Young people think they don't need health insurance

[Darth Wong]

http://www.cnn.com/2009/HEALTH/03/20/ca ... index.html

'Young invincibles' OK with risk of no insurance
By Stephanie Smith
CNN Medical Producer

NEW YORK (CNN) -- Austin Horse talks about his collision with a taxi cab with the sort of droll indifference you might expect from a 24-year-old.

"Every now and then, you know, there'll be accidents or mishaps where a car hits me," said Horse, a full-time bike messenger, smiling as he leans against his mottled, rusted bike frame. "You try to avoid those."

His apathy might be understandable if he had not already had a cab roll over his legs, had not already plowed into car doors while biking, and had not already had countless other mishaps during the past four years cycling around New York City streets.

"Once I was run over by a taxi and another time I had a livery cab knock me off my bike and I got stuck in a sewage grate," said Horse.

Despite his inherently dangerous job -- Horse has made a couple of trips to the emergency room in the past few years -- he is working without health insurance.

Horse is one of millions of what the insurance industry has dubbed "young invincibles," a group of 18-to 29-year-olds who reside in a precarious gray area when it comes to insurance coverage. Many work low-wage jobs, yet they just miss qualifying for government low-income health insurance programs. They can no longer get insurance under their parents' plans.

"Health insurance is not one of the things that younger adults are focused on," said Dr. Ken Thorpe, a professor of health policy at Emory University. "They come off their parents policies, and they're now facing a very high cost. They basically have to pay that high price themselves."

Instead of paying exorbitant prices, many young people choose to remain uninsured, risking injury while harboring the belief that youth alone can buffer them from illness.

A recent study conducted by the Commonwealth Fund, a center for health care policy, found that 13.7 million people ages 19 to 29 did not have health insurance in 2006. The total number of uninsured that year was 47 million, which means "young invincibles" composed almost one-third of all the uninsured in the U.S.

Despite their good health relative to aging populations, a recent report from the Centers for Disease Control and Prevention paints a grim picture about health care trends among young people.

The study, released earlier this year, found that accidents accounted for 70 percent of deaths among those 18 to 29.

"It is a big mistake not to get insurance," said Dr. Alan Garber, director of the Center for Health Policy at Stanford University. "There may be a tendency on the part of young people to underestimate how likely they are to have an accident or some severe illness."

Horse argues that "young invincibles" aren't throwing caution to the wind, simply believing that they're unsusceptible to injury. He gives credence to the notion that young people feel invincible, but adds that many feel a general leeriness about the health care system.

"I've had many friends who have had insurance, and they've had something really serious happen to them," said Horse. "And they have had all sorts of issues where the insurance didn't do anything for them, and they're left with not just medical bills but this frustration."

Griffin McPartland was about Horse's age when he biked the streets as a messenger in San Francisco, California, without health insurance.

Fact Box

18 percent
Percentage of Americans under age 65 without health insurance

36 percent
Americans polled who are not confident they could pay bills after major medical emergency

$1,946
What the average worker will pay for health coverage at large companies this year

Sources: National Coalition on Health Care, CNN/Opinion Research, Hewitt Associates

"In the days when I was an independent contractor, I was only concerned with the fallout from an accident," said 34-year old McPartland. He scoured the market for jobs offering insurance, but they were hard to come by. His strategy, at least for a few years, was to stretch out his time in junior college and take more classes so that he could stay on his mother's insurance plan.

"Those were slim times," said McPartland. "As a goal, I always tried to get a job with insurance, but it just didn't work out that way."

Meanwhile, other uninsured acquaintances found ways to circumvent the problem of no insurance.

"You would hear stories about people giving fake names at the ER or blowing out before being discharged so they wouldn't be responsible for the bill," said McPartland. In New York, Horse says he sees the same thing.

But somebody pays, said Emory's Thorpe.

"In cases where somebody who doesn't have health insurance shows up in the emergency room, we all end up paying for it. Taxpayers pay for it. People with private insurance pay for it. Somebody's picking up the bill."

