism and Security Professionals, and watched the Sept. 11 attacks from his office window in Manhattan.

Still, the normally outspoken Ahlburg did not return my two calls to his home.

Based on his background and interests, Ahlburg is obviously a man who values liberty. But he apparently has the financial means to maintain his freedom from health insurance. “He’s been paying his own way any time he incurs medical expenses,” Rivkin said. “He’s done that for years. His health care footprint is zero, and he has no desire to buy health insurance.”

Brown must be an even more freedom-loving person, because she does not seem to have the resources to pay for costly medical care out of pocket.

According to NFIB spokeswoman Melissa Sharp, Brown has co-owned the Brown & Dockery auto repair shop for four years and is “struggling to keep the doors open.” She does not have health insurance for herself and doesn’t provide it to her two employees. Brown has two daughters and two step-daughters; Sharp said she didn’t know the ages of Brown’s children or whether they have any health coverage.

“She’s adamantly opposed to the government telling her she has to buy coverage,” Sharp said.

Rivkin said, “I wouldn’t care to speculate about what she’d do if she became ill. That’s how she chooses to lead her life. There are certainly people who believe that given their current circumstances and health, it is prudent for them to defer getting coverage until some point in time in the future.”

When I asked Brown herself how she pays for health care for herself and her children, she said she gave all that information to the Baker Hostetler lawyers and that I should ask them.

While Rivkin argues that Brown’s and Ahlburg’s personal circumstances are irrelevant to the legal case, Washington & Lee University law professor Timothy Jost says those facts eventually will be highly relevant. “The judge will certainly want to know a lot more about their circumstances,” said Jost, who has written extensively about health reform.

But, he said, the individual plaintiffs’ personal circumstances will only matter in 2015, when the tax penalty applies to those who don’t obtain health insurance. Until then, he said, the lawsuit is not ripe because there is no actual injury. Thus, the courts lack jurisdiction. He predicts the courts will toss the case on that basis.

Of course, by 2015 Brown and Ahlburg may have changed their minds and gotten health coverage. After all, under the new reform law, insurers won’t be able to turn away people in their 50s with preexisting conditions, and there will be sizable subsidies for small business owners like Brown. If that happens, then the states and the NFIB would have to look for some new plaintiffs who demand freedom from health insurance.

Meyer is a journalist based in Yakima, Wash., and winner of the Gerald Loeb
Award.  He has over 27 years of reporting experience for law and health
care publications, alternative newsweeklies and television news.

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42 Comments on "Why do the uninsured want to stay uninsured? They won’t say"

Down with Greedy Bastard Doctors
Jul 16, 2010

Mr. MD as Hell goes against every single goddamed and forlorn thing that he’s supposedly sworn to uphold in the Hippocratic-now-Hypocritcal oath:
“I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
That bastard, Mr. M(A)D as Hell, has NO CONSCIENCE WHATSOEVER; Furthermore, he is certainly just another BLIGHT on this godforsaken and greed-pitted landscape of the now-rotten United States of America.
So, Mr. MD as Hell, may you burn in your very own self-made hell in which you condemn the downtrodden, everyone who is sick and beaten down by the evils of free-market Capitalism, etc. etc. etc.
People like you should be dropped smack-dab down in South-Central Los Angeles whrere you can try to tell those people just what you think.
You are, you filthy idiot, nothing more than a worthless, worse than useless PRICK…
Cheers and GOOD HEALTH TO ALL!!!!!!!!!

Jun 9, 2010

PAY IT FORWARD. I’m a health insurance agent that meets people everyday that can’t get insurance because of pre-existing conditions or lack of money. I also meet seniors in the “doughnut hole” of their Medicare Part D. There’s a community service project to I sponosr to help people pay for their medicaitons. Go to http://www.helpinglives.net to print your own discount prescription drug card. Use this card on all your prescriptions. There is no expiration date and no limit on the usage. Save between 10-60%. It works at over 60,000 participating pharmacies like Wal-Mart, Walgreens and CVS.

Jun 7, 2010

“SS and Medicare are nothing more that Ponzi schemes.”
They’re paying off pretty well for ponzi schemes. Isn’t the entire world economy (especially private health insurance) a ponzi scheme, music stops payouts stop.

Jun 6, 2010

Are you a Madoff knock-off? SS and Medicare are nothing more that Ponzi schemes. When the music stpos…see if there is a chair left.


Thanks, MD. Unfortunately, I don’t have any good answers, but I strongly believe that if everybody stepped off their little soap boxes (including me sometimes), and particularly in Washington, we could reach an optimal solution.

Jun 6, 2010

Breast cancer and heart events were always considered major medical events. There used to be very affordable insurance for major medical, back when prices were reasonable. Today’s discussion has been about a monolithic bureaucratic healthcare bill and system that is to cover everyone for anything their hearts desire. That is impossible to administer and to afford.
As for access for breast cancer and heart disease, there needs to be a risk reward consideration in everything an adult chooses to do. If they choose to build their house with straw or twigs, then they might get blown away. Whose fault is that? Where is the line between freedom from tyranny and tyranny for the benefit of those unwilling to plan for their own future? Anyone with a cell phone and cable could afford major medical insurance if they wanted to buy it, but the costs of a plan that covers everything from Tylenol to titanium can never last no matter who pays for it.
As for very premature babies, it is a very thorny issue. A recordable death in North Carolina is at a gestational age over 20 weeks. No fetus is viable at 20 weeks. In the time since I trained in the late 1970’s there have been many advances in neonatology creating the ability to lower the gestational age of viability. There is also no funding mechanism for this very costly care. People continue to conceive without a second thought of how to pay for child care when the child is normal and healthy, much less a child born early who now survives with seizures, crebral palsey, and a feeding tube and a shunt.
I have not thought out the care for the very young. I can tell you I do not believe in elective terminations. Probably neonatal care should be undertaken incrementally, being ready to continue or not based on progress or complications. But who decides?
Margalit, you are very reasonable and ask great questions here.

Jun 6, 2010

“We are force to pay a tax for SS and Medicare, but their is nothing in it for young people when they pay in.”
Why, because young people can’t see past today when deciding what to spend on what they can enjoy NOW. But I agree because young people, and everybody, should have access to the same system, regardless of their financial resources and age. The solution is not to force everyone to pay into a grossly out-of-control profitable system, but to bring down costs so that the payment burden is a low as reasonably possible.


MD as HELL, I respect you enough to know that we can have this conversation on a different level.
How about the 40 years old with breast cancer, or the 50 year old with heart disease, or a very premature baby….. ?

Jun 4, 2010

” .. We are perfectly fine with some people having less house, less car and even less food, but are we OK with some people having less life?”
The USA is the only country where “poor” people die prematurely from heart attacks due mostly from over-eating, smoking, dope, booze, NASCAR-like living, and watching too much TV and doing nothing else. “Poverty,” indeed!
Not to mention the illegal immigrants who have 4+ anchor-babies. You really think OWE-bama’s claim that illegal immigrants won’t be treated is real? Sure — and Bernie Madoff is innocent. Heck — even France has started to evict illegal immigrants — even their patience has worn out!
The average Jane has been played for a sucker for the last time. See you in court.

Jun 4, 2010

“Why shouldn’t we be free to say “No, you’ve got to contribute as well.”
Not when inexperienced INCOMPETENTS are in charge, Mr. Democrat. That’s on y-o-u, sir.
Fight your INCOMPETENT masters, to the end. See you and your pal Barack in court.

