Those Forked Tongue Democrats: How Many Uninsured?

Snake.jpgOne of the perpetual bones of contention in the ongoing health care reform debate is the precise number of people in serious need of help in this area. All too frequently we encounter various, exaggerated estimates, including some fact challenged quotes right here at TMV, which put the number as high as 50 million. Well, that’s certainly a troubling statistic for anyone to contemplate. In fact, the New York Times had a heartfelt opinion piece this weekend which recognizes a number of serious problems with the math on these figures, but then essentially bats them away, saying we shouldn’t dwell on the numbers.

But how many Americans are we really talking about here? And what mitigating factors need to be considered? A good place to start would be the most recent edition of the U.S. Census Bureau’s report on Income, Poverty and Health Insurance Coverage in the United States. (Follow the link, please, for the full PDF of the report.) It’s the same one cited in the Times piece. Turning to page 27 we find that the total number of people put in the category of not having health insurance during the previous year starts at 45.7 million (not fifty) which is down from 47 million in the previous reporting period. But that’s still a lot of people, isn’t it? We’ll need to do some more digging, obviously, and we will.

But first, here’s one more item which generally goes unmentioned when it comes to the Census Bureau’s Current Population Survey results, linked above. If you turn to appendix C, buried back on page 67, you will find that the Bureau doesn’t even have faith in its own numbers on this score.

National surveys and health insurance coverage

Health insurance coverage is likely to be underreported on the Current Population Survey (CPS). While underreporting affects most, if not all, surveys, underreporting of health insurance coverage in the Annual Social and Economic Supplement (ASEC) appears to be a larger problem than in other national surveys that ask about insurance. Some reasons for the disparity may include the fact that income, not health insurance, is the main focus of the ASEC questionnaire. In addition, the ASEC collects health insurance information by asking in February through April about the previous year’s coverage… Compared with other national surveys, the CPS estimate of the number of people without health insurance more closely approximates the number of people who are uninsured at a specific point in time during the year than the number of people uninsured for the entire year.

The report then refers you to the CBO’s report on How Many People are Uninsured and for How Long. This fascinating report informs us that, of the large numbers cited, roughly 45% of the people included in that statistic are not the chronically uninsured, but rather people who are in transition between jobs and are likely to have health insurance again within 120 days.

Next, we need to go back to the Census Bureau report and turn to page 31 where we are informed that their total number includes the category of those who are listed as “non-citizens” (which are carefully broken out from naturalized citizens vs. native born citizens.) The non-citizen rate of uninsured individuals clocked in at 43.8%, or roughly 9.4 million non-Americans. Since these people are not here legally and not paying into the system, that portion of the crisis is better addressed in a debate on immigration issues, but taxpaying Americans don’t need to be on the hook for that segment of the total.

While the number continues to drop, it’s also worth noting that we’re not talking exclusively about the abject poor who can’t afford insurance. As this Business and Media report informs us, that same Census Bureau summary includes the following:

But according to the same Census report, there are 8.3 million uninsured people who make between $50,000 and $74,999 per year and 8.74 million who make more than $75,000 a year. That’s roughly 17 million people who ought to be able to “afford” health insurance because they make substantially more than the median household income of $46,326.

Once you do some fairly basic math, you come up with the same figure that the Kaiser Family Foundation arrived at.

The liberal Kaiser Family Foundation puts the number of uninsured Americans who don’t qualify for government programs and make less than $50,000 a year between 8.2 million and 13.9 million.

Let’s say we take the high end figure and round up to 14 million. Yes, that’s still a lot of people in need of help, but the figure is becoming manageable at this point. If you look at the GOP’s health care bill, currently buried in Ways and Means, you realize that we could approve means testing for people in that category and issue them advancements and/or vouchers for five thousand dollars in coverage and you’d have accomplished the largest goal which most ObamaCare proponents claim to want to achieve. The price tag would not be chicken feed, coming in at 70 billion dollars, (and that figure assumes that every single person in that category would sign up) but after staring H.R. 3200 in the face at a cost of either 800 billion or two trillion (depending which CBO scoring method you go by) I can assure you that you’d have members from both parties doing back flips in their eagerness to sign on. And you could do it without driving a major American private industry into the ground and overloading public programs which we still don’t know how we’re going to finance in years to come.