According to Thorpe, who is also the executive director of an organization called the Partnership to Fight Chronic Disease, about $50 billion a year is spent to cover medical bills incurred by the uninsured.

The Obama administration has laid out a broad framework plan to help uninsured people. Cornerstones of the administration plan include reducing costs and providing affordable health care that is accessible to anyone who needs it.

After years of living without insurance, McPartland says he "made a grown-up decision" and became a garbage man.

"The benefits are out of control," said McPartland, who now raises a 21-month-old daughter with his wife. "This is worlds apart from anything I've had in the past. I don't have to worry about co-payments, prescription drugs, nothing out of pocket."

Right now, health insurance is not on Austin Horse's radar but, he says, he believes that one day universal coverage might be a reality for him.

"The government would pay for health care, and yet we would still have our private choice of doctors," said Horse. "It's the best of both worlds."

Until universal coverage becomes reality, Thorpe suggests that "young invincibles" purchase a high-deductible plan that at least covers catastrophic events, such as major accidents, as a temporary remedy to the soaring cost of health care.

"If we're ever going to get toward universal coverage," said Thorpe. "We've got to find ways to get younger adults to purchase health insurance."

This is the problem with allowing people to opt out of the system. "Freedom"!

[Kanastrous]

It would be less of a problem if opting out meant that you positively forfeited coverage by the system, and that no exception would be made to help you if you decided to opt out. At least that way the bulk of the problems fall squarely on the people choosing to opt out, rather than being laid at the doorsteps of the people who decided to opt in, but would otherwise get stuck with the tab for those who didn't.

[Slacker]

Well, without putting too fine a point on it, I can afford health insurance or I can afford to pay my other bills every month. It's not cheap for someone like me who doesn't have a contracted position in their school district yet, and I can't pay for health insurance if I can't also pay for, example, my rent and my car insurance. The reality of the beast is that a large number of people in my age range just don't have health insurance as any sort of reasonable option. I'd certainly *love* health insurance, and hope to have it for next year, but realistically I'm not going to bankrupt myself and still not receive adequate coverage. I had insurance last year, as I was registered as a student, and still ran up a six or seven hundred dollar bill for one trip to the ER with stomach pains. That was the first time I needed medical care in something like ten years. So why should I lay out thousands of dollars a year for something I probably won't need, can't afford in the first place, and, due to what I could afford to pay for insurance, generally won't adequately cover whatever malady I might have anyway.

[Broomstick]

That is the crux of the issue - it's not just a feeling of invincibility that makes people decide to go "bare", it's also financial reality. It's no different than when I was laid off and my Other Half and I had the choice of either paying COBRA premiums to maintain our insurance and definitely going bankrupt in 3-4 months, or taking the risk of going bare and hoping that we didn't have anything we couldn't handle until we did get insurance again but being able to pay for housing, food, and all the other necessities of life.

A lot of these young adults are actually making a rational choice, choosing possible disaster (a medical problem) over certain disaster (trying to pay for insurance priced high enough to bankrupt them). Due to the cost of insurance, and to the difficulty of getting any individual policy with even a minor pre-existing condition, they are essentially being forced into taking this gamble.

In other words, the "choice" to go bare is often not much of a choice at all. I have to eat... I might need health coverage. Eating takes priority. Having a place to live takes priority. You can't eat health insurance and it won't keep the rain off your head.

[Darth Wong]

Which is precisely why the whole damned thing should be a government program. Then its support could be means-adjusted.

[Alferd Packer]

I thought this was particularly interesting:

Horse argues that "young invincibles" aren't throwing caution to the wind, simply believing that they're unsusceptible to injury. He gives credence to the notion that young people feel invincible, but adds that many feel a general leeriness about the health care system.

