Hearing all of the talk about the great uninsured masses lately would lead one to think the bodies must be piling up in the streets by now, but what are the real facts behind so many of these conflicting reports?
According to the Census Bureau, as of 2008, 47 million people or (15.8% of our current population) are currently without health coverage.
An alarming number to say the least, but as we often find with such data, the real truth rests in the details.
Although previously estimating the number of uninsured Americans to be about 31 million, the Congressional Budget Office has recently revised their totals, arriving at a figure of 45 million for 2009. As you can see in the chart below, the CBO places the number of non-elderly uninsured at 17%, the same as the percentage of people currently on Medicaid.
According to MIT economist Jonathan Gruber, illegal immigrants make up as much as 13%, or nearly 6 million people, of the total number of the uninsured today.
In addition, a Commonwealth Fund brief places the number of uninsured young people ages 19-29 at 13.2 million in 2007. The Census Bureau places those numbers for the same year at 17.9 million with the 18-24 year old demographic (often termed the "invincibles") representing 7,991,000 of the uninsured and the 25-34 year old group comprising 10,329,000 of the total. Young people are often afflicted with incurable cases of good health which may explain why many often choose not to pay for coverage.
In 2007, 17.6 million of the uninsured had annual incomes of more than $50,000 and 9.1 million earned more than $75,000. More details here.
James L. Payne of AmConmag writes:
Politicians are also wrong to assume that I am pitiable. Like many Americans, I have significant savings and can afford medical expenses out of pocket. (Census Bureau figures for 2000 show that over 18 million households had assets in excess of $250,000.) Our savings make it possible for my wife and me to decline both private insurance and Medicaid. (We are 68.) Those without savings are in a different situation: they probably need insurance or subsidy or charitable help. My point is that if you can handle your own medical bills through savings and personal responsibility, this is a sound approach. Politicians should encourage this state of self-reliance, not make it a crime.
Putting all of these numbers together we arrive at the following:
6.0 million illegal immigrants
17.9 million young adults and “invincibles”
9.1 million affluent that choose not to purchase insurance
I did not include the 8.5 million making between $50-75,000 per year as health coverage could still represent a significant, albeit not overwhelming, bite of their household budgets.
I'd also like to stress that these numbers are only approximations. Statistics are easily skewed to represent one particular point of view, but even a generous tally would place us in the neighborhood of 15 million legitimately uninsured citizens or just under 5% of the total population (304,059,724). Many of those included in the total are often between jobs and will have coverage again in the future so the actual numbers are probably considerably lower.
The arguments against the currently proposed healthcare reform bill notwithstanding, what are we to do with these people? I've stated previously that I have no problem with providing coverage for those making less than $35,000 per year and a sliding scale for those earning up to $50,000 (maybe we could add that additional 8.5 million back into our total while we’re at it).
Medicaid eligibility and compensation varies from state to state, but perhaps standardizing the qualification limit at 200% above the poverty level would provide some instant relief for those unable to afford coverage.
Real, comprehensive reform of Medicaid would probably do much to cover a large percentage of the legitimately uninsured in this country. Obvious additional steps would include things such as tort reform. According to statistics from a Pacific Research Institute report:
Approximately $124 billion dollars is spent annually by the healthcare profession to avoid medical liability.
About $30 billion more is spent on direct liability lawsuit costs.
Malpractice liability cost is 1 percent of GDP and increases the cost of healthcare by approximately 7 percent. These added costs deny health insurance coverage to between 2.4 and 4.3 million people, according to the Department of Health and Human Services.
Allowing people to select "ala carte insurance coverage" would allow individuals to customize plans for their specific needs — does everyone really need coverage for in vitro fertilization as is required in policies throughout many states?
Converting all medical records to an electronic format and eliminating waste within the current systems are two obvious steps that could be taken now without creating a new governmental entity. These are ‘no-brainers' that would have a small but immediate impact.
We should take the necessary steps (for a number of reasons) to curb the flow of illegal immigration into this country. I'd also like to see an expansion of HSA (Health Savings Accounts) options and a hefty tax credit for doctors and hospitals providing free or reduced fee services.
The contributions of charitable donations and basic human decency should not be underestimated. On a local level, I recently spoke with several people at Munson Hospital and was astounded to find out how much care is donated to our area's less fortunate residents.
According to their fact sheet, "Munson Medical Center's mission is to care for all who pass through its doors, regardless of their ability to pay." Munson's cut-off for charity care is currently $20,420 for individuals and $41,300 for a family of four — 200 percent above the poverty level. In 2008, the hospital's charity care, write-offs and free programs to our community amounted to $30 million.
I presented them with a scenario of a 40-year-old uninsured laborer making $25,000 per year. This man just found out that he needs a new heart valve or has cancer requiring extensive treatment, what are his options? I was told that regardless of his condition, credit score or ability to pay, he would be provided full treatment and counseling with their financial aid dept. to work out a payment plan.
This is the type of solution we need. Obviously this sort of charity needs to be paid for somewhere along the way and all businesses (hospitals included) are in the game to make a profit, but this is a far cry from government mandated solutions and I would venture to guess that we'd find similar mentalities in hospitals throughout the country. There are also free clinics and local programs for uninsured adults such as the CHP through Community Mental Health.
To completely abandon our current system in exchange for a government plan that covers an additional 5% (or even 10%) of our population seems irrational given their track record and the long history of arguably failed initiatives such as Medicaid, Social Security, Welfare, the Community Reinvestment Act, Ethanol, The Homestead Act, Prohibition, the DEA and so on. If you'd like more, a partial list may be found here.
Hawaii recently ended a disastrous attempt at government healthcare known as Keiki care. Designed to provide affordable coverage to the state's children, the program was quickly abandoned as thousands who previously paid for their family's coverage shifted to the free system ($7/month), wreaking havoc on the state's budget. According to the Dept. of Human Services, 85% of those enrolled in the state plan had previously been paying for their own coverage.
Hawaii Governor Linda Lingle commented:
I think it should be a cautionary tale to anyone that there can be unintended consequences of these plans, and when you think you’re doing something that’s a good idea and you have good intentions, that’s often not enough.
While many on the left might argue that there are no failed government programs, only "under-funded" ones, I'm uncomfortable adding nationalized healthcare to the list above. Doing so would be about as effective as ordering chemotherapy for a headache.