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COLUMNISTS
TODAY'S STORIES
20.08.2008
Crippling Medical Bills--Coming to a Person Near You

One reason this country has never mustered the will to enact universal health care is that most Americans have felt their own insurance arrangements were adequate. They sympathized with the plight of people who couldn't pay their medical bills, but couldn't imagine themselves in that situation.

A new report released Wednesday suggests that may be changing. The report, called "Losing Ground," comes from the Commonwealth Fund (which has underwritten some of my own research) and is based upon survey data the Fund has collected over the last few years. Its conclusion: More and more Americans are having trouble paying for health care. That's true of people without insurance and, increasingly, it's true of people with insurance, as well.

Among the specific findings:

Forty-one percent of working-age adults, or 72 million people, reported a problem paying their medical bills or had accrued medical debt, up from 34 percent, or 58 million, in 2005. ...

The share of U.S. adults reporting that the costs of health care prevented them from getting needed care increased from 29 percent in 2001 to 45 percent in 2007. Reports of cost-related access problems rose across all income groups and among both insured and uninsured adults. ...

All told, in 2007 nearly two-thirds of adults, or 116 million people, were either uninsured for a time during the year, were underinsured, reported a problem paying medical bills, and/or said they did not get needed health care because of cost.

The essential caveat here is that this type of survey information is notoriously imprecise: People have fuzzy memories, they interpret questions differently, and so on. But given the rising costs of medical care, it makes sense that more people would be struggling with their bills, even if the survey results overstate the problem. In other words, there are an awful lot of people out there for whom the price of heatlh care is a major problem.

Oh, and in case I haven't mentioned it lately, Barack Obama supports universal health insurance. That is, he wants the government to guarantee that all Americans can get affordable coverage, thereby shielding them from cripping medical bills. John McCain doesn't. In fact, he's proposed reforms that might actually leave more people in trouble. (Check the links if you want to see why.)

--Jonathan Cohn

Posted: Wednesday, August 20, 2008 9:51 PM with 11 comment(s)

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teplukhin2you said:

If this is an economic security election, the liberal Democrat wins. If it's a national security election, McCain wins.

If Obama's to pull this one out, he has to knock nat-sec'y concerns off the table with not one but many bravura performances * * * without his teleprompter * * *, and get back to economic issues.

Maybe he can do it, but based on his difficulties speaking off the cuff in crisp and coherent fashion on any subject, let alone E Eur and Russia, I'd say he's facing many long nights of cramming sessions before November.

August 21, 2008 3:00 AM

aeromonas said:

Teplukhin's Most Excellent New Doom-for-Obama Meme:

BHO can't speak extemporaniously without saying "Uh" and "Um" too much.

Sigh.

August 21, 2008 7:54 AM

ratnerstar said:

Americans are also used to having cheap and easy credit available -- from cards and HELOCs -- to finance their medical bills.  I suspect we'll see more of this.

August 21, 2008 9:07 AM

icarusr said:

"We have agreed that some goals, some aspirational timetables for how that might unfold, are well worth having in such an agreement."  This is Ms. Rice, announcing a possible agreement with the Government of Iraq on withdrawal timetables.  I know Crowley will cower in a corner and declare that this means the One Issue For Obama is not longer relevant, but then, McCain can shove his "patriotism" attacks deep up - somewhere ...

As for Eastern Europe and Russia, the crisis seems to be defusing (or diffusing?); the Economist, no "liberal" newspaper, has declared Russia the winner of this game; Israel has cancelled its latest contract with Georgia and brought back its advisers (Someone mentioned that the architect of Israel's disastrous Lebanon adventure was a military adviser to Saakashvili ... oy; and Georgia's Def Min has ties to the Israeli Labor Party - another Amir Peretz? Double oy.).  Russia's Foreign Minister, meanwhile, said that there are other menaces, of a nuclear nature, in the region for which the US needs Russian help; and conspiracy theory blogs in Iran are all abuzz that the reason for the muted - anaemic, pathetic - response of the US to the Georgia crisis was ... a deal on Iran. (Iranians still consider the US the almighty superpower that can do no wrong and that plans and executes strategies without fault for the next fifty years, taking into account any and every contingency that could arise by using "supercomputers in the NSA basement"); triple oy.

