A. When we’re talking about Americans without health insurance.
You’ve all heard the statistic: “45 million Americans with no health insurance.” I just saw it in this article: “According to the U.S. Census Bureau, almost 45 million Americans have no health insurance.” It’s been a major topic for Democratic presidential candidates:
- John Edwards: “You tell me what it means when you ignore 45 million Americans today, who have no health care coverage.”
- Hillary Clinton: “The money we save from the waste we eliminate and the way we change how we care for people should be used to help finance coverage for the 45 million Americans who have no insurance,”
- Barack Obama: “If you are one of the 45 million Americans who don’t have health insurance, after this plan becomes law, you will have health insurance available to you,”
Oops, they counted non-citizens. So, what do I mean about 45 million not being 45 million? Well, the number originally came from the Census Bureau’s 2005 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC), which was corrected last year to 44.8 million people without health insurance. If you read the report, however, you’ll find that 9.2 million of the uninsured are not citizens of the United States.
That means that there are 35.6 million Americans who don’t have health insurance. That’s 12.3% of the population, rather than the quoted 15.3%. Does “36 million” sound as impressive as “45 million?” I don’t think so.
Let’s pause here for a moment and consider what the Democrats are proposing. What they are saying is that they want to radically change the way health insurance is handled in this country because 1 person in 8 is without insurance. That is, they want to force 7 out of 8 people to change their health care system to accommodate that one person.
A tyranny of the minority.
Uninsured for how long? Now let’s look at those 35.6 million people a little more closely. When we say that somebody is “uninsured,” most of us imagine some poor betrodden worker laboring for years without medical attention because he can’t get insurance. I call this “chronically uninsured” – somebody who can’t afford to get into the insurance system, and so goes without insurance for long periods of time.
The Census Bureau report (cited above) notes that the number of uninsured people that they quote are not “chronically uninsured.” In fact many of them have had insurance during the preceding year, but were “between insurances” at the time of the survey. They suggest looking at a Congressional Budget Office Report, “How Many People Lack Health Insurance and For How Long?,” to understand this effect.
The Census Bureau says that its data best corresponds to a “point in time” survey, i.e., the answer you would get if you asked people: “Are you insured right now?” The CBO report tells us the relationship between “point in time” data and “uninsured all year” data:
The most direct comparison of the two measures comes from a study of SIPP data that found that 14.8 percent of Americans (including the elderly) were uninsured at a point in time in 1992, while 7.6 percent were uninsured all year.(13) That nearly two-to-one ratio is echoed in the 1998 figures from SIPP,16.6 percent versus 9.1 percent.
So of the 35.6 million uninsured from the Census Bureau survey, we can estimate that about half didn’t have insurance for an entire year. Those 18 million people are the “chronically uninsured,” and are the people that policy changes should address. Or, I should say more accurately, they are the only group of people whose plight warrants major legislative intervention.
Conclusion. The 18 million citizens who are chronically uninsured represent only 6% of the population. Turning the health care industry upside down for 1 out of 15 people seems a bit much, and running a presidential campaign on the basis of the welfare of 1 out of 15 people seems like a distortion of priorities.
But “45 million” repeated again and again will probably carry the day for health care reformers.
June 5, 2007 at 8:10 am
true, but it’s still a significant amount.
June 5, 2007 at 8:17 am
Yes, but the cost-benefit ratio has changed by a factor of 2.5X.
June 5, 2007 at 8:32 am
true, but it’s still a significant amount.
So what?
June 5, 2007 at 9:29 am
Ver interesting! I appreciate your hard look at the stats — it makes me think of lots of questions:
Why do the Dem candidates percieve it’s in their interest to over-inflate the numbers to such a huge degree? Or is it just intellectual laziness combined with a desire to make a bigger impact in their speeches?
What typically happens when an uninsured person gets sick or injured? Do they fall into whatever safety net is available? Are they more likely to skip treatment because they can’t afford it? Are they more likely to skip treatment for their sick kid because they can’ afford it?
Putting aside whether there’s a moral imperative to try to solve this, is there a market imperative? What’s the cost of insuring everyone vs. the cost of letting 18-45M people remain uninsured?
June 5, 2007 at 9:40 am
What’s the cost of insuring everyone vs. the cost of letting 18-45M people remain uninsured?
The real question, I think, is how broken is the system? That is, how much change do you need to fix it? Are we talking about universal health care or just an expansion of Medicare? A rider to unemployment insurance, or a complete socialization of the health care industry?
The much smaller number of actual long-term uninsured people suggests that the system works for more people, and only needs a band-aid to handle the rest. As it were. Back in high school debate we used to call this the “Status Quo + Minor Repairs” solution.
But the Dems are framing this as a mandate for a complete revamping of our health care system. I think that’s dangerous and unjustified by the real numbers. As to why, all I can say is that it’s an emotional issue for many voters, and the desire to fix things is a fundamental part of the progressive psyche (by definition, really). So it’s easy to use as a vote-collector. There may be motives beyond that, but I don’t have a clue as to what they’d be.
July 16, 2007 at 2:48 pm
Why do the Dem’s view this as a voter getter? The answer, I believe, lies in the belief of many of their supporters that they will receive FREE health care. Since a sizable portion of their votes come from people who aren’t paying much or anything in taxes anyhow, this may, in fact, be true for them.
The socialized health care plan will shift a substantial portion of the costs from the individual payer to the middle class tax payer. By the way, generally the level of care provided by a Nationalized care system isn’t as nice as that provided by private plans. In my experience this means taxes are paid for the basic care and then an insurance policy is purchased for a nicer care experience. Since the poor aren’t paying for their care, the middle class taxpayers pays for their care and his own basic care in taxes – that is pays more than he does now. Additionally he’ll have an insurance payment, on top of that.