OP-ED

When Health Insurance is Free

Did you know that an estimated one of every three uninsured people in this country is eligible for a government program (mainly Medicaid or a state children’s health insurance plan), but has not signed up?

Either they haven’t bothered to sign up or they did bother and found the task too daunting. It’s probably some combination of the two, and if that doesn’t knock your socks off, you must not have been paying attention to the health policy debate over the past year or so.

Put aside everything you’ve heard about ObamaCare and focus on this bottom line point: going all the way back to the Democratic presidential primary, ObamaCare was always first and foremost about insuring the uninsured. Yet at the end of the day, the new health law is only going to insure about 32 million more people out of more than 50 million uninsured. Half that goal will be achieved by new enrollment in Medicaid. But if you believe the Census Bureau surveys, we could enroll just as many people in Medicaid by merely signing up those who are already eligible!

What brought this to mind was a series of editorials by Paul Krugman and Robert Reichand blog posts by their acolytes (at the Health Affairs blog and at my blog) asserting that government is so much more efficient than private insurers. Can you imagine Aetna or UnitedHealth Care leaving one-third of its customers without a sale, just because they couldn’t fill out the paperwork properly? Well that’s what Medicaid does, day in and day out.

Put differently, half of everything ObamaCare is trying to do is necessary only because the Medicaid bureaucracy does such a poor job — not of selling insurance, but of giving it away for free!

Writing in Health Affairs the other day, health policy guru Alain Enthoven and health care executive Leonard Schaeffer revealed some of the gory details of what people encounter when they do try to sign up for free health insurance from Medi-Cal (California Medicaid) in the San Diego office:

Of the 50 calls made over a three-month period, only 15 calls were answered and addressed. The remaining 35 calls were met by a recording that stated, “Due to an unexpected volume of callers, all of our representatives are currently helping other people. Please try your call again later,” followed by a busy signal and the inability to leave a voice message. For the 15 answered calls, the average hold time was 22 minutes with the longest hold time being 32 minutes.

This study, by the way, was conducted by the Foundation for Health Coverage Education (FHCE), a nonprofit organization dedicated to helping the uninsured enroll in available health coverage programs. The head of FHCE’s national call center reports that his staff has taken hundreds of calls from people who have tried in the past to enroll in Medicaid, but who found the process so complicated and difficult that they simply quit trying.

I know what you are thinking. What about doctors and hospitals? Can’t they help poor people sign up for public programs and isn’t it in their self-interest to do so? Turns out that medical providers have just as much difficulty with the Medicaid bureaucracy as the patients do:

[I]t routinely takes more than 90 days for the state to enroll uninsured patients into public programs. This is because it is the patient‘s responsibility to apply directly to the state program to receive the needed documentation for hospital reimbursement. Once treatment is provided and the medical incident is over, it is difficult to ensure that the patient continues with the enrollment process.

Can you imagine Aetna taking 90 days to sell someone an insurance policy? What about WellPoint? Or Blue Cross?

Another problem is the Medicaid payment rates. They are so low that California hospitals frequently don’t even bother to try to enroll patients who come to the emergency room, unless they’re admitted to the hospital:

[P]ublic program reimbursement is often so low that hospitals are more likely to only seek reimbursement for patients who are eligible for public coverage that fall into the “treat and admit” category rather than those patients who enter the Emergency Room with minor emergencies or illnesses. Furthermore, hospitals estimate that they receive as low as nine percent of fully-billed charges for Medi-Cal patients. Therefore, the providers have little financial incentive to encourage patient enrollment in public programs.

Most people view ObamaCare as a radical reform. Here’s an idea that is even more radical: why not abolish Medicaid? Texas A&M professor Thomas R. Saving, a former Trustee of Medicare, has proposed the idea of Health Care Stamps. They would work like Food Stamps. People who have them would be able to shop around and buy care in the same medical marketplace that caters to the needs of all other patients — rich and poor alike.

I’ll write more about this idea in the future.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.

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44 replies »

  1. Well actually there are free marketplace sites out there like a free dental discount plan run by a group of dentists called http://www.healthsouk.com (HealthSouk) and there is a medical marketplace called castlighthealth.com as well

    Free health insurance isn’t that FAR away !

  2. Can you imagine Aetna or UnitedHealth Care leaving one-third of its customers without a sale?

    Actually both of those firms reject about 25% of people who apply for their services.

  3. Once again, conflicting goals are to reduce public spending and social ideals of the health system, which would be publicly funded.

  4. Again, a conflict between the aims of those reducing government spending and the ideals of a social healthcare system that would be publicly funded.

