Why might some people go uninsured?

While reading two Jan. 5 articles — “Prison sued in inmate’s death” (in the metro section) and “What to do about the health care invincibles?” (in the opinion section) — the following thoughts immediately came to mind:

(1) The prison is being sued over the “rationed-care strategy” governing medical services for inmates. What of the Affordable Care Act and its provisions for bureaucrats determining care? Are we not to be concerned?

(2) The commentary about the invincibles cites a $35,000 hospital bill that was negotiated down by a nonprofit hospital to $5,000, with $30,000 being written off because the patient cannot afford it and does not have insurance. This tells me the actual cost of the treatment was overpriced to begin with.

Think on this.


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It’s true that $35,000 is one hospital’s chargemaster rate, but the article doesn’t supply either what the cost would have been to an insurance company or to Medicare. Anyone familiar with Steven Brill’s long special report for Time (March 4, 2013) on medical pricing would suspect that the hospital made a profit at $5,000. Then there’s the issue of what another hospital would have charged.

As a very small sample, Brill describes the price of a blood test for two patients at different hospitals: One is charged $199.50 and another $239, but the punch line is that Medicare pays $13.94. An insurance company would probably pay somewhere around $25.

One theory of pricing, the “just price,” goes back at least to St. Thomas Aquinas and holds that the price of a product should be the cost of production, plus enough to allow the producer to continue producing and live modestly. The alternative is the “all the traffic will bear” theory, which says the price of something is whatever the producer can coerce, bamboozle, persuade or reason the consumer into paying.

Medicare rates seem to be something like the just price; for everyone else, it’s whatever hospitals can get away with. Insurance companies have some power, so they pay less, but a powerless individual gets charged whatever the hospital wants. If they collect, great for them, and if they forgive the bill, they look all the more generous.

JOHN SHERMAN, Moorhead, Minn.

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My husband and I carried our own health insurance through a Blue Cross Blue Shield health savings account. In October, we received a letter informing us that our health insurance premium would increase by $200 a month. Given that my husband has been on company furlough three days a month for the last five years and that I have been laid off various jobs due to the economy, where are we to find this extra money? We were already dipping into retirement savings to pay the monthly premiums. We seldom go to restaurants; we don’t spend money on things we don’t need and our cars are 10 years old. Yes, we have researched options on MNsure, but no, it would not save us money. To lump people like us into a category of the “petulantly uninsured,” as the commentary about the invincibles seems to do, is just plain name-calling.




Maybe it’s just part of a natural cycle

People are always moving and looking for change. Young families are seeking an adjustment to the classic suburban life (“In reversal, families leaving the suburbs,” Jan. 5). The classic idea of “I’m not going to raise my children like I was raised!” will always be expressed. Different reasons can be offered for moving away from the suburbs, such as being able to walk to stores or easily go out for a fun night in downtown, but the underlying reason will always be the need for variation.

Thirty years from now, the story will be about how more young people are moving to suburbs as the urban core ages, simply because the next generation will want a change from their childhood. Suburbs should not try to make changes to bring young families back in, but should adjust to the current, older population. Golden Valley and Edina, for instance, have taken great initiative to accommodate this shift.




Humans limit progress. This isn’t a bad thing.

As I think about it, I hope that UPS does not decide to beef up delivery service for next year’s holiday season (“Griping about your First World problems? Go on …,” Jan. 5.) I hope, instead, that there is a deliberate education of the consumer under some theme such as “enough is enough.”

Every system has a human element. Hearing aids can only get so small or we can’t replace their batteries — the human element is the hand. Smartphones can only ask us to type on a keyboard so small — the human element is the eye and the fingertip. And on it goes. Even First World consumers eventually must learn to live within a human limitation. What? Not enough people want to work seasonally and rush around in below-zero temps at every hour of the day to deliver packages? What? UPS workers need to sleep? We must, in every possible system, learn to live within natural limits.

So Happy New Year, everyone. I hope we’ve learned something about the turn that must happen in our ever-demanding culture of want vs. need.