Vampire myths surface in the twilight of debates, when woozy voters, their eyes glazed over, watch the political soap opera with waning interest. Who lied? Who cried? Who reneged? The candidates lob factoids, to keep voters from switching the channel to ESPN or Comedy Central. Some factoids segue into myths. Lets put a stake through these.
Myth One: The problem of the uninsured requires business-savvy tweaking of the system. With business acumen, this problem will vanish; and the system, or non-system depending on perspective, remains intact.
In actuality, the problem of the uninsured is the system itself. Any employer-based system will leave a major swathe of the population uncovered. The country recently exulted in high employment, low inflation, and general prosperity, yet the number of uninsured still crept up. This basic problem will not vanish with tweaking.
Myth Two: Most of the uninsured dont work. Reams of data, years of study, shelves of policy manuals notwithstanding, this myth holds sway among a segment of blissfully cocooned voters. About 46 million Americans are uninsured, but the cocooned voters dont know any of them. And they have never asked the server who gives them their morning coffee at the neighborhood café, the counter-person at the laundry who gives them their shirts, or the maid who washes their floors: Do you have insurance?
Myth Three: The uninsured are free-loaders who havent bought insurance because they know that if they get sick, the safety net providers will pitch in. One candidate for President (guess which one) at a New Hampshire debate dismissed many of the uninsured as free-loaders, and touted his states plan to mandate that everybody buy insurance (another clue).
In reality, most of the uninsured would like a Blue Cross or Aetna or whatever card. They cannot afford the premiums especially if they must buy insurance on the individual, non-group market. Premiums for a family can top $5,000 a year. If the individual is ill, insurers may not even sell him/her a policy.
Myth Four: Public clinics and hospitals provide care for people without insurance. Yes, the country has a gossamer safety net of nonprofit facilities, stretched to fiscal insolvency. Those facilities cannot serve everybody equitably. Consider two recent studies. Researchers looked at people uninsured and insured with cancer. The uninsured were nearly twice as likely to die within five years as the insured cohort. (American Press, Dec. 2, 2007). Another study tracked a sample of people ages 55 to 72. The health of both groups with insurance and without it declined as they aged to 65, but the uninsureds health declined more quickly. Notably, though, after age 65, when everybody had Medicare, the gap in health status steadily lessened. (Journal of the American Medical Association, Dec, 26, 2007).
Myth Four: You can insure everybody without a public sector subsidy. This is like squaring the circle. State plans that extend coverage are predicated on a substantial subsidy.
Myth Five: We are paying for services that dont work. Experience-based practice guidelines promise relief. In reality, we do pay for services that have not run the gauntlet of extensive clinical trials. Clinical trials will point physicians to more effective practices; but those trials are costly. Besides, the most efficacious treatments may turn out to be the most expensive. So while experience-based guidelines will improve care, they wont necessarily slash costs.
All the candidates promise to speak the truth to us the voters. Unfortunately, in this season of vampire myths, the truth is sometimes truthiness.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, February 15, 2008
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