My wife and I are smack in the demographic of the article, and we have excellent insurance through my wife's company, and my wife balks at ever going to the doctor for some reason. She understands that we need to have insurance, but for some reason, she feels we shouldn't use it except in emergencies or as part of routine yearly checkups. I am of the opinion that we should take full advantage of it if we feel something is wrong; that's the whole fucking reason for it. Why let something progress to an emergency?

About six months ago I felt a strange, persistent ache in my lower abdomen, so I decided to go to the doctor. Well, some blood and urine work, X-rays, and finger up my ass later, I learned I had prostatitis, and I was prescribed some antibiotics and sent on my way. They didn't quite do the trick, so I went to see a urologist a few weeks later who confirmed the prostate infection(oh, yippie!), prescribed a different antibiotic, and after the infection cleared up, did a follow-up ultrasound on my prostate to confirm that infection was clear. I was pronounced fit as a fiddle some four weeks after I first went to the doctor.

Now, maybe the first batch of antibiotics would've cleared up the infection, if given a little more time. But why fuck around? And for the record, once it was determined (twice) that there was indeed something wrong with me, my wife was all for the doctor visits. But who knows what complications there could've been if I'd let the prostate infection percolate until I was doubled over in pain and absolutely had to go to the doctor?

As an aside, the total costs for all my doctor's visits were probably well over $1000, and that was just for a relatively straightforward prostate infection. I absolutely cannot imagine having to shell that kind of money out of pocket, and I'm extremely grateful that I'm fortunate enough to only have a 20$ copay for any kind of visit.

[Edi]

There was a good article on Time in the March 16 issue about underinsured people. The worst possible thing anyone can do is take limited time insurance, because every time it comes up for renewal, everything diagnosed up until that point, even if it is ongoing, is a "pre-existing condition" and all claims will be denied.

By the way, guess which state has the worst situation with regard to any and all health insurance issues and regulation? Texas. Their legislation is such that it is tailor made to allow insurance companies to rip people off and fuck them over and leave them with no recourse.

The only reason that article was written, by the way, was that the brother of the reporter who wrote it got fucked over by some fly-by-night scam insurance operation with the limited time insurance bits.

[salm]

My wife and I are smack in the demographic of the article, and we have excellent insurance through my wife's company, and my wife balks at ever going to the doctor for some reason. She understands that we need to have insurance, but for some reason, she feels we shouldn't use it except in emergencies or as part of routine yearly checkups. I am of the opinion that we should take full advantage of it if we feel something is wrong; that's the whole fucking reason for it. Why let something progress to an emergency?

There is such a thing as overuse of insurance. There´s a certain type of person who will run to the doctor for every little bullshit they get. Small cut on the hand, go to the doctor. Slight cold, go to the doctor. This can be a drain on the insurances for no good reason which will make the insurances more expensive for everybody. Germany had a problem with that and is trying to counter it by introducing a 10€ fee. If you go to the doctor you now have to pay 10€. This is supposed to keep poeple from going to the doctor for really minor bullshit. I´m not sure if it works but it indicates the problems that can come up if your doctors visit is completely free.

[Justforfun000]

After reading Edi's examples it makes me even more certain that universal health care is the only fair way to go. It's absolutely unconscionable that a company who's prime objective is to make as much money as possible, and lets face it.. what corporation isn't, is involved in issues of basic health. Fine, if you want some kind of EXTENDED insurance that has to do with awards of oh....$200,000 if you lose a limb and things life that which they offer from companies like Visa and such, than it's a different animal. That's supplementary and more to do with compensating yourself in the event of bad luck.

But primary health care and the ability to block you from any "pre-existing condition? What kind of fucking health system is that? It's completely contrary to not only preventative screening, but sends out the strong message that "Don't discover you're sick before you really need us because you only have one shot and then you'll be excluded".

That really encourages a healthy, regular checkup and screening mentality with your doctor, eh?
It's absolutely ridiculous.

[PeZook]

You know, I can't help but wonder if America is shooting itself in the foot with this.

