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Subject: Health (Un) Insurance numbers rss

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Scott Russell
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I heard from a friend (so there's a good chance it was on Fox News) that the 40 million uninsured number is greatly inflated.

Supposedly if you have a gap in insurance like when switching jobs and are without coverage for even a single day, you are counted as not having insurance that year.

Also, people that are covered by Medicare and/or Medicaid (can't remember if it was both or only one) also count as in the uninsured.

Anyone know if this is legit info?
 
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David desJardins
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qzhdad wrote:
Anyone know if this is legit info?


No, it's exactly backwards. The Census estimates count anyone who had health insurance for even one day of the year as "insured" (although there is some underreporting). See page 19:

http://www.census.gov/prod/2008pubs/p60-235.pdf
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David desJardins
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P.S. There were 44 million Medicare beneficiaries in the US in 2008. So one can safely imagine that they aren't being counted as uninsured!
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Scott Russell
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Thanks, it sounded fishy.
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Any figure about how many of those insured aren't fully covered?
 
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David desJardins
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HeinzGuderian wrote:
Any figure about how many of those insured aren't fully covered?


The reference I quoted, at least, is from census data, so they just ask people if they are/were insured and accept their responses.

It would be a lot more work to get a large random sample of Americans to give you the exact details of their health coverage so you could determine if it's adequate. Which is why statistics on that are sketchy.
 
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Jorge Montero
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HeinzGuderian wrote:
Any figure about how many of those insured aren't fully covered?


Relatively few people are fully covered, if by that you mean the Spanish level of coverage. You'll be hard pressed to find a plan withoun a $150 payment for visiting an emergency room, and $20-$50 for going to a doctor's office. Then, there's deductibles(minimum amount, outside of copayments, that you must pay from your pocket before insurance kicks in), percentages not covered (like only taking care of 80% of hospital costs), and lifetime maximum benefits.

Now, the problem is defining what underinsurance means. A $7000 Out Of Pocket maximum with only 80% of hospital expenses covered is not going to destroy a programmer's economy, but someone else in my company that only makes $8.50 an hour would have a lot of trouble paying those $7000 if something happened to them. Something long term that involved paying near this fee every year, like needing dialysis, would send them straight into bankruptcy without passing go.
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David desJardins
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Koldfoot wrote:
I think unemployment numbers are based on the number of people seeking unemployment benefits... with some tinkering with the numbers here and there.


Shhh. Don't try to confuse him with facts.
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Richard Hefferan
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Koldfoot wrote:
Drew1365 wrote:


Similarly, although I am self-employed, I am counted as unemployed.

I think unemployment numbers are based on the number of people seeking unemployment benefits... with some tinkering with the numbers here and there.


Wow...you may want to stop swaying to the right when Koldie is steering you back towards the center. I think that may be one of the heralds of the apocolypse.
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Snoo Py
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Koldfoot wrote:
Drew1365 wrote:


Similarly, although I am self-employed, I am counted as unemployed.

I think unemployment numbers are based on the number of people seeking unemployment benefits... with some tinkering with the numbers here and there.


Btw, what happens when people reach the end of their unemployments benefits? Are they still being counted as unemployed?
 
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Richard Hefferan
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Joe Cool wrote:
Koldfoot wrote:
Drew1365 wrote:


Similarly, although I am self-employed, I am counted as unemployed.

I think unemployment numbers are based on the number of people seeking unemployment benefits... with some tinkering with the numbers here and there.


Btw, what happens when people reach the end of their unemployments benefits? Are they still being counted as unemployed?


Short answer, no.

Long answer, no, but the "end" of unemployment benefits is a nebulous thing in hard times. Unemployment benefits were extended at least twice under Bush, and may have been under Obama as well. I stopped checking when I went back to work. In good times they last 6 months. I received mine for 12; I eventually found a job in a different career because I couldn't stand not working any longer.
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David desJardins
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Joe Cool wrote:
Btw, what happens when people reach the end of their unemployments benefits? Are they still being counted as unemployed?


Yes. Pretty much none of what has been posted here about measuring unemployment is true. If you have a job, you're counted as employed. If you don't have a job, but you are available for work and actively looking for work, you're counted as unemployed. Otherwise, you're not counted in the labor pool at all.

http://www.bls.gov/cps/cps_htgm.htm

Unemployment benefits don't, strictly speaking, have anything to do with it. But, to collect unemployment benefits, you do have to be actively looking for work, so some people give up looking for work when their benefits run out, and thus drop out of the labor pool. But you don't have to.
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Eric Knauer
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This study may be of interest-

http://www.cato.org/events/pdfs/oneill_06-2009-who-are-the-u...