Obviously there are other problems and they should be addressed as well. Those transitional people mentioned above should be able to move on to their next job without getting hit with preexisting condition clauses or major increases in premiums. Constantly increasing health care costs should be intelligently driven down, mostly by allowing interstate competition between private companies. But these are things where I believe the Republicans and Democrats can already find common ground. First, we’ll need to get the big issues put to bed, and a good place to start would be by being honest about how many people we need to insure and how we can most reasonably, efficiently and economically do it.

Previous Coverage:
Those Forked Tongue Democrats: Keeping Your Plan
Those Forked Tongue Democrats: Long Term Costs

EDIT: Changed 60 billion to 70 billion in paragraph eleven.

         

77 Comments

  1. CStanley,
    I know what you're saying, but I don't understand the big difference between mandating coverage for getting your teeth cleaned and seeing your primary care physician once a year. And since I'm talking about doing it through a government plan which would available to everyone, it wouldn't possibly price people out of coverage.

    Without examining the laws in all 50 states I cant say what I would or wouldn't choose to have as part of a Federal standard. My only point is that I think dental and vision should be covered.

  2. Chris, I'm actually not in favor of 'covering' a visit to the PCP once a year in the sense of having no out of pocket expense for most people. HR3200 is moving in the wrong direction in that sense, because apparently the new mandates of the exchanges would eliminate virtually all out of pocket expenses and make people even more unaware of the real costs of their medical care (and completely unaccountable for it if they overuse services.)

    I think there are ways to ensure that people who truly can't afford their checkups can get annual exams for free or a very small cost (scaled to income.) You don't have to ensure that every middle class family has no out of pocket expense for them.

  3. CStanley,
    People shouldn't be of the opinion that healthcare is free, that's why I'm not saying there shouldn't be co-pays and the like. And government health spending accounts (like those in Singapore) can help keep those from being too onerous for the poor.

    But even if costs are more transparent, that's still only part of the battle. People are going to want to follow the advice of their doctors regardless of the cost in most cases. So, how do we make sure the doctor's are also trying to be efficient without sacrificing care?

  4. Chris, the more that people are directly responsible for paying the bill (the doctor's bill, not the health insurance bill), the more pressure there is on the doctor to promote that kind of efficiency.

    I think I know what I'm speaking of here because I deal with it everyday in the practice of veterinary medicine. I don't know if you read that thread where Polimom talked about having her broken foot set in a boot cast instead of having surgery. That would be an example of the kind of medical decision based on cost consideration that you're speaking of, no?

    Well, in veterinary medicine we offer those kinds of options every single day, because we are the ones who have to sit face to face with clients and tell them how much the gold plated option costs. And we have to offer them a box of Kleenex when they tell us that they can't possibly afford that, and then we come up with plan B. Or, as often happens, we have to know when it's not really appropriate to offer Cadillacs when Chryslers will do just fine, so we avoid those tearful conversations altogether.

    Of course even though I'm proud of the level of medicine that we offer, I'm not suggesting that human medicine should be handled exactly the same way. We shouldn't have doctors telling poor folks that they'll have to settle for inferior treatments- but we should make doctors accountable for knowing which treatments aren't really inferior but can reduce costs.

  5. CStanley,
    I don't think we're disagreeing anymore… so bravo ;-)

    But before I go crazy without an argument, I want to go back to something you said earlier:
    “Good legislation stands up to scrutiny; this plan does not. I don't know what went into the thought processes of the people who've been seriously thinking about this for decades, but my guess is that it's been more politically driven thought than a serious attempt to control costs and remove barriers to access to healthcare.”

    You're right that this is a politically driven process, but that's unavoidable. Politics is how we govern the country. What's unfortunate is not that this process is too political, but that this process is being unduly influenced by lies/smears and politicians in both parties that bow only to corporate interests.

  6. People shouldn't be of the opinion that healthcare is free, that's why I'm not saying there shouldn't be co-pays and the like.

    So, what happened to that concept when those smart people you mentioned spent a couple of decades thinking about the problem of healthcare costs? HR3200 will eliminate copays on all preventative care. ;-)

  7. Chris- my complaint with the politics involved in this particular policy debate is that I think that the political forces are moving us in the wrong direction- making real reform even harder to achieve. Some people are saying 'Well, this bill isn't perfect but it's a start' but to me that's like trying to drive from GA to NJ and starting out by heading down to FL.

  8. “So, what happened to that concept when those smart people you mentioned spent a couple of decades thinking about the problem of healthcare costs? HR3200 will eliminate copays on all preventative care. “

    Unfortunately, the smart people are only advising (directly and indirectly) the people writing the bill.

    “my complaint with the politics involved in this particular policy debate is that I think that the political forces are moving us in the wrong direction- making real reform even harder to achieve.”

    Possibly, but the last time health care reform was defeated, it took us 15 years to try again. In the mean time we got the managed care people were afraid of, but instead of it being blunted by humane public policy, we got the corporate version with fun things like pre-existing conditions, rescission, etc.

  9. Chris, during that 15 years, there were a few conservatives working toward the conservative vision of reform. But then, just as now, partisanship and ideology prevented the Dems in Congress from working with the GOP (and I'll concede also that there was not nearly enough push from the GOP leadership- it was only a small group of conservatives pushing for healthcare reform.) Plus, those few individuals apparently made a boneheaded choice to support the Medicare drug bill as a way of getting their HSA legislation in, since it wouldn't have been allowed to come to a vote on it's own (the Dems would have filibustered it.) I don't think that was a good tradeoff, because that unfunding expansion of the Medicare entitlement also moved us in the wrong direction.

    As far as recission and preexisting conditions- do you have any data on that? I see a lot of people questioning the conventional wisdom that this is a large part of the reason for people's uninsured status. It seems to me that a much larger issue is that a lot of people have just been priced out of the insurance market- not that they're being denied coverage.

  10. CStanley,
    Well, I don't have numbers on exactly the number of claims that get rejected because of preexisting conditions or are denied insurance or priced out of it on those grounds. But according to CAP, there are 73 million people who might face pre-existing condition discrimination if they lost their insurance. http://www.americanprogress.org/issues/2009/04/

    (Hardly a non-partisan source, but they took their numbers from the center for disease and control, and the census. Plus I haven't come across any others.)

  11. Bolt: You're not quite correct. As far as attacks on Jazz or others, I'll provide comment as I see fit, as well as with the much greater problem we're seeing with lefties attacking “righties” (using a grossly expanded definition, effective) falsely (in in poor ways) for all kinds of imaginary “reasons.” We're seeing it in particular right now with the Dems' most ambitious and most [self-]endangered effort this year, the health care effort. The desperation and the anguish (not only anxiety) among the few faithful who still are in support of this effort (or anything with “Dem” or “health care” stamped on it), and their behavior, has become remarkable and remarkably bad (though not surprising when you think of it).

  12. Hmm…I am skeptical because of the source as well as the word “might”, but I'll look at it.

    Back to this for a moment:
    Unfortunately, the smart people are only advising (directly and indirectly) the people writing the bill

    First, I'm not even sure that the smart advisors are as smart as some people think they are, nor as impartial as they should be.

    Second, even if it were true that some braniac think tankers have come up with the ultimate solutions and now those solutions are being watered down or made ineffective because of the politics involved in writing the actual bill, I still don't see how you then can say that we shouldn't really need to keep debating the bill. At the very least, even if a majority of people agreed with the solutions put forward by the 'thinkers', shouldn't people take time to examine the 1000 pages to see if it actually does what the 'thinkers' say we should do, based on their decades of thinking on the problems?

  13. “[... A]ccording to CAP, there are 73 million people who might face pre-existing condition discrimination if they lost their insurance. http://www.americanprogress.org/issues/2009/04/

    (Hardly a non-partisan source, but [...]“

    It suffices. We with pre-existing conditions are a “silent” or “invisible” group, for the most part — we deal with the problems as we can (pay more, move elsewhere, etc. (So often what you encounter are activists who are campaigning on these people's behalf rather than the occasional testimonals from such people themselves.)

    Knowing this, I wouldn't be surprised if the total (with or without including a related issue, recission) involved more than 100 million people. (On the other hand, is it really approaching or reaching approximately one-third of the entire population?) Certainly it's large enough that either one is one of these people or knows well one or more instances of such people, and knows this this is one of a number of problems with the insurance-based health care system today. (This is why so many activists for years have sought “community rating” in place of “experience rating” and underwriting. Universality of federal health care includes this appeal and related implementation details, though are other reasons that universality appeals to “Medicare for All” advocates.)

    * * *

    “We're trying to enact good legislation that people have been thinking seriously about for decades.”

    That is absolutely, demonstrably (every day) false about the current Dems' health care legislation.

    (That is also the truth about everything the Dems have been doing all year, worsening with time.)

  14. “shouldn't people take time to examine the 1000 pages to see if it actually does what the 'thinkers' say we should do”

    Especially those who will be voting whether or not to enacted what's in these 1000+ pages?

  15. “Hmm…I am skeptical because of the source as well as the word “might”, but I'll look at it.”

    That's fair. But any one of those people would be screwed if they lost their job, or decided to start their own business or whatever. Whatever the numbers, any discrimination on those lines is immoral and we should work to address that fact.

  16. “the last time health care reform was defeated, it took us 15 years to try again”

    That doesn't mean another 15 years will elapse before the issue is revisited this time.

    The last “reform” attempt was bad and wrong, as this one is; having to wait 15 years is no argument against passing this one now, anyway, irrationally.

    Obviously the effort is failing and is inept (and incoherent) as well as having other problems; best would be for everyone to stop, then actually think about what they want (which they've shown in numerous ways to have failed to do, or do well), limit themselves to that (sensibility, please), then work to get it enacted.

    I shudder to think of the manned space program starting from scratch under “guidance” of these people.

  17. It seems to me that a much larger issue is that a lot of people have just been priced out of the insurance market- not that they're being denied coverage.

    CStanley — Because we're talking about “insurance” and “risk”, the problem is as you say. I've known people with serious preexisting conditions who had no health insurance. Coverage for one couple I knew would have run into the thousands per month. So I guess you could call that priced out rather than excluded, but it's kind of a semantics thing I think.

  18. That's fair. But any one of those people would be screwed if they lost their job, or decided to start their own business or whatever. Whatever the numbers, any discrimination on those lines is immoral and we should work to address that fact.

    It looks like all they're really doing is calculating the number of people who might be vulnerable because there is no state law to prevent denial on the basis of preexisting condition in their state.

    So why would the solution to that problem be to create a new govt run health insurance system rather than to make a federal mandate that gives the same protection to the people in those states that is currently protecting those in states with mandates?

    Or, figure out an alternate way to handle the patients who have increased risks, like high risk pools that some states have?

  19. “any discrimination on those lines is immoral “

    It's not immoral, given that what's sought is “insurance” if only nominally (it's comprehensive care).

    Dishonest recission or bogus identification of pre-existing conditions is immoral, but a separate issue, too.