  5. The main difference seems to be the replacement of soybean meal, fish meal, soybean oil, and “corn flour” in 7912 from casein, safflower oil, and “cellulose” (which may be the same as “bran wheat “) at 00 522. This would be necessary to make the mixture of n-3 deficient, as soybean meal and fish contains high amounts of n-3, including ALA.

  6. We need some kind of global budget. Management of health expenditure is the definition of a reduction in the income provider. It will be painful for some.

  7. My concern is that only 1% of the population is funding election campaigns. Until we address that I believe we will continue to get “the best government money can buy” instead of a government that represents the interests of the people of this nation. Voting is great. I encourage everyone to do that. However, we need to also get beyond “sales job” that is being fostered upon us by the ads and corporate media leading up to elections.

  8. “Go vote and vote your interests. It’s the only democratic antidote to greed, hate and ignorance.”

    Faith-based political science, without a shred of tangible proof.

    Lots and lots of people vote their interests. They vote to get free money from other people. This is the very definition of the crisis of the Western democracies. There is no correlation between the turn-out of an election and the fiscal balance which that mandate produces when translated into legislation. (see: 2008)

    That the recent recession was created a few rich greedy financiers, and the common people would prevent such silliness if they were only watching, requires great mental effort to keep believing.

    Never search for a secret conspiracy of wall-street wolverines when obvious culprits are milling about. In simple fact, a large number of common people borrowed money they could not repay, at variable rates. Lenders were insulated from the risk because they could pass it on to the government. Ergo, the bubble was a government-facilitated bubble.

    These are the same common people who vote yes for every social benefit, and no for every tax. American entitlements are nothing other than a bubble.

    A bubble inevitably forms when two things coincide: personal gain, and collectivized risk. A synonym for this pathology is: voting your interest.

    Some people are poor because of bad luck. Some are poor because they have chosen avocations. But lots of poor people are poor because they are incapable of delaying their gratification. “Greed” is not a characteristic of income; the federal budget empirically does not balance when the masses vote their “interests”.

  9. “we could enroll just as many people in Medicaid by merely signing up those who are already eligible!”

    Nope. Illegals, a significant portion of those people are not allowed to sign up for Medicaid. Also, I dont really find it surprising that underfunding Medicaid leads to fewer people being able to sign up. Signing up for Medicaid is controlled at the state and local level. THe rules vary from state to state as do the qualifying levels of income.

    “Can you imagine Aetna taking 90 days to sell someone an insurance policy? What about WellPoint? Or Blue Cross?”

    My corporation is small. We are subject to underwriting. Having done this for over a dozen years now, it takes us 45-60 days to sign up and have the insurance in place. (We need to change plans almost every year to keep costs down.)

    “Our poor are less literate, work fewer hours, have fewer skills, and your surprised they have less money?”

    As well they should. However, our wealthy are not more productive or run their companies any better, but they make roughly an order of magnitude more than their counterparts overseas. They crashed the economy, then were made whole with bailouts.

    Steve

  10. Yeah, unlike you.

    I am a open book. You are not. It’s that simple. I’ll let others here who give a shit decide which one of us is “such a bitter ass.”

    Y’see, I give you fine-grained detail about the broader issue pertaining to the question I posed, and all you can do is reflexively glom onto — and intentionally mischaracterize — my personal story.

    Yeah, Nate, I’m really stuck in such a swamp of bitterness. My life has been a totally unproductive, angry, “ignorant” (your favorite epithet) waste of time. I add no value to any issue.

    Yeah.

    Again, flatter yourself.

    – Poor BobbyG

  11. “Unlike YOU”

    Again, knowing nothing about me how do you make these claims? Yet you continue to place your hard path in life above all others. Only poor BobbyG has suffered like he has. No wonder your such a bitter ass, at least that part is understandable now.

  12. “What about you Bobby, you a militant marching, women’s’ right to abort babies any time until delivery on the tax payors’ dime sorta guy?

    Still haven’t seen anything meaningful or contributory out of you today, all you have to contribute today is a question and 3-4 ad hominem attacks?”
    ___

    Unlike YOU, I have personal skin in the game. I am no abstraction-fondling moral dilettante. Here, Nate:

    http://bgladd.blogspot.com/2008/04/diploid-dave-et-al.html

    Read all of it.

    Spare me.

  13. If you want the really short version Peter1, the one thing you really need to take away from the test and subsiquent paper is this;

    http://press.web.cern.ch/press/PressReleases/Releases2011/downloads/CLOUD_SI_press-briefing_29JUL11.pdf

    “Based on the first results from CLOUD, it is clear that the treatment of aerosol formation in climate models will need to be substantially revised, since all models assume that nucleation is caused by these vapours and water alone. It is now urgent to identify the additional nucleating vapours, and whether their sources are mainly natural or from human activities.”

