Map of life expectancy at birth from Global Education Project.

Thursday, October 22, 2009

The world turned upside down

Since people who are chronically ill presumably need health care even more than people who are not, one might hope that people who are not insured are disproportionately those who are young and healthy and just figure they don't need it. And indeed, that's what a lot of defenders of the status quo will say. Alas, it is not so.

As Pizer et al report, low income people with chronic health problems and disabilities have high rates of not being insured, even though one of the purposes of Medicaid is to provide access for that population. Indeed, they have considerably higher rates than the average among all Americans. This is yet another malignantly ridiculous situation in which common sense understanding of reality collides with policy to produce a massive explosion of inhumane idiocy.

The data for this analysis, from the Medical Expenditure Panel Survey, already moves us a step or two away from reality. MEPS asks about nine chronic conditions, but not, for example, cancer or chronic kidney disease, HIV, and others one might think are important. And it's definition of disability depends on functional categories, whereas the relevant category for policy is ability to work, since that's what determines Medicaid eligibility. Many people with disabilities, or course, do work, although bizarrely, many cannot only because they would lose their Medicaid if they took a job. (No joke.)

So already we're a bit askew. Nevertheless the results are instructive. Overall, the MIPS from 2000-2005 has 16.4% of adults under 65 uninsured. (It's more now, of course.) among moderate and higher income people, people with disabilities and chronic health conditions were somewhat less likely to be uninsured than those without; but among low income people, that is not the case. The disparity is most striking in the South, where more than half of people with incomes below 125% of poverty were uninsured, including 32.3% of people with chronic health conditions and 21.5% of people with disabilities.

Yup, the South rises again. The region where political resistance to health care reform is the strongest is the region where 1/3 of low income people with chronic health problems didn't have health care five years ago, and more don't have it today. And what happens when your diabetes is uncontrolled? Oh, not much. You might lose your legs, you might go blind, you might have kidney failure, you might drop dead. But the alternative would be socialism.

No comments: