American Cancer Society Says Broken Health Care System Will Be "Bigger Killer" Than Tobacco

The American Cancer Society has dedicated its entire advertising budget to the issue of lack of access to health insurance because it fears that the uninsured do not get adequate cancer screenings. From the NYT:

“I believe, if we don’t fix the health care system, that lack of access will be a bigger cancer killer than tobacco,” Mr. Seffrin [chief executive of the cancer society] said in an interview. “The ultimate control of cancer is as much a public policy issue as it is a medical and scientific issue.”

The two 60-second television commercials that form the spine of the campaign make that point.

One features images of uninsured cancer patients, appearing hollow and fearful. “This is what a health care crisis looks like to the American Cancer Society,” the narrator begins. “We’re making progress, but it’s not enough if people don’t have access to the care that could save their lives.”

The other commercial depicts a young mother whose family has gone into debt because her insurance did not fully cover her cancer treatment. “Is the choice between caring for yourself and caring for your family really a choice?” the narrator asks.

Census figures released this week show that the number and percentage of people in the United States without health insurance rose last year, to 47 million and 15.8 percent. A 2003 study estimated that one of every 10 cancer patients was uninsured.

Expect to see the ads on cable channels starting Nov. 17 through Thanksgiving. There will also be print ads in magazines as well.

Cancer Society Focuses Its Ads on the Uninsured [NYT]

Comments

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  1. danic101 says:

    I don’t think the health care system is broken. I should have to fork out thousands more in taxes to take care of some slacker.

  2. rbb says:

    They are predicating their efforts on bad statistics. Of the “47 million uninsured”, 10 million are not US citizens and 18 million live in households with incomes above $50,000/year (i.e., they can afford health insurance, but for one reason or another, choose not to purchase it). Removing one or both groups certainly reduces the impact of the 47 million claim…

  3. Roadgeek says:

    Is this health care going to be subsidized by taxpayer dollars? It is time to remove the distorting influence of Medicaid/Medicare from the health care marketplace. Health care is not an entitlement, and I do not desire to have my wallet tapped to pay for the health care of others. Yet I have a strong feeling that if the american Cancer Society has its way my wallet will indeed be a little lighter.

  4. TechnoDestructo says:

    “”Is the choice between caring for yourself and caring for your family really a choice?” the narrator asks.”

    I remember watching this national geographic video from the early 90s or late 80s, where African elephants were going through a drought. There was very little water, barely enough for the adults, so they drove the calves away from the water and allowed them to die.

    Without the adults around, the calves would have died anyway. And the adults can make more calves.

  5. TechnoDestructo says:

    @Roadgeek:
    You’re going to end up paying for it one way or another. If any health care should be free, it’s preventative care.

    I can’t completely and unequivocally disagree with you, though, since we aren’t talking about INFECTIOUS disease. (Well, not for the most part)

  6. MENDOZA!!!!! says:

    @technodestructo
    You’ve been reading “ishmael” again, haven’t you.

  7. ancientsociety says:

    @Roadgeek: I’m not nuts about funding others’ healthcare also but, an important point to make is that this is a bigger issue than simple economics.

    The benefits of everyone in this country having at least basic access to affordable preventative healthcare would far outway the costs associated with such a program. Off the top of my head, I can think off a decrease in communicable diseases, lower healthcare costs by preventing further issues/diseases/etc. left untreated, higher standard of living, less people being in debt from medical costs, etc.

  8. Beerad says:

    @Roadgeek: Ummm, if you don’t have insurance, do you know what happens when you go to a hospital? You get treatment. Who do you think is paying for that? Yes, the costs get passed on in turn to everyone else who participates in the system. So good luck not paying for it. The only question is would you rather do it as a taxpayer or do it through your insurance premiums?

    Frankly, I would rather live in a society that respects human life enough to provide all its members with basic health services, as well as one that’s smart enough to recognize the huge economic benefit that preventative care and screenings put into the system.

  9. dregina says:

    RBB – Just because someone earns more than $50,000 a year doesn’t mean that they can choose to buy insurance if they want to. Anyone with a history of even minor mental or physical illness can tell you what a nightmare it can be to find an insurance company willing to insure you – even if you do, you’re looking at astronomical rates. There are plenty of horror stories out there on the internet (I remember that one of Slate’s correspondents wrote about how her dx of Postpartum Depression affected her ability to get insurance a few months back.) The bottom line is, disposable income is just one of the many barriers people can face when it comes to finding affordable insurance.

