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March 15, 2011 08:58 PM UTC

Foster Care for Kids Whose Parents Won't Pay More for Medical Care?

  • 17 Comments
  • by: Jason Salzman

(Or can’t…? Damn. – promoted by Colorado Pols)

Last week, state Sen. Greg Brophy (R-Wray) got on conservative radio and said parents of poor kids 1) use air conditioning, 2) smoke cigarettes, and 3) play Lotto, and 4) therefore they should pay more for their children’s state-subsidized medical care.

KOA’s Mike Rosen didn’t press Brophy on whether he thinks kids in poverty won’t get medical treatment under his proposal. So I called asked Brophy to find out.

I told him, let’s assume you’re right, that some number of people in poverty could come up with more money for their kids’ health insurance.

But is Brophy willing to risk that some parents, not all of them, won’t pay the extra dough, and some number of our poorest kids will go untreated, get sick, and who knows what else will happen to them?

“I try to tell the truth and then tell you how I feel about it,” he tells me, emphasizing that he believes people “respond to incentives.”

“And I think they will make better choices with their health care, which means, yes, they won’t go quite as often. They won’t go to the emergency room for a runny nose as often. They will make much better choices with regard to that terribly expensive visit [to the ER].”

I had just spent an evening in the ER because brother, who has health insurance, thought he was having a heart attack (but didn’t). It was 3 a.m. and I was thinking, could this be more expensive? So Brophy’s point made some visceral sense. On the other hand, what if my brother actually had a heart attack? And what if he was a kid in poverty, without a high co-payment, and his parents decided not to take him because of the cost?

So I asked Brophy, what if a child from a poor family doesn’t get treated?

“That is terrible by the way, and everybody knows that,” he replied. “And I hope that doesn’t happen.”

I believed Brophy, but still, what if it happens?

“I trust that most of them would,” he said. “And I guarantee you that the people who are making their kids suffer for that, are making them suffer in all kinds other ways too.”

“I guess if they are so bad that they refuse to take care of their kids,” he said, “we do have solutions for that, too, that aren’t pleasant.  But it’s in the best interest of the children. That’s foster care. If they are as bad as you’re suggesting, that they just won’t take care of their kids.”

“I know we can’t continue to keep spending as much money as we’re spending on Medicaid, because no one has it.”

Setting aside the question of whether the world’s richest nation doesn’t have the money to pay for health insurance for its poorest kids, I did a bit of research and found that Colorado has Medicaid copayments of about $20 for ER visits, and small copayments (around $2-$6) for sick visits. There are variable annual enrollment fees for SCHIP, the federal children’s health insurance program, of about $35 for more than two kids. Some states charge more. Alabama charges $100. There are also variable co-pays capped at 5 % of income.

Here’s Brophy’s “back-of-the-envelope” calculation: “The average kid on Medicaid or SCHIP costs the state a little over 2,000 bucks per year.  Let’s get from them a $15 or $20 co-pay, which is a third or so of the cost of going to the doctor, and a little co-pay on medicine perhaps, again all as reasonable as you can make it, with participation fee from the SCHIP folks. Back of the envelope, $300 million is savings per year. And it puts us on the path toward sustainability with these programs. ”

But broadly speaking, does charging these kinds of co-payments (some of which may not be allowed under federal law) put kids at risk?

“It can be an absolute barrier for some parents,” said Adela Flores-Brennan of the Colorado Center on Law and Policy, citing a study showing that a new $6 – $20 premium lowered the Oregon’s Medicaid rolls by nearly half.

“So that becomes cost-shifting, not cost savings,” Flores-Brennan said, “because we’re covering them in other ways. It also deters the preventative care that keeps people out of the emergency room and going to the doctor and seeking appropriate care.”

Over at the Independence Institute, Linda Gorman told me, “We don’t have good studies that show that kids don’t get good treatment just because they don’t have coverage. Don’t you dare portray us as saying we don’t want kids to have medical care. The question is, what’s the best way to do that?”