Jun 3, 2010

Deform creates a monolithic bureaucracy that will consume tons of resources before the first doctor visit ever occurs. Why should anyone be forced to support it? People will always die. People should live the life they have been given while they are healthy. When health is lost, no amount of money really restores it. What is the value to a 27 year old of a 90 year old maintained on dialysis?
If the family of a 90 year old had to spend the value of the ranch on the care of the 90 year old there would be a different choice made.
Freedom cannot simply be nothig left to lose.


Here’s my problem with the house/car analogy. If I am the CEO of Cigna, I buy this big 12 room mansion in a gated community and pay my mortgage. If I am the receptionist at Cigna, I buy a little condo in the city and pay my very different mortgage as best I can. Maybe later, when I get a promotion I buy a ranch house a couple of hours away from the city. Both as CEO and as receptionist, I can lead a happy useful life.
When it comes to large health care expenses, there is no condo. A triple bypass is a triple bypass. The reason health care is so hard to manage is that for the big ticket items, the price is pretty much fixed and totally out of regular folks price range.
So you either pool resources and some pay for others at certain times, or everybody purchases whatever they can afford, which means that most people will die from treatable disease, or at least die much sooner.
Unlike cars, food, housing and clothing, life seems to be judged by a different set of values. We are perfectly fine with some people having less house, less car and even less food, but are we OK with some people having less life?

Jun 3, 2010

I am an ED physician. I already am working for far less than half of my charges. My biggest thief is the US government. My hospital sees everyone.
People would have enough money for healthcare if the feds had not wrecked the price list in the 1980’s. An office visit in 1979 was 12 dollars. Thanks to government and third party payors the rice ramped up to today’s unbelievable and unaffordable levels.
But people don’t need cash for care. People don’t have cash for a car either, but they buy them all the time. They pay for them over 4-7 years. People don’t have cash for a house, but they buy them all the time. They pay for them over 15-30 years. Why should healthcare be any different? If people kept their premiums and saved them and used them as they wanted instead of as maggie wants, they could afford all their care.
The problem with healthcare deform and with insurance is it costs too much for what you may or may not get or need. Ever since insurance started paying for discretionary care or care on demand there has been a disconnect between premium and value. This has incented people to use there coverage inappropriately and to demand more and more tests and care, and incented doctors inapropriately to order more and more tests. The docs may have a profit motive or a defensive medicine motive. But since the patient has nothing holding back demand, they are like cougars seeking prey, along with their favorite iteration of John Edwards.
No one can compell me to work for free. I can chooose to give my service away. The IRS does not allow me to deduct this from my taxes.
People should be required to save for their own needs. There is no other service or commodity that is so misappropriated as healthcare and healthcare dollars.


MD as HELL, are you suggesting that health care taxes should be levied by the States instead of the Feds, or are you suggesting that physicians should be compelled to work for free?
I understand that you personally will not let someone die in front of your eyes, if you could help it, but most physicians and hospitals will refuse to see a patient without money or with too little money. Are you accepting Medicaid? Will you accept Medicare if the cuts go into effect? Do you see charity as the solution, and by charity I don’t mean tax payer reimbursed care? Millions and millions of people showing up at your door steps begging for treatment? Are you going to attempt to separate the “deadbeats” from the deserving ones?
Or maybe people should just know their place and if they can’t afford fresh strawberries or a new Honda, then they most definitely shouldn’t have their eyes set on that fancy breast cancer treatment.
Does this sound to you like the future envisioned by those who wrote the constitution?

Harris Meyer
Jun 3, 2010

People don’t need health insurance to pay for health care??? Not even catastrophic coverage? How about bartering chickens for health care? You think the Mary Browns of the U.S. (read most Americans)have the means to pay out of pocket for medical care for serious illnesses or injuries to the tune of tens of thousands of dollars? I sure don’t know such people among my middle-class friends, relatives, and acquaintances. MD as Hell is still dodging the essential contradiction in his opposition to mandated health coverage. Someone is going to pay for that costly care for the uninsured, and that someone is taxpayers and people with insurance. Why shouldn’t we be free to say “No, you’ve got to contribute as well.”