    Roadgeek – For our lovely free market to function, we need healthy workers. Businesses are being taken out right and left by the cost of insuring their workers, when that cost could be spread out equally throughout the population. And, in most cases, the earlier diseases like cancer are caught, the less expensive the treatment. The Health care situation is this country is a CRISIS. We don’t have the luxury of philosophizing it away – we need a practical solution that will protect people without wasting money. I agree that it’s hard to have faith that the government can do it, but other governments have, and with some experimentation I believe that the US can find a workable solution too. IMO, we have to, if we want to remain competitive on a global scale.

  10. I can’t completely and unequivocally disagree with you, though, since we aren’t talking about INFECTIOUS disease. (Well, not for the most part)

    @TechnoDestructo: I’m sure I’m having a massive brain cramp here (at the very least it’s a headache) but why would it being infectrious make you disagree with Roadgeek?

  11. FLConsumer says:

    Having / not having insurance can make a difference in access to preventative care, but when you get really sick, expect your insurance co to find any reason they can to deny treatment or delay/deny payment.

    As much as I don’t want socialized medicine in this country (I love the idea, just don’t want to see how badly we’d botch the concept here), the current private insurer method certainly doesn’t work. The overhead of insurance cos and medical billing departments at hospitals is huge. The CEO of Aetna insurance has a nice $35m annual salary. I have a feeling that $35m would cover many doctors office visits for those who can’t afford it.

  12. Nemesis_Enforcer says:

    The biggest source of uninsured here in Cali at least are Illegals. One of my friends parents live in mexico and whenever they need medical services they literally pay a coyote to bring them in go to the emergency room give fake info to the hospital get the service they want and cross back to mexico. The dad has done this at least 10 times in the last 3 years. Even staying at a hospital for over 20 days due to a heart condition.

    Yet no one bothers to try to stop it! It totally pisses me off that my HMO now has a f’kn deductible but these leeches can have whatever they can get done thru the ER for free.

  13. morganlh85 says:

    We are the only civilized Western country that forces its citizens to pay for their health care. I’d rather my tax money to go the health of my neighbor than blowing up Iraqi children or lining the pockets of Halliburton execs.

  14. dregina says:

    Nemesis Enforcer – I call bullshit. While your story is very exciting and entertaining, here are some facts:

    Undocumented immigrants use fewer health services than citizens and documented residents.Undocumented immigrants are disproportionately low users of health care services for two reasons.

    1) Undocumented immigrants tend to be younger and healthier than the average Californian. Research from the Pew Hispanic Center estimates that one in six undocumented immigrants is a child and that only 11% are age 40 or older. A RAND survey in Los Angeles County — one of the few formal studies to gather reliable data on documentation status — found that just 19% of undocumented immigrants reported having a chronic health condition, compared to 38% of the native residents.

    2) Some undocumented immigrants avoid using the health care system. In addition to being less reliant on the health care system because of better health status, some undocumented immigrants avoid seeking health services even when they do need care. They may avoid interacting with the health care system because they lack insurance or other means to pay, because they are unfamiliar with the U.S. health system, or because they are concerned they might be queried about their citizenship status. Among male undocumented residents, 40% had never received a check-up, compared to 19% of male citizens.

    Finally:

    When they use health services, undocumented immigrants are less reliant on public funds to pay for their care. RAND found that both documented and undocumented immigrants are more likely than native Californians to pay health care costs out of pocket rather than rely on public funds. For example, undocumented immigrants pay, on average, 36% of their medical costs out of pocket and 23% of their medical costs are paid with public funds. Native born Californians pay about 20% of their health care costs out of pocket and 28% of their medical costs are paid with public funds.

  15. dregina says:

    Hey, Nemisis Enforcer, check your facts:

    From the California Health Reform website –

    Undocumented immigrants are disproportionately low users of health care services for two reasons.

