You were already paying for the uninsured

There was just a newsflash on MSNBC that someone was on fire on the National Mall. I just can’t deal with the crazy anyone.

Anyway: everywhere you look, the keyboard commandos are fighting the good fight for freedom to pay more to insurance companies. They can’t seem to get it through their heads we were already paying for the uninsured.

The first thing to understand is that when people don’t have insurance, it hurts other people withinsurance. In fact, the uninsured affect the finances, quality of care, and availability of medical assistance to every person in a community, regardless of their insurance status.

This is the fundamental issue that too many people do not understand. There seems to be this belief among some that those who are uninsured simply go off and die somewhere, thus having no impact on the medical-care-delivery system in the United States. But the opposite is true—the uninsured have some of the most dramatic effects of any group on our nation’s health-care system.

Here’s why: they seek out care, but usually when their once easily treated conditions have blossomed into a serious illness. Because private doctors do not take them, and because free clinics are not readily available, the uninsured seek their care in emergency rooms.

To some Republicans, that’s just fine. During the 2012 campaign, Mitt Romney burbled happily about how the uninsured could simply go to emergency rooms for health care. So did George W. Bush in 2007, when he stated, “People have access to health care in America. After all, you just go to an emergency room.”

I’m not sure if the folks pushing this line are trying to deceive their listeners or actually don’t understand the impact of what they are suggesting. Here is reality, spelled out simply in a reportissued by the Task Force on Access to Health Care in Texas, which is composed of major health-care providers, businesspeople, medical economists, and other experts—folks who, unlike politicians, actually know what they are talking about when it comes to this topic. It states:

The uninsured are often unable to pay for medical services they receive. These expenses are passed on to others through higher medical fees and insurance premiums.Since many uninsured and underinsured individuals obtain primary care at emergency rooms, they risk overburdening of the local trauma system. This impacts the finances and ability of emergency rooms to handle trauma. The overuse of an emergency department can even lead to increased local taxes.

In other words, when people complain that they don’t want to be subsidizing “freeloaders” through Obamacare, they don’t understand that they are already paying for the care of the uninsured. And these are not small amounts. In fact, since emergency rooms are the most expensive forms of front-line care, the cost is very high, far more than the cost of a visit to a doctor’s office.

I’ve had people tell me I was damned lucky to survive my many trips to the emergency room with pancreatitis. It seems I’m lucky to be alive. And I remember how many times I was told I needed “immediate” surgery, only to be sent home when I told them I didn’t have insurance.

Obamacare website

Yeah, it’s a piece of shit. I haven’t been able to get past the security screen yet, it keeps crashing. But it’s not a bad thing that so many people are trying to get through, since Republican Heroes of the Shutdown keep insisting everyone hates Obamacare.

Anybody get through yet?

“A couple of weeks ago, Apple rolled out a new mobile operating system, and within days, they found a glitch, so they fixed it,” Obama said. “I don’t remember anybody suggesting Apple should stop selling iPhones or iPads or threatening to shut down the company if they didn’t.”

But the Obama administration doesn’t have a basically working product that would be improved by a software update. They have a web site that almost nobody has been able to successfully use. If Apple launched a major new product that functioned as badly as Obamacare’s online insurance marketplace, the tech world would be calling for Tim Cook’s head.

The good news for Obamacare is that lots of people want to sign up. Lots and lots of people. Many more, in fact, than anyone expected. The bad news is that the Obama administration’s online insurance marketplace — which serves 34 states — can’t handle the success.

“The amount of demand is really driving the issues,” a senior administration official told me. “But we’re adding capacity every hour.”

Yes, the overwhelming crush of traffic is behind many of the web site’s failures. But the web site was clearly far, far from prepared for traffic at anywhere near these levels. That’s a planning flaw: The Obama administration badly underestimated the level of interest. The fact that the traffic is good news for the law doesn’t obviate the fact that the site’s inability to absorb that traffic is bad news for the law.

Part of the problem, according to a number of designers, is that the site is badly coded, which makes the traffic problems more acute. There’s a darkly amusing thread on Reddit where web designers are picking through the site’s code and mocking it mercilessly. “They’re loading 11 CSS files and 62 (wat?) JavaScript files on each page, uncompressed and without expires headers,” writes Spektr44. “They have blocks of HTML inexplicably wrapped in script tags. Wtf?”
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