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Dr. Klein's Health Insurance Relationship Advice Corner

As something of a follow-up to the last post, I want to point out a different poll result that helps explain why reformers can't attack private insurance too aggressively. There is, among a lot of liberals, a sense that people really really hate their private insurance coverage and are desperate for an escape hatch. But there's not much evidence of that in the polling:

are_you_satisfied_with_your_health_insurance_coverage?.png

About 80 percent of the population is some strain of satisfied with their health insurance. About 19 percent isn't. That's not an uncommon result. And those aren't the sort of numbers that let you detonate the system. Indeed, I occasionally compare this to having a friend in a bad relationship. You see his girlfriend being ruthlessly critical of him, standing him up, badmouthing him behind his back, isolating him from his friends, and generally being a crummy partner.

But he insists that he's happy in the relationship.

Demanding your friend to break up with his beloved probably isn't the way to go about your intervention. But maybe you introduce him to some nicer girls. Maybe you gently point out some examples where he's been mistreated. Maybe you try to take him out more often. Maybe you try to expose him to couples with a healthier bond. That's sort of the theory behind health reform. The situation is objectively quite grim, but people are attached to it anyway, and it's neither possible nor effective for reformers to simply change that by fiat. But it's entirely possible to offer better options and alternatives and then let people make the choice for themselves.

By Ezra Klein  |  June 24, 2009; 10:40 AM ET
Categories:  Health Reform , Polls  
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Comments

If you're "somewhat satisfied" with your SO, they may be good enough for now*, but you'd probably like to have some other possible partners in your life.

Same with this poll and the public plan. If you're somewhat satisfied, you wouldn't want anyone to take away the insurance you've got, but you'd be all in favor of having the set of viable alternatives expanded.

* "Good Enough For Now" is a terrific Weird Al song, btw.

Posted by: rt42 | June 24, 2009 10:51 AM | Report abuse

So your advice is for them to date an even bigger and more incompetent bully instead and poison the market for all other alternatives. That's brilliant dude.

Didn't you see the fruits of Government management on the Red Line?

Posted by: fallsmeadjc | June 24, 2009 11:02 AM | Report abuse

It would be fair to include the 1 in 6 Americans without health insurance in the "very dissatisfied" column. That would change the results to look like this:

****************** 36% Very Satisfied
**************** 32% Somewhat Satisfied
***** 9% Somewhat Dissatisfied
*********** 22% Very Dissatisfied

I think that number of about a third of all Americans that know their relationship with their health care is dysfunctional isn't news, but it's a lot more than the Post poll graph shows even before addressing the denial factor.

Posted by: NealB1 | June 24, 2009 11:16 AM | Report abuse

I'd put myself in the Very to Somewhat satisfied category with the insurance I get through work. Given my and my family's current health status, my only complaint is it's cost, which is a nuisance, but not a hardship. But I'd like to have other options, and even more, I'd like to know that I had some security were I laid off (as were several of my colleagues this spring).

fallsmeadjc, "Scary Socialism!!!!!11!1!" isn't much of an argument if you don't defend your underlying premise.

Posted by: JEinATL | June 24, 2009 11:17 AM | Report abuse

i have blue cross-anthem in california.
i pay a fortune for my coverage, and i have had if for almost twelve years.
i love my plan. it has helped me through bouts of very serious illness, and everyday, i am grateful for the autonomy and coverage that i get with this plan.
the cost of it is out of sight, but it has kept me alive, and not a day goes by that i am not thankful for it.
kaiser permanente is a lot less expensive....but i dont want that kind of system for myself, even though i know many people love it very much.
i recognize that we are a whole spectrum of folks out here, and many of us are struggling with no insurance, exorbitant insurance and many health issues....but i also recognize that many of us want different things.
i hope there are options for all of us, and that in a few years, things will be better for all of us.
long ago, i stopped bellieving in magic bullets, but may we all not get shot in the foot...and may things be better for all of us, with a freedom of choice and gratitude for positive changes that will come our way.

Posted by: jkaren | June 24, 2009 11:17 AM | Report abuse

Very curious to see what will happen to the satisfied folks if indeed health insurance becomes part of their "salary" and is thus taxed.

Posted by: anne3 | June 24, 2009 11:29 AM | Report abuse

What percentage of those satisfied have government provided health insurance? Medicare etc. It can't be small.

Posted by: joelw | June 24, 2009 11:31 AM | Report abuse

Another meaningless poll. The vast majority of people make very little use of their health insurance, as with any insurance. So "satisfaction" for those not actually using a product can only be based upon cost in this case.

For the large fraction of the working population, that gets its coverage through their employer, the out of pocket cost also does not reflect the true cost, most of which is invisible to them.

A more meaningful question would be to ask those who actually have had to make use of their insurance for more than routine care how satisfied they are. As those in New Orleans discovered after Katrina, what you get when a real disaster occurs can be far different than what you thought you were covered for.

Polls of those who actually use their insurance find a much higher rate of satisfaction from those in Medicare than those in private plans.

The horror stories one hears are about those not being covered for certain treatments, or being kicked out of the plan when they do get sick because of phony claims about failure to report prior conditions or losing their coverage altogether when they are forced to stop working due to illness.

How satisfied are you with your home fire insurance? Have you ever had your home burn down? No. So how valuable is your "opinion"? Preferring the status quo means nothing except to provide fodder to those who gain by preserving it, namely the for-profit health suppliers.

Posted by: robertfeinman | June 24, 2009 11:40 AM | Report abuse

One more thing - regardless of how "satisfied" most people are with their insurance, costs are unsustainable.

