THE MEME ITSELF
The great "Free Rider" myth is that there are these great numbers of people who can afford medical insurance, but who don't carry it. Instead, we are told, they simply use emergency rooms which are required by law to provide medical care to any and all who show up at their door for free. The extreme form, which taints all others and permanently imprints one's mental image is that these are healthy young, well employed yuppies who are rolling the dice in order to pound more bucks into their 401Ks.
This is false, insulting to our natural allies, and makes us look desperate to those who are aware of the real underlying truth of the matter.
Let's get a tiny dose of reality here just below the orange surgeons knot.
This is like one of those "How many things are wrong with this picture?" puzzles, and it is doing us little good. For starts, it is simply not true. I don't know about you, but I am uncomfortable spouting falsehoods in order to try to sell some idea, plan or proposal. I do a shitty job of arguing if I am bullshitting and therefore fail to convince anybody. Using this meme weakens the credibility of those who repeat it if any of the hearers know better, and such credibility loss can spread if those who detect it spread the word. It also insults a very large number of people who are naturally in our camp and who we should recruit instead of alienate, the working poor and even a chunk of the bottom of the middle class.
LunchMedical Care in the Emergency Room?
The putative requirement for emergency rooms to provide medical care to people for free is a flat out myth. If you don't believe that, next time you get seriously ill, drop by the nearest emergency room and tell them you are uninsured, indigent and sicker than hell and see what happens. This falsehood is a radical distortion of a provision in COBRA that requires emergency rooms to provide some level of emergency care in a non-discriminatory manner, regardless of ability to pay, to persons undergoing medical emergencies.
What that means is that if you are dying or undergoing immanent organ failure, they must at least stabilize you before dumping you back on the street or transferring you elsewhere. They are required to give an appropriate exam to determine if you have a medical emergency, which may be simply a few questions or blood work or an ekg or whatever, and then to stabilize any emergency conditions. This is not free, recipients of care will be billed, at abnormally high rates, and if they cannot pay at the time of care, they will be hounded by bill collectors until they do die.
What it also means is that people do not go there for free routine care, because they won't get any. People without any regular doctor or clinic, however, do go to such facilities on a cash-and-carry pay-up-front basis for treatment of injuries and ailments and if the facility can handle the workload, it might take care of them. The key here is that they have to pay up frontfor non-emergency care.
Affordable to whom?
Now what does affordable mean and to whom? The free-rider propaganda meme was written by folks who don't know what affordability means because they have never known real want. They are thinking in bourgeois English and using bourgeois thought processes. The result is as erroneous and deceptive as if it were intentionally misleading. This is best explained by example.
Joe, single and working poor, has $5 left after paying his monthly bills and stocking enough in the fridge to get by to the end of the month if he is very careful. He has no savings and his clothes and shoes are reaching the end of the road, but they will hold up for a while yet and he hopes to put the $5 aside toward contingencies, emergencies, medical needs or whatever. He passes a yard sale advertising, among other things, a pair of kid's bunny slippers for $1 and a really ugly "abstract" painting, also for $1. Can Joe afford either or both of those items.
To the economist, the CBO and others using bourgeois speak, it is obvious that he can easily afford them both. He has more cash on hand than either costs. He has enough cash that he can buy both without incurring debt and still have cash left over. So, they are affordable.
To Joe and the rest of the working poor, however, they are not affordable, because Joe cannot use them. Nobody among the poor can "afford" to throw money away on something that they cannot use.
Affordable Medical Insurance
There has been a lot of palaver about what medical insurance costs. It varies with location and other things, but I'm going to set it for Joe's area at $4,900 per year. (This can't be that extreme because I have an acquaintance who pays $720 per month for single coverage, but it doesn't matter, because we just adjust Joe's disposable income to match .) We'll give Joe a better job, such that with major scrimping and absolutely nothing going wrong or breaking, and prices staying the same and him being able to walk to work and shopping, he can save $5,000.
Can Joe afford that insurance? Sure, he'll still have $100 left over, right?
Wrong-O. One cannot afford what one cannot use, and that insurance is absolutely useless to Joe. Entry level bottom grade insurance will have a deductible well in excess of Joe's residual $100. Beyond the plan deductible, it will have a deductible for each particular sub-category of care, such that it will probably take well over a grand of out-of-pocket medical care payments before Joe qualifies for any coverage, and, that eventual coverage will have a mandatory up front cash copay of another 30 bucks or so. All the studies and statistics in the world will show that Joe can "afford" (bourgeois speak) that insurance, and they will all be wrong.
I'd like to present two scenarios for poor Joe.
In the first scenario he buys the insurance. He gets a case of pneumonia. Because the insurance has exhausted his financial resources, he cannot afford any medical care after losing a few days wages due to the illness and he gets worse and worse. It is possible that he will end up in emergency, unable to pay for any treatment and not covered by insurance because his insurance won't cover any.
In the second scenario, he doesn't get the insurance, spends a bit more on a somewhat better diet and socks the rest away. He might not even get sick, because he is getting better nutrition, but let's say he does. He has about $4,000 cash to go to the local clinic or emergency room and buy treatment.
In effect, buying medical insurance will prevent Joe from obtaining any medical care, while not buying insurance will allow him to pay for a few thousand of such care should he need it.
1) A huge percentage of those who "can afford medical insurance but don't get it" really can't afford medical insurance. The first half of the meme is based mostly on myth and partly on a few studies that make an improper use of the word "afford", assuming that one can afford stuff that one cannot possibly use.
2) These people aren't getting free medical care at emergency rooms -
a) They can't get normal medical care in ERs without paying cash up front.
b) Even emergency care is not free in an ER, those who cannot pay up front become indebted to the ER.
So, both legs of that 2 legged meme are false, and it would be really nice if we could all stop spouting it.