Ronald Reagan used to pick on “Welfare Queens,” black, urban, female welfare recipients who were supposedly living high on the hog by having lots of children and squeezing extra money out of the system. The image played to people’s stereotypes and was generally believed, even though it was always hard to find real-life examples. Meanwhile there were plenty of fat cats using tax shelters to avoid paying taxes, but they weren’t stigmatized.
The uninsured seem to have become the new welfare queens. From the Boston Globe (Uninsured not to blame for ER waits)
Contrary to conventional wisdom, hospital emergency departments in the United States are not overrun by uninsured people who want free treatment, US researchers said today…
“The uninsured are actually underrepresented in the emergency department. Seventeen percent of Americans are uninsured, almost one in five people. But in the emergency department, we see somewhere between 10 and 15 percent uninsured, closer to 10 percent,” [study author Dr, Manya] Newton said.
One reason for this, she said, is that unlike the insured, people with no insurance are billed for the full cost of the visit.
Readers of the Health Business Blog won’t be surprised by these findings, since I’ve written multiple times that the uninsured use the ER less than insured people.
The perception that the uninsured are clogging up emergency rooms is a dangerous one, not only because of the bias it represents against the less fortunate, but also because it drives incorrect policy assumptions. One of the arguments for universal health insurance in Massachusetts and California was that it would [at least partly] pay for itself by shifting patients from the ER to primary care. Here’s what Blue Cross Blue Shield of MA said in its explanation of the Massachusetts health reform law back in 2006:
Since Massachusetts already pays at least $1.1 billion to provide health care for the uninsured, the additional funding requirements are expected to be modest. The bill will redirect the existing funds that currently pay for the cost of care, which is often accessed in the emergency room by people who lack insurance. In the future these funds will subsidize the cost of insurance, which will enable people to access care in more appropriate settings and establish relationships with PCPs.
Actually what happens is the insured use all modes of treatment more. Providing people with health insurance means they’ll consume more of everything, as we’re seeing in Massachusetts.
It’s not that shocking that cost influences people’s decisions on whether or not to seek health care services. I’m not surprised that hard economic times are causing people to delay or skip care they would otherwise have sought. Even insured people have substantial out of pocket costs, and those costs can be enough to make a difference, especially when the world around them seems to be going to pot.October 22, 2008