The real problem is that too many are insured
American Medical News
April 25, 2005
Uninsured a problem hard to grasp, solve
By Joel B. Finkelstein
…disagreement over exactly how many uninsured Americans there are continues to muddy the national debate about how to fix the problem, experts said.
The Census Bureau’s Current Population Survey offers the most-often-cited number of 45 million Americans without health insurance for all of 2003. But a survey by the Dept. of Health and Human Services found that only 28.8 million lacked health insurance that year. The surveys differ in size and methods.
In a separate analysis of the Census Bureau data, HHS suggested there may be as few as 9 million uninsured Americans.
Researchers arrived at that number after deducting individuals who should be in Medicaid, illegal immigrants, young adults with little or no health care costs, and people who could afford health insurance but chose not to buy it.
http://www.ama-assn.org/amednews/2005/04/25/gvsc0425.htm
Comment: The Department of Health and Human Services makes a very important point. Policy decisions should never be made based on raw data alone. An intelligent “administrative analysis” of the data can provide us with a much more rational basis for establishing policy. Thanks to HHS’s expertise, it looks as if we may be faced with establishing policies for only 9 million uninsured rather than the 45 million estimate of the Census Bureau.
Giving this more thought, we’ve been pretty stupid in our approach to health care coverage. Instead of being concerned about the 45 million without insurance, we should have been directing our attention to the real numbers: the 251 million who do have insurance, which is 85% of our population.
About 237 million people (80% of our population) use about $380 billion in health care (20% of our national health care spending). That means that the average health care costs per individual for this 80% of our population is about $1600. Yet the Kaiser Family Foundation survey reported that we spend $3700 per individual in health insurance premiums.
If we had used our data more effectively, we would have reframed the debate quite differently. We should have been asking why anyone in their right mind would pay $3700 to cover $1600 in health care benefits! Quite obviously we should have been establishing policies that would make certain that none of these 237 million have health insurance, since it is clear that the real problem is that we have excessive numbers of individuals covered!
But when we discuss our new brilliant analysis of the raw data, we do have to be careful not to mention the other 20% of our population whose health care costs average $26,000 per person. After all, why should we ever establish policies that benefit the minority at the expense of the majority?
HHS is right. The 9 million without insurance is only 3% of our population. That’s such a small number that we can ignore it. Thank goodness we have an administration which selects brilliant bureaucrats who can provide such clarity in our approach to health policy issues.
And the dead that will result from these policies? Everyone understands that collateral damage is just a fact of life.
Don McCanne, MD
Senior Health Policy Fellow
Physicians for a National Health Program
www.pnhp.org
(Please share this message with others. After all, it’s time that we get our national priorities right!)