Think about it: if a 19 year old working an entry-level job without health insurance gets a disease and goes bankrupt because of his emergency room bills, he will never become a stable middle-class worker paying taxes throughout fifty years and capable of supporting his family.

He'll become a hobo and freeze to death under a bridge. And, well...the chance of that happening over nearly ten years is really pretty high.

[Eulogy]

You know, I can't help but wonder if America is shooting itself in the foot with this.

Think about it: if a 19 year old working an entry-level job without health insurance gets a disease and goes bankrupt because of his emergency room bills, he will never become a stable middle-class worker paying taxes throughout fifty years and capable of supporting his family.

He'll become a hobo and freeze to death under a bridge. And, well...the chance of that happening over nearly ten years is really pretty high.

Or he'll turn to crime, excaberating the problem and making more people poor (unless he only targets rich people, but what are the chances of that happening, eh?), and evenutally burst the already burdened prisons.

Enough cases like this, and the US WILL collapse, becoming even more of a third world nation.

[Guardsman Bass]

More likely, what will happen is that he'll go broke, and end up trying to use one of the Medicaid-equivalents. Assuming, of course, that he can get on the roll and get care, seeing as how Medicaid is pretty much always on the chopping block when the bad economic times come.

[Darth Wong]

This is the thing: Americans think that they keep people from "suckling off the public teat" with policies like this, but in reality they actually make it more likely that they will do so. The difference is that by the time they get on public assistance, they will have been virtually destroyed as contributing members of society, sucked dry by the health-care industry.

[Duckie]

I don't know how anyone can do this- I had the flu and got almost 2500 dollars in medical bills just from going to the emergency room- x-rays, antibiotics, doctors' fees, lab work, etc. Thankfully I have health insurance because I'm not sitting on 2500 dollars right now.

I dunno how anyone can survive without health insurance if they get sick, and who doesn't get really sick like once every year or two?

[General Zod]

I don't know how anyone can do this- I had the flu and got almost 2500 dollars in medical bills just from going to the emergency room- x-rays, antibiotics, doctors' fees, lab work, etc. Thankfully I have health insurance because I'm not sitting on 2500 dollars right now.

I dunno how anyone can survive without health insurance if they get sick, and who doesn't get really sick like once every year or two?

The only times I've managed to get seriously sick in the last . . .6 years or so were food poisoning related; and I only went to the hospital once out of both those. Maybe I'm just lucky but I manage to avoid getting seriously sick most of the time; although given how expensive hospital visits tend to be I generally won't go in at all unless it's something that won't go away after the first 48 hours and is otherwise seriously debilitating. Even the health insurance plan I got right now isn't that great, and I only have that through my employer; if better plans were more affordable I'd have fewer qualms about contacting a doctor for a checkup.

[PeZook]

The only times I've managed to get seriously sick in the last . . .6 years or so were food poisoning related; and I only went to the hospital once out of both those. Maybe I'm just lucky but I manage to avoid getting seriously sick most of the time; although given how expensive hospital visits tend to be I generally won't go in at all unless it's something that won't go away after the first 48 hours and is otherwise seriously debilitating. Even the health insurance plan I got right now isn't that great, and I only have that through my employer; if better plans were more affordable I'd have fewer qualms about contacting a doctor for a checkup.

Yeah, if you're lucky and have a resillient system, you can easily go through half a lifetime without getting a cold. But if you don't, and you catch something before you can save up money to pay the medical bills, you can easily be destroyed as a contributor to society.

Better yet, since a person who can't afford health insurance generally won't go to see a doctor untill the problem becomes severe, something which could be stopped by a brief doctor's visit and some cheap antibiotics can easily become a problem requiring expensive diagnostics, specialist consultations et al.

[White Haven]

Just need to echo there...I'd have health insurance if I could, but that takes more money than I have after rent, bills, food, and suchlike. Am I invincible? Heck no. I've got a solid immune system, so I rarely get sick, and when I do I tank it. So far, so good, but it's a gamble, and one I'd much rather not have to make.

