Leading policy-makers and scholars explain how market forces, deregulation, and consumer choice can work to improve health care for all Americans.


No crisis of the uninsured
Mike Rosen, Rocky Mountain News, 1-12-07

Rosen thinks that the growing national impetus to do "something" about the uninsured overlooks the fact that Americans without health insurance are far from a homogenous or stable group. In fact, the number of Americans who are chronically uninsured is far fewer than is commonly portrayed in the media.

Forty–six million is the snapshot figure, the average number who have no insurance on a given day. To see how misleading this can be, consider this: At any time perhaps 50 million Americans have a head cold. And during the course of a year, probably 300 million Americans will have a cold at one time or another. This is hardly the same thing as saying that 300 million Americans have a permanent head cold.

The uninsured can include those between jobs or students just out of school. The Census Bureau stimates that the average family that loses its health insurance will be reinsured within 5 1/2 months; 75 percent will be reinsured within one year. The Congressional Budget Office estimates that between 21 million and 31 million Americans may be uninsured for the entire year, including about 12 million foreign-born residents many of whom are here illegally.

The largest group, 42 percent, of longer–term uninsured, about 19 million, are between the ages of 18 and 34. Most are healthy and could afford health insurance but choose to gamble, opting to run the risk of going uninsured rather than forgoing current consumption. This is motivated in part by the ease of acquiring government–regulated health insurance after becoming ill or obtaining free treatment at a hospital emergency room if unable to pay.

While the number of those without health insurance has grown by 3 million between 1996–2003, that's primarily because the nation's population has grown, much of it from illegal immigration. In fact, the percentage of those without insurance, 15.6 percent, is unchanged over the period. And it's not poor people who are adding to the ranks of the uninsured. Thanks to the expansion of means-tested Medicaid programs and State Children's Health Insurance Programs (SCHIP), the number of uninsured in households with annual incomes under $25,000 has actually decreased by 21 percent between 1996–2005. At the same time, there are 117 percent more people without insurance among households with incomes over $75,000.

Let's look at the portion of the glass that's full, not just the empty part. According to the Census Bureau, more than 247 million Americans had either private insurance or were enrolled in a government health program in 2005. That's almost 85 percent of the population. As many as 14 million of the uninsured are adults and children who are already eligible for existing government programs but have failed to enroll.

The serious problems are confined to about 10 million to 15 million who can't afford insurance but make too much to qualify for Medicaid, and another 2 million to 3 million who are uninsurable because of specific diseases. But these problems are manageable. We already subsidize health insurance for those who can't afford it. So we can do a little more of that and provide special coverage for pre–existing conditions.

Project FDA.
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