Changes In Economic Conditions And Health Insurance Coverage, 2000-2004
By John Holahan and Allison Cook
Health Affairs
November 1, 2005
Between 2000 and 2004, the number of uninsured Americans increased by six million, primarily because of a decline in employer-sponsored insurance. All of the increase occurred among adults, for whom the drop in employer coverage was not offset by an increase in public coverage. The number of uninsured children fell slightly. About two-thirds of the growth in the uninsured was among Americans below 200 percent of the federal poverty level. Coverage rates have also fallen among higher-income Americans. About half of the growth in the uninsured was among young adults ages 19-34, about 55 percent among whites, and 73 percent among native-born citizens.
The decline in employer coverage is likely to continue. Increases in health care costs, and thus health insurance premiums, are likely to continue to grow faster than workers’ earnings. The decline in employer coverage will be further exacerbated if the shift from working in large and midsize firms to small firms and self-employment and from high- to low-coverage industries continues. The problem of the uninsured can be addressed in many different ways, such as tax credits or public program expansions, but doing so is likely to prove very difficult. Federal budget deficits are large, which will limit the federal government’s ability to act for the foreseeable future, and all indications are that the government will pursue spending cuts to address the huge cost of hurricane recovery in the coming years.
States also face serious budget problems in part because increases in health care spending outpace the growth in state revenues, a trend that is likely to continue. As a result, it is difficult to envision a reversal of the trends we have described in this paper.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.498v1
Comment: So employment-based coverage is declining, and the increases in the numbers of uninsured cannot be addressed because federal and state spending must be cut. What? Why is that last statement presented as if it were an immutable given?
We do have the option of moving health care spending from private ledgers to public budgets. Yes, there would be challenges in a publicly-budgeted system. In using public funds we would have to be certain that everyone was covered, and that access and funding would be on an equitable basis. But that really wouldn’t be much of a challenge for a single payer system since it would achieve precisely those goals by design.
As the problem gets worse, tens of thousands more will die. Yet we do nothing because one individual says, “No new taxes.” Isn’t there a higher ethical principle that should guide us?