I remember way back in the paleolithic era when the debate was actually going on over what health care reform would look like (before we settled on "greatest threat to liberty ever," that is) and my comment section was deluged with folks who railed against the very concept of universality in healthcare insurance. They, further, denied that such a thing as involuntary uninsurance existed, or that underinsurance was a problem at all. These commenters tended to be the rugged individualists of our great nation, and their testimonies were along the lines of: "I have type 1 diabetes and I've had three limbs amputated and I do just fine with my catastrophic health insurance plan" or "I have chosen not to buy health insurance and I'm just so badass that if I ever get sick I will go off onto an ice floe so as not to be a burden to society, so why should we hand out free healthcare to goddamned moochers?"
Or something like that.
So, it actually turns out that catastrophic/high deductible plans actually kinda suck. I'll take a moment to allow you to recover from the shock of that.
Now we already knew that being uninsured made you (that's the general you, not you in particular) more than four times as likely to skip or delay needed care. That makes sense. Healthcare is expensive, even if you're only paying charity rates, if you can find them. If you have to pay, and you don't have a lot of money, in many cases you just don't get it. And it turns out the same phenomenon is at play with high-deductible "catastrophic" plans. When you have to pay out of pocket (which is the central concept of these plans), you're more than twice as likely to skip or delay needed medical care.
Still, high-deductible plans are great if you never have to make a claim, but there you have it...
Fun factoid: if you have a high-deductible plan, and someone in your family is ill, then the effects on your own health trickle down, as you also tend to skimp on your own health care.
And back to the subject of the truly uninsured, the CDC came out with a report which found that (again, brace yourself for the shock) being unemployed makes you about 3 times as likely to be uninsured.
Aaron Carroll takes on directly the myth of the "uninsured by choice" cohort:
Many people like to think that being uninsured is a “choice”. And they’re correct, in the sense that you can “choose” not to buy insurance. I get that. But many people “choose” not to buy insurance for the sole reason that it’s crazy expensive. The average – not gold plated, but average – employer sponsored insurance plan for an individual plan in the United States last year was $5429. And that was just the premium. It didn’t include deductibles, co-pays, or co-insurance. The average family plan was $15,073. The median salary in the US, on the other hand, was less than $50,000 for households. For individuals, the median paycheck is $26,364. When you’re making that amount, and you lose your job, paying for that insurance plan is no longer possible. Paying for COBRA is even harder, as it’s usually more expensive.I kind of wonder why I am wading back into this topic. Experience has shown me that it's become such an ideological shibboleth that the true believers are completely impervious to reason and data. I'm like a moth to the flame, I guess. I just can't leave it alone. Someone is wrong on the internet.