The Uninsured

We frequently hear that the number of Americans without health insurance is 46 million. When you hear a number like that being repeated frequently and by the President of the United States, that doesn't mean you can trust it. But seems to come from the Census bureau, which is generally a reliable source. Moreover, if the number were bogus, it would be challenged by the conservative think tanks, and they aren't doing that.

By contrast, you don't hear much more about that 45 million. Who are they and why are they uninsured? And for how long? Are these mostly people who never had or who lost and are never going to get back their health insurance?

According to the Census Bureau, about 10 million of the uninsured are not citizens, a category that includes legal and illegal immigrants. My guess is that it's largely the latter, since legal immigrants usually have sufficient resources and family backing to get into the job market. The point here is not that the illegal immigrants are undeserving, but that it's hard to provide benefits for persons who choose to remain below the radar. Unless, of course, you simply hand out benefits to all who ask, something that might be the Christian thing to do, but would amount to a form of de facto legalization.

According to the Congressional Budget Office, see Julia Seymour at Business and Media Institute, 45% of the uninsured will get health insurance back within four months. I believe I heard John Goodman, of the National Center for Policy Analysis (a free market think tank) say, on Fox, that within two years 90% of the [temporarily?] uninsured get health insurance back.

A lot of the uninsured could afford health insurance. According to Seymour,

More than 17 million of the uninsured make at least $50,000 per year (the median household income of $50,233) – 8.4 million make $50,000 to $74,999 per year and 9.1 million make $75,000 or higher.

See National Bureau of Economic Research.

Finally, at lot of those who can't afford health insurance are eligible for programs like Medicaid and SChip. About 25% of the uninsured simply fail to sign up for these programs.

How many Americans are without health insurance because they can't afford it? According to the Kaiser Family Foundation, between 8.2 and 13.9 million people. I assume that means citizens.

None of this is to say that we don't have a problem. But the problem is largely a gap problem. Most people get their health insurance from their employers, and they sometimes lose it between jobs. People who could afford health insurance but don't buy it are also a problem, because they frequently can't afford being sick and the rest of us end up footing the bill. People who don't go to the least bit of trouble to get access to programs they're entitled to, that's another problem.

But breaking up the uninsured population this way makes the problem look more manageable, and suggests solutions that are within reach. I am not prepared to take side on solutions, but some form of tax credit, amounting to a voucher for the disadvantaged, might be very doable. You could take that with you while you are looking for your next job.

Of course you don't want the problem to look manageable if your goal is not to rescue the uninsured but to use them as an excuse to transform the system in the direction of Canada and Europe. Maybe that would be a good thing. I doubt it, but I was wrong once before, in 1993. I won't say what about. I will say that I don't think European style heath care is likely to happen. Insisting upon it, to the exclusion of more practical policies, will likely result in nothing getting done.

Comments

[Erik]

KB,
Give it up man.
Erik

[KB]

Erik, my friend, what exactly should I give up? Is trying to be clear about the problem we are trying to solve a bad thing? That you should think so supports my general argument: that nobody in this reform movement knows or wants to know what he is doing.

[A.I.]

It isn't just "the problem" though. It's many problems like spiraling costs, the under-insured and people private insurers won't cover. It's people stuck in bad or limiting jobs because a pre-existing condition locks them into their current employer's health plan. It's people bankrupted by medical bills because they are unlucky enough to suffer an illness their company doesn't cover of covers marginally. It's a system that treats illness rather than trying to prevent it in part because people are punished with co-pays for trying to practice preventive medicine. And its a system that wastes countless hours of medical staff time trying to decifer unstandardardized billing forms and coverages while a bunch of other people are looking for ways to limit coverage.

Those are just a few more problems we should be dealing with. I'm sure their are many more.

[KB]

A.I.: Yes, there are lots of problems with the health care system, and with every other system. I agree particularly on the medical records issue. It seems crazy that we don't have a standard system for this. As for medical forms, the idea that more government in health care will lead to fewer or simpler forms is like saying that more winter will lead to warmer temperatures. It defies all experience.

When the President calls for health care reform, he almost always talks about cost reduction of the 45 million uninsured. So maybe we ought to be clear about those problems first.

[Erik]

KB:
Fair enough, I think I was just expressing my frustration at the complexity of the problem. I was rude, I apologize. But I do think that it is immoral that we have millions of Americans with no health insurance. And part of the conservative response to national health insurance, are just delaying tactics.

[KB]

Erik: I took no offense. I agree with you that this business is frustrating.

[A.I.]

And thank you, KB, for providing the forum.

I agree standardized forms may not be simpler, but they would all be the same. So the effect of standardization would be simplification of the process because those filing claims would not be dealing with myriad different rules. And to be clear, I'm referring to claim forms, not medical records.

There are various ways to get to a system of standard forms. We might force all insurers to offer the same basic level of coverage as a public option plan and to provide forms identical to those used by the government. We might allow private insurers to offer plans that would enhance the public option, but all would be required to use the same forms. The public option could offer various levels of coverage with standard forms for each and private insurers would be limited to identical plans. Or we could simply go to a single-payer system which would automatically result in standardization.

As we're told single-payer is politically impossible to achieve at this time, I opt for a public option that at least includes such features as transportability, acceptance and full coverage of those with pre-existing conditions at rates equal to those of malady-free patients and a guarantee that developing a chronic or expensive illness will not result in loss of coverage. Sans those provisions, I will be about as enthused about "change" as you are.

Every advocate for change does mention the uninsured a lot. Yes Obama has linked costs and the uninsured and he has talked about ballooning health care charges from providers. Perhaps he should also be talking about charges from private insurers and monopolization of the industry if this study is at all accurate: http://healthcareforamericanow.org/site/content/new_report_private_insurers_consolidate_and_control_prices.

If you get into the state reports, you find that from 2000 to 2007, South Dakota health insurance premiums increased 3.3 times faster than family's median earning. During that same period, profits at the ten largest insurance companies rose 438%. To paraphrase what Ronald Reagan once said of government, it would appear the private insurers are part of the problem, not the solution.

[Derrick]

Hi, I wrote a short article on considering Healthcare Plans as an alternative to expensive insurance plans, and it provides a partial solution to the issues your article addresses.

Also, can I use the illustration on this page? I can put a link on my site, referencing your article posting?