How Many People Are Uninsured? Part 2

Stanley Feld M.D.,FACP,MACE

The three examples of the involuntary uninsured have been described in my previous post. They are real and must be addressed. The actual number of uninsured does not matter. Whether the number of uninsured is 47 million or 18 million is irrelevant. Either number is a national disgrace if the people understand they need healthcare insurance and cannot get it for one or more reasons. Both sides of the debate present the number of uninsured. They do not present the causes or the solutions to cure the problem. One side lumps all the causes of lack of insurance and gets a big number (47.5 million). The other side divides the causes into small numbers without the defining the subsets for the cause.

Everyone should have the opportunity to purchase affordable healthcare insurance. This presupposes that the inefficiencies of the healthcare insurance companies, hospital systems and physician practicesthat we have discussed be eliminated. It also presupposes that preventative medicine be supported, and that efficient systems of care be promoted to decrease the complications of chronic disease. This also presupposes that the patient is motivated to actively participate in preventing the complications of chronic disease. It also presupposes that the patient can afford to adhere to the medication and drug therapy prescribed.

It is important to remember that 90% of the Medicare healthcare dollar and 80% of the private insurance dollar is spent on the complications of chronic disease. The complications of chronic disease cannot be handled by an inefficient healthcare system that penalizes prevention and the care of chronic disease.

With the encouragement and support of the development and execution of systems of care for chronic disease we could decrease the complication rate by at least 50% and decrease the total cost to the healthcare system by 45% for Medicare and 40% for private insurance. This savings should certainly be passed on to the consumer by the government and the healthcare insurance companies in the form of affordable premiums.

Citizens should have the right to choose to be uninsured in a society where affordable insurance is readily available. However, they should bare the responsibility and burden of being uninsured. The burden of their cost of care is currently being paid for by local tax money. A motivational deterrent against lack of insurance can be constructed.

The New York Times covered the issue of the uninsured by lumping everyone together to try to precipitate change.

“The bureau reported a large increase in the number of Americans who lack health insurance, data that ought to send an unmistakable message to Washington: vigorous action is needed to reverse this alarming and intractable trend.”

It is clear that fear leads to political action but not necessarily logical and common sense change.

“Last year, the number of uninsured Americans increased by a daunting 2.2 million, from 44.8 million in 2005 to 47.0 million in 2006. That scotched any hope that the faltering economic recovery would help alleviate the problem.”

If more people lost jobs there would be more uninsured. There are more people coming into the system yearly. If they can not get healthcare insurance an illness could be disastrous to them and our economy.

“The main reason for the upsurge in uninsured Americans is that employment-based coverage continued to deteriorate. Indeed, the number of full-time workers without health insurance rose from 20.8 million in 2005 to 22.0 million in 2006, presumably because either the employers or the workers or both found it too costly.”

This is true. The inefficiencies in the system and the outrageous profit in the healthcare insurance industry has generated unaffordable premiums for an individual who would qualify to buy insurance. Additionally, the individual has to buys insurance with after tax dollars while his employer buy insurance with pretax dollar. This makes the healthcare insurance even more costly.

“The challenge to the White House and Congress seems clear. The upward trend in the number of uninsured needs to be reversed because many studies have shown that people who lack health insurance tend to forgo needed care until they become much sicker and go to expensive emergency rooms for treatment. That harms their health and drives up everyone’s health care costs.”

Again true, true and related. The emergency room fees are also outrageous because of the billing system. The healthcare insurance companies get a deep discount from the retail bill for emergency room care. The uninsured are responsible for the entire retail bill. The above paragraph does not get to the issue about why so many people are uninsured. It simply is a scare tactic to try to precipitate a solution. As pointed out previously, the heathcare insurance industry does not want a solution. They are not the stakeholders in pain. They are the stakeholders in control. The result will be the government will take over and be a single party payer. This is socialized medicine. It will be a disaster as we have seen illustrated over and over again
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The other side of the argument has a different number for the actual uninsured. They claim” the increase in the number of uninsured largely due to immigration, population growth and choice.”

Our nation has provided for the immigrants in the form of Medicaid. It is difficult for an English speaking person to negotiate the system. It is even more difficult for a person just learning English. The other two issues seem lame because healthcare insurance is unaffordable.

“Nearly 18 million uninsured Americans live in households with annual
incomes above $50,000, and could likely afford health insurance.”

Many of these people have jobs but their companies have stopped insuring them. Many are uninsurable as individuals. Many could buy insurance with unaffordable deduction and intolerable exclusions using after tax dollars.

“More than 84 percent (250.4 million) of U.S. residents were
privately insured or enrolled in a government health care program,
Such as Medicare, Medicaid or the State Children’s Health Insurance
Program (SCHIP”).

The number seems correct. There are over three hundred million people in this country. Therefore, 47 million uninsured is a probable number.

” In addition, a recent BlueCross BlueShield Association report on the uninsured estimated nearly 14 million adults and children qualified for government programs but did not enroll.”

The story of the 42 year old Hispanic U.S. citizen whose children where dropped from Medicaid happens over and over again. It cannot be dismissed with a slight of hand. If it was simple to obtain Medicaid and keep it, I know this man would have it. It is not simple to negotiate the system. The solution to this problem is to make it simple.

“Although immigrants (including naturalized U.S. citizens) make up slightly less than 12 percent of the population, they make up 27 percent of the uninsured.”

I can believe this number is true. It is difficult for these people to work their way through the bureaucracy, especially when they are afraid that any complaint they have can get them in trouble. The solution is easy. We can make it easier to get the coverage, we as a nation, have committed to provide.

“By this count, nearly 10 percent of uninsured Americans theoretically have access to some form of insurance but have chosen to forgo it.”

The reason this 10% choose to be uninsured must be defined. I would guess it is because the premium is intolerable or the exclusions end up providing little coverage. It sounds like a good argument. However the insurance that they can get is usually worthless. Insurance that is worthless is not insurance. The goal should be to make good healthcare insurance affordable!

“Approximately 75 percent of uninsured spells last one year or less.”

This number could be significant in exaggerating the number of uninsured people.

Both sides of the uninsured argument exaggerate the issue to defend their position. They never answer the essential questions. They do not offer solutions. The articles that exaggerate the high number of uninsured do not break down the reasons for the lack of insurance. They do not study the reasons for those subgroups. They are convinced the solution is a single party payer.

The conservative health policy wonks try to defend the free market economy. The problem is the healthcare system in its present form is not a free market economy because the consumer is not in control creating competition. The insurance industry is in control and is abusing its privileged position. I believe in a true free market healthcare economy with the consumer owning his healthcare dollar and forcing competition among the other stakeholders. This is the only way to solve the problem of the uninsured.