Insuring the Uninsured

At any one time as many as 46 million Americans lack health insurance.  What should we do about that?  For more than 25 years, my colleagues and I at the National Center for Policy Analysis have been studying this problem, and we have created proposals which have been championed by both Republicans and Democrats, liberals and conservatives.  Type in the words "insuring the uninsured" at the NCPA's Web site and you will find 174 entries.  Below is a brief summary.

Give everyone a health savings account: 

  • Every individual should be able to deposit up to $200 into a tax-free health savings account (HSA) every month.
  • Employers should be encouraged to automatically enroll their employees in a HSA.

Give all private health insurance the same tax break:

  • Currently, the federal government "spends" about $250 billion a year on tax subsidies for private insurance, so the government is paying almost half the cost of a middle-income family's insurance.
  • The solution is to subsidize all insurance uniformly; people should receive the same tax advantage for the purchase of insurance, regardless of how it is obtained.

Give every family the same tax break:

  • Ideally, a uniform, refundable tax credit should be offered to every individual for the purchase of private insurance.
  • An example is McCain's proposal to offer a tax credit of $2,500 (individual) or $5,000 (family).

Give people alternatives to Medicaid and SCHIP:

  • When people enroll in Medicaid and SCHIP plans that pay Medicare rates they have far fewer options.
  • The solution is to reverse the process, making it as easy as possible for people to use their Medicaid dollars to enroll in employer plans and other private insurance.

Construct a workable, funded safety net.

  • The offer of $5,000 to every family should be reserved for healthcare, regardless of the family's choice.
  • If the family stays uninsured, the subsidy should go to a local safety net institution that will be called on to provide free care if the family cannot pay for it.

Comments (9)

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  1. Vicki says:

    This should be required reading for all those left wing bloggers who were attacking Goodman for not caring about the uninsured. It won’t supply them with a sense of humor. It will teach them something about health care.

  2. Tom says:

    This is not only a very serious approach to the subject, it is refreshingly original.

  3. Frederick W. Ford says:

    The better plan to insure everyone is to support John Conyer’s bill, HR 676, The National Health Insurance Act, which would expand and improve medicare to cover every one in the country under a single payer, not for profit system. As long as the insurance companies continue to be involved in the delivery of health care in the country, no system, hovever well intentioned, will work. Under HR 676:

    • Everyone receives a Medicare card assuring payment for all needed care.
    • Free choice of doctor and hospital.
    • Doctors and hospitals remain independent, negotiating fees and budgets with Medicare.
    • Financed through progressive taxes (increase of Medicare payroll deduction to 4.75%, considerably less than the private insurance premiums being paid by employees and employers now).
    • Public agency processes and pays bills.

    Some Implications of “True” Medicare for All

    • The same coverage for everyone: No means testing; coverage would not depend on income, employment or age.
    • Medicaid would no be longer needed. Everyone would be under one system.
    • Hundreds of billions of dollars in administrative costs would be saved.
    • Costs would be controlled through capital planning, budgeting, and quality reviews conducted through the single insurer.

    Get more information at and

  4. Jim Johnston says:

    How will we be able to determine the cost of insurance to cover a cost that there is no control over. The first problem is to get control of health care. Work on first things first and then you can control the cost and method of insurance

  5. Gregory Isaacs says:

    As with all of your other suggested plans, you don’t address pre-existing conditions which prevents people from getting insurance or the cost of individual poliocies. I am a healthy 60m year old and my health insurance goes up every six months. It is now more than my mortgage.

  6. Clinton J Sewell, MD says:

    That “local safety net institution” should be a community-based healthcare delivery system of primary care physicians organized as a corporation of private practices. Efforts are being made throughout the country therough Sermo, an online website fo 70,000 physicians, to establish these networks, called CPNs or Community Physician Networks.

    As an integrated delivery system, their objective is to deliver more efficient and higher quality healthcare to the communities they serve. They will do so by engaging with their respective communities in forums outside of the office – schools, community centers, churches, healthfairs etc. as well as providing an integrated approach to care delivery that will lead to better health awareness and measurably improved treatment outcomes.

    CPNs will provide the kind of quality healthcare service that can be presented to an employer (especially large employers) as an option to purchasing insurance, through direct payment arrangements or by establishing HSAs in network affiliated institutions
    for their employees.

    These networks would be the appropriate ‘safety net’ to provide the healthcare needs of the uninsureds of the
    community. The individual or family subsidies would be held in a local financial institution, and disbursements made by use of a swipe card/ID (credit card type) system.

    The accelerated development of CPNs, however, will require the support of government in the areas of technology and infrastructural development – an area in which both presidential candidates have some agreement. Your support, as an expert on healthcare policy will also be invaluable. Please do not hesitate to promulgate the virtues of CPNs to captive audiences.

    For more information on CPNs, visit and view the FAQs on the Physician Networks page.

  7. Bob Kramer says:

    A spectacular analysis, again. Why don’t people remember what they read? My main concern is from the provider side; it is almost impossible for a physician to earn a living AND practice good medicine if he (or she) has to rely on Medicare and Medicaid as their revenue source. This could provide for a great in-depth analysis.

  8. Patricia Masters says:

    Only problem I foresee is…

    If a person gets their health insurance through their employer AND it is a CS125 plan that IS NOT included in their Gross Taxable Wages and, therefore, not taxable for any Federal and State Income Tax purpose..
    … they should not get the $5,000 credit

    Otherwise, they are ‘double-dipping’… they get the tax break from non-taxable compensation AND $5,000 tax credit…

  9. Atidje says:

    Search health ianurnsce on yahoo or google it. There are several plans that you can apply for which will cover your maternity care. You will have to pay about 150 or so a month and pay for your co-pay, but its about half the cost of what your out of pocket costs would be. You can try filing for medicaid or medicare, but if you make too much you wont qualify. Try talking to your HR rep and find out what you can do to up your ianurnsce coverage during your pregnancy, if she doest know you can call and ask your insurnace company. You may have to pay a little more towards it during your pregnancy, but that is better than paying out of pocket. Your HR dept or your benefits dept has the key to this. They should be able to up your limit. If you have to quit your job and get cobra, they will cover it. Though, once again, you will have to pay a monthly amount. Then you can search for a job else where.BTW new ianurnsce companies will cover you .pregnancy is not a pre-exisitng condition since it is short term. And as long as you have had ianurnsce previous to applying for new ianurnsce, they should cover you at no charge.