Health care, an issue of race and riches

Throughout the long, at times agonizing health reform debate, conservatives and insurance-industry lobbyists have argued that we don’t need a public insurance plan to compete with private insurers.

Their argument usually goes like this: 47 million Americans have no health insurance. And your point is? That’s only 15 percent of the population. And you know what? A lot of those folks choose not to get insurance. The real number of uninsured Americans — that is, those who want insurance but can’t get it — is probably around, oh, say, 20 million. No, probably more like 13 million. Who knows? It could be as few as 6 million. That’s just a fraction of the population.

Yes, all the good, hardworking Americans without insurance really don’t want it because they’re just too cheap to pay the premiums. They’d rather take their chances and forgo regular health treatments and eventually die of cervical cancer or a blocked artery.

Who are we kidding? I’m sick of fuzzy math and intentional obfuscation. Here’s the truth: Most people without health insurance either aren’t offered it at work or can’t afford it. After graduating from an Ivy League university at 22, I went without health insurance for eight months not because I was unwilling to pay the premiums, but because I was working as a substitute teacher without benefits. I was, in fact, quite worried that I had no insurance. I realized that I was taking my chances not only with my health, but also with my finances. If I had been severely injured or suffered an awful medical malady, I would have been done for on both fronts.

According to the federal Agency for Healthcare Research and Quality, whether you are insured and have a primary-care physician depends in large part on your race, your age, your wealth and where you live. Among 18- to 44-year-olds, only 48.6 percent of Hispanics have a primary-care physician, followed in reverse order by Asians (50.4 percent), blacks (59.5 percent) and whites (69.4 percent).

Compare that with the over-65 population, eligible for Medicare. In this age group, access to primary care is nearly identical among the four racial groups. Around 90 percent have primary-care physicians.

Wealth also plays a role in whether you have insurance and primary care. Among the four races, only 54 percent of the working poor ages 18 to 44 have primary-care physicians, while 70 percent of wealthy people in the same age group do.
Finally, where you live makes a difference. In the so-called “liberal” Northeast, where public health programs are better funded by the states than in other parts of the country, 84 percent of the working poor receive primary care, virtually equal to the percentage of wealthy people who do. In the West, only 67 percent of the poor get primary care, and in the South, only 69 percent. The Midwest fares a little better, at 73 percent.

As Congress slowly moves closer to passing a unified health-reform bill, the rhetoric lambasting a public insurance plan will inevitably ramp up. We’ll probably hear a great deal from the insurance industry about the 85 percent of Americans with health insurance, but little about the 15 percent without it.

I ask only that we think more deeply about those 15 percent. Most are young. Most are minorities. Most are the working poor. And most just want to make a better life for themselves and their families, with some semblance of a security net to catch them when they fall.

Some housekeeping: My column last week, “How the county exec can beat high property taxes,” ran a little long, so the last two paragraphs were cut. There I advocated for accessory apartments — apartments within single-family homes — only if they meet fire codes. Also, I noted that any number of towns, including Riverhead, have moved to permit accessory apartments.

After the column appeared, readers wrote to remind me of the millions of dollars we could save if we consolidated Nassau County’s 57 school districts and eliminated their superintendents and assistant superintendents — roughly $45 million annually, according to my calculations. With the county’s 418,000 homes and businesses, that would break down to a savings of about $107.65 per property per year, or $8.97 per month. In return, we would have to give up local control of the schools.

Thanks, but no thanks. Give us accessory apartments, which, by my estimate, would have the potential to increase homeowners’ income by $6,000 to $12,000 a year, after taxes, depending on the neighborhood.

Scott Brinton is senior editor of the Bellmore and Merrick Heralds and an adjunct professor at the Hofstra University Graduate Journalism Program. Comments? SBrinton@liherald.com or (516) 569-4000 ext. 203.