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Until the middle class truly cares, forget about health reform

Regular THCB contributor Michael Millenson published an op-ed piece in Sunday’s Washington Post, in which he says that until health insurance truly becomes an issue of the white middle-class, politically, nothing will happen.

Michael’s words:

"Here’s a cold truth: Despite much media hand-wringing on the subject, most of us give about as much thought to those who lack health coverage as we do to soybean subsidies.The major obstacle to change? Those of us with insurance simply don’t care very much about those without it. It’s only when health care costs spike sharply, the economy totters or private employers begin to cut back on benefits that the lack of universal health care comes into focus. Noticing the steadily growing ranks of the uninsured, the broad American public — ‘us’ — begins to worry that we’ll soon be joining the ranks of ‘them.’"

"The responses I’€™ve gotten by putting my personal email on the page have certainly been … educational," Michael told us. You won’t get his personal email here — you’ll have to visit the Post for that.

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9 replies »

  1. rbar,
    I don’t necessarily agree with the analogy. To me, it’s more like trying to blame the last 2 inches of rain, when it was the 9 inches before it that really did the damage.
    As for the example you present I’d like to say two things. First, an extra $5000 would be enough to cover a high deductible, HSA-eligible plan health plan for an entire family (I know because I own one that costs me $300/mo). In my experience these plans cap your yearly liability at some number between 5k and 10k. Clearly, this isn’t a panacea, but that gets me to my second point. You remark, rightly, that there is no guarantee that the extra $5,000 would go towards insulating oneself against large medical expenses. I would claim that currently there is a 0% chance of it going toward that goal because it’s being confiscated.

  2. Bret, this is an interesting way of phrasing your argument … you would probably say that the dams in Wisconsin did not break from the recent heavy rains, but from the water that was already in the lakes before the rain started – and you are certainly entitled to your very own perspective.
    If median household income in the US is 50000 and you bring the tax burden down by a whopping 10% of total income (disregard the issue how you want to achieve that and whether this is feasible). Do you think the yearly “extra 5000” will be readily available to cover catastrophic medical cost (unless you mandate a health savings account and give everyone a decade), or do you think that money will go into consumption, gas, housing, college? Do you know how high medical bills can run for e.g. cancer treatment, and that these expenses are not necessarily “one time”?

  3. Really, rbar? Middle class bankruptcies due to health costs? How do you determine that any given bankruptcy is due to health care costs as opposed to the 12% FICA, 4% Medicare, and 20%+ income tax?
    For most of the middle class America government paying all forms of government is their second largest payment, making them fundamentally less able to weather a large, onetime fee (like health care).

  4. Really, Bret? Are you aware of the rising number of middle class bankruptcies due to health cost reasons?
    If there is a system based on the solidarity principle (i.e. with a progressive element), there will be always winners and loosers (as a side note, I’d consider people who have catastrophic medical illness and expenses to be in a rather deplorable situation, even though they are financial “winners” if they have coverage). I personally think that is, to some extent, one of the pillars of living in a society.

  5. Considering that all large-scale welfare programs (read Universal Healthcare) unduly punish the middle-class, it doesn’t seem that odd to me that they would have a hard time coming around. I mean, they are going to be the ones footing the bill, right? I think passing them all off as uncaring, ignorant, or even racist is intellectually dishonest.

  6. Sadly, Mike has nailed it. 93% of the voting public has health insurance, exempt from tax both for them and employers. And while people worry about the cost when they are out of cash in their household budget, people pay only 12% of the nation’s healthcare bill themselves. The tax exemption and the insurance itself are a powerful anaesthetic, more powerful and morally corrosive than heroin. And because we have segregated ourselves into socioeconomically homogeneous communities, we never see the “other people”. . This recession will not be deep or long enough to penetrate deeply enough into the middle class to change the situation Mike talks about.
    (Notice the the issue is falling in saliency as food and energy prices rise).

  7. This article is correct to a certain extent. A lot of people are insured, and who is to say what percent of those people give a crap about the uninsured. Bold move for writing this article, but I agree with you. Get smart, buy the right plan, and everything will work out. That is the mindset of people that are insured.

  8. Michael’s article seems simple-minded and sets a low bar for the public’s sense of decency. The public, even the white, middle-class segment, at some point is going to realize they should not be letting their neighbors die for some insurance company’s profits.
    And, people are getting smarter. Chrysler essentially was given away because of health care obligations on its books. Some say Starbucks pays more for health insurance than coffee beans. People are getting smart enough to know all of this hits their bank accounts sooner or later.
    Why doesn’t his article emphasize that U.S. health insurers contribute nothing, impede and mess up a whole lot, and add 20 to 40% to our costs? Isn’t Cover the Uninsured just a front for the insurance industry, by the way?
    The analysis was presumptive and ignorant. AARP didn’t advocate for the Medicare prescription plan, blindly supporting it because the elderly buy a lot of drugs. AARP was smart enough to know the prescription plan was an abomination designed to make money for insurers and their wholly owned lackeys, the pharmacy benefits managers. They fought against the plan, just as the public will fight against our obscene U.S. health system based on private insurance.

  9. When their co-pays start creeping up again, and the economy goes further into recession, I think they will start complaining.
    With so many people on life dependent drugs, and premiums always on the rise, it will get to the point where we will see more employers putting limits as to how much they will cover per employee. The difference will then be felt by those employees.

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