But should we be experimenting with cost savings on our country’s poorest children, when, at best, the debate is about conflicting studies and cost-shifting versus cost-savings, with even Sen. Brophy talking about a potential expansion of social services and foster care.

Why put kids at risk?

“There is a risk,” said Gorman. “But how much should we spend? Should we spend 10,000 per kid? I’m willing to have a discussion about the risk.”

Ok, sure, but I can think of a lot of other discussions that should happen first.

Follow Jason Salzman on Twitter @bigmediablog

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17 thoughts on “Foster Care for Kids Whose Parents Won’t Pay More for Medical Care?”

  1. room, waits for four hours (+/-), all for a runny nose?

    If anything, having the luxury of decent insurance would make people more willing to go for illnesses. That’s certainly what I noticed from my own childhood.

    I guess, why wouldn’t we want to dissuade folks from seeing the doctor? The swine flu could’ve been much worse. Fewer people go, more disease, more would-be fraudulent voters knocked out of the gene pool. He’s really just saving America.

    No one wants to see your fancy pants cost comparisons, Jason.

    1. What parent hauls their uninsured kid into the emergency room, waits for four hours (+/-), all for a runny nose?

      My wife was in the ER a couple of years ago for a true emergency (head injury from a fall) and the ER was overloaded with runny noses, tummy aches, and various other non-emergencies.

      1. and they’d be costing us a fraction of what they do now and those with real emergencies would get quicker better care, an issue for the well insured as well as the uninsured.  It’s so obvious that joining the civilized world by providing universal healthcare is the cheapest and best way  to provide it, I just don’t get why, in the 21st century, we’re still having this conversation in the only modern industrialized country on the planet that still doesn’t provide affordable healthcare for all. Those who want more bells and whistles could still purchase on the private market as is the case in plenty of countries that have universal affordable public coverage too. What the heck is not to like?

        1. What about the government take-over of health care?  You won’t be able to keep your own insurance?  You won’t be able to keep your doctor.  The line for care will be so long, people will die.  And of course, what about the death panels that will refuse Granny treatment?

          Of course the problem isn’t that this isn’t a smart idea.  Ask Mitt Romney.  The problem is your post and Republicans in general is that this doesn’t fit with the right-wing meme, it was proposed by the anti-Christ Obama and it’s too logical.

          1. they can’t always keep their own doctor now in when they join HMOs and PPOs. That there are real live death panels right now but the decisions are made strictly on the basis of the bottom line.  

            Guess the same way they don’t notice that their taxes are lower, drilling  has increased in the past  few years, we already don’t get most of our our oil from the Middle East yet prices are no better for us than for those who do. It’s not like we’ll get special locally “grown” oil cheaper if we drill more. Or be anything less than still completely dependent on foreign oil and prices set on the world market.  Stuff like that.

          2. What if the government took over the INSURANCE industry, like in Canada, or like Meicaid in here in the US: Medicaid. VA is an example of Government taking over Health Care.

            Health Care costs in Canada are 1/3 lower than in the US, so you can see with one simple change, we would drop our costs tremendously.

            Private insurance companies siphon off 30% of our $$ that should be going to health care, using it for profits, overhead, paperwork, and 100s of Millions in corporate salaries.

  2. I recently shipped myself off to an ER facility for the same reason – chest pain, weird feelings in extremities. Like your brother, Jason, I didn’t have a heart attack. But at some point, you can’t tell and you need medical expertise and possibly immediate attention.

    Was it worth $5000, which is what an uninsured patient would have paid? Not on an actual cost basis. Was it worth $2800 once the insurance company got its discount? Again probably not, if I added up all the costs I could tally from my visit. Was it worth my life, which I’d say is worth that $5000 and then some to me? Yep.