"...at the outset of this report, we noted that the annual report
by the Census Bureau of the official number of uninsured
has been dramatized by advocates and the media to
the point where many people believe that the millions of
people cited as uninsured are without care and are in very
poor health. However, a significant fraction of the uninsured
are in a financial position to purchase their own insurance,
and we refer to them as the voluntarily uninsured.
The remainder are the involuntarily uninsured, those
with incomes that are low enough to make it unlikely
that they could afford health insurance if they wanted to
purchase it.

We define the voluntarily uninsured as those whose incomes
are at or above 2.5 times the poverty threshold and
find that about 43 percent of the uninsured in the 18–64
age group fall into that category. (The percentage of the
uninsured classified as voluntary varies among the states
from a low of 27 percent in Mississippi to a high of 55
percent in Vermont.)

The socio-economic characteristics of the uninsured, and
particularly the involuntarily uninsured, are very different
from those of the privately insured population. Education
differences are striking. One-third of the involuntarily
uninsured are high school dropouts compared
to only 7 percent of the privately insured. A disproportionately
large percentage of the involuntarily uninsured
are young, a third are immigrants, close to half are single
without children, and close to 40 percent did not work
during the year. Presumably, efforts to cover the uninsured
would target the low income population..."
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Snoo Py
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DaviddesJ wrote:
Joe Cool wrote:
Btw, what happens when people reach the end of their unemployments benefits? Are they still being counted as unemployed?


Yes. Pretty much none of what has been posted here about measuring unemployment is true. If you have a job, you're counted as employed. If you don't have a job, but you are available for work and actively looking for work, you're counted as unemployed. Otherwise, you're not counted in the labor pool at all.

http://www.bls.gov/cps/cps_htgm.htm

Unemployment benefits don't, strictly speaking, have anything to do with it. But, to collect unemployment benefits, you do have to be actively looking for work, so some people give up looking for work when their benefits run out, and thus drop out of the labor pool. But you don't have to.


Thank you.
I followed your link, and found these tables:
http://www.bls.gov/news.release/empsit.nr0.htm

The thing that I found surprising is that unemployment for men is more than 30% higher than for women. I wasn't expecting this, and moreover with such a strong difference. Times have changed. It would be interesting to dig into the reasons for this.....
 
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David desJardins
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eknauer wrote:
We define the voluntarily uninsured as those whose incomes
are at or above 2.5 times the poverty threshold


Making up nonsensical definitions makes the Cato Institute look pretty dumb, huh?
 
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Eric Knauer
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DaviddesJ wrote:
eknauer wrote:
We define the voluntarily uninsured as those whose incomes
are at or above 2.5 times the poverty threshold


Making up nonsensical definitions makes the Cato Institute look pretty dumb, huh?


There's a section on why they chose that definition:

"Despite the subjectivity involved, as one looks up and
down the income distribution, there are clearly some
income situations that would not cause controversy if
classified as income at which health insurance is affordable.
For example, a $10,000 health insurance policy
would represent only 6.7 percent of the income of a married
couple with no dependent children and a family
income of $150,000 a year. It is likely that uninsured
couples without children at such high income levels are
voluntarily uninsured, as the purchase of health insurance
would not require them to seriously cut back their
spending on necessities such as food and housing. At the
other end of the spectrum, a $10,000 insurance policy
would represent 40 percent of the income of a couple
with children and a family income of $25,000; a $6,000
policy would be almost a quarter of their income. Most
would conclude that the uninsured in those situations
are involuntarily uninsured.

It becomes more of a challenge to distinguish the involuntary
from the voluntary when we consider the 23.7
million uninsured persons who are in households with
incomes between $25,000 and $75,000 who make up
50.5 percent of the uninsured. In this range, it is obviously
more difficult to determine a reasonable standard
for “ability-to-pay”—i.e. the dollar amount of income an
individual or family unit must have in order to afford a
given policy premium....

...Our basic approach to determining who among the uninsured
are involuntary or voluntary is to observe the
proportion of individuals at various income levels who
obtained coverage from private insurers or were uninsured
(where income level is measured as multiples of
the poverty line for each family type). We assume that
the greater the proportion who obtain private coverage
at a given income level, the more likely it is that those
at the same income level who remain uninsured are voluntarily
uninsured."


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Ben Vincent
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Joe Cool wrote:
The thing that I found surprising is that unemployment for men is more than 30% higher than for women. I wasn't expecting this, and moreover with such a strong difference. Times have changed. It would be interesting to dig into the reasons for this.....


Men tend to dominate fields like construction and manufacturing, which are very susceptible to recession. Unemployment in the construction industry is significantly higher than the national average. Women are much more prevalent in education and health care, which are much more resistant to recession.
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David desJardins
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eknauer wrote:
There's a section on why they chose that definition:

Our basic approach to determining who among the uninsured
are involuntary or voluntary is to observe the
proportion of individuals at various income levels who
obtained coverage from private insurers or were uninsured
(where income level is measured as multiples of
the poverty line for each family type). We assume that
the greater the proportion who obtain private coverage
at a given income level, the more likely it is that those
at the same income level who remain uninsured are voluntarily
uninsured."


