Why Aren’t The Uninsured Protesting In The Streets Like The Egyptians?

Why Aren’t The Uninsured Protesting In The Streets Like The Egyptians?

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Maybe the uninsured could learn something from Egyptians and the Arab street. At a time when landmark health reform granting most of the uninsured access to medical care for the first time in their lives is being seriously threatened, protests by the uninsured themselves are nowhere to be seen.

In 2009, a staggering 51 million Americans from every walk of life and every corner of the nation had no health insurance. The Urban Institute estimates that 400 of them die each week due to lack of access to care. However, instead of pouring into the streets to protest when an activist judge calls the health reform law unconstitutional or conservative ideologues threaten to cut off funding, the uninsured leave the loudest push-back to (well-insured) political partisans.

This quiescence on a basic human right to care contrasts sharply not only with those braving tear gas and truncheons in Cairo. In this country, merely mentioning gun control fuels a firestorm of protest by firearms supporters. Gay marriage has mobilized liberals and libertarians alike over the “freedom to marry.” The children of undocumented immigrants have dared arrest and deportation to plead publically for the right to become American citizens.

More than one in six Americans is now uninsured. Where are they? The few exceptions to this rule show how much their faces and voices and names are missed. At a hearing by Sen. Tom Coburn (R-OK) in 2009, a sobbing, middle-aged woman confessed she couldn’t afford care for her brain-injured husband. Coburn, a physician, glibly responded that “the idea that government is the solution to our problems…is very inaccurate.” The partisan Republican crowd applauded, in an exchange captured by CNN, but the reaction of ordinary Americans was far more negative.

An estimated 690,000 Oklahomans have no health insurance. Why were so few in the room? Why did hundreds of them not pour into Coburn’s office the next day? Why do they not continue to tell their stories?

Like the ruling elite in Egypt who genuinely don’t comprehend the problems of the average family, polls going back more than a decade show that Republicans are more likely than Democrats to genuinely believe that the uninsured really don’t have any problem getting good-quality care.

Yet among the less partisan, there’s a readiness to reconsider. Personal experience plays a key role, an analysis in Health Affairs concluded, with those who are younger, poorer and female being more sympathetic. The elderly, whose rich Medicare benefits have shielded them from the brutal effects on medical care access of the weak economy, “are not cognizant of the problems faced by the uninsured,” the article noted. A just-released poll shows a majority of the American public does not back repeal or ending funding, but how the issue is framed is critical.

Put plainly, the political and legal peril in which health reform finds itself is directly attributable to the failure of the uninsured to visibly advocate on their own behalf. Those without health insurance have allowed a civil rights issue of guaranteed access to medical care to become a referendum on Big Government rather than a test of basic human compassion for brain-damaged husbands. And, even more ironically, have left the heavy lifting on lobbying against repeal to the big insurance companies of the world such as Aetna, Humana, UnitedHealth Group and WellPoint

Worse, while the prestigious Institute of Medicine characterizes the consequences of a lack of access to care as “needless illness, suffering, and even death,” it is Republican physicians in Congress brazenly lead the effort to repeal care coverage.

By coincidence, there are about the same number of elderly on Medicare as there are uninsured. Egyptians understand the power of an aroused populace. Do the uninsured? In Red States and Blue States in 2012, there will be Congressional districts and senatorial races up for grabs and a contest for the presidency featuring a man who made a historic effort on their behalf. Will Republicans whose party has never put forth a serious proposal to provide access to care for all suffer any consequences at the ballot box from turning to the sick, the scared and the suffering with a curt, “Government is not the answer.”

Or, perhaps, have conservatives been right all along that liberals have vastly overestimated the scope and impact of this problem?

If there’s anyone who understands the power of individuals coming together to make demands on their own behalf, it is a black man who rose to the presidency from being a community organizer on Chicago’s South Side. Yet rather than rally the uninsured to present their case as people just like us, President Obama has allowed Republicans to frame the issue as a debate over the Commerce Clause of the U.S. Constitution.