    That is direct from CERN Peter1, CERN is saying all existing climate models need fixed. Let me guess they are ignorant asses as well?

  14. Here is some reading for you since your ignorant comment made it clear you haven’t actually read the study, well in your case had someone read it to you.

    The CLOUD results show that trace vapours assumed until now to account for aerosol formation in the lower atmosphere can explain only a tiny fraction of the observed atmospheric aerosol production. The results also show that ionisation from cosmic rays significantly enhances aerosol formation. Precise measurements such as these are important in achieving a quantitative understanding of cloud formation, and will contribute to a better assessment of the effects of clouds in climate models.

    —– its important to remember there has never been a scientific test proving or even showing man is responsible for the majority of global warming, they have models that predict man is responsible. These models have consistently been proven wrong so they make some changes and tweaks then release a new model with the same claims. To date none of these models account for clouds and their effect on climate. No one is saying the CERN test proved clouds are responsible but it is a theory that is far more logical then manmade global warming. This test would be the first step in decades of test to prove clouds have a significant role in earth’s temperature—

    “These new results from CLOUD are important because we’ve made a number of first observations of some very important atmospheric processes,” said the experiment’s spokesperson, Jasper Kirkby. “We’ve found that cosmic rays significantly enhance the formation of aerosol particles in the mid troposphere and above. These aerosols can eventually grow into the seeds for clouds. However, we’ve found that the vapours previously thought to account for all aerosol formation in the lower atmosphere can only account for a small fraction of the observations – even with the enhancement of cosmic rays.”

    Notice first observation, no one is claiming science is settled, oh wait yes the Al Gore Sheep are, besides those idiots everyone knows there is a lot of science left to be done.

    For an easier to understand summary even you should be able to read go here;

    http://www.theregister.co.uk/2011/08/25/cern_cloud_cosmic_ray_first_results/

  15. silly little Peter1, never miss a chance to show how stupid you are.

    I said;

    “ramifications in regards to man’s culpability in global warming”

    you link an article that argues;

    “New CERN study said by climate skeptics to prove no human global-warming effect”

    now who’s the “ignorant ass”?

    Oh wait, you probably don’t even grasp the polar difference in those two statements. When you figure out the difference then come back and talk to me.

  16. undecided, someplace between zygote and heart beat. I’m also not opposed to all abortion, if done early enough, if paternal rights are equally protected with maternal rights, and it’s not tax payor funded, abortion sadly is a better outcome then birth in some situations.

    What about you Bobby, you a militant marching, women’s’ right to abort babies any time until delivery on the tax payors’ dime sorta guy?

    Still haven’t seen anything meaningful or contributory out of you today, all you have to contribute today is a question and 3-4 ad hominem attacks?

  17. Why? Reagan signed a terrible amnesty bill which was suppose to resolve the problem not open the door to 10 million more.

    Is your argument because we passed one terrible bill that failed miserably almost 30 years ago we should continue to do so?

    How does a national amnesty bill equate to city level sanctuary cities that flaunt federal law. Do an internet search for enumerated powers, repealing invasion is one of the few things the federal government is actually tasked to do. They should spend less time worrying about my health and more time protecting our borders.

  18. “more workers means more taxes, unless they are unskilled and unemployed. Depending on who was being killed it could have been good or bad for federal deficits. We would be a younger nation which is generally good for current deficits but bad for long term deficits as its more unfunded promises.”
    ___

    You’re really grabbing at straws now. THAT is your argument? That our current deficit would be smaller had abortion been outlawed?

    Question: does “life begin at conception” for you?

  19. According to the Centers for Disease Control (CDC), since 1973, roughly 50 million legal induced abortions have been performed in the United States

    (CNSNews.com) – There were only 1.75 full-time private-sector workers in the United States last year for each person receiving benefits from Social Security, according to data from the Bureau of Labor Statistics and the Social Security board of trustees.

    more workers means more taxes, unless they are unskilled and unemployed. Depending on who was being killed it could have been good or bad for federal deficits. We would be a younger nation which is generally good for current deficits but bad for long term deficits as its more unfunded promises.

  20. “Copy that.”

    “You are such an amazing expert on EVERYTHING.”

    “That pertains to federal deficit arguments precisely HOW?”

    “You need to stick to things you know about. Science is not one of them.”

    “Flatter yourself.”

    That is an impressive body of work. I just wanted to take a moment out to applaud the enlightening contribution you make Bobby. No one else has said it so let me thank you for everything you add.