    Undocumented immigrants tend to be younger and healthier than the average Californian. Research from the Pew Hispanic Center estimates that one in six undocumented immigrants is a child and that only 11% are age 40 or older. A RAND survey in Los Angeles County — one of the few formal studies to gather reliable data on documentation status — found that just 19% of undocumented immigrants reported having a chronic health condition, compared to 38% of the native residents.
    Some undocumented immigrants avoid using the health care system. In addition to being less reliant on the health care system because of better health status, some undocumented immigrants avoid seeking health services even when they do need care. They may avoid interacting with the health care system because they lack insurance or other means to pay, because they are unfamiliar with the U.S. health system, or because they are concerned they might be queried about their citizenship status. Among male undocumented residents, 40% had never received a check-up, compared to 19% of male citizens.
    When they use health services, undocumented immigrants are less reliant on public funds to pay for their care. RAND found that both documented and undocumented immigrants are more likely than native Californians to pay health care costs out of pocket rather than rely on public funds. For example, undocumented immigrants pay, on average, 36% of their medical costs out of pocket and 23% of their medical costs are paid with public funds. Native born Californians pay about 20% of their health care costs out of pocket and 28% of their medical costs are paid with public funds.

  16. burgundyyears says:

    @morganlh85: Disingenuous comment to the max there.

  17. dextrone says:

    That took a while…

  18. Nemesis_Enforcer says:

    @dregina: Hmm you can say what you want but do you actually live out here? Well I do and the last time that I waited in a ER for 7 1/2 hours because I broke my tibia wasn’t a dream. It was full of illegals, I love it when I go to the hospital and they ahve to “find” someone that speaks english for me to talk to. My wife also had to wait for almost 4 hours with a deep cut on her chin from a car accident..same story. Pardon me if I don’t trust a report about illegals delivered from a Hispanic center. Thats like beliving things about Iraq from a Fox news report.

  19. TechnoDestructo says:

    @Rectilinear Propagation:

    Because infectious disease affects everyone. By allowing it to progress ANYWHERE you put everyone else who could come into contact with those people at risk.

    That is why I was exposed to tuberculosis. Despite vigorous treatment programs in Alaska cities, it is still rampant in the rural areas. Even if you cured every single person in the cities, it would keep coming in from the villages.

    “But what if I’m vaccinated?” you might ask. Well, that’ll be fine for a while, but if the disease has its own happy little playground of occasional half-assed, when-I-can-afford-it treatment, it could develop into something to which you are NOT immune.

  20. Jiminy Christmas says:

    @Nemesis_Enforcer: Wow, you can identify illegals just by looking at them?? If that’s the case, Immigration & Customs Enforcement is looking for talented individuals such as yourself.

    Or, by “illegals” do you just mean “all brown people who aren’t fluent in English”?

  21. acambras says:

    @jrford8:

    Very well put.

  22. dregina says:

    @Nemesis_Enforcer – The website I pulled that data from is actually a website concerned with healthcare reform in CA, not immigrant’s rights, or Hispanic rights.

    I live in Texas, so that would make it easy for me to claim that illegal immigration has had an impact on my community, but, personally? When it comes to these types of social issues? I find data more useful than anecdote.

    I don’t blame you for being pissed at the way things are, but you’re aiming your anger in the wrong direction. It’s not poor people who are stealing from you.

  23. bostonguy says:

    The ACS can frig off.

    “One features images of uninsured cancer patients, appearing hollow and fearful. “This is what a health care crisis looks like to the American Cancer Society,” the narrator begins. “We’re making progress, but it’s not enough if people don’t have access to the care that could save their lives.””

    Back in 2002-2003, I had to make very frequent trips from my home to Boston (about 30 miles, 45 minutes) to get chemo treatments at Mass. General Hospital. The ACS has what I’ve heard is a great program to help cancer patients match up with volunteers that offer to do things like drive them to/from their doctor appts.

    Oh, I forgot to mention that I was about 30 years old at the time, and the nice people at the ACS flat-out told me that they gave preferential treatment to the older folk. I managed to get 1 rider out of them before turning back to having my mother in-law take time off of work left & right to help me out, since my wife was busy working full time to keep the bills paid.

    I’ve long ago stopped caring what the ACS says.

    (Yeah, I sound bitter, but I’ll never forget being told that I was too young for them to pay attention to me…)

  24. alice_bunnie says:

    @morganlh85:

    We are the only civilized Western country that forces its citizens to pay for their health care.

    WHAT? You don’t think making someone pay through taxes not only for their own healthcare, but for everyone else who can’t afford it, forcing? That’s forcing.

