Health Care CRISIS! Perspectives

Here's Keith Hennessey's look at the real numbers undergirding the drumbeat of "CRISIS!" in US health care. He asks the question that should be the starting point for any solution to the "CRISIS!" namely: How many uninsured people need additional help from taxpayers?

Let us walk through the graph from top to bottom.

• There were 45.7 million uninsured people in the U.S. in 2007.
• Of that amount, 6.4 million are the Medicaid undercount.  These are people who are on one of two government health insurance programs, Medicaid or S-CHIP, but mistakenly (intentionally or not) tell the Census taker that they are uninsured.  There is disagreement about the size of the Medicaid undercount.  This figure is based on a 2005 analysis from the Department of Health and Human Services.
• Another 4.3 million are eligible for free or heavily subsidized government health insurance (again, either Medcaid or SCHIP), but have not yet signed up.  While these people are not pre-enrolled in a health insurance program and are therefore counted as uninsured, if they were to go to an emergency room (or a free clinic), they would be automatically enrolled in that program by the provider after receiving medical care.  There’s an interesting philosophical question that I will skip about whether they are, in fact, uninsured, if technically they are protected from risk.
• Another 9.3 million are non-citizens.  I cannot break that down into documented vs. undocumented citizens.
• Another 10.1 million do not fit into any of the above categories, and they have incomes more than 3X the poverty level.  For a single person that means their income exceeded $30,600 in 2007, when the median income for a single male was $33,200 and for a female, $21,000.  For a family of four, if your income was more than 3X the poverty level in 2007, you had $62,000 of income or more, and you were above the national median.
• Of the remaining 15.6 million uninsured, 5 million are adults between ages 18 and 34 and without kids.
• The remaining 10.6 million do not fit into any of the above categories, so they are:
  • U.S. citizens;
  • with income below 300% of poverty;
  • not on or eligible for a taxpayer-subsidized health insurance program;
  • and not a childless adult between age 18 and 34.

As a policy matter, we care not about the total number of uninsured, but about the subset of that group that we think “deserves” taxpayer-subsidized health insurance.  That is a judgment call that involves some value choices.

Absolutely right, but the "CRISIS!" mongering that we hear out of the government and the media is designed to avoid just such choices, but merely seeks to expand the government's reach at the expense of efficiency and choice.  

Hennessey's basic point is that there are already millions of the legendary 45 million uninsured people who are already "covered" through existing programs. There are millions of non-citizens who are uninsured who are also part of the 45 million "uninsured." I would guess that the average US citizen would have little or no enthusiasm for a "CRISIS!" solution that was designed to cover non-citizens, illegal or not. So, instead, the "CRISIS!" mongers lump them in with all the rest and hope no one notices. And, for the most part, no one does. 

There are a lot of "CRISES!" facing Americans at the moment. Some are real. Some are bogus. Some are ambiguous. The health care "CRISIS!" fits in the latter. Everyone thinks they pay too much for insurance and healthcare. Certainly, there are inefficiencies in the system. Certainly, there are unjust results: the proto-typical "toddler with rare blood disease who is dropped from her HMO." Certainly, it's too easy for people to walk into the ER for treatment, and then walk away from their bills. Certainly, it is too easy for doctors to be sued and second-guessed. 

But, the only solution being discussed is the one-size-fits-all gov't sponsored solution. And that solution is based, in large part, on a number - 45 million uninsured - that doesn't truly express the extent of the problem. 

Health care has been described by progressives as a "right." But our other rights - speech, association, equal protection of the law, due process - are essentially priceless; they lack a price tag. Health care, no matter how much folks want to believe otherwise, comes with a very high price tag. That's not because of Big Pharma, Big Insurance, and Evil Republicans. It's because the infrastructure and treatments that 21st century Americans demand are expensive. But, a big part of the arguments put forth by health care progressives doesn't address this. Instead, they contrive a "CRISIS!" out of scare-numbers and anecdotal horror stories without wondering who are we trying to cover and why.