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Middle Class, Self-Employed Fall Into Health Insurance Gap

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In a page right out of Professor Warren's book, the New York Times today reports that, "Solidly middle-class people are one of the fastest growing subgroups of uninsured Americans." The source? The nonpartisan Employee Benefit Research Institute, who released a new report showing that "more than one-third of the uninsured ... have family incomes of $40,000 or more" and "more than two-thirds of the uninsured are in households with at least one full-time worker."

For the sake of politics, this sort of data is important. Health insurance is not an us-versus-them sort of issue. Rather, it strikes squarely at the center of the electorate.

The NYT story highlights two other aspects of the problem:

First, self-employed individuals have a particularly tough time getting coverage. Isn't entrepreneurship supposed to be central to the American pathos? Surely, we can find a way to get those folks covered. The NYT story quotes an industry rep, explaining why health premiums are prohibitive for those outside group plans:

In a group health plan, the employer typically pays a large share of the premium, so most employees sign up as soon as they are eligible, regardless of their health status. The health plan covers a mix of sick and healthy workers. By contrast, individuals and independent contractors are more likely to defer coverage until they need it, so the pool of people insured is, over all, less healthy. Sick people consume more health care. As a result, the cost to insure them is higher.

This is a classic collective action problem. Even if some people were prudent enough to join an individual plan early, too many others "defecting," making coverage unaffordable to all. It seems that a health coverage mandate, like that included in the new MA law and under consideration in CA now, may be the only way to resolve this social dilemma. It seems a little odd to force people to buy coverage, but that seems to be the rational remedy to the problem.

Second, the NYT story says,

Politicians are once again speaking about universal coverage as a goal, though opinion polls show that many voters still oppose the idea of a government-run health care system.

This is pretty lame reporting on NYT's part. OK, "many" voters oppose the idea, but HOW MANY and what is your source anyway? As Derek Lindbloom reported right here at Warren Reports last week, the New York Times's own poll found that, "64% of Americans believe the government should guarantee health insurance for all Americans (against only 27% who say it should not)." Moreover, "60% said they would be willing to pay more in taxes for universal health care." See the original NYT story here. The title? "Most Support U.S. Guarantee of Health Care."


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The problem of obtaining health insurance for middle class self-employed people is nothing new, and also extends to small businesses with only a few employees. The costs are extremely prohibitive and have been so for decades. I know that years ago, when I first started working in my field, I recieved three offers of employment, and felt I needed to select the only one that offered health insurance, even though the two other firms would probably have been better choices, career-wise. As far as I can see, only some sort of universal system where the risks are spread across a large group, rather than individual companies, can resolve this.

Why is it that we as a society have tied health coverage to employment in the first place?

The hardest thing about any political campaign is how to win without proving that you are unworthy of winning. ~~Adlai E. Stevenson

The "American pathos"? While this may be sadly appropriate, I think you meant to say the "American ethos".

No, I meant pathos. I meant to say that entrepreneurship is wrapped up in our emotional identity as a nation. Ethos would refer more to the identity of the speaker.

http://en.wikipedia.org/wiki/Pathos

http://en.wikipedia.org/wiki/Ethos

Well, ok, but I think you're confusing the technical meaning in rhetoric (which does not apply, since you're not using it to describe an argument that someone is making) and the meaning when applied to a value system. See

http://en.wiktionary.org/wiki/ethos
http://en.wiktionary.org/wiki/pathos

But I agree with your main point - I am employed at a corporation partially so I can provide health insurance for my self-employed husband.

I was indeed referring to an argument, albeit an implicit one.  The argument goes something like this:  Entrepreneurship is important to us Americans -- its part of how we define ourselves as a country.  Yet, our entrepreneurs have no good way of getting health covereage.  Therefore lets fix this system, so that they can get covered.

Why is it that we as a society have tied health coverage to employment in the first place?
Mostly by historical accident, unintended consequences of WWII. One reason was that some businesses, under wage and price controls, could offer medical coverage as a benefit for competitive recruiting, but one that didn't fall under the controls.
Another aspect was Henry Kaiser's belief that a healthy workforce helped productivity, so he started, as a not-for-profit, what became Kaiser Permanente.
Of course, it wasn't that expensive to provide the limited medical care available at the time.

--
Howard

*equal opportunity offense to both extremes*

"Those who cannot remember the past are condemned to repeat it" [George Santayana]

Try using Websters instead given that your meaning refers to a "distinguishing feature" of American identity.

Websters: ethos

Websters: pathos

[update: the wiktionary also provides the correct definitions.]


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