Next year, when Barack Obama becomes president, he will almost certainly move quickly toward some form of government-provided -- and possibly government-mandated -- health insurance. A principal reason for this is the oft-cited figure of 46 million uninsured Americans.
But what does this number mean? And do we really need to remake our entire health-care system to protect the uninsured? Most people have an incomplete understanding of the uninsured population, which can lead to bad policy choices.
Many Americans believe that the uninsured are too poor to purchase coverage and that government programs aren't available to them. But a study published in Health Affairs in November 2006 estimated that 25% of the uninsured were in fact eligible for public coverage, and another 20% probably could afford coverage on their own. If we apply those percentages to today's uninsured population, roughly 25 million people would need assistance in order to get health insurance.
That's a major concern. But the notion that there are 46 million Americans who can't get the health care they need for lack of money or public assistance is a myth.
The other two common misperceptions are that the uninsured don't get health care, and that when they do they're "free riders," i.e., they don't pay for the care they get.
A study published by the California HealthCare Foundation (CHCF) in April 2000 found that, of the uninsured California residents whose household income was at least twice the poverty level, 50% (about 1.3 million) had received care in the last year for which they were charged, and another 8% had received care for which they weren't charged. The study also found that 89% of these people were either somewhat or very satisfied with the care they received, and that only 15% went to the emergency room versus a doctor's office or clinic when they got sick.
Another recent study, published in Health Affairs in August, had similar findings, and estimated that uninsured Americans will receive $86 billion worth of health care in 2008.
These two studies also provide evidence that disputes the free-rider myth. The CHCF study found that of the 1.3 million uninsured who received care for which they were charged, 80% had paid for it, and almost half of the remaining 20% were paying in installments. The study published in Health Affairs estimated that the uninsured would pay for $30 billion of their health-care costs this year -- more than one-third -- out of pocket.
For the millions of the uninsured, then, who are getting and paying for satisfactory care on their own, foregoing needed care and sticking the public with huge ER bills is a myth.
Most of the proposals under discussion today involve a significant expansion of government programs, a legal requirement for everyone to carry insurance, or a combination of the two. But if millions of people have found ways to access and pay for satisfactory health care without involving an insurance company, is forcing them to buy traditional insurance an effective solution?
Perhaps we should look for ways to encourage the millions of people who are currently eligible for existing government programs to enroll before we expand programs to include people that may not need assistance.
Providing and funding care for those who have truly fallen through the cracks should be an urgent priority. But given the demands on state and federal budgets today, it's more important than ever to tailor solutions so limited resources can provide the most relief possible.
Come Jan. 20, President Obama and Congress should do all they can to separate myth from fact before tackling America's health-care problems.