  21. Again:

    “Right to life for murders and rapist but not babies?”

    That pertains to federal deficit arguments precisely HOW?

  22. Being liberal and pretty cocky maybe you could help me out with something. Whenever I ask a liberal to discuss the CERN study, how it was suppressed for 10 years, and its ramifications in regards to man’s culpability in global warming, they either run off screaming or just go silent.

  23. Is that another personal attack? How would you know my base of knowledge having never meet me nor talked about anything besides healthcare? I got to say I don’t think your qualified to make that statement. For all you know I could hold multiple PhDs in science. With or without college degrees I’m certainly more knowledgeable then you.

    Any time you want some science lessons I’ll be happy to teach you, hopefully you’re a better student of science then you are healthcare delivery and economics.

  24. “You are such an amazing expert on EVERYTHING.”

    Is that an ad hominem attack I see? BobbyG wouldn’t approve of that.

    You don’t need to be an expert to know when someone fakes science and claims universale support and agreement they don’t have is following religion not science. One must not suffer death by power point to see clearly.

  25. “Faith based science like global warming”

    You are such an amazing expert on EVERYTHING.

    “Right to life for murders and rapist but not babies?”

    That pertains to federal deficit arguments precisely HOW?

  26. “the current economic disaster was not brought on by illegal immigration and it was not brought on by health care costs,”

    Then where do States get the money to cover their Medicaid liability?

    Where does the 40 trillion Medicare is short come from?

    Where does the 60 trillion for Social Security come from?

    If Federal debt is not the problem why is Obama talking about it so much?

  27. “the current economic disaster was not brought on by illegal immigration and it was not brought on by health care costs, as another thread here seems to imply. It was brought on by unadulterated greed of the few, coupled with failure of the silent majority to act.”

    As usual you have no clue what you’re talking about Margalit, the current financial crisis is due to sovereign debt which was brought on by international welfare spending, of which healthcare is a big part of, for the masses. Greed of a few doesn’t have anything with the problems we have today, a few individuals are not capable of bringing down the world economy.

    What does the greed of a few have to do with the PIIGS’s bonds? It’s the PIIGS’s bonds that are driving the markets all over the place and forcing US and GF to promise unlimited dollar borrowing to keep the system from collapsing.

    This is a great example of the true problem, clueless people running their mouth and demanding changes when they have no idea what they are talking about.

    Faith based science like global warming and Al Gore sell? Talkj about a bunch of made up BS.

    Right to life for murders and rapist but not babies?

  28. Nate, the current economic disaster was not brought on by illegal immigration and it was not brought on by health care costs, as another thread here seems to imply. It was brought on by unadulterated greed of the few, coupled with failure of the silent majority to act.
    There is a new evil spirit making its way into the political discourse in this country, and unless the majority of Americans, who I believe are decent at heart, do something to squelch it, it will eventually become our way of life (at least for a while). People need to get off their temporary comfortable couches and go vote. In droves.
    If we don’t, we may very well end up with a government put in place by the well dressed, well fed minority sitting in fancy auditoriums and cheering the death of young uninsured citizens. A minority that believes vaccines cause retardation and science is faith based. A minority who cannot accept the terms Mexican and College in the same sentence. A minority who chooses not to provide disaster relief to the suffering. A minority who believes in right to life, but only if you managed your portfolio of investments wisely. A minority which does not represent America or the interests of its people.
    So as Harry Truman advised everyday people in thousands of small towns many years ago: Go vote and vote your interests. It’s the only democratic antidote to greed, hate and ignorance.

  29. “There’s a real glut of low-skilled manual labor in the area,” he says. “There’s just nothing for people to do.”

    I don’t recall Reagan supporting Sanctuary Cities, do an internet search for New Jersey and Sanctuary Cities, if they have an excess of low skilled labor maybe they shouldn’t be trying to attract more illegal low skilled laborers?

    How many unemployed American’s do we have right now? How many illegal aliens do we have working in the country right now?

  30. John are you really surprised that people not doing anything are not moving forward? Our poor are less literate, work fewer hours, have fewer skills, and your surprised they have less money?

    Then to top it off you think the Reagan Revolution is the problem, you need to learn about the counter productive distruction of failed welfare policies and how they allow generations to stagnate and digress.

  31. I recall years ago, as an American GI, I stepped over two children sleeping on a sidewalk in an Asian country and thinking how much Americans take for granted. I never expected to witness the retrograde disintegration of our own society that has taken place as a result of what has euphorically been hailed as the Reagan Revolution. When one percent of the population collects annually upward of a fourth of new economic wealth and we stand in the midst of an economic train wreck not seen since the Twenties, all I know to do is shake my head and roll my eyes in disbelief.

    http://t.co/cHlGwuo

  32. “State taxpayers better thank their lucky stars ”

    Ya just stick it to those federal tax payors they can afford it. The State taxpayers need to stop being treated like ATMs for Federal Taxpayers.

