What exactly is health reform all about? Readers will be forgiven if they can't come up with a quick answer to that question. No one else can either. But during the Presidential election campaign, Barack Obama mentioned universal coverage a lot. With that in mind, consider that:
- Uninsurance is a lot like unemployment; it happens to many people for short periods of time, but it afflicts very few people for long periods of time.
- In fact, of all the people who are uninsured today, less than half will be uninsured a year from now.
- Less than one in ten will be uninsured two years from now — an amount equal to less than 2% of the nonelderly population.
Let's concede for the sake of argument that these chronically uninsured people have a problem that warrants federal attention. If Congress doesn't keep its eye on the ball (and it is inconceivable that it will keep its eye on the ball) we can end up spending $1.5 trillion over the next 10 years and — at the end of the day — have no assurance that the 2% will actually have been helped!
That works out to about $325,000 for each person who may not be helped!
When logic and proportion
Have fallen sloppy dead …
Remember what the dormouse
Said: "Keep your head."
Who exactly are the uninsured? At any given time:
- Roughly one-fourth of the uninsured are eligible for Medicaid or a State Children's Health Insurance Program (SCHIP), or have already enrolled and are erroneously counted as uninsured. If they are not otherwise getting free care, they can generally enroll at the time of treatment — or even later!
- More than 40% of the uninsured live in households with annual incomes in excess of $50,000 and presumably could pay premiums (or the employee's share of premiums) — although there is some argument about the meaning of this number.
- About one-fourth of the uninsured are immigrants, many of whom are illegal and will not be helped by health reform in any event.
Some of these categories are overlapping. Here is Keith Hennessey's attempt to give an integrated accounting.
Two more things to keep in mind: (1) federal and state legislation has made it increasingly easy to get insurance after people get sick and (2) an enormous amount of free care is delivered to people who have no insurance. These two factors alone virtually guarantee that many people will voluntarily choose to remain uninsured so long as they are healthy:
- Federal legislation prohibits employers from denying coverage to employees because of health status and legislation in every state prohibits group insurers from denying coverage because of health status.
- Six states even extend this type of regulation to the individual market and almost every state that does not has risk pools with subsidized insurance for people with pre-existing conditions.
- The Urban Institute estimates that public and private charity care totals to more than $1,100 per year for every uninsured person in America.
So tell me again, why we are about to spend $1.5 trillion on health reform?