It is true that health insurance premiums are going up (due in great part to government policy). It’s true that affordability limits access. But the extent to which it limits access is debatable. Sometimes people just make high-risk choices – that is, the choice to smoke and to go uninsured.
In North Carolina – which has among the lowest cigarette prices in the country despite heavy new taxes – a pack of cigarettes costs about $4.85 – that is, if you buy it by the carton (cheaper). A pack-a-day smoker will therefore pay about $145.50 per month.
Also, in North Carolina, which has fair-to-middling insurance premiums compared with other states, has a $1000 deductible health insurance plan (Blue Cross/Blue Shield Blue Advantage Plan B) for a man my age (35 years old) for $140.28 per month ($2500 deductible, not that much if you have to have $30K knee surgery). There is also an HSA plan (with a $5000 deductible) for $80.00, then you can contribute some extra each month to an HSA (which happens to be the plan I have and like, and HSA funds will pay the deductible).
Both of these plans pass what I call the “cigarette test.” That is, if you can get insurance for less than a pack-a-day habit, then anybody who smokes doesn’t have a bitch. They can quit smoking and thus have cheaper health insurance. As it happens 30-35% of people considered “poor” are smokers.
That means that at least 30 percent of people who are poor enough to qualify for Medicaid could afford to buy private health insurance, despite the soaring costs. I’ll pass over the fact that the costs are soaring (again) largely due to government policy.
Some of my brief talking point proposals on the Next Right track well with the Singapore model, though I don't mention higher copays across the board. In any case, I have a piece coming out in the Raleigh News & Observer soon, where I give a nod to Singapore.
In any case, we shouldn't be emulating France. Not only is the French system a massive unfunded liability, it is also a black box (i.e. they don't measure waiting times like they do in Canada). See Glen Whitman on the circularity of the studies on world health systems that put France up top.
There are far too many things to blog about. The holiday was nice, but it's just as therapeutic to have an outlet for errant thoughts and anger spasms as it is to take a break from feeding the beast. So I guess I'm back. Nothing deep or earthshattering today. Just thought I'd lube your Google Readers so that you'd look out for new posts. As ever, I'd like to thank my 36 or so readers for being patient with me.