On the communication front, I have to agree with Tep: not so much the ums and ahs, or the reflectiveness, but the punchiness.  Perhaps he has brighter law students than I do, but for mine, I have to speak in short sentences and inject comedy (and an expletive, plus an occasional ethnic slur against Ruritanians) every third paragraph to keep their attention. (As I tell my students, I have no compunctions in appealing to their baser instincts by talking exclusively about cases that involve alcohol, hormones and sex - and I teach international law; Obama needs to relax a bit as well.)

August 21, 2008 9:59 AM

raylward said:

The trend (more Americans having difficulty paying medical bills) is a function of an aging population, in particular an increase in the nearly old (age 55 to 65) who don't qualify for Medicare and are increasingly underinsured.  I know.  I'm nearly old (age 56).  Each year I increase the deductible on my health insurance to help offset (but not totally offset) the increase in the premium.  Of course, the higher deductible means I pay more if I have medical expenses, the likelihood of which increases each year as I age.   If universal coverage is adopted, it will be because of the efforts of the nearly old who are most vulnerable under the current health care system and make up an ever increasing segment of the population, for the young don't believe they will ever be old (or nearly old) or sick and the old already have Medicare.  

August 21, 2008 10:23 AM

blackton said:

ick, I could understand Obama's hesitancy. Everyone realizes McCain is a gaffe a minute guy so the MSM never calls him on his latest stupidity, but now Obama is being criticized for saying um or uh, God forbid if he actually did relax and not carefully think of what he needs to say.

McCain's health care plan is about the worst imaginable, the only benefit is that it has no chance of passing. Let's get rid of company sponsored health care and replace it with tax credits, one size fits all is about the dummest thing I have ever heard. But the worst thing is nothing will be done for another 4 years.

August 21, 2008 10:28 AM

icarusr said:

Ah, McCain, the gift that keeps giving:

"John McCain said in an interview with Politico on Wednesday "that he was uncertain how many houses he and his wife, Cindy, own."

"I think -- I'll have my staff get to you," McCain said. "It's condominiums where -- I'll have them get to you.""

This last line is precious.

August 21, 2008 10:33 AM

icarusr said:

Blackie: I think you're right in a sense - any gaffe by Obama is capable of being far more damaging than something far worse by Grampa McSimpson.  Still.  When I train litigators, I tell them to think in French or as a civil law lawyer not a common law lawyer: common law lawyers, especially constitutional lawyer, especially those involved in Bill of Rights litigation, tend to think inductively, which means qualifying and hemming and hawing before blurting the answer.  It's great as a tool of persuasion when you're inventing new law, but terrible as a litigator and worse on the stump.  Engineers, blowhards and French speaker think deductively: pronounce a principle and draw two conclusions from it; they qualify rarely and so never show intellectual "weakness" as to the principle at issue; and the message comes our loud and clear. (That's why the French sound arrogant to anglophones, and anglophones utterly baffles French-speakers in their reasoning ....)  At Saddleback, Obama could not do this on the abortion issue; on the stump he's good on Iraq.  

Now, he has to find a middle ground between the two (so as not to sound either arrogant or wishy-washy) on a range of issues and stick to it: get the message our first, qualify if you must, make two or three points that area easily digestible; make sure they fit into the narrative - and I agree with Tep that the narrative should be the economy and health care, not his love for America, not his dad's roots, and not foreign poilcy.

