Matthew Holt

Is John Goodman joking or just mean?

The uninsured numbers went down a touch because in 2007 Medicaid expanded. In 2008 they’ll go up as unemployment increases and S-CHIP coverage is cut. Really this doesn’t change too much.

Right-wing nut jobs all over the Internet are saying that uninsurance doesn’t matter. It’s surprising that one of the more sensible right-wingers has joined in and now says that the uninsured don’t exist.

But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care).

"So I have a solution. And it will cost not one thin
dime," Mr. Goodman said. "The next president of the United States
should sign an executive order requiring the Census Bureau to cease and
desist from describing any American – even illegal aliens – as
uninsured. Instead, the bureau should categorize people according to
the likely source of payment should they need care.

"So, there you have it. Voila! Problem solved."

<SNIP>

According to Mr. Goodman, only people who are denied care are
truly uninsured – everyone who gets care is effectively insured by some
mechanism. "So instead of producing worthless statistics that people
fling around in vacuous editorials and pointless debates, the Census
Bureau should produce meaningful numbers, identifying all of the
sources of funds people will draw on if they need medical care," he
said.

Goodman’s no dummy. He knows that low wage, uninsured
workers who have a health crisis have a miserable life. He knows the
stories in Jonathan Cohn’s Sick are true. He knows that according to the Institute of Medicine 18,000 of the uninsured die prematurely each year.

Of course, coming from a guy sitting on top of his and
his wife’s half-million-plus dollar salaries derived from his
well-heeled Conservative donors, all this is pretty rich.

So the question is, is he joking or is he just mean?

Or now that he’s on McCain’s advisory team
does he think that helping to ensure a Democratic victory this Fall
will increase NCPA’s funding from his conservative nut-job backers, and
therefore keep upping his payday? After all, he believes in market
forces and responding to incentives!

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Brian RosmanGregg MastersSteveHbev M.D.Mary Recent comment authors
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Peter
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Peter

Brian, I don’t consider much difference between Medicaid and Commonwealth Care – both tax payer supported programs. Of the 439,000 of newly covered ONLY 32,000 could afford private insurance. I would also need to see how those 32,000 needed to adjust their spending/saving needs to pay for mandatory insurance AND if they get sick can they pay the high detuctable, stay solvent, and stay covered without defaulting to Medicaid or Commonwealth Care. I would also like to know what kind of employer coverage the 159,000 got and how (once again) the tax payer is subsidizing the employer to pay for… Read more »

Brian Rosman
Guest

Way up near the top, commenter TCoyote wrote this: “BTW, one-quarter of the decrease was in the State of Massachusetts, a result of their health reforms. True, most of that was Medicaid/S-CHIP expansion, but it was a tangible payoff from their controversial and expensive reform legislation. It certainly was not produced by an expansion of employer based coverage.” That may be a common perception, but it’s not true. Of the 439,000 newly covered in MA since health reform passed, only 72,000 are in Medicaid. Most of those were not in the expansion, but got enrolled into existing programs as a… Read more »

MG
Guest
MG

As for applying for Medicaid, any person should know that even incredibly “liberal” states that include a richer benefit package and expanded eligibility still make the enrollment process difficult to some degree. This can include all kind of administrative burdens including have to reenroll multiple times a year, having to present multiple forms of identification to multiple agencies, limited ability of non-English forms, and lack of hours/locations in which to apply for Medicaid benefits. Granted this can vary considerably from state-to-state but almost every state tries to make sure that their Medicaid enrollments are only at a certain level lest… Read more »

Peter
Guest
Peter

Yea Ray, I care, as do most people on this blog. The question is does John Goodman (and the Republican Party) REALLY care or even know what he/they is talking about. I read Johns reply hoping for a much more extensive rebuttal to Paul Krugman, or even an explanation saying his statement was tongue-in-cheek and meant to start discussion. But he said nothing, or at least what he did say was something he believes but has not experienced and not based on fact. I give you a response to his blog statement that shows Republicans live in a dream world… Read more »

Gregg Masters
Guest

and who said elections don’t matter?
As Buddha says: “Have compassion for all beings, rich and poor alike; each has their suffering. Some suffer too much, others too little.”
I suspect Goodman knows not of this pain.

SteveH
Guest
SteveH

My guess would be that Ray works at NCPA. The idea that being able to go to an ER is like having catastrophic insurance is laughable. If you show up at an ER with metastatic cancer because you had no screening or primary care when the cancer could have been caught earlier, and you have no insurance, do you think the hospital is not going to bill you or your estate? How is this like having catastrophic insurance? Does Ray (or Goodman) think the hospital is required to provide extensive chemo or palliative care? Give me a break.

Ray
Guest
Ray

If anyone cares, John Goodman replies to Krugman and others who read a lot into his comment…
http://www.john-goodman-blog.com/krugman-over-the-top/

bev M.D.
Guest
bev M.D.

So as Mark Twain said (paraphrasing), “There are lies, there are damn lies, and then there are statistics.”

rbar
Guest
rbar

Ray, you are mistaken that everything serious will be taken care of in the ER. They are obliged to stabilize your serious condition, and that’s it with regard to this unfunded mandate.
When you refer to “catastrophic coverage” by the ER, you forget that a good share of medical problems (e.g. cancer or most orthopedic conditions) may be serious enough – deadly or debilitating – but you will not get any help from the ER. Don’t let anyone tell you that “if you have sthg serious, the ER will take care of it”.

Peter
Guest
Peter

Ray, the solutions to access and affordability do not lie with a blind dependence on private insurance models. The insurance industry got us here, or were at least active participants, why do you think they will get us out? How much savings do you think we can achieve by buying across state lines when we will be buying from the same insurance companies? How will insurance companies cut doctor, device, drug, and hospital fees? How will insurance companies insure the pre-existing conditions market?

Ray
Guest
Ray

Don’t read too much into Goodman’s statement. It is a point about a method of thinking about healthcare payment. I read nothing in it about everything being wonderful, or there not being any struggling Americans, or anything else of the sort. That’s not the purpose of his post…all this “meanness” is something that people are reading into it. He supports several measures to help people get health insurance, such as allowing people to buy insurance across state lines. So obviously he doesn’t think everything is rosy and there are no problems. My guess is that he would rather not talk… Read more »

Mary
Guest
Mary

What if everyone- the haves and the have nots decided to boycott every HMO drop their health insurance altogether? Would this kind of action have the same result as other kinds of boycotts? Is it possible that the hospitals, pharmeceutical companies and insurance companies would begin to work together to develop fair health care packages?

Peter
Guest
Peter

“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care. “So, there you have it. Voila! Problem solved.” Yea Ray, this statement shows concern for, “starving or struggling Americans”. This smacks with the Bush re-defination of hunger in America, “you’re not hungry you just have a… Read more »

MG
Guest
MG

Ray – You can talk about all the other points you want to (and many of them have legitimate merit). However, the post was about Goodman’s comment about the insured and he didn’t mince words. His response was flip and glib to a real problem that effects millions of Americans. He deserves to be castigated for it.

Matthew Holt
Guest

I’m surprised that a good free-marketeer like my friend John Graham doesn’t think that Goodman is angling for an Obama win to increase NCPA’s fundraising drive. After all, the HSA’s future–given the likely coming changes to Medicare–is pretty bleak, and maybe looney Rooney and the Scaife crowd will have other stuff to spend their money. And given the quality of the analysis of the health care system on the conservative right — David Gratzer & Rudy? — you’ve got to say something pretty outrageous to keep those big grant checks coming! But if you really think there’s no difference John,… Read more »