Fortunately, the fight to retain actual funding for the expanded coverage in the Affordable Care Act is just beginning, with “aggressive” hearings scheduled by Republican committee chairs in the House and by opponents in the states. It is a battle that Democrats can win only if Americans genuinely understand that it is the health and lives of their friends, neighbors and relatives that is at stake. For that to happen, those whose lives are most intimately affected must first stand up for themselves.

This post was first published at Forbes.

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of "Demanding Medical Excellence: Doctors and Accountability in the Information Age".

 

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26 Comments on "Why Aren’t The Uninsured Protesting In The Streets Like The Egyptians?"


Guest
Lynn
Feb 6, 2011

MD as Hell: honest folks who are desperate for care for a child or a spouse with a catastrophic illness will do anything to get that family member care.

Guest
MD as HELL
Feb 5, 2011

Thre are many more “worried well” burning through benefits than there are sick people burning through benefits.
Fix that and you have a sustainable system.

Guest
MD as HELL
Feb 5, 2011

Lynn,
Honest folks don’t lie to get Medicaid.

Guest
nate
Feb 5, 2011

I love people like you Steve, so easy to argue with cause your foot is always in your mouth. So I administer COBRA, send the letters out, see who elects. I see how long people work and with HIPAA certs how long since they worked. Are you claiming I don’t know current labor trends? Who would possibly know more about enrollment in group health plans then the person who administers the group health plans?
“People change jobs and are out of work for extended periods of time much more than in the past.”
Are you trying to say its longer then 18 months? Labor statistice would disagree with you, so if your not claiming all the facts are wrong COBRA would already address this sitution.
” These plans may cover just $2000 in benefits per year.”
May but they don’t? Why would you base an argument, let alone policy and something that is not real. People get hit by cars should we outlaw all cars so the 0.0001% of the population that get hit by cars won’t? The number of people with a $2000 mini med is a rounding error, but this is your argument for changes in our system?
Steve is it safe to assume you are even more opposed to pensions since they are even less mobile then healthcare? Think of all the Union employees trapped in their job chasing their 30 years instead of opening new businesses or chasing better opportunities…..funny the liberals never complain about that shackle….

Guest
imdoc
Feb 5, 2011

Does the author assert healthcare as a “basic human right” on a moral basis? If so, that acknowledges government can and should legislate morality on a wide basis.

Guest
steve
Feb 5, 2011

Barry-nate knows enough to spin it his way. Talk to your kids and their friends, or read Douthat and Salam’s Grand New Party. The way we work is changing. People change jobs and are out of work for extended periods of time much more than in the past. It is now predictable that a growing number of people will be unemployed for some period of time each year. That 51 million number will grow. It wont be the same people and they may not be all unemployed at the same time, but they will be there.
Which brings us to the poorly functioning individual insurance market. It works well if you are young and healthy. If you are older and/or sick, you quickly get priced out. If you are sick enough, say you had a prior PE, you cannot even get price quotes (at least in Pennsylvania). So, we have a large group, at lest 5 million, that cannot get insurance at all.
Then we have the group that is not talked about enough, the underinsured. The working poor who have mini-med type plans. These plans may cover just $2000 in benefits per year. These are medical discounting plans, not insurance. One delivery or one procedure of almost any type will go way past those limits. These people do not show up as uninsured for statistical purposes, but they are.
Most OECD countries have figured out better ways to handle health care. Our politics cripples us on this issue. Just for fun, here is libertarian writer and editor at Reason on how things could work.
http://reason.com/archives/2009/12/07/why-prefer-french-health-care
Steve

Guest
Yana
Feb 4, 2011

Lynn is correct. And sick people are not well enough to fight.