I want to know why a well child visit for a healthy child costs $508 per child (at least with my plan.) Do people know how much a doc's visit truly costs? Probably not, if the only thing they have to pay is the $20 co-pay.

If they had to be responsible for the bills, they'd probably be shocked to learn of all the extra add-ons that are billed to the insurance company....things like vaccine admin costs and developmental check up fees that are in addition to the fee for the office visit.

And if they understood the true cost of their health care - how many would be checking off that "satisfied" box?


http://wardonwords.blogspot.com

Posted by: anne3 | June 24, 2009 11:54 AM | Report abuse

I think the most important thing to achieve is universality, health care that cannot be taken away from you, even if you have some bad luck. If people are happy with their health care/insurance, that's all the more reason to stress universality, giving people extra security that they'll get to keep what they have, even if they have some bad luck.

I guess the fear is that universality will be portrayed as taking money from the insured and giving it to the uninsured. But the way to deal with that politically has always seemed pretty simple to me. Repeal the Bush tax cuts, and replace them with a health care tax cut. The uninsured will get the money they need to buy insurance, and the already insured will get a nice tax cut, which in most cases will wind up being more than they would have received under the Bush tax cuts.

The Democrats have already counted the revenue from the Bush tax cuts several times over, but it seems to me that universal health care should be the first priority. If the Democrats can't get universal health care, then voters won't, and probably shouldn't, trust them to do anything else.

If revenue is the obstacle to getting universal health care, then what that shows to me is that the stimulus bill was a gigantic mistake, wasting money that would better have been spent on universal health care, both on moral and economic grounds. Moral, because no other first-world country makes a large swathe of their citizens live in economic terror the way we do, and economic, because fear of not being able to afford necessities is why American households, post-bubble-burst, have been frantically trying to stockpile cash; guaranteed access to affordable health care would do much more to increase economic confidence than random, haphazard government spending.

Lastly, if revenue is an obstacle to getting universal health care, what about a Tobin transaction tax? Churning your account, after all, is just as much a vice as smoke & drink;)

Posted by: roublen | June 24, 2009 11:57 AM | Report abuse

I wonder what percentage of the satisfied crowd really haven't interacted with their insurance much. I have insurance through my job and haven't had anything to complain about, but other than the odd checkup here and there I haven't really had to use it. So, I guess I'm satisfied, but that'd probably change really fast if I had a major, necessary healthcare expenditure and had to wrestle with my insurance provider to get it paid for.

Posted by: MosBen | June 24, 2009 12:24 PM | Report abuse

So I guess this doesn't include the 15%-or-so who would select 'What health insurance?'

Posted by: CarlBentham | June 24, 2009 12:32 PM | Report abuse

"Didn't you see the fruits of Government management on the Red Line?"

Funny you should mention that. This is the first accident in metro history with fatalities. How many car accidents occur every day? Lots. I know several people who have been in serious car accidents, but I know no people who have been in a public transportation accident. In any case I am very satisfied with Metro, which I use every weekday, and glad I have it as an option among others. Think of Metro as the public plan; without metro I would only have the option of commuting with my car or car pooling to work (I can't walk or bike to work) with metro I have the option of commuting with Metro or with my car. I choose Metro.

Posted by: Castorp1 | June 24, 2009 12:41 PM | Report abuse

The important crosstab here, as robertfeinman notes, is "have you been sick in the last year, and if so, something fairly harmless or something serious?"

Posted by: pseudonymousinnc | June 24, 2009 12:46 PM | Report abuse

To support robertfeinman, look at the recent Commonwealth Fund Study (which Ezra has never mentioned) which shows that people with private insurance report 2.5 times as many problems with their insurance as those who have Medicare.

Posted by: lensch | June 24, 2009 2:00 PM | Report abuse

Andrew Sullivan posted a quote from the Declaration of Independence today in reference to the people of Iran. I think this portion is pretty apropos here:

"...and accordingly all Experience hath shewn, that Mankind are more disposed to suffer, while Evils are sufferable, than to right themselves by abolishing the Forms to which they are accustomed."

Posted by: dkoll | June 24, 2009 2:35 PM | Report abuse

The concept of "insurance" has been muddled, leading to poor program design and ineffective policy choices.

Much health "insurance" is really pre-paid health care. Normal, healthy people generally have a fairly modest and predictable (over a large population) amount of health spending each year. The premiums are set to cover this. Health savings accounts are a way to try to make this explicit.

But the traditional meaning of insurance is coverage for exceptional cases. That's why we have fire, auto and other forms of catastrophic event insurance.

A portion of health insurance premiums go into a communal fund which covers these rare events. There is no guarantee that you will ever get any of this money back. This catastrophic insurance can be run as a government function (Medicaid) or private as with auto insurance.

By combining these two functions together we have a system where private firms try to minimize their exposure to catastrophic claims. This leads to vetting for pre-existing conditions, denying coverage and kicking people out using phony claims about under reporting prior health issues. The insurance industry likes Medicare/Medicaid it takes the highest risk people out of the pool.

These two functions should be separated. A universal coverage plan where the deductible for routine care depends upon one's ability to pay would cover the pre-paid aspect and an expansion of Medicaid so as not to require total impoverishment before it kicks in could cover the catastrophic aspect.

Those with less ability to pay would see the division between pre-paid and catastrophic set lower than those who can afford more.

Posted by: robertfeinman | June 24, 2009 3:04 PM | Report abuse

"It would be fair to include the 1 in 6 Americans without health insurance in the "very dissatisfied" column. "

I've seen the question asked & most are satisfied. Most can afford insurance and choose not to have it or qualify for aid if they need it.

Posted by: tom32 | June 24, 2009 3:26 PM | Report abuse

The comments to this entry are closed.

 
 
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