ENTtoday

Why Being Uninsured Makes Sense for Many Americans

by Gerard J. Gianoli, MD •

Objections to Being Uninsured

Two major objections to forgoing health insurance are typically cited:

Objection #1: I won’t get emergent health care.

Unlike homeowners’ insurance and automobile insurance, you would still receive medical care even without health insurance. If you don’t have insurance and total your car or your house burns down, no one will buy you a new car or house. But regardless of your insurance status or ability to pay, your acute appendicitis will be swiftly treated. As most physicians are aware, no insurance does not mean no health care. EMTALA [the Emergency Medical Treatment and Active Labor Act] ensures emergency care for all regardless of ability to pay.

If you knew someone would buy you a new house if your house burned down, would you purchase homeowners’ insurance?

The obvious concern (among the fiscally moral among us) is: what about the hospital and doctor bills? There are a number of ways this can be dealt with. If the patient has enough money to pay the bill, he or she can simply pay it. If not, the patient can pay on an installment basis. Most hospitals and physicians’ offices will not send patients to a collection agency if they faithfully pay at least small installments on their outstanding balance.

For those unable or unwilling to make even small installment payments, there are other ways of dealing with the debt. Most hospitals and doctors’ offices will not press the issue of nonpayment of services beyond a collection service. The only consequence to this patient will be some harassing phone calls and a poor credit rating. And finally, for those who have large debts that seem insurmountable and the hospitals and physicians are pounding on the door for their money, there are basically two options: bankruptcy or litigation.

One and a half million Americans filed for bankruptcy last year. Almost 80% filed for chapter 7, which allows for complete dismissal of virtually all debts in return for the liquidation of nonexempt assets. Exempt assets vary from state to state but typically include an automobile, home (in Louisiana, up to $25,000 of home equity is exempt from bankruptcy), tools of a trade, household goods, and most items that would have little resale value. Even though bankruptcy may not be desirable for most, going without health insurance risks bankruptcy, but it is far from inevitable.