August 21, 2008 10:45 AM

teplukhin2you said:

Thanks, ick. Yes, the deductive types - in this country, the engineers and the MBAs - tend to be far more effective at to-the-point communication than the lawyers.

mpathendricks - fine, don't listen to my screeds, just listen to the Dems' communications expert, Lakoff, or our elder statesman on f-p, Brzezinski. They both see that Obama can't, as ZB says, "crystallize the issue."

More from Lakoff, quoted in sfgate.com article today:

"It's not panic time - yet - but some Democrats watching Barack Obama say his campaign should have gotten a wake-up call this week, not only from his appearance with John McCain at the Saddleback Church but from a major poll suggesting he no longer leads his GOP opponent. At the Saddleback forum with Pastor Rick Warren on Saturday in Orange County, the Republican presidential candidate delivered on-the-money messages and answers so effective they were "scary to me," said George Lakoff, a renowned author and UC Berkeley linguistics professor who has studied how the human brain absorbs and processes messages.

Lakoff, whose work has helped shaped numerous Democratic candidates' campaigns, said that "right through the motivational campaign theme, they were doing everything right." By contrast, Obama was "overconfident ... and certainly not prepared" before the evangelical audience with definitive answers to clearly explain to voters his world view, values and vision, Lakoff said....

"John McCain is jujitsuing Obama's strengths," said one leading California-based Democratic strategist, who spoke on condition of anonymity because of his work with a nationally known party figure.

The strategist said many Democrats witnessed their candidate's performance at the Saddleback forum with "a feeling of vague nausea" because "the stature gap (between Obama and McCain) widened dramatically in the mind of any viewer who watched."

Lakoff, a progressive academic often cited for his views on the importance of "framing the debate" in politics, said the discussion at the Lake Forest evangelical church provided an unusually clear window into the two candidates' strengths, including how effective they are heading into upcoming debates and the final sprint of the presidential race.

Two examples from Saddleback that Lakoff and others said underscore Obama's troubles:

-- McCain - asked his reason for running for president - confidently outlined a strong message of "country first," urging service to America. That idea, dominant in McCain's message and the theme of the GOP convention, showed that McCain Republicans have "figured out the formula" of effective campaign communication - and brilliantly melded ideas touted by both Presidents Ronald Reagan and John F. Kennedy.

-- Obama, in contrast, delivered a far more nuanced plea for empathy and building bridges across party lines instead of a more direct answer - telling voters what those values would mean specifically "to your children, your future, your environment," said Lakoff.

August 21, 2008 11:24 AM

lesserliz said:

A big driver in the cost of medical care is Medicare. Before it everyone could afford medical care and hospitals were antiseptic-smelling carpetless places. Now costs are prohibitive and hospitals  are like hotel lobbies and are infested with MRSA and C-Diff. When gov subsidizes or pays, costs go up and there are shortages like with grain. Hey did you see on that HBO John Adams series where they did a mastectomy in his daughter's bedroom-there's economy for you. Well John lived to be 90+ and died at home and not hooked up to tubes at a cost of tens of thousands to the taxpayers. Also I noticed that the vaccinations for smallpox worked out well back then-without the FDA-not like today's which cause autism. (I'm only being half serious in all this).

August 21, 2008 11:46 AM

Jonathan Cohn said:

lesserliz-

You say that "before it everyone could afford medical care." This is flat-out wrong. The reason the government created Medicare was that large numbers of the elderly were depleting life savings and falling into severe poverty because they coudln't find insurance and, thus, couldn't pay their medical bills.

If you meant to say that "before it medical prices were a lot lower," that's certainly true. The biggest reason for that is the unchecked demand for new technology. Medicare has abetted this; after all, it brought insurance to millions of people who didn't have it previously. But that has nothing to do with whether Medicare is a government program.

On the contrary, over its history Medicare has actually held down costs better than private insurance. And, if you look abroad, universal coverage systems--including single-payer models--hold down costs better than our fractured, non-universal, and heavily private system does. And the better ones do it while providing access and quality that is, if anything, better than what we get here.

Respectfully,

Jonathan

August 21, 2008 1:53 PM