HEALTH CARE/Joan Retsinas


Republicans smote the Democrats in the mid-term election, at least when it came to control of the House of Representatives. But smoting and governing are two different things.

The numbers have catapulted Republicans into euphoria. The November elections delivered a reverse alchemy, turning Democrats’ gold into lead. As the tallies mounted — 29 governors, 239 seats in Congress, 41 Senators, 25 state legislatures — the Republicans, especially the Tea Partiers, gloated. They were ascendant. They had smote the liberal establishment.

And the smoted – at least some of the more pragmatic ones — now question the wisdom of health reform. Maybe Obama care was just too drastic, too soon. Maybe we should have worried about the economy, or the military, or anything else before proposing to nudge our nation’s health care system into a model adopted by the rest of the developed world. Maybe we should have done nothing — voters are more prone to attack a sin of commission than of omission. Maybe we should have waited.

Of course, smoting and governing are separate, as many victors have discovered. Here are some more numbers that the victors should ponder.

• 50.7 million (16.7% of the population). These are the uninsured, according to the latest Census tally. Notwithstanding Republican praise for our current system, the uninsured are not going away. In 2008, 15.4% were uninsured. If you count only adults younger than age 65 (Medicare, the government behemoth, insures that swathe), the proportion climbs above 25%. The numbers were rising even when all the indices of prosperity were high; now that we have high unemployment, the numbers still rise. (

At the same time, the “safety net” grows porous. Some states have slashed funding for the State Children’s Health Insurance Programs. Hospitals used to be nonprofit, with a mission of providing “uncompensated care” to people who couldn’t pay. As hospitals have morphed into for-profit entities, that mission has fallen by the wayside. “Uncompensated care” now includes the hefty co-pays that even the insured can’t pay. As for immigrants, we have frightened some legal ones from seeking care.

Predictably, many Americans who were uninsured skipped medical care because of cost. [Vital Signs: Health Insurance Coverage and Health Care Utilization — United States, 2006-2009 and January-March 2010, Morbidity and Mortality Report]. Sadly, we Americans are not an especially healthy populace; indeed, our health indices are lower than elsewhere in the developed world.

• One in seven. This is the fraction of individuals that health insurers reject. (Janet Adamy, Wall Street Journal, Oct. 13). About 16 million Americans are covered under the “individual” market. ( They are not part of a group. Those would-be enrollees apply on their own for insurance, and the would-be insurer judges each applicant’s risk individually. A survey of the four largest insurers (Aetna, Humana, UnitedHealth Group, WellPoint) pegs the refusal ratio as 1 in 7. Insurers say “no” most of the time because the applicant needs too much costly care, although many insurers will also routinely say “no” to pregnant women, fathers-to-be, and adoptive parents. Forty-five states allow insurers to say “no.” (The exceptions are Maine, Massachusetts, New Jersey, New York and Vermont — decidedly blue states). ( In the rest of the country, it is enrollee-emptor. Consider cancer: we have treatments that can extend patients’ lives, put many patients into remission for years. Yet one in ten patients with cancer reported that insurers denied coverage; another 6% lost their coverage. ( )

• Three billion dollars a year. Over ten years, factoring inflation, $40 billion. The Tea-partiers declaiming against excessive government spending should ponder that number. The administrative costs of “individual market” policies come to 29% of premium dollars, compared to 12% for group policies (and 3% for Medicare). ( All that evaluating of risk gobbles up money. If we transferred those enrollees to group policies, we would save $3 billion a year.

The status quo — which Republicans so admire — is costly as well as cruel. The victors must confront these numbers as they reconcile deficit reduction with our nation’s health.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, December 15, 2010

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