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."


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

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!

Categories: Matthew Holt

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34 replies »

  1. 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 this. And lastly, the system still remains twice as expensive as other healthcare programs provided in other countries – a win-win for insurance companies and providers who suffer no loss but for a while can get the uninsured issue off their PR backs.

  2. 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 side-benefit of all the focus on enrollment.
    Some 159,000 of the new enrollees are in employer-provided coverage, and another 32,000 newly insured purchased individual insurance. Lastly, 175,000 are in Commonwealth Care, the new program with sliding-scale subsidies for private coverage.
    So most were not in Medicaid, and good proportion are in private plans.
    Today’s NY Times has a good editorial on MA’s success:

  3. 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 they risk the wrath of voting taxpayers (with increased taxes or limited spending in other critical areas including education and law enforcement).

  4. 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 of an altered reality and that they say what they want to believe exists but actually does not – if they cared to look under the rocks.
    “Lorrae Says:
    August 29th, 2008 at 5:50 pm
    Just a note from a mother/grandmother who has been through the process of helping adult children try to get the medical aid that supposedly so many people qualify for.
    Mr. Goodman, you clearly have never had to apply for government aid. The process is brutal, dehumanizing, and nearly impossible for poor people who don’t have cell phones, cars or child care in order to traverse the many, many appointments, calls and paperwork needed. My son is married with four children, lost his job, and was actually KICKED OFF of medical aid because he was on unemployment. The $880 per month he received was too much income for a FAMILY OF SIX to qualify. That’s what he was told. I don’t even know if it’s true. We couldn’t get the Social worker to answer our calls.
    There is far less aid out there than you imagine, and it’s so hard to access, it might as well not exist.
    Before you write these cold-hearted, elitist columns, perhaps you should really consider what you are saying and do some research. Mr. Krugman was right on about you.”

  5. 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.

  6. 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.

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

  8. 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”.

  9. 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?

  10. 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 about insured versus uninsured, but instead talk about the quality of healthcare that is accessible and the quality of insurance. If we think about it that way, we may realize that even those with insurance are not in great shape…for example, if their insurance does not give them a lot of choice over their physicians.

  11. 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?

  12. “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 different food security”.
    Ray, affordable healthcare won’t come from better insurance options through the private sector.

  13. 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.

  14. 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, would you rather have a serious illness and have Medicaid or nothing. And don’t think about your health like some pussy liberal, think about the effect on your wallet. That’s what this is about, and there is nothing logical about Goodman’s or John Graham’s remarks.
    And by the way John, under Thatcher in the UK and to some extent here, that’s how they did/do count unemployment!

  15. Peter, I don’t think John Goodman is claiming anything as a success story. Nor is he unconcerned with starving or struggling Americans. He believes that reform is needed to make insurance affordable for all — or at least almost all — Americans. Let’s not put words in his mouth.
    In this post, he is only arguing that talking about insured versus uninsured is overly simplistic. It ignores the most important question, which is whether people have access to needed healthcare.

  16. I guess John Goodman thinks we should not be concerned about hunger in this country because hungry people have access to food banks – and that somehow that’s ok and a sign of success in this county’s policies.
    The uninsured are also the under-insured, are also the insured who can’t keep up with co-pays and deductibles. The uninsured are also people with assets who go bankrupt with medical bills. The uninsurd are also people who loose their jobs and their health insurance because of health problems. The uninsured are also small business owners who can’t afford insurance or the cost of care at ERs. Is John Goodman (or anyone else)really serious about claiming this as a success for U.S. healthcare in a 21st century industrial power that can spend billions on a bogus endless war but can’t/won’t provide affordable healthcare for all it’s citizens.

  17. It seems like we are talking about two different things here.
    1. catastrophic insurance
    2. Insurance that covers more regular care, such as checkups, chronic disease management, etc.
    Having access to an emergency room does nothing for #2, but it is important for #1.
    When we talk about the number of uninsured, we should be explicit about which type we are talking about. John Goodman’s point is that if it means not having #1, then there are very few uninsured.
    If it means having #1 but not #2, then there are many more uninsured. But it also raises the question of whether it is the purpose of public policy, or insurance companies, to provide #2. There are strong economic reasons for #2 being the individual’s responsibility.
    btw, it doesn’t further anyone’s understanding to call John Goodman names, or to tell me my post was dumb. Let’s discuss arguments instead.