Thus illustrating the true ideological bias here. The essence of the health insurance crisis is that people with health problems, those who need health insurance the most, are least able to purchase it. So it's not at all surprising that some people with a given income (healthy people) can buy insurance, while other people with the same income (people with health problems) can't. The idea of drawing an income line and declaring that people under that line can't afford insurance and people over the line can ignores the whole nature of the problem.
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Eric Knauer
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DaviddesJ wrote:
eknauer wrote:
There's a section on why they chose that definition:

Our basic approach to determining who among the uninsured
are involuntary or voluntary is to observe the
proportion of individuals at various income levels who
obtained coverage from private insurers or were uninsured
(where income level is measured as multiples of
the poverty line for each family type). We assume that
the greater the proportion who obtain private coverage
at a given income level, the more likely it is that those
at the same income level who remain uninsured are voluntarily
uninsured."


Thus illustrating the true ideological bias here. The essence of the health insurance crisis is that people with health problems, those who need health insurance the most, are least able to purchase it.


How is a couple whose income is $100,000 and chooses not to pay for insurance less "able to purchase it" than another couple with the same income who choose to pay for it? The "ideological bias" present seems to be one of basic subjective preference:

"The premise that guides our thinking is that there is
an underlying distribution of individuals/family units
ranked by their preferences for health insurance coverage,
and this distribution depends on health status, risk
aversion, and other personal characteristics. We also assume
that when income rises, people at a given level of
taste or preference for insurance will likely spend more
on health coverage. (In other words, health insurance is
what economists call a 'normal good.') However, those
with a relatively low taste for health insurance may not
increase their purchase of insurance very much, if at all,
as income rises. Thus, we can observe a small proportion
of higher income individuals who remain uninsured,
and they will be individuals who place the lowest value on healthcare.

At the other end of the income distribution
are those who have relatively low incomes, yet purchase
health insurance. This group likely assigns a high
value to health insurance, either because they have poor
perceived health or are highly risk averse. At the lowest
income levels, of those remaining uninsured, there will
be a number of persons who value insurance but simply
cannot afford it. This is the underlying conceptual model
that has guided our assignment of the numbers of voluntarily
and involuntarily uninsured."
 
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David desJardins
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eknauer wrote:
How is a couple whose income is $100,000 and chooses not to pay for insurance less "able to purchase it" than another couple with the same income who choose to pay for it?


Your question has nothing to do with the excerpt that you posted approvingly, in which the Cato Institute authors argue that whether one can afford to buy health insurance depends only on one's income and on how much one "wants" to have health insurance, and not on one's actual health.

This despite the obvious fact that insurance costs several times more, or is not available at all, to people in poor health.

Would you please explain how the quoted excerpt can be accurate, and everyone making more than 2.5 times the poverty level can afford to buy insurance if only they wanted to? I can point to any number of examples in our present system of people in poor health who have more money than that but wouldn't be eating or have a roof over their heads if they tried to buy health insurance at market rates.

Some people are not in good health. They can reasonably expect that their health care in the next year is going to cost $50,000, or more. If their annual income is $50,000, how on earth can they buy insurance on a free market? Who would sell it to them? Only a company that wants to lose lots of money?
 
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Eric Knauer
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Quote:
David desJardins
Quote:
Would you please explain how the quoted excerpt can be accurate, and everyone making more than 2.5 times the poverty level can afford to buy insurance if only they wanted to?

Not everyone (studies deal with estimates). As far as the 2.5 number, the authors write:

“The percentage of all individuals (excluding those with public coverage) who obtain private coverage rises to 89 percent for those in families with incomes equal to or greater than 3.75 times their poverty threshold and to 79 percent for those with incomes between 2.5 and 3.75 times their poverty threshold. In view of the large percentages covered at those levels, we consider uninsured units with incomes above 2.5 times the poverty threshold to be voluntarily uninsured. Among families with incomes below 2.5 times the poverty level, the percentage obtaining private insurance drops to 61 percent for those with incomes between 1.25 and 2.5 their poverty thresholds and then falls even more sharply to 36 percent for those with incomes less than 1.25 times their poverty thresholds.”

The authors note the difficulty of determining a “a reasonable standard” for the ability to pay but clearly there is a level of income that makes a difference.
Quote:
I can point to any number of examples in our present system of people in poor health who have more money than that but wouldn't be eating or have a roof over their heads if they tried to buy health insurance at market rates.

Yes, I understand anecdotally this is unfortunately the case.

