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    Saturday, February 28, 2009

    Health Care - Why Hard Cases Make Bad Case Law

    William F. Buckley used to like to say that "Hard cases make bad case law" as a way to counter arguments that Liberals usually used to explain why their particular choices needed to be enacted into law.

    These usually involve some hard luck sob story that is designed to stir people to say "We should do something about that." The Conservative typically has a difficult time refuting these things, focused as we tend to be on the larger picture. The reality is the consequences of setting policy based on the needs of the few usually results in unintended consequences in regards to the needs of the many.

    Such is the case of Pamela Rinchich, who Rob (of The Online Magazine formerly known as Rob's Blog) highlights today (guess this story ran on CNN this week).

    While the story says her case is "not unique" it provides us no numbers to back this up, and the Families USA group who is pushing this story does not give us any numbers either.

    But, applying a little Radcon math to it, we can make some assumptions - let's assume that about 92% of Americans who want to work today are employed, and that of those 92%, all of them have either employer-provided health coverage, or can provide it themselves through a private policy (it's Radcon math, y'all, so unless you can improve the assumption with some actual numbers, I am going with it). That leaves the 8% of Americans who are now unemployed. The latest number who are drawing unemployment benefits is about 7 million Americans. Again, the number is higher for all unemployed, but let's limit our discussion to those drawing unemployment benefits, as they would be the one's who fall into Ms. Rinchich's scenario.

    Let's assume all of them lost their employer-provided health insurance with their jobs and went the COBRA route. Of those 7M, how many need to use their COBRA benefits for the 18 months for something other than routine medical care? About .5% of Americans will be diagnosed with cancer each year, and let's assume that the vast majority of them are in retirement, say 50% are, so they are ineligible for our survey. That means about .25% of people who fall into the "employment eligible" group have cancer. Let's multiply by 10 to make that number account for other expensive diseases, and we'll get to 2.5%. So, using very crude radcon math, we're looking about 150,000 people who fall into Ms. Rinchich's scenario. Of those, we can expect that some number of them will be covered completely under the COBRA scenario, and eventually find work again. Since COBRA benefits can be carried for 18 months, let's assume that of that 8% unemployed, half of them find work in time to resume their medical benefits. That cuts the number down to 75,000. So, that's my estimate of the number of people who fall into Ms. Rinchich's category.

    Certainly 75,000 of anything does not make it unique, so, I agree that her situation is not unique. But, is it worthy of radically altering our entire health care system, which seems to work just fine for the 260M or so of covered people? Hard cases make for bad case law.

    Since Rob cherry picked the article, I have some more questions that the article didn't answer:
    • Ms. Rinchich is now married. Is she not covered under her husband's health plan? Is he unemployed, too? Is it a pre-existing condition for her that they won't cover her? (Seems given the political persuasion of CNN, this would be another chance to bash the current system, so I assume this is not the case).
    • The story says she owes $268 dollars to her cancer doctor. Can she NOT come up with $268? Is there no United Way where she lives? No church's or other charities?
    • Has she run out of money to pay anything? Does her husband have no money? She was laid off in March 2008. Under COBRA, she would have 18 months of coverage at her expense, but, less than 5 months later (Honeywell covered her through September), she has quit paying the premiums, apparently. Why? The article leaves us to wonder. My suspicion is she elected not to pay for her COBRA coverage, which probably she was eligible for in September, when her Honeywell severance package likely expired in September.
    What Rob doesn't tell us is that the just-passed Stimulus package includes a provision where the government will pick up 65% of COBRA premiums as part of the unemployment package. So, for people in her situation, there is already some relief.

    That doesn't answer the problem. We have a problem with coverage in this country. The government just isn't the answer.

    See my previous post on this for more.


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