How Sick are the Uninsured?

A new study by our old single-payer friends, Harvard professors David Himmelstein and Steffie Woolhandler, and colleagues, is in the Annals of Internal Medicine.  The conclusion: nearly one-third of the uninsured suffer from a chronic condition. 

Media Spin: the uninsured are not as young and healthy as everyone thinks; they are sick and probably have a lot of unmet health needs.

Correct Spin: regardless of how chronic conditions are measured, the uninsured are healthier than people with health insurance.

The researchers determined the number of people with a chronic condition from self-reported data and prescription data.  If you were ever told by a physician that your blood pressure or cholesterol was too high, or that you had "sugar diabetes," for example, the researchers assume you have a chronic condition.  In addition, if you are currently taking a prescription for a chronic condition they assumed you have the condition.

This brings three thoughts to mind: 1) The methodology is destined to make the chronic population very large. 2) If the existence of chronic conditions was ascertained by prescription data, the patient is apparently receiving care for the condition. 3) If a patient was told by a physician that she has, say, high blood pressure or high cholesterol, she apparently has access to physician care.

Something else is interesting.  The study found that 31.3% of the uninsured had one of six chronic conditions. What's the prevalence of chronic conditions for people with health coverage, you may ask?  It is 45.4%.  When you control for demographic factors such as age, sex, race, etc., the numbers are 44% (insured) and 38% (uninsured).

The study confirms the conventional wisdom among most health policy wonks: the uninsured are younger and generally in better health than those with health insurance.

Comments (3)

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  1. Joe S. says:

    Here is what the news coverage should have said:

    1. Almost half the population has a chronic disease, under the authors’ loose definition.

    2. The incidence of chronic disease is 50% greater among the insured than among the uninsured.

  2. Gregory S. Isaacs says:

    Once again, you are exactly correct. “Chronic” conditions are so loosely defined by the insurance companies that they apply to half the nation. This is why people have so much trouble getting coverage. I pay $1,000 a month for terrible coverage – my pre-existing condition? I am 62. That’s it. You should send out some “secret shoppers” with some mild and common “chronic conditions” and see the results. It should prove your point … if you are correct.

  3. Elaine C. says:

    You are cruel, inhuman meanies. Health care is a right, not a right to make money on medical fate. It appears you have validated that America has a well-oiled functioning caste system when it comes to care of the human body. If you can pay for it, you get to live. If not, hey, we have a fine selection of gutters for you to roll over and die in. I am the face of the uninsured. I’m a college graduate, an award-winning writer, over 50 and unable to get insurance that I can afford, or that would do me much good. I’ve been priced out, and I’m not even a scumbag. One day, your greedy ideology will become subsumed by people so angry at how profits are made at our expense you will have to find a new belief system. You’re malevolent and vile. I want to be “free” too, that is, free to live without fear that a mole on my arm will bankrupt my family.