Some interesting numbers from the study:

-A simple regression of the percent of the population ages 18–64 either insured or voluntarily uninsured on state GDP shows that for every $10,000 increase in state per-capita GDP, the percent either insured or voluntarily uninsured increases by about 7 percent (a statistically significant result).

-the uninsured are more likely to be male (55 percent versus 49 percent) and under the age of 35 (50 percent versus 33 percent); they are much more likely to be unmarried and have no children (49 percent versus 29 percent).

-a much larger percentage of uninsured men than women are single and have no children, while uninsured women are more likely to be unmarried with children.

-those who are unmarried and have no children, women are more likely to have insurance than men (an increase of 6 percentage points). This result is consistent with that of other research that has found women to be more risk averse than men. Among those who are married with children, there is no significant difference by gender, which is to be expected given that spouses are likely to be jointly covered.

-Race has little effect on insurance among the married with children group. However, among the not-married/no-children group, the black non-Hispanic population is less likely than white non-Hispanics to have private insurance (a 5 percentage point difference). Much stronger differences appear between Hispanics and other ethnic groups. Thus, the probability of having private insurance is 13 percentage points lower among Hispanics who are not married and without children than it is for corresponding non-Hispanic whites.

-regression analysis indicates that personal characteristics such as educational attainment, immigrant status, and income are important factors in determining who is likely be insured by private insurance and who is likely to be uninsured, both voluntarily and involuntarily.
 
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David desJardins
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eknauer wrote:
Not everyone (studies deal with estimates).


No, the problem with this study is that they don't try to estimate how many people can afford insurance, based on available data. They just assume that everyone at a certain income level can afford health insurance.

Thus, they assume the nonexistence of the very problem that health care reform is designed to solve! No wonder they don't support it.

Quote:
"The percentage of all individuals (excluding those with public coverage) who obtain private coverage rises to 89 percent for those in families with incomes equal to or greater than 3.75 times their poverty threshold and to 79 percent for those with incomes between 2.5 and 3.75 times their poverty threshold. In view of the large percentages covered at those levels, we consider uninsured units with incomes above 2.5 times the poverty threshold to be voluntarily uninsured."


Exactly. Can't you see how ludicrous this is? Say there are 10% of people at a certain income level who can't afford health insurance, because of preexisting conditions and the structure of the market. So they don't have insurance. Then the Cato Institute argues that, the other 90% of people in that income bracket can afford insurance, so of course, by the laws of probability, they must be able to afford it too.

What nonsense.
 
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Eric Knauer
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Quote:
"The percentage of all individuals (excluding those with public coverage) who obtain private coverage rises to 89 percent for those in families with incomes equal to or greater than 3.75 times their poverty threshold and to 79 percent for those with incomes between 2.5 and 3.75 times their poverty threshold. In view of the large percentages covered at those levels, we consider uninsured units with incomes above 2.5 times the poverty threshold to be voluntarily uninsured."

Exactly. Can't you see how ludicrous this is? Say there are 10% of people at a certain income level who can't afford health insurance, because of preexisting conditions and the structure of the market. So they don't have insurance. Then the Cato Institute argues that, the other 90% of people in that income bracket can afford insurance, so of course, by the laws of probability, they must be able to afford it too.

What nonsense.


I think you're being a bit hysterical, David. Say there is 2% who can't afford the insurance? Say there are many at two times the poverty level who can afford insurance and choose not to? Is a five percent change either way that significant? It's clear that many choose not to insure and that decision is strongly influenced to socio-economic factors. This wouldn't be the case if it was just an affordability issue.

Feel free to post other studies that have addressed this topic.

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David desJardins
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eknauer wrote:
I think you're being a bit hysterical, David. Say there is 2% who can't afford the insurance?


Say there are 20%.

Quote:
It's clear that many choose not to insure


It's not clear to me. That's the whole fucking* problem. It's certainly not clear from the Cato Institute data, since they don't make the first effort to find out who in their population can afford insurance and who can't. They just make the ridiculous statement that whether you can afford insurance depends only on your income. Which is the goal of health care reform, and very, very different from the situation today.

* note intensifier used here
 
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Bojan Ramadanovic
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Also, note that if the large number of uninsured are people who choose not to insure that does not mean that it is in any way a good thing.

If anything, if everyone for whom it would be economically advantageous to not insure went ahead and did not insure then the cost of insurance would become unbearable for those who need to insure and the entire system would collapse.

One of the major points of achieving the full coverage is to reduce the cost by increasing the amount of "good risk" in the pool. Seeing as greatest risk factors for (expensive) diseases are either genetic or linked to the childhood circumstances, this policy amounts to an enforced money transfer from those who won a birth lottery (born to healthy and prosperous parents) to those who did not.

Seeing as there is absolutely no personal merit involved in having been born with low propensity for disease I fail to see how this is not a just action to take.

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