  18. John, what most people care about in the health care debate is not the fact whether people are insure/uninsured or on welfare, but whether they have access to health care. I hope I don’t have to explain to you in this forum that access to EDs does not mean access to health care.
    “People who have the ability to enroll in insurance, but choose not to” are, unless they are multimillionaires, speculating on socialization of their potential unforeseen health care expenses (e.g. when they get into an accident or get Hodkin’s disease). Why would you not call them uninsured?

  19. MG, I think he is saying that there are problems with the way the uninsured are counted. And he is going a step further, and outside the box. He is saying that the people who have the ability to enroll in insurance, but choose not to, should not be counted with the uninsured.
    And there are other groups too. They are mentioned in the same blog posting…but unfortunately they aren’t included in Matt’s excerpt of it.

  20. Is Matthew Holt joking or just mean?
    Goodman made an effective point. Let me try another approach. If someone loses his job he’ll likely lose his health insurance. If that unemployed/uninsured person applies for Medicaid, he is counted as “insured”; but if he does not apply, he is counted as “uninsured”.
    Consider if we counted the unemployed (apart from health insurance) that way: if he applies for welfare, he is counted as “employed”; but if he does not apply, he is counted as “unemployed.”
    People on Medicaid are not “insured”, they are on welfare.

  21. Mr. Goodman’s comments should promote intelligent debate and discussion. For example:
    1. Having insurance and getting access to medical care are issues that need to be better defined and studied.
    2. To what extent do those states that mandated benefit coverage requirements impact the cost and availability of competitively priced health insurance for consumers.
    3. For those states that require guaranteed issue and community rating, what is average cost for same coverage compared to states without these requirements? And, how do these practice impact consumer health insurance purchasing decisions?
    These are important questions that can help consumers better understand the public policy debate around the affordability of health insurance.

  22. If Goodman had said that there are issues with the way the uninsured are counted (very legit) and what meaning this has, it would be entirely different story. He didn’t.

  23. Ray – That frankly is one of the dumbest things I have seen posted on here in a while. If you don’t have insurance, you can’t afford quality health care in the U.S. This is true for probably 99% of the U.S. population.

  24. John Goodman is neither joking nor mean.
    He isn’t saying that there’s no such thing as uninsured Americans. He’s saying the real question is how many people have access to quality healthcare, not how many people are insured.
    Insurance is one method of paying for healthcare, but it doesn’t have to be the only way. And it isn’t always the best way. People in Medicaid are insured, but they are not always better off than the uninsured.

  25. 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.

  26. I think it is fairly obvious he is joking with regards to the accounting methods of who is truly uninsured. People get so wound up about that number when in actuality the more important thing is not the classification of have or have-nots, but the affordability to the individual and burden on society. The unpapered illegal effectively has just as much or more health coverage and the lower middle income tax payer. In effect they ARE insured because there is no documentation of income and their bills are paid by someone (read other insured or cash patients effectively making up the gap) or some other institution (i.e. state and federal programs).

  27. This post title should have read (a take on one of my all-time favorites headlines):
    Goodman to Uninsured: Drop Dead!

  28. Sometimes I wonder why the Democrats waste so much damn time and run around in circles chasing their owns tails (Pelosi) or bickering amongst themselves (Clintons).
    The Republican establishment is less than thrilled with McCain but guess what – they stand behind their man and McCain nows actually stands a legit chance (still probably less than 50/50) to win this election.
    If the Democrats lose this election given all the things in their favor, then they seriously needs to reconsider their viability as a party that can put forth a viable presidential candidate.

  29. The truly interesting thing is that Michelle Obama earned her equally large salary at the University of Chicago by figuring out how to move those without health care out of the Emergency Room and into local clinics. Everyone benefitted.
    First, those without health care were able to get treatment before their problems became dire (it is and Emergency Room)
    Second, the Emergency Rooms and the staff were much less stressed by the pressure of a huge case load and could devote themselves to actual emergencies
    Third, the net cost was much lower, which you think would make Mr. Goodman happy.