Charles Gaba has updated his psychedelic donut which attempts to show exactly where every American gets their health insurance as of January 2023. It is an incredible piece of work. I want to put a slightly modified version below:
That small black circle in the upper left hand quadrant is basically what I think about every damn day. This little black circle is the vast majority of my research agenda. It is where I have policy impact. It is where I can lay a legitimate claim of expertise. It is tiny.
The larger peach oval is the area where I have some knowledge and research production. A paper I edited on Monday afternoon is a pediatric Medicaid paper. I have some knowledge but not deep expertise. But even with that being said, the most I can claim any useful knowledge on is maybe a third of the entire US population’s health care insurance systems. And I think about health insurance way too much for my own good or health.
And I think about health insurance way too much for my own good or health.
And we are all better for it. Thank you seems inadequate, but thank you.
Seriously, though, cool chart.
@PBK: Agree. It’s hard to find as an extensive source of information about health insurance in the U.S. David does yeoman’s work on the subject. And it’s telling that a substantial part of the uninsured white space is due to GOP cruelty.
@RevRick: Yes to all this.
20M Medicare w no medigap!😱
The efficiency of the market in action! /s
You can tell what the goal is with a system like this. It’s not helping deliver health care.
Wow. If you had asked me to color in this chart, just as an average person/“man on the street”, I would have made the Large and Small Group Markets (private) sections at least twice as large as they are. Maybe larger. Because we are always told (not here) that a big stumbling block to universal coverage is all those people who like their employer-provided coverage and wouldn’t want to give it up. We are led to believe that private employer coverage is both the norm and the ideal.
They are a minority! Maybe about a third? Between the people who get their coverage through their government employment (including military), and Medicare, Medicaid and Chip, plus the ACA marketplace, the government is either covering or has a large part of covering the majority of us. Just in the most inefficient way possible.
@p.a.: Yes, scary for them. A lot of medical bankruptcies waiting to happen. Wonder what the stories behind this is — people trying to save money, people who don’t understand why a Medigap policy is needed, other? It is a reflection of how complicated Medicare is.
Another thing I would have got wrong is the size of the circle of David Anderson’s expertise. I would have had it surrounding the entire doughnut!
I can only imagine every large health insurance company has their own version of this chart, which they use in brainstorming ways to suck out even more money from the system(s).
This is exhibit number one for why getting healthcare in this country is so difficult. Is this directly related to why that healthcare is so bad? I don’t know, but I’m finding it difficult to even find adequate care in a timely fashion here in Albuquerque. I firmly believe that insurance companies should not be in charge of anyone’s healthcare. And I’ve been told recently that Medicare Advantage plans are a scam? I despair.
@jame: Medicare ADvantage is not a scam (vast majority of the time). They are a trade-off; more predictable benefits and cost caps in exchange for losing some degree of decision-autonomy (either network or prior authorization) relative to Medicare FFS with a supplement.
@Ohio Mom: About twenty years ago we were in the small group private market and my husband single-handedly blew up my company’s imsurance with an expensive procedure at the Cleveland Clinic that didn’t even work. Fun times.
@sab: When I was in my twenties, I worked for a church that was part of a mainline denomination, in their nonsectarian neighborhood outreach program. One year we got a letter that two employees from other states had had major medical catastrophes and as a result, all of our premiums were shooting up. Permanently.
When Ohio Dad worked for a smaller defense contractor back in the early 2000s, for various reasons tne personnel manager really liked Ohio Dad. All of our claims for Ohio Son’s speech and OT were green lighted. The other engineer who also had a son on the spectrum did not see his claims approved.
One thing you can say about programs run by the government is that they have set rules that are adhered to. Even if they are complicated.
@jame: Many Medicare Advantage plans skim lots off the top — the NYT recently had a big article on this. It costs us taxpayers extra money but I don’t think it directly hurt any of the subscribers.
There are pluses and minuses to Advantage Plans vs. traditional Medicare, too much to go into here.
What is the purple (or blue) “stain” on part of the chart indicative of?