The Uninsured

Like many plant species, the uninsured numbers bloom once a year, giving pundits an opportunity to spout another round of nonsense. The numbers do not change very much from year to year. Neither does the nonsense. Here for your reading pleasure are four items: Brief Analyses by Greg Scandlen and Devon Herrick, an editorial by me, and Herrick’s calculation of the amount of free care consumed each year by the uninsured. Combined, they make the following points:

  1. The official estimate overstates the actual number of uninsured by as much as twofold.
  2. Despite claims that the uninsured do not get health care, they get about $1,500 of free care per person per year, on top of the amount they pay for out-of-pocket.
  3. From one-fifth to one-third of the uninsured are de facto insured – they can enroll in free government programs at the drop of a hat – often months after care has been delivered!
  4. The vast majority of remaining uninsured are also probably de facto insured, considering how easy we have made it to become insured even after people get sick.
  5. Another one-third, have above-average incomes and presumably can afford to purchase insurance.
  6. Once people see a doctor, they get roughly the same care whether insured or not – so says RAND.
  7. Medical debts need not cause bankruptcy in most cases because hospitals rarely ever take people to court to force payment and credit bureaus often do not even list unpaid medical bills.
  8. Individual mandates are no solution – auto insurance is mandated almost everywhere and auto uninsurance rates are very similar to health uninsurance rates nationwide.

Comments (6)

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  1. Anonymous says:

    As long as there is “free care”, somebody on the giving end is being screwed.

  2. Anonymous says:

    auto insurance is different than health insurance. The uninsured in the former, pay by the month in order to satisfy MVD requirements. Once they obtain the necessary stuff, they stop paying the premiums. Then they get a free ride until they have an accident and the victim has no recourse…

  3. Anonymous says:

    the uninsured get care at least equal, and many times better than the insured. They usually go to large academically connected hospitals where care is often many times better.

    There are government sponsered programs, but there are lots of people who are just too lazy to sign up. Why should they go to the trouble since they’re not going to pay anyway. We need to develop some failsafes to prohibit this from happening

  4. Anonymous says:

    Half of the uninsured work full time for companies that provide health coverage, but the premiums are so high, the employee can’t afford it. HSA with ahi dollar deductible and the first $2-3000 paid by the employer, WITH THE PROVISION THAT IF IT IS NOT USED AND PATIENTS THINK ABOUT WHAT THEY ARE SPENDING ON, THEN THOSE FUNDS CAN ROLL OVER AND POTENTIALLY FUND A RETIREMENT PLAN.

  5. Daniel H. Johnson, Jr., M.D. says:

    Several points: 1. I wish the folks on our side would make more of the insured side of the equation than the uninsured. Those who have insurance through their employer are worried about losing it. 2. We are a long way from having people convinced that it is their responsibility to buy their own insurance. We're not going to get there in my lifetime. But we could easily get to a defined contribution model in which whoever is currently providing a subsidy would provide the same subsidy no matter what insurance plan an individual purchases. Then the individual who is employed would own his/her insurance, not the employer. 3. As a practical matter, from the perspective of a practicing physician, it is far easier and efficient to deliver services to someone with insurance than someone without it. 4. I personally believe that the overall goal is to provide the appropriate care in the appropriate setting at the appropriate time in a case of illness or injury. That is difficult enough in a patient with insurance, but much more problematic in a patient without insurance. 5. "de facto" insurance is just not the same as having insurance, especially if you accept the goal in #4 above. 6. While I recognize that you have never liked managed competition, I continue to believe that we should have a system in which multiple different financing and delivery mechanisms are in place. – Beneficiaries should have a wide array of choices from which to choose. – Individuals should have the opportunity and the responsibility to choose and own their own insurance, with the periodic right to change if they do not like their previous choice. – Whoever is providing a subsidy for the purchase of insurance (government, in the public sector; employers in the private sector or simply with tax credits) should put up the same subsidy no matter what plan the individual chooses. I personally feel that a system that enables those three points without spelling out benefit design and without price controls is the way to go, no matter what you call it. Keep up the good work! Daniel H. Johnson, Jr., M.D.

  6. brent out for self . says:

    its about time the goverment due for the people first concern itself with profit making big insurance later best would be a single payer system remove insurance cos from it take away there massive profits at the expence of people how to pay for it i could care less as long as its not me and it will not be because i am out for self let the upper income pay taxes they can afford it if you earn or have taxiable income of over 150,000 per year you can afford to pay more no one really needs that much thats over 12,500 per month you can only live in one house at a time and only drive a car one at a time get over your selfs