"...what sane person would not have health insurance?"

Yesterday, a very intelligent person I follow tweeted this:

Now, Doug is a smart guy. I don’t always agree with his views, but they are generally well thought-out and well argued, so I thought such a simplistic statement had to be trolling. Clearly, nobody wants to be uninsured! That’s OBVIOUS. Right? Hello? The answer was so easy that, of course I missed it. He, and I’m sure many other people, really believes people make a conscious choice to remain uninsured. So I thought I’d share a few stories from my own life, my own family, to illustrate that sometimes it’s not as simple as just getting off your ass and buying insurance. Stories are true, only names are changed.

1. James: My brother James is 29 years old. He has no high school diploma and he lives with our parents. He has asthma and bipolar disorder. He has been uninsured since he turned 25 and aged out of my parents’ policy. He makes $12 an hour working security. He and 2 coworkers drive 202 miles round trip to the nearest major city 4-6 nights a week in order to work. His income pays for keeping his car registered, insured and running, his cell phone, and cigarettes. Yes he needs to quit smoking but it’s the only pleasure he has in life (he doesn’t drink or do drugs and can’t afford to date). When he needs asthma medication, he has to save up and go to an occupational medicine clinic, or he shares my mom’s asthma medicine if she has extra. If neither of those are an option, he just has to hope that when the next asthma attack hits that he’s not working and can get to an ER. He is not on medication to control his bipolar disorder because he cannot afford it. He’s resigned to the belief that his asthma will kill him.

2. Natalie: My cousin and his 26 year old girlfriend Natalie have a baby together. Natalie works part time as a waitress (no benefits). My cousin works commercial construction (also no benefits) and travels where the work is, and is often gone all week and home on the weekends. They have few childcare options. She receives government assistance so she can buy food for the baby. They can’t get married because if they do, she will no longer qualify for government assistance because of my cousin’s $40k a year income. Neither of them has or can afford medical insurance. The baby is covered under Medi-Cal. They don’t do anything or go anywhere.

3. Jenn Jenn finished high school and college early, kicked ass in law school, but can’t seem to pass the bar exam. Her family of attorneys cut her off when she failed the first time, and her prospective employer rescinded her offer. She couldn’t find a job for months, moved in with her boyfriend who pays her rent, and got on food stamps. She was eventually able to find a job at Nordstrom and takes home an average of $2000 a month from commissions (more at Christmas). Nordstrom doesn’t offer benefits. She has carpal tunnel in both hands which makes it very difficult for her to write or type (a problem when you’re studying for the bar). She needs another surgery and can’t afford it, and can’t afford her pain medicine.

4. Me: In 2008 I worked for a law firm and had fantastic PPO insurance. I was laid off in December 2008. My student loan payment was around $600 a month; my share of rent was $550 a month. Unemployment paid $1,800 a month. The layoff was a surprise and I had no savings. COBRA was going to be over $800 a month so I opted not to continue coverage, thinking I’d get individual insurance when I got back on my feet. The market was still in the toilet and there were no jobs, so I bit the bullet and opened my own firm, but didn’t have any income for 4 months. By the time I was able to afford insurance, I had unknowingly developed a condition that made me uninsurable at the time and will always be considered a preexisting condition. Luckily I got married and am covered now under my husband’s insurance. Individual coverage would probably still be too expensive.

These stories are sad, but by no means unusual. In 2010, the US Census reported the median household income at $44,000; over 54% of households in the US earned less than $50,000  per year. Households, not individuals. At income levels that low, we’re talking about the ability to pay rent and buy diapers.

The debate about the ACA and the individual mandate continues. Personally, I think the ACA got it wrong. We all need access to affordable care, but I think it should be done through a government-subsidized (that’s right socialized I said it) program. Forcing everyone to buy private health insurance just supports and strengthens the root of the problem: privatized, profit-driven healthcare. But that’s another post altogether.

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