Some History: What We Have Learned Regarding Coverage

by John W Rodat on January 17, 2017

I’ve been working on health coverage issues since the late 70’s. Here are some of the key things that WE have learned during the time since.

  1. Prior to Medicare, private insurers did not offer coverage to the elderly. Most elderly simply got dropped when they turned 65. That’s why we have Medicare.
  2. Prior to the Affordable Care Act (ACA), most people without coverage were in families with at least one working person. Many were in families with two working persons. But the employer/s didn’t offer coverage or the wages were too low to take advantage of what was offered. And, in many states, Medicaid did not offer coverage either.
  3. Those uncovered families included a lot of kids.
  4. There were lots of people without coverage and the numbers were growing, even after Medicare and Medicaid and until the ACA was implemented
  5. Coverage makes a difference in whether and when you get health care. And the more subtle (or insidious) the condition, the bigger the difference.
  6. If you seek care without coverage, it’s usually later in the disease process and thus, worse and more expensive to care for. It’s usually later because you don’t know you’re sick or the nature of your illness. Think late-stage cancer vs. cancer that’s detected early.
  7. Getting care makes a difference in whether and how well you live.
  8. If you get care without coverage, you’re more likely to go bankrupt.
  9. If you get care without coverage, people with coverage cover the cost through higher prices that eventually insurers and government pay.
  10. If you seek care without coverage, you usually go to the least efficient provider, namely a hospital emergency room.
  11. Not covering kids, especially with broad coverage that includes preventive care, is especially dumb.
  12. Higher numbers and percentages of uninsured patients undermine the financial health and viability of hospitals – including those that serve the insured. So coverage won’t protect you from indirect effects.
  13. People with infectious diseases, but without coverage, are still infectious and more likely to spread the infection. So coverage won’t protect you from indirect effects.You can’t hide from all those diseases in some gated community. 

Well, I hope I’ve learned other things too, but I think this list covers the key things. 

So repealing the Affordable Care Act without a credible replacement is downright foolish. 

And, no, I’m not a liberal and not even a fan of single-payer structures. But increasingly, I think I’d take single payer over a system collapsing of its own weight, both financial and political.

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