_You Do Not Have Health  Insurance_ (http://www.truthout.org/080709A) Wednesday 05 August 2009 _by: James Kwak  |  Visit article original @  The _base_line Scenario_ (http://_base_linescenario.com/2009/08/05/you-do-not-have-health-insurance/)   At a free clinic in Denver, Colorado, Timothy Taylor -  who is unemployed and without health insurance - speaks to his son. (Photo:  Getty Images) Right now, it appears that the biggest barrier to  health care reform is people who think that it will hurt them. According to a  New York Times poll, 69 percent of respondents in the poll said they were  concerned that the quality of their own care would decline if the government  created a program that covers everyone. Since most Americans currently have  health insurance, they see reform as a poverty program - something that helps  poor people and hurts them. If that's what you think, then this post is for you.   You do not have health insurance. Let me repeat that.  You do not have health insurance. (Unless you are over 65, in which case you do  have health insurance. I'll come back to that later.) The point of insurance is to protect you against  unlikely but damaging events. You are generally happy to pay premiums in all the  years that nothing goes wrong (your house doesn't burn down), because in  exchange your insurer promises to be there in the one year that things do go  wrong (your house burns down). That's why, when shopping for insurance, you are  supposed to look for a company that is financially sound - so they will be there  when you need them. If, like most people, your health coverage is through  your employer or your spouse's employer, that is not what you have. At some  point in the future, you will get sick and need expensive health care. What are  some of the things that could happen between now and then?   Your company could drop its health plan. According to the U.S. Census   Bureau (see Table HIA-1), the percentage of the population covered by   employer-_base_d health insurance has fallen every year since 2000, from 64.2%  to 59.3%. *  You could lose your job. I don't think I need to tell anyone what the   unemployment rate is these days.**  You could voluntarily leave your job, for example because you have to move  to take care of an elderly relative.   You could get divorced from the spouse you depend on for health  coverage. For all of these reasons, you can't count on your  health insurer being there when you need it. That's not insurance; that's  employer-subsidized health care for the duration of your employment. Once you lose your employer-_base_d coverage, for  whatever reason, you're in the individual market, where, you may be surprised to  find, you have no right to affordable health insurance. An insurer can refuse to  insure you or can charge you a premium you can't afford because of your medical  history. That's the way a free market works: an insurer would be crazy to charge  you less than the expected cost of your medical care (unless they can make it up  on their healthy customers, which they can't in the individual market). In honor of the financial crisis, let's also point  out that all of these risks are correlated: being sick increases your chances of  losing your job (and, probably, getting divorced); losing your job reduces your  ability to afford health insurance, either through COBRA or in the individual  market; if your employer drops its health plan, that's either because health  care is getting more expensive (meaning harder for you to afford individually)  or the economy is in bad shape (making it harder for you to get a job that does  offer health coverage). In addition, there is the problem that even if you  are nominally covered when you do get sick, your insurer could rescind your  policy, or you may find out, as Karen Tumulty's brother did, that your insurance  doesn't cover the treatment you need. But while important, this is a  second-order problem. The first-order problem is that as long as your health  insurance depends on your job, your health is only insured insofar as your job  is insured - and your job isn't insured. The basic solution is very simple. In Paul Krugman's  words: regulation of insurers, so that they can't cherry-pick only the healthy,  and subsidies, so that all Americans can afford insurance. I know that there  are lots of details that consume people who know health care better than I do,  and I know those details are important. But as an individual who is worried  about his or her own health insurance (and that is the point of this post),  that's what you want. You want to know that if you lose your job, you won't be   shut out because you're too sick,*** and you won't be shut out because you're   too poor. But we won't get there as long as people remain  convinced that health care reform is for poor people. It's for everyone -  everyone, that is, who isn't independently wealthy or over the age of 65.  Because all of us could lose our jobs. (Have I repeated that point enough?) Now, I admit that if you are over 65, health care  reform is not for you, because you are in the one group in our society that  enjoys true health insurance - insurance that you cannot lose, that is paid for  by taxes, and that is effectively guaranteed by the government. So maybe there's  nothing in it for you, except perhaps an improvement to the pre_script_ion drug  component of Medicare. But I cannot believe that, as the only people who have   reliable health insurance, you would oppose health care reform that would  provide reliable insurance for the rest of us.   * This doesn't necessarily mean that all those people  lost employer-_base_d health coverage because their employers dropped their plans;  some of it could be that the employee contributions were increased to the point  where they couldn't afford it anymore. 1.1 percentage points of the shift is due  to people becoming eligible for Medicare or military health plans. ** If you lose your job, or you get divorced from a  spouse through whom you get health coverage, you are eligible for continued  coverage under COBRA. However: (a) this only necessarily applies if your  employer has 20 or more employees; (b) you have to pay the full, unsubsidized  cost of your health plan, which can be particularly difficult after losing your  job; and (c) it only lasts for eighteen months. *** I said earlier that insurers can't charge  premiums that are less than the expected cost of your care unless they can make  it up on the healthy customers, and they can't in the individual market. But if  all insurers are prohibited from doing medical underwriting (pricing _base_d on  healthiness), then they will all have to overcharge the healthy customers, and  the system could work. This is still a tricky issue - and single-payer (like  Medicare) would be much simpler - but it can be made to work even in a  competitive market. Update: A couple of small things. and one big  thing: First, I called rescission a second-order problem,  which was probably surprising, given that my post on it got over 100,000 page  views (thanks to the Huffington Post). I meant second-order not to mean that  it isn't important, but that it is logically subsequent to the question of  whether you have health insurance in the first place, and this post is about  whether you can count on having health insurance in the first place. Second, J.D. points out in the comments that there is  a problem with COBRA I didn't mention: If you relocate to an area where your  employer doesn't have a plan, then you can't count on it at all. Third, a few people said that it was the fault of the  administration (or the Democrats generally) that health care reform is _frame_d as  a poverty program. There's something to that point, but I don't think it's  quite right (and I didn't put it right in the first paragraph above). I think it  is a poverty program - but the vast majority of us are, actually, poor. The   combination of job loss and serious illness could wipe out almost anyone (under   the age of 65 - actually, anyone over 65 as well, since Medicare doesn't cover  extended nursing home care), and we all suffer serious economic insecurity  because of it. The political problem is that the median American doesn't  identify as poor (although he probably thinks he needs more money) and thinks  that poverty programs are for other people. I think that middle-class and  upper-class people should support poverty programs for other people, but that's  an unnecessary discussion. My point here is that the vast majority of us are  poor, when it comes to health care, and therefore we should get behind reform  out of self-interest. When you're a mental midget, every mole hill looks like a  mountain .