Guest
Barry Carol
Feb 4, 2011

“Only 5 million americans need insurance and can’t get/afford it. Why not create a sensible program to help those 5 million instead of screwing up coverage for the other 300 million that are happy with what they have?”
Nate – While I agree with you conceptually and you probably know more about this than I do, I thought I would pass on what I learned at a recent health policy conference in DC regarding the state high risk pools.
Prior to PPACA, 35 states operated high risk pools which covered 208,000 people altogether. While the insurance is very expensive, especially for the 55-64 age group, the medical loss ratio for these plans ranged from 150%-300%. One panelist who was familiar with Maryland’s pool said its medical loss ratio, when he worked there, was 275%. Only about one-third of the revenue needed to run the pools came from member premiums. A significant piece of the rest was funded by surcharges on insurance companies and there was a general revenue component as well. At the population level, the 55-64 year old age group consumes 5-7 times as much healthcare as those in their 20’s. Decent insurance coverage for this population could easily cost taxpayers $10K per person or $50 billion per year for the whole group less whatever could be collected from member premiums that these people could afford – perhaps 8%-10% of income.
Under PPACA, a 4 to 1 age band is allowed for high risk coverage vs. 3 to 1 for regular insurance. Moreover, one has to show that they were uninsured for at least six months before becoming eligible to buy what is likely to be very expensive coverage. It’s no wonder that only 8,000 people or thereabouts signed up for it so far.

Guest
Bill
Feb 4, 2011

I’ve tried writing my Congressman and Senator about it, and gotten the usual form letter acknowledgement back from them along with being added to their PR mailing lists.
As has often been stated, the measure of a society is how we treat those less fortunate. The US gets a failing grade for issues like housing, education and health care on these basic measures of how we’re doing in this regard.

Guest
Lynn
Feb 4, 2011

nate: tried the INC route but in my state it’s a no go. Why in the US should I have to create an extra layer of private bureaucracy to acquire basic health insurance coverage? This lack of insurance access is a significant barrier to entrepreneurship.
I’ve actually learned a great deal shopping and paying directly for health care services. I know where to find Medicare allowables, I know where the lowest cost highest quality mamograms can be obtained, I’ve learned consulting the pharmacist first then discussing medication changes with the MD saves money.
I also know that many of my physician clients don’t provide insurance for their staffs. The good ones worry about that and the other ignore it and hope for the best. I’ve also watched the perverse incentives rob too many kind, decent, regular folks of any degree of dignity…not for themselves but for care for family members. I’ve watch honest folks lie to get Medicaid.
Our Rube Goldberg system assures those who want to can avoid seeing the misery hidden just out of sight. It’s not the America I feel proud of. Access regular health care shouldn’t be a game with ever more complex and changing rules. It should be a basic, simple, human transaction.
Matthew are you sure Jeff is paying for hair cuts, may be if he paid a little more he’d could go to a stylist while there’s hair left.

Guest
MD as HELL
Feb 4, 2011

Don’t worry. Peter. You are not paying for their care that I provide. They are just stealing it.

Guest
Peter
Feb 4, 2011

“Why Aren’t The Uninsured Protesting In The Streets Like The Egyptians?”
Why don’t poor people vote or even advocate for themselves? Why don’t young people vote in same numbers as older Americans?
“They are just well and see no need to either buy insurance or insist the government buy it for them.
They are free.”
Free to show up at the ER for “free” care that you pay for.

Guest
Feb 3, 2011

I’m concerned about Jeff’s economic insights in general now I’ve discovered that he PAYS someone to cut his hair.
http://bit.ly/fDAYBe

Guest
Stephen J. Motew, MD
Feb 3, 2011

A key distinction preventing a civil uprising from the uninsured is that ‘uninsured’ does not equate to complete lack of access to health care services. No doubt that the many fine points made on this post hold true, but in the end, when absolutely needed, no one in this country is denied access to health services…just walk into any E.D. Is this optimal? Is it economical? Are the uninsured being treated appropriately? Of course not, but the stimulus to ‘rise-up’ just does not exist.

Guest
Michael Millenson
Feb 3, 2011

Many thoughtful comments with much insight. I still believe that with all the barriers, thousands of the 51 million could and should be mobilized. Instead, as we see with this week’s New York Times, we get onesies and twosies as props in newspaper stories, the same way that they show up in speeches and hearings. Perhaps (OK, it won’t happen) the press could ask the victim-of-the-week whether they’ve even tried to contact their representative or senator.