Saturday, March 03, 2007

Universal health care as a progressive issue

There are several issues that I consider key issues for progressives, but I'll only focus on one of them now: Universal health care. Universal health care is the general principle that everyone has access to good affordable health care, no matter their income. For most of the Western world, this is considered a given. However, in the US, it's estimated that 18000 people dies per year because of lack of proper health care.

I have argued before that not only is the current US system more expensive than other health care system, the quality and availability of health care is among the worst in the Western world. Even when you only consider the government expenditure to health care, the US ranks among the top when it comes to cost, especially when taking buying power into consideration.

This post is about the other reasons why universal health care should be a major issue for progressives in the US. All numbers in the following are taken from different reports by The Henry J. Kaiser Family Foundation, unless stated otherwise.

The basics

First some basic numbers: In the US, 61% of all non-elderly have a job-based insurance (either their own, or as a dependent), 5% have a private insurance, 16% depend on Medicaid, and 18% are uninsured.
In other words, nearly one in five of all non-elderly Americans are not covered by a health care insurance.

Unsurprisingly, most uninsured and Medicaid dependents are among the poorest Americans. However, many job-based insurances only covers some medical costs, which might lead to big medical bills, even with a health care insurance.

A study shows that 54.5% of all personal bankruptcies are at least somewhat caused by medical reasons, and that 27% of all people who went bankrupt had uncovered medical bills exceeding $1000 in two years before filing for bankruptcy (source: ). Yet over 60% of those filing for bankruptcy had not had any lapse in health care coverage in the last two years. When you consider that 1.458 million Americans filed for bankruptcy in 2001 where the study was conducted, we are talking staggering high numbers here.

So we have a situation where not only are nearly one in five American uninsured, people risk financial ruin even if they are insured.


Since 61% of all non-elderly have a job-based insurance, they are dependent on working (or having a partner working) for a company that covers them. This means less flexibility to change jobs, in effect forcing people to stay in jobs they are unsatisfied with, until they can find a different job with coverage.

Job-dependent insurance is not necessarily available to all employees. Often it is only available to full-time employees, making it hard for people in low income jobs (which often are part-time) to get a job-based insurance (Barbara Ehrenreich covers at least some of the issues with health care for low-paying jobs in her book Nickel and Dimed – On (not) getting by in America).

So the current system forces people to stay in works that they might not want to stay in, and often doesn't cover people who don't work full time.

Rising prices

Job-based health care insurance is partly paid by the employer and partly by the employee, while private insurance is paid fully by the insured. The current average cost of insurance is $4242/year for an individual insurance, and $11480/year for a family insurance. In the case of a job-based insurance, the employee pays ~14.8% of the individual insurance ($627) or ~25.9% of the family insurance ($2973). For low-income families, that's a rather large part of their available money.

Insurance prices are of course not unchanged, and the trend during the last 20 years has been an increase in insurance prices well above both the annual inflation and the increase in the workers’ earnings (the only exception to this was in 1996). Figure 1 shows the increases in insurance premiums, the inflation and the increases in workers’ earnings.

As can be seen in the figure, there is absolutely no comparison. To make the differences even more clear, I'll try to explain it in a different way.
If someone earned $100 in 1987, they would earn $146.6 in 2005, which means that they earn slightly more than they did back then, since $100 in 1987 is equal to $145.4 in 2005, when you take inflation into consideration. In other words, both of these parameters have increased less than 50% in the last 20 years.
The insurance premiums, on the other hand, have in the same period increased to $325.1 for every $100 paid in 1987 - an increase of 225%.

No wonder that more and more Americans are uncovered.

The feminist issue

Another problem with job-based health care insurance is that some of the health care is dependent based. In other words, only one member of a family has a job-based insurance, but it covers all of the family.

Given the headline of the section, I guess people can guess which gender of workers is more dependent on their partner's insurance than the other (I am not being hetro-normative here – as the US system works, same-sex couples are in general not considered dependents).

Yep, that's right. Women. 62% of all women have a job-based insurance, but nearly 39% of these are as dependents (24% of the total). Men on the other hand have 63% job-based coverage, of which fewer than 21% are as dependents. So, in other words, while men and woman are generally equally covered by job-based insurances, nearly twice as many women as men are not covered in their own name.

Need I explain why this could be very problematic in the case of a divorce? And why this is generally problematic, seen from a gender equality perspective?

Think of the children

Yes, the children.

The stats for the children: 56% are covered by a job-based insurance (likely most as dependents), 4% by a private insurance, and 28% by Medicaid. That leaves 12% uninsured. 12% of all children living in the US.
That’s 9 million children.

69% of these 9 million children live in families where at least one family member works full time. And they are still uninsured. You know why? Because their families earn an income below or close to the poverty level. Fully 73% of the uninsured children comes from families that earn less than twice the poverty level – that's less than $40,000 per year for a family of four.

Of course, some people will probably point out that there is a difference between an uninsured 18 year old and an uninsured younger kid. Well, let’s break down the numbers:

18 years: 3.9 million, of which 18% are uninsured.
13-17 years: 21.8 million, of which 13% are uninsured.
6-12 years: 27.7 million, of which 10% are uninsured.
1-5 years: 20.3 million, of which 10% are uninsured.
Less than 1 year: 4.1 million, of which 14% are uninsured.

In other words, there are literately millions of pre-school children that are uninsured.


Given the above information, I cannot see how universal health care cannot be one of the key issues for any progressive candidate, Not only is the current US health care system expensive and inefficient, it’s also strengthens then unequalness in the US society, not only when it comes to income, but also when it comes to gender (and given the differences between ethnic groups when it comes to income, it almost certainly also strengthens it when it comes to race unequalness).

It is also a question of human decency. How can the US live with having tens of millions of people uncovered by some kind of health care plan? How can it live with having hundreds of thousands of people going bankrupt every year from medical related costs? And how can any society let millions of children be uncovered by health care?

And not only is it a progressive issue – it's a winnable issue. Poll after poll shows that a majority of Americans support universal health care. Many even if it means increased taxes (which I will still claim it doesn't). So why are the Democrats not hammering on this issue? Why do they let the Republicans frame the debate about health care costs?

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Blogger Kaethe said...

You know, the only answer I have is that the insurance companies must be extremely generous campaign donors.

March 08, 2007 5:49 PM  

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