    I have been uninsured, by choice and not. I’ve never been denied healthcare, and when I did need it, often it was less expensive paying the doctor outright than paying insurance premiums that were unneeded.

  25. Mojosan says:

    You pay for your healthcare, I’ll pay for mine.

    Stop citizens of other nations form getting healthcare in the USA. They need to be taken care of by their nations taxpayers, not my taxes.

    Set up a mandatory insurance program. There is a huge difference between not having healthcare and not wanting to be bothered paying for healthcare so you have more money for Doritos and HBO.

  26. Jiminy Christmas says:

    @Mojosan: Sign me up.

    If I quit my Doritos and cable TV habit I can easily come up with another $60 per month. Just tell me where to submit my application for health insurance with a $60 premium. Seriously, send me a link or something.

    Meanwhile, try this on for size: A family I know (mom, dad, 3 kids) buys an individual policy, as both mom and dad are self-employed. Their monthly premium for a policy with a $2000 annual deductible is about $1000/month. Explain to me how the snack food and entertainment budget of the typical family covers that.

  27. Elviswasntmyhero says:

    The Problem:

    A Failed Private Insurance System that Puts Profits Ahead of Patients

    The United States has the highest health spending in the world, yet 45 million Americans have no health insurance and millions more are under-insured and unable to access care. Illness and medical bills contribute to half of all U.S. bankruptcies. Prescription drug costs are the highest in the world. Even though other industrialized democracies spend less on health care, their citizens are guaranteed coverage for life, live longer, and have better access to care.

    The Solution:

    Non-Profit National Health Insurance

    Americans spend more money for less coverage and care because we are the only industrialized country that allows for-profit insurance companies to be middlemen in our health system. In their drive to enroll healthy (and profitable) patients and screen out the sick, private insurers waste vast sums on billing, marketing, underwriting, utilization review and other activities that enhance profits but divert resources from care and hassle patients and physicians. The paperwork they inflict on doctors and hospitals and nurses wastes hundreds of billions more each year.

    Replacing private insurance companies with a single-payer public program – “Medicare for All” – would save more than $350 billion per year by slashing bureaucracy, enough new money to provide guaranteed comprehensive health benefits for all.

    http://www.sickocure.org

  28. BritBoy says:

    @Roadgeek: “healthcare is not an entitlement”

    The US is the richest nation on earth with access to the highest technology that man has had the power to invent. In the 21st century, can we ensure that every American has access to basic healthcare ?

    (note : I’m not suggesting any particular method of implementation. Once we can agree on this goal, we can look at how to get there from our current situation. I cannot imagine anyone seriously believing that the current healthcare system is optimal)

  29. @Beerad: Personally, I’d rather do it through a single payer system with 3% overhead rather than the current private insurance system with 24% overhead.

    But that’s just me.

    (Also, the seriously ill without insurance are quite likely to end up on the public health dole ANYWAY, so you’re going to pay for their care out of your taxes ANYWAY, but since you’re not paying for it preventively, it costs a hell of a lot more after they’re broke and need more serious health care, and housing, and foodstamps ….)

    @Nemesis_Enforcer: The plural of anecdote is not data.

  30. asherchang says:

    @Roadgeek: I AGREE WITH YOU!!!

    We should SO not subsidize health care at all!

    In fact, I don’t think the government should pay for any non-vital service, period!

    Let’s get rid of the evil socialist system of public education!
    Corporations and individuals without children in government-sponsored
    schools shouldn’t have to pay for OTHER PEOPLE’S kids to go to school.
    And what’s up with the whole thing about being required to go to school
    till you’re 16?

    Education, health care, security and fire protection should ALL be
    bought and paid for by individuals. We need to live in a society where
    people are RESPONSIBLE FOR THEMSELVES!!! Who cares if living in a
    country where many go uneducated, unprotected from crime, uncared for
    their sicknesses, etc cuz they can’t afford these services will create
    a highly unstable society and an inefficient economy??? Everyone should
    just fucking look out for themselves.

  31. BritBoy says:

    @Eyebrows McGee: “single payer system”

    The single payer proponents and oppoenents are highly polarised. The presence of a single payer (governement sourced/backed) health service provision does not in itself exclude private, for profit healthcare.

    A valid criticism of single payer/social healthcare concerns the wait-times for care. Often the care is also more basic (no private rooms with wide screen TV !). This actually creates a market niche for private for profit healthcare for those who can – and choose – to afford it.