Then of course you get into the innate problem of having employers supply your health care. When employees are hard to come by, there's incentive for employers to offer coverage and things of that nature. When qualified, unemployed people are lining up out the door, where's the incentive for an employer to offer coverage if he doesn't have to?

[The Yosemite Bear]

I'm almost 40, I spend a good deal of my monthly expenses on medicals, and I see too many 18-24 kids telling me how usesless our company's medical plan is. Which I find insulting, because it's one of the last, good, old fashioned currupt, union medical plans with life insurance and pension included. Sure I'm talking $58 a month, for Medical, Dental, Vision, Life, and a pension?

The employer pays 80% of the overage, $10 doctor's visits, and $8 perscriptions?

[Slacker]

Your younger co-workers are insane, I'd happily pay for that coverage, and will receive similar when I do managed to land a contract. We pay a little bit more of a monthly fee, but still.

[Ziggy Stardust]

I don't think it is necessarily just an issue of younger people thinking they are invincible, but a lot of people in this age range grew up without having to worry much about health care (I am referring to the middle-class, I realize the case is different for people from lower-income families). I know plenty of people whose parents were always able to afford insurance coverage and health care for their children (and would intentionally hide any financial inconvenience it might have caused from them). I think it is possible that younger people from middle-class backgrounds simply don't realize how important health insurance can be. Of course, this is a jaded perspective based on my experiences with college kids.

[Count Dooku]

I broke my hip, femur, and dislocated my leg (all at the same time) I was on the verge of death. Total bill for the weeks of hospital stay and numerous surgeries to keep me alive, let alone fix the hip and femur, was $180,000. That was the cost to keep an 18 year old kid alive. My femoral artery was compromised, and I thought I was going to bleed outt in the ER. After I was stable (almost a week and two surgeries), I got a really nasty infection from the second surgery that almost killed me. I had to stay in the hospital the entire time. I was too weak to sit up. Once the infection was finally gone, the doctors rebroke my hip and femur so that they could go in and fix it properly.

Now, half the left side of my body is Titanium Carbide, and I'm back to normal. Total cost for all that shit: almost $250,000. If I didn't have medical insurance, I'd be in debt for life. There is a reason medical bills are the number ONE cause of bankruptcy in the U.S. I can't believe (well, I really can) that so many 'kids' in the U.S. think they don't need health insurance. The ONLY reason my generally redneck friends actually pay for their own health insurance is because of my ordeal.

What I find odd is that they had no problem with my being bed ridden for 6 months, and on a cane for three more, but they're up in arms when they hear about the disabled needing government money to get by. I've asked them before what they think I would have done if I was on my own, and the best response I've ever gotten was, 'shit I don't know'. I ALMOST got through to them once or twice with that, but to them, I'm just an exception to the rule.

I know my situation isn't the norm, but it does happen.

[Covenant]

I'm not invincible but I'm also not made of money, so I can't afford health insurance. At the moment I'm probably going to be getting a little more money, so I may be able to afford something--I have catastrophic coverage in case I get hit by a bus, but I can't go to the doctor if I'm sick. I do have an Aetna discount card for my dental coverage, which is worth every cent.

If single-person plans were affordable, we'd buy it. I'd love health insurance, but it isn't offered to me, and I don't make enough to buy a car and pay housing, so spending a good deal of money per month for things I can afford to grit my teeth through? It's not feasible.

[darkjedi521]

When I fell of my parent's plan 2 years ago, my job didn't include coverage. I was able to be covered under COBRA on my parents plan to the tune of $650/month ($40/month less than my rent). It was very tight financially, but I was in a new area and the nearest relatives were 2 and a half hours away from me. If it had cost too much more, I would have done without till I found my current job. Tying insurance to full time employment ensures that a large segment of the population can not get private coverage, even if they are willing to pay because it is more than one can hope to pay on a low wage job.