BACK TO BASICS: What's At Stake

Earlier this week we explained why the status quo in health care is neither acceptable nor sustainable. In fact, in health care, there's really no such thing as the status quo. Joe Paduda at Manage Care Matters provides further evidence in his two-part look at "your life without health reform."

But when something can no longer continue, it won't. When enough Americans lose their coverage, when cost-shifting gets to the point where those left with insurance are paying thousands in premiums to cover those without, when local taxes to pay for teachers' and police benefits get so high that folks are losing their houses, when Medicare finally goes insolvent, when hospitals are collapsing due to the cost of indigent care ... then, and only then, will the screaming hordes at Town Hall meetings decide that any health care coverage is better than none.

The LA Times this week had  a well-written piece arguing that the people living in states with the most to gain from health reform passage are among its most vocal critics.

As proof, they point to Wyoming. The state, "with an economy marked by farming, ranching and small businesses, has a disproportionate number of people without medical insurance. And by that measure and others, its people are among the likely winners if Congress approves a health care overhaul." The state's senior senator, Mike Enzi is the ranking Republican on the Senate HELP committee and one of the "Gang of Six" bipartisan negotiators in the Senate Finance committee. Yet at a town hall in Gillette, a state legislator stood up and demanded that Enzi pull out of negotiations, drawing a round of applause from the audience. A few days later, Enzi was delivering the weekly GOP radio address harshly criticizing the health reform proposals in Congress. (LBJ would have had a different response...)

To elaborate on the dynamic described by the LA Times, we gathered state-level data on the uninsured, poverty, and job loss to give you an idea of which states stand to lose the most from health reform's failure. The maps are taken from the Kaiser Family Foundation's excellent resource, www.StateHealthFacts.org and were modified to include our calculations and some additional employment data from the BLS.

More than a fifth of the working age population in Oklahoma is uninsured. These are the people who would get help purchasing private health insurance in a more competitive and more affordable market if health reform passed. As much as Oklahoma Sen. Tom Coburn believes "government is not the answer," sometimes it's the best way for individuals to realize their shared responsibility of a community, Bake sales and collection jars only go so far.

Since December 2007, employment in Michigan has declined 3.6 percent. In Nevada it fell by 4.1 percent and in Alabama by over 5 percent! As people lose their jobs they also lose their insurance. A one percent rise in unemployment is associated with one million newly uninsured. Moreover, the high cost of health care often prevents people from going out and starting small businesses, which could be an engine of economic recovery.

Close to half of the population in South Carolina makes less than twice the Federal Poverty Level -- $41,300 for a family of four. An average family health insurance plan provided through your employer costs about a quarter of that. In 2016, it will represent more than 60 percent of the median family income. Health reform will make insurance more available now and more affordable over time.

Much of the criticisms directed towards health reform have very little to do with health care. They're about everything from the state of the economy to the cable news station we watch. While capitalizing on those emotions makes sense to some, the value of such opportunism will be limited if health reform fails. The problems in health care will only get worse, while the solutions available will be fewer and more draconian. The town halls then will make today's seem like the most civil of tea parties.