  32. Beerad says:

    @Eyebrows McGee: Hey, I’m with you boss. Heaven forfend this country would actually let its citizens decide an issue of such importance, but I’d be first in line to vote yes on socialized medicine.

  33. hokey1 says:

    We already have socialized medicine in the US. If an uninsured person needs medical care every tax payer covers that cost. (Socialism) In a business we have for profit socialized medicine, for example: In a business where everyone has insurance, if I pay $200 a month for insurance through my company and I am there 5 years that is about 10 grand payed in (plus what my employer pays). If I become ill and rack up a $100,000 hospital bill who pay for the $90k I am short? The rest of the employees cover what I am short. The HMO will now raise the rates or cut benefits (or both) to insure a profit. Because of my illness my fellow employees now have worse health care because the HMO has to turn a profit. That is just wrong.

  34. julieannie says:

    The American Cancer Society is absolutely right. I had cancer at 19 and thankfully I was still in college and under my parents’ insurance plan. My bills for one year totaled just at one million dollars were covered. So many people my age and older don’t have insurance.

    After treatment, we all donated our leftover pills back to the hospital to pass under the rug onto other patients without insurance. My hospital did an extended billing type thing so cancer patients could choose to receive treatment, but they couldn’t do this for the $400/pill anti-nausea meds. And when you have chemotherapy, those anti-nausea meds should be considered a necessity, not a luxury.

    The real problem I had graduating college was trying to get insurance. My first job didn’t offer it till 6 months out and by then, I would have lost coverage for my pre-existing condition. I had to quit my job and work for my parents until I could bump up my wedding date just to get insurance. How screwed up is that?

  35. Me. says:

    Has anyone here been diagnosed with cancer when they didn’t have insurance?

    …because I have.

    I’m 25, have minimal debt, a FICO in the 800s and I made the stupid mistake of not covering my ass as I transitioned from the university health care to my first job (where I’d get health insurance). I graduated May 11th and was diagnosed with Stage 2 Hodgkin’s Lymphoma June 15th. Had I not qualified for the state healthcare, my life would be ruined. I repeat: my life would be ruined. I would be at least $20,000 in debt by now (I’m only two treatments in) and all my hard work to be financially responsible would be 100% shot to hell because I didn’t get insurance to cover me for ONE MONTH.

    My point: Not everyone who gets assistance from the state or government is a lazy sack of shit or illegal. Some of us are financially responsible people who just happened to get sick at the absolute worst time. And hey, guess what? I’ve been paying taxes into the system too.

  36. Mr. Gunn says:

    Lot of good comments here from people noting how vaccination, basic education, and universal health care for all are good for everyone. In the end, it’s dregina who said it best.

    They’ve got you voting for them on promises of saving a couple bucks in taxes, meanwhile they’re robbing you blind.

  37. Consumer-X says:


    I sure hope the American Cancer Society is better with chemotherapy than they are with statistics because the latest numbers show that the evil US health care system provides superior cancer treatment than socialist health care systems.
    [www.telegraph.co.uk]

  38. du2vye says:

    Healthcare is a HUMAN RIGHT. Everywhere, unless you like to watch people dying in the streets. I can not believe so many people don’t know someone, a child – coworker – parent that would have died without proper medical care, unrelated to ability to pay, at some point in time.

    That includes you to. PIPA did a study and the majority of medical bankrupticies, the person was working at the time they became ill. That means nothing. They were UNDERinsured (i.e. insurance company kept denying care was necessary) and the person had no clue UNTIL they got ill.

    I had a 95% survivable cancer 4 years ago that my insurance would only cover palliative care for. I was under 50 and all it took was a major surgery. No long term treatment. My healthcare was federal insurance. That’s the barometer.

    Be very scared. How many paychecks are you away from the street if you suddendly had to come up with several hundred thousand dollars for care to even start? One of the problems of going without insurance is that you are charged for subsidizing the private healthcare insurance low rates that they negotiate. You pay top dollar as an individual.

    The data even from INF supports that illegals do NOT have high healthcare needs, are not scamming ‘the system’. Most would prefer going back to Mexico even after they are legal. Why? Universal healthcare. Several states (including TX) did studies when enrollment for children into Medicaid was so low.