    And therein lies at least some of the problem. It seems that some portion of the health care industry has decided to charge on a “what is it worth to you” basis rather than a cost plus basis. There’s a news tidbit going around about a forumulation of progesterone used to prevent premature birth; the general usage has been around for a long time, with shots costing $10-20 per dose (one dose per week until the baby is delivered).  The FDA, undoubtedly with some prodding, decided it wanted a formal dosage/formulation, declared it an “orphan drug”, and awarded a company exclusive rights for “developing” that formulation.  The company is now planning on charging $1500 per dose, and is contacting all of the other manufacturers telling them to halt production of this once cheap drug. Why so expensive? Well, what is keeping your baby – and keeping it healthy – worth to you?

    If we want to control costs, I think we need to start looking at pricing. What does it really cost to do this and that? Where’s the overhead?

  3. Craig, you are such a dork.  Under universal healthcare, more clinics would pop up, such as the ones in Walgreens, and then eureka!  a lot fewer people in ER.  And no long lines waiting for the Dr.  You know, you should go to some European country with socialized medicine, and you will realize a) it is a LOT cheaper than here b)people aren’t so desperate they take their kids to ER for earaches (which can be quite frightening to both kids and adults, you good hearted man) c) you already have long waits for a lo of issues (I had to wait 6 months to see a dermatologist, 9 to see a rheumatologist, and believe me i could have used seeing either one a lot sooner).

    Go troll somewhere else.

  4. unless the “runny nose” turns out to be an illness that causes, oh, say, unconsciousness or paralysis, and those damn cheap parents call an ambulance, which goes straight to the emergency room and maybe the OR, and then that’s even more expensive.  Sure would be cheaper if those children of indigent parents would just…., well….

    “That is terrible by the way, and everybody knows that,” he replied. “And I hope that doesn’t happen.”  

  5. “respond to incentives.”

    If you don’t want to be poor, just decide to be rich.

    This formulation of the world posits that people are poor or lower middle class because they choose to be.  In this world view all are free to decide to be rich.  The poor are lazy and content, much like the happy slave of antibellum visions of idyllic plantation life: slaves, and by extension all African descendants, are morally flawed deserve their wretched state.

    Ludicrous.

    Most poor folks and the wage slaves a little above them are incredibly hard working.  They work multiple jobs and struggle with tough to obtain childcare and transportation options that are always on the brink of disaster.

    When their kids are sick,they typically don’t get paid sick days and every day they takeoff is a day they are not earning. Oh and by the way, the daycare which costs more than your rent just called and you have to come pick up your sick kid.

    Senator Brophy I believe there are enough incentives embedded in the system.

  6. Clearly, Brophy has no clue what even high co-pay, very high deductible insurance costs when you have to pay for it yourself because your employer doesn’t provide it or because you are self employed.  For a family of four, hundreds a week.  And generally the copay only covers the visit, not any tests or procedures up to your deductible which is in the thousands for a lower priced plan, The simplest things cost in the hundreds with many costing over a thousand and under the deductible.

    And the foster care solution?  Does he really think that would be less expensive than covering children in hard working families?  That’s funny because Rs are so unsupportive of  resources for things like foster care as it is, there is next to no supervision. Abuse and instability abound. If he wants a foster care system that guarantees great health care, nutrition, and a simple lack of abuse he’s going to have to pony up for many, many times what the state is spending in that system now.  And then, of course you have the drop out, homeless, often delinquent kids that hit the streets as soon as they age out.  

    Brophy and friends are seriously disconnected from the reality based world.  Plenty of hard working middle class people can’t afford the cost of decent health care.  

    Many who hang on to insurance by the skin of their teeth in case of a catastrophe can’t afford to use it for routine care anymore. That’s us.  We never go to the doctor anymore with our high cost plan. We don’t have the thousands to spend out of pocket to get past the deductible.  

    Nobody would want or need to go to the ER for a runny nose or any other non-emergency illness if we started behaving like 21st century civilized people, either.

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