  33. “You are absolutely right. Let’s fix that, shall we?”

    We shall, lets start by having Medicare cover everyone once they turn 65 like it was intended instead of pushing people back onto private insurance and shifting risk back to employers.

    What’s that, Medicare can’t afford to offer the coverage it promised? Without shifting risk back to employers it would be even further over budget? If Medicare for all is the answer why do they keep pushing people off?

  34. “Did you know that an estimated one of every three uninsured people in this country is eligible for a government program (mainly Medicaid or a state children’s health insurance plan), but has not signed up?”

    State taxpayers better thank their lucky stars that the program falls short of getting full enrollment. Tell me John, where will the money come from?

    “TEXAS nursing home leaders are concerned about how they will care for the frail and elderly if lawmakers carry out plans to drastically reduce the state Medicaid budget.
    Deep cuts would gut many nursing homes, forcing them to pare back services, reduce staff or even close, administrators said. A majority of the state’s nursing home residents depend on Medicaid for long-term care.”

    “CALIFORNIA is seeking deep cuts in Medicaid, a move that could ripple out to other states and affect some insurers. The state is seeking federal approval for new Medicaid restrictions, including possible limits on the number of times they can see a doctor, the Los Angeles Times reports.”

    “NORTH CAROLINA – New cuts to health services for the poor take hold in October, with the elimination of eye exams and glasses for adults on Medicaid.
    Medicaid recipients are receiving notices about reductions, eliminations or other changes to an array of health services in the next few months. The $354 million Medicaid cut in the state budget includes limits and other changes to services totaling $16.5 million.”

    “(Reuters) – Three years before Medicaid is due to cover millions of uninsured Americans, state funding cuts may be undermining how much care the government-run health insurance program for the poor will offer new enrollees.
    Two dozen states across the country plan to slash at least $4.7 billion from their Medicaid plans following four straight years of budget shortfalls, according to data provided separately by the nonpartisan Center on Budget and Policy Priorities and the consumer advocacy group Families USA.”

  35. “a program that does not need to market and campaign for sales”

    The National Medicare & You Education Program: Beneficiary education is a top priority for CMS, especially as the new benefit options are implemented. CMS must ensure that beneficiaries have the essential information they need to make complex and personal health choices.

    The total FY 2007 program level for the National Medicare & You Education Program (NMEP) is $316 million, a decrease of $6 million from FY 2006. In FY 2007, over 58 percent of NMEP funding covers the 1-800-MEDICARE helpline. The balance will be used for beneficiary materials, CMS websites, community based outreach, the National advertising campaign, and program support.

    ” a program that pays doctors and hospitals adequately”

    “Congress needs to assure that physicians are adequately compensated for providing cancer care to Medicare patients,” said Nancy Davenport-Ennis, CEO & Founder, NPAF. “Otherwise, increasing numbers of Medicare beneficiaries will be unable to access care as more physicians decline to accept Medicare patients.”

    Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.

    Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program.

    Worse yet will be the impact on clinical geriatrics, which includes geriatric medicine and geriatric psychiatry. Specialty geriatric practices depend almost entirely on reimbursement from Medicare. These practices already are barely viable financially. They cannot compensate by taking more young patients, so the impact on the geriatric sub-specialties will be catastrophic. A staggering crisis already exists in the geriatric workforce (try finding a geriatrician or geriatric psychiatrist to appreciate how big a problem this is). The Institute of Medicine’s report of April 2008 Retooling for an Aging America: Building the Healthcare Workforce concludes that this predicament is an emergency for which immediate action is needed. The IOM report concludes that inadequate reimbursement is the single greatest barrier to geriatric workforce development.

    “a program that does not discriminate”

    You have to be 65 or disabled how is that not discrimination?

    “efficient”

    10% lost to fraud gives efficency new meaning.

    Oh wait my bad you were talking about Canadian Medicare not the disaster we call Medicare in the US

  36. Yes, John, I so totally, wholeheartedly agree. Let’s abolish Medicaid.
    Let’s get all those “eligible” for Medicaid into a program that is simple and easy to enroll into; a program that pays doctors and hospitals adequately; a program that does not need to market and campaign for sales; a program that is uniform, efficient and easy to understand; a program that is not dependent on States quirks and political situation; a program that does not discriminate; a program that could work well for everybody – Medicare.

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