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Uninsured Are Under Siege Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men We uninsured Americans gotta stick together. Socialists, who want the government to force us to buy their idea of health insurance or to "cover" us with government-provided insurance, are attacking us. California Gov. Schwarzenegger, Massachusetts Gov. Patrick, and others who worry about a "hidden tax" that we inflict on the insured are also attacking us. Then there are those who want to force us to buy health insurance. We're being attacked from all sides. Before I get into more details, remember that health "insurance" is not the same as actually getting medical needs met. Having health insurance is often very different from actually getting medical problems evaluated and treated quickly and appropriately.
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Centralized or socialized health services always seem to end up delaying medical care for serious conditions or expensive treatment, such as cancer and joint replacements. The Soviet Union, England, Canada, and many other countries cause much suffering because the supposedly guaranteed rights to medical services were often not fulfilled in time. Some of our uninsured brethren don't pay their bills for hospital emergency room services, forcing hospitals and doctors to make up the difference by overcharging those who can pay, such as people with insurance or uninsured people with money. John R. Graham of the Pacific Research Institute based in San Francisco recently published "The Uninsured Versus The Insured: Who Subsidizes Whom?" (Go to www.pacificresearch.org/pub/hpp/2007/HPPv5n2_0207.pdf.) He writes, "To back up this notion, Families USA, a self-styled consumer advocacy group, estimates that the uninsured used about $29 billion worth of health services in 2005 that the privately insured paid for through higher premiums." But there's more to the story. Graham calculates that "the uninsured likely pay at least $60 billion extra in federal income taxes alone, by forgoing the tax savings associated with private health insurance." These dollars — five times the purported hidden tax — "dwarf the hidden tax of uninsurance."
In terms of taxes paid, we uninsured are actually subsidizing the insured rather than the other way around. The insured are the ones getting the income tax break, not us uninsureds. Graham claims there is indeed a real hidden tax, "but it is levied by the insured on their fellow insured. Because of bad incentives, insured Americans use health services twice as much, per person, as the uninsured." Some politicians want to force us uninsured to get some kind of insurance so that they can claim that they have solved our "problem" of not having (or not wanting) health insurance. Graham notes, "political success in health policy now consists, basically, of ordering the uninsured to become insured." We doubt that any such mandate will be any more effective than the laws in 47 states that require drivers to buy liability auto insurance. As Greg Scandlen, president of Consumers for Health Care Choices based in Hagerstown, Md., reports in the Baltimore Sun, "the notion that a legislature can wave a magic wand and change everyone's behavior is naive at best." Although my own Washington state requires automobile owners and drivers to have auto liability insurance, about 18 percent of motorists do not. Even though health insurance isn't mandated, 16 percent of the Washington population do not have coverage, according to Scandlen. And speaking of mandates, most states have laws to force insurance companies to include pet coverages in health insurance policies. Although politicians often try to claim these mandates "protect the public" or are "good for you" mandates invariably reflect the medical and financial interests of pressure groups. If mandates did protect the public at the expense of special interest groups, those groups would campaign against them. Special interest groups, such as general medical or limited practitioners, back proposed mandates, not the other way around, to enhance their own power, income or both. I am uninsured because health insurance is unhealthy for me. After diligently studying and promoting medical savings account (MSA) plans 10 years ago, I bought a policy from Anthem Health of New Jersey to cover my college-age son and me. To make the long story short, the insurance proposal of dozens of pages had a $2,000 individual deductible; but the 100-page insurance policy actually issued had a $4,000 deductible, causing a great deal of correspondence and dismay when medical services were actually used. I canceled that policy early in 1998. I've been living uninsured and more happily ever since, until the Social Security bureaucrats foisted Medicare Part A on me. I could swear off Medicare Part A but the ever-so-wise Social Security Administration would then stop sending Social Security checks. I am currently "covered" for hospital services by Medicare Part A. I have sworn off Medicare Part B and D. (Don't ask me what Part C is.) Health insurance can be a valuable financial planning tool. But insurance itself is not the goal; the goal is appropriate, timely and efficient care of medical needs, as judged by real patients and their families, not politicians or medical insurance bureaucrats. Editor's Note: Robert J. Cihak wrote this week's column. Contact Drs. Glueck and Cihak by e-mail.
* * * Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in economics and citizenship at the International Trade Education Foundation of the Washington International Trade Council.
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