    Google for “medical tourism”. People are NOT coming the the U.S. for healthcare. The U.S. does not have the best healthcare in the world. The current leader for treatments including spinal cord injuries and cardiac care is in Thailand. India and Singapore want to challenge that. Mexico is on the map to build a globally competitive teaching hospital in Mexico City that will be state of the art. U.S. citizens can sign up for $400/year. That includes nursing care. Reading ex parte boards, the quality was comparable including major healthcare.

    When you tighten up the borders, you prevent illegals from returning to Mexico for healthcare.

    I live in Phoenix. There are 3 charter buses a day leaving to go to Mexico for healthcare. There are more from every other town and city full of U.S. citizens. Half the doctors across the border are U.S. doctors or have U.S. medical degrees. They are sick of the system too.

    The U.S. has been paying Medicare HMO’s additional money to treat Medicare patients since 1986. The amount just keeps getting bigger. If you look at the patterns of people who have chronic healthcare, they return to Medicare traditional. Even with the exztra funds Medicare HMO’s could not compare in reasonable care.

    Spend a day at a major regional non-profit cancer center. Talk to people and listen. 3/4 ths of people were signed off on by their insurance and left to die. They are mortgagin homes, their parents homes , having fund raiser like car washes and desperate for care from what is USUALLY a surviable cancer. They are not old people with a million other chronic conditions.

    BTW – Insurances companies make money off investments, not premiums. Stocks go down and premiums go up. The only control against higher premiums has been putting a profit cap on insurance companies. ERISA has not worked. Tort reform has not worked. Those stop gap measures have worked to prevent people from making their health insurance paying for medical care.

    Healthcare in the U.S. is a fantasy myth.

  39. du2vye says:

    “Time to take the “distorting influence” of Medicaid and Medicare out of the marketplace?

    Why – because they work and private healthcare doesn’t?

    Or was that a joke?

  40. facted says:

    There are a lot of interesting points of view on this topic, of course. I do agree with some of the writers here that insurance companies are really in the wrong place in our system. They are responsible to their shareholders to make money off of sick people. That is their job. Think about it. While a hospital should charge a set amount for a procedure directly to the patient, the insurance company comes in and says, pay us a smaller amount than the hospital is asking for and we’ll pay them 1/2 of that. While the consumer is happy he’s paying less than he otherwise would, the hospital is getting ripped off.

    Who do you to pay? A non-profit hospital, or a for profit insurance company?

    Also, people talk all the time about how we spend such a ridiculous amount of money on our health care and yet our outcomes are so poor. I agree, our outcomes on a lot of standard things are very poor indeed. But did anyone ever look consider where our costs of healthcare actually go? Are we paying for preventive care? Or are we paying millions of dollars to perform countless “life-saving” procedures on a demented patient who is weeks away from a painless death simply because their family can’t quite understand that everyone passes away at some point.

    Our culture is obsessed with end of life care and “doing everything”, even if there is nothing to do. The national health care system that people call for will not help that. In fact, many other countries with nationalized health care (such as England, for example) turn their back on end of life care. In england, you will not get dialysis if you are over 65. Yet here, we dialyze just about anyone or anything that is alive. Perhaps we should…but people shouldn’t complain then that our health care costs are out of control.

  41. Rusted says:

    @rbb: Why even buy it? If one’s really sick, they always find an excuse not to cover, and if healthy, no need for it. It’s just another scam for insurance companies to make money.

    Canadians are so lucky they got a single payer system.

  42. uricmu says:

    One critical thing to remember is that if you are not insured, you pay inflated costs for your medical care. You know how your hospital thing says one thing, but your insurance invoice tells you how much it really cost (because that’s what the insurance paid, and the hospital still makes money).

    Sometimes the difference is huge. A series of blood tests, for example, cost me 300$ the one time the insurance didn’t cover it. My new insurance carrier covers them every time with 30$. If you don’t have the “negotiated price”, Quest diagnostics will tack on 10$ every time for “surgery” (the act of taking out blood).

    Recently I had a hospital test that had cost 3000$. Want to guess how much it really cost my insurance? less than 300$. Yep folks, a 1000% premium. If individuals paid what the insurance companies pay in “neogitated fee”, maybe it could work.

    And anyway, the figure of uninsured offers refers to those who can’t get insurance because they have a preexisting condition.