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Counting the Uninsured

08.29.2007 - 11:45 AM

The annual Census Bureau report on income, poverty, and health insurance coverage was released yesterday, and set off the usual flurry of confusion and bad ideas on the last of those three subjects. The number of Americans without health insurance increased last year to roughly 47 million Americans, or 15.8 percent of the population. The raw number is less important than the percentage: in a growing population the raw number of both those without insurance and those with insurance is likely to grow (and indeed, the number of insured Americans increased by about 800,000 last year, while the number of uninsured increased by about 2 million.) But at 15.8 percent, the proportion of the uninsured matches its highest level ever (last reached in 1998).

In looking at this figure, though, a great deal of caution is warranted. As Eric Cohen and I pointed out in the February issue of COMMENTARY (and as the Census report itself notes) the number masks much nuance.

For instance, a family that loses its health coverage will, on average, become insured again in about five months. Only one-sixth of the uninsured lack coverage for two years or more. In addition, about a fifth of the uninsured are not American citizens, and so could not benefit from most proposed reforms. Roughly a third of the uninsured are eligible for public-assistance programs (especially Medicaid) but have not signed up, while another fifth (many of them young adults, under thirty-five) earn more than $50,000 a year, but choose not to buy coverage.

This is not to say that there aren’t a great many Americans going without health insurance, or that their plight doesn’t merit attention and action. It does, however, mean that unqualified use of the 47-million figure as a political rallying cry is not responsible.

Health insurance is, indeed, too expensive, for too many families. But the private health insurance system does work well for the great bulk of those who can afford it (a 2006 Kaiser Foundation poll found that 88 percent of those with health insurance rated their coverage good or excellent, and almost 60 percent were even satisfied with its cost). A sensible solution to the problems of the uninsured would help them afford access to private coverage, rather than replace the entire American health insurance system with a government funded single-payer approach. This approach—if we are to judge it by the experience of many nations that have tried it—is likely to reduce doctor and patient freedom, increase wait times, hurt quality, and (as we can already see from Medicaid and Medicare) threaten to bankrupt government budgets.

The Census figures show only that the uninsured are in need of help getting access to our (mostly) free-market health care system, not that America needs a huge new health insurance bureaucracy.

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