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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JasonBrian HsiehMedical Interior DesignJoeWInative Recent comment authors
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Jason
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Jason

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 !

Brian Hsieh
Guest
Brian Hsieh

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.

Medical Interior Design
Guest

Let us wait for the time when health insurance is free.

Joe
Guest

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

Joe
Guest

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

Joe
Guest

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.

Joe
Guest

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.

tim
Guest
tim

“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… Read more »

BobbyG
Guest
steve
Guest
steve

“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… Read more »

BobbyG
Guest

“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.

nate ogden
Guest
nate ogden

“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.

BobbyG
Guest

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

nate ogden
Guest
nate ogden

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?

BobbyG
Guest

“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?

Peter1
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Peter1
nate ogden
Guest
nate ogden

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.

nate ogden
Guest
nate ogden

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… Read more »

nate ogden
Guest
nate ogden

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… Read more »

nate ogden
Guest
nate ogden

“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.

BobbyG
Guest

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

nate ogden
Guest
nate ogden

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.

nate ogden
Guest
nate ogden

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.

BobbyG
Guest

Flatter yourself.

nate ogden
Guest
nate ogden

“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.

BobbyG
Guest

Again:

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

That pertains to federal deficit arguments precisely HOW?

nate ogden
Guest
nate ogden

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… Read more »

nate ogden
Guest
nate ogden

“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… Read more »

BobbyG
Guest

“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?