• Don’t forget children

    Paul Krugman made me pause this morning with his op-ed, Free to Die. In particular, he made me remember that as we debate (even here) whether we can actually choose to let people opt out of life-saving care in the United States, there is a sector or the population that doesn’t get to participate in that argument. I’m talking about children, because of course, children don’t get to make a “decision” to forego health insurance. Their being uninsured is not “freedom“. And here in the US, it’s worth remembering that we do a terrible job of protecting our children with respect to health insurance. Here’s the percentage of children who were uninsured for all of 2008 in a number of comparable countries: Note that doesn’t include kids in the US who were uninsured for some of the year, or who were underinsured. If I included those children, we’d look even worse, and everyone else would look about the same. And lest you think I’m cherry picking a bad year, here is most of the last decade:

    As we congratulate ourselves for slightly better outcomes in this metric in the last year, I think it’s important we remember how much room for improvement remains. Moreover, as we debate the “freedom to choose” not to purchase insurance, it’s important to remember that there are large numbers of individuals who lack that right. They still need to be considered. And sometimes protected.

    • When conservatives say that they really do care about the needy and people unable to fend for themselves, children would seem to fall into this category, I tend to take them at their word. Some of the nicest, most giving people I know are very conservative. Then, I hear them defend a system with these kinds of results. The cognitive dissonance is harsh. I think this is at least partially because our society has become so stratified that you can easily live not knowing those who fall into the above group.


    • I am playing the devils advocate here because I am not against providing care for children, for one thing it is pretty cheap.

      This brings up some issues:

      1. To what extent should people be responsible for their children?
      2. How quick do we intervene between children and parents?
      3. Without insurance one can still pay for care after the fact.

      I think that as much as possible conservatives want parents to responsible for their children directly. It tends in general (healthcare may be an exception) to be more efficient that way.

      BTW the children of the Amish do not have what would be officially considered health insurance and they might not accept Government provided if it were offered to them.

      In some of your posts lately you post seem to be trying to shame us but how about this, how about Haitian kids in Haiti? Before we buy any luxuries, should we ensure that they have health insurance and care equal to that of middle class Americans? Some Americans spend hundreds of dollars on health care for pets but send not a dollar to provide healthcare to poor Africans.

      It is not only conservatives. We humans are just not that good. We believe parents should provide first. If you want to shame us why focus on the relatively well of USA children?

    • As ‘health advocates’ stand against the backlash from the Hard Right in the coming years, I hope we all remember to ask this question of the budget cutters, the libertarians and any other wolves in sheep’s clothing who would roll back ObamaCare and/or Medicaid, ‘Pray tell, what child does not deserve health care?’ Having asked that, I hope we all draw an indelible line in front of the removal of any child from health care coverages now in place. If we do not ALL stand and fight for universal coveage for children, who are we?

    • I remember a segment on CBS Sunday Morning show from years ago when Charles Kuralt was still alive. The singer Paul Simon had funded two mobile health vans, one in NYC and the other in Louisiana I think, to bring care to uninsured children. After the segment Kuralt pointed out that European countries didn’t have to have charitable contributions from famous people to try to make sure their children had access to health care. All their children had access.

      Does this mean Europeans simply care more about their children than Americans do? he asked. Why yes, he answered, it does.

      • If the question is whether Europeans care more about their own children than Americans, the answer is No. If the question is whether Europeans care more about ensuring the safety and comfort of other people’s children in their nations than Americans, then the answer has to be Yes. But of course, “Europeans” and “Americans” have a spectrum of views, so this is an abstraction and a kind of average, not a universal truth.

    • The Amish will take advantage of healthcare, even if they don’t have insurance. The community also has money set aside, in case of emergency. They also can’t be in debt for more than 7 years, the family provides land for farming, the community will build houses and/or barns if needed. And they don’t pay electrical or phone bills. Some are investing in solar technology (for their barns) and the community provides a school for them up to, I think, 8th grade. So, they might not have the “luxuries” but their community would seem to take far better care of their children than we English do.

    • I am confused by this post, Austin. Cherry picking in Medicare is incentivized when a single rate per member is paid by the government to the plan, but the plans’ cost varies according to each member’s health. However, Medicare Advantage has been moving away from a flat payment rate for years now. Medicare payments by the feds are risk-adjusted, and there is a desire by insurers for members with pre-existing conditions.

      Also look at all the activity in Medicare SNP (special needs plans)..

    • Sorry, Aaron, not Austin!

    • By the sheer numbers, it sounds like most of these kids are illegal immigrants to US. Which easily explains why they are not covered by Medicaid.

      And the second easy reply – what percentage of these kids does not actually get medical care? Without this statistics, the numbers you showed are irrelevant.

      Thirdly, without any discussion about the parents, this statistics proves nothing. If you remember, massive amounts of money is spent on Medicaid, welfare, foostamps and subsidized housing. How come the parents cannot afford to get insurance for the kids? Or maybe they don’t think their kids need insurance, because they pay in cash? And maybe, those parents are illegal immigrants, as are their kids – which is why they don’t get Medicaid.

      All in all, this statistics proves nothing, because it lacks sufficient background information.

      Last but not least – what’s the age bracket in this graph? Who is considered to be a “child”? According to Obamacare, people as old as 26 should be kept on the parents’ insurance.

    • “‘Pray tell, what child does not deserve health care?’”

      Let’s ask the parents who decided against buying insurance. Shall we?