The further I get away from Washington the harder it is to communicate with reporters. My time these days is spent mostly with working people. Some are small-scale entrepreneurs like store owners, insurance agents, and guys that help people with computer problems. Some are low-level managers, medical technicians, a dentist or two, home repair guys, mechanics. You get the drift.
These days when a reporter calls, it is these people I’m channeling. Not professors, not lobbyists, not corporate executives. I’m not in daily touch with that type anymore. So when a reporter for a major national publication wanted to talk to me about the Affordable Care Act I knew it wouldn’t go well.
She said they were going to publish a major piece showing all the opinions about the law, pro and con. She especially wanted to quote someone who opposed the law and would refuse to purchase coverage under it.
I sent her an e-mail explaining that I’m now on Medicare so I personally wouldn’t be affected by the mandate. But I went on to explain –
I spent 18 months uninsured before becoming eligible for Medicare in June. I did have individual coverage in Maryland, but premiums went up 19% on Jan 1, 2011, so I dropped it, in part because I took early Social Security and simply couldn’t afford it. Some of this increase was due to the ACA, Hard to tell how much, but certainly the new mandates played a role.
I also realized that if I got sick I would be able to enroll in the new high-risk pools — but only if I had been uninsured for six months or more. So I had a strong incentive to get uninsured ASAP to start the clock.
All of this is by way of introducing the real topic. The calculations I made will be made by almost everybody. Why bother paying for insurance if you can get it instantly if and when you need it? That is just money down the toilet. Why would anybody do that?
The tax penalties of the ACA are trivial, the subsidies are complicated, and the available plans will provide little value to most people. I don’t need coverage for psych counseling and in vitro fertilization.
This is how many (most?) people think. So, I therefore believe the ACA will result in FEWER people being covered, not more.
We know, for instance, that one-third of the uninsured are already eligible for free coverage through Medicaid or SCHIP. Yet they do not enroll. What has changed to get them to enroll now?
We know that mandates never work. Typically 15% of the population ignores them. This is true of helmet laws, auto insurance laws, child support laws, even taxes. In some cases the penalty for violating them is severe, including jail time for the latter two. Yet still people violate them.
Finally we spoke on the phone. She really wanted to talk to someone who would refuse to sign-up. I told her I know several people like that but there is no way they would talk to a reporter.
For instance, I know one fellow, let’s call him Sam, who makes a living reselling trucks he buys on e-Bay. He is mostly underground. I don’t think he reports his transactions to the IRS and he operates strictly on cash. He is uninsured and plans to stay that way. Interestingly, he is a big fan of Obama. Sam didn’t vote for him because Sam is not registered to vote. He isn’t about to do anything to bring attention to himself. And he is unconcerned about the regulations and mandates Obama is passing because he has no plans to comply with them.
Sam had a heart attack a couple of years ago. He went to the hospital and they inserted some stents, which he has no intention of paying for. They recommended he take certain drugs, so he buys them from a woman he knows who is on Medicaid and can get them for free. The doctors gave him a prescription to get some blood tests. He didn’t realize he had to use his own initiative to go and get the test done.
Do you think Sam will talk to a reporter? Do you think he will enroll in ObamaCare before he needs a service? Do you think Sam is unique?
I know a bunch of people like this around here. I knew even more when I lived in Maine (part of the reason Maine ranks low on income scales is because so many people live on cash and barter. It never gets reported.) I knew them when I lived in California.
Not a single Washington bureaucrat, and certainly not a single reporter, has any idea these people exist. Their operating assumption is that everyone is just like them — employed at a regular job and able to respond to new mandates or incentives for fear of being on the wrong side of the law.
They aren’t. Even if you put an insurance card in their wallet they wouldn’t know what to do with it. They won’t read the contract. They won’t keep appointments. They won’t take their meds as prescribed.
This is part of the reason I am a big fan of John Goodman’s approach to health care vouchers. Everyone gets one. Those that don’t use it for health insurance have their voucher put into a safety net system of direct delivery. It is a fine way of making sure that Sam and several million people like him get the care they need.
We need to get over this obsession with universal health insurance.