    That it's unpleasant and may result in harsh consequences for the individuals of concern is obvious, and is one of the things that so many of Republicans (even) admit are a known problem with the health care system today. (Note that one person I heard comment on this said that the true hard-core population, the truly uninsureable, numbers about [only] ten million.)

    There are a number of things that the federal government could do to reform the insurance system we have.

    This has been neglected, and in fact intentionally avoided (sidestepped), insofar as anything definitive is part of the current health care effort, because the private insurers really aren't seen as meriting any other than a token position (for now, though not later) by those in charge of the current effort, whose principal goal is to augment federal provision (if only through payment) of health care, replacing the private sector.

  20. PM- actually what I meant was that a lot of other people on the lower income part of the scale are being priced out because of general rise in price of insurance. You're right that that's also another way of describing people who lose coverage and then can't pick up a new policy at an affordable price, but that wasn't what I meant in my earlier comment. I honestly just don't know how the numbers break down- there obviously are people like the couple you mentioned, but also some people who are generally healthy but feel that they can't afford insurance (esp in states where prices are particularly high, which is sometimes related to mandated minimal coverage which includes all sorts of things that some people really don't want or need, or would be willing and able to cover out of pocket if they had to.)

  21. “[Why not] make a federal mandate that gives the same protection to the people in those states that is currently protecting those in states with mandates?

    Or, figure out an alternate way to handle the patients who have increased risks, like high risk pools that some states have?”

    Or:

    * Community rating (with possible mandatory insurance purchases) state-wide, region-wide, nation-wide;

    * Inter-state and multi-state insurance (health care provision) and providers;

    * Uniform benefit packages (kept to the realistic minimum to keep the cost reasonable — _insurance_).

    This isn't hard. This never hasn't been hard, insofar as _reform_ of the current system is concerned.

    But that's not what the current people in charge of the health care effort want — which is “replacement, not reform” — (incremental, partial) replacement of private health care with public (government) health care.

  22. “So why would the solution to that problem be to create a new govt run health insurance system rather than to make a federal mandate that gives the same protection to the people in those states that is currently protecting those in states with mandates?”
    That is in fact part of the proposed solutions being written in the House and Senate. The government run system is primarily a way to address universal coverage and long term costs. It also provides a backstop against an insurance industry that finds innovative new ways to avoid paying for health care (like rescission).

  23. It's a separate issue (and something I've stressed for ages, as well as the recent subject of another thread), but one of the first things people need to do is to distinguish (and perhaps, to divorce) the concept of insurance from what is normally being viewed and meant instead, (comprehentive) health care.

    That's certainly on the minds of those who want any incrementalist federal takeover of health care, and if they were honest, they'd say so.

  24. The government run system, on the other hand, is primarily a way to address universal coverage and long term costs. It also provides a backstop against an insurance industry that finds innovative new ways to avoid paying for health care (like rescission).

    But the same thing could be accomplished without a govt health insurance provider by simply strengthening the regulation of the insurance industry WRT those practices, and passing legislation for the individual mandate to get health insurance with tax credits or vouchers for people who need financial help. Conservatives won't like that, of course, but at least by avoiding the additional step of expansion of public healthcare, the same goals are addressed in a manner that would represent more of a true compromise between the Dem/GOP stances on the issues. Instead, the Dems insist that they've already compromised by shifting from single payer to public option (and now perhaps to coops) but really all of those will probably involve a govt run health insurance entity (I say probably because the coops may or may not end up like that, depending on how they're structured.) Their 'compromise' is mostly semantic and still always insists that having a govt provider is necessary- and on top of everything else that conservatives will be forced to swallow, why should that be non-negotiable when the same goals can be addressed in a different manner?

  25. Jazz says

    “Polimom, the often left out aspect of that is that here in America we spread out and have to pay for the R&D end of things.”

    Jazz obviously didn't read the link or he wouldn't make such a fact free assertion.

    Or are you willing to confine your mother to a wheel chair should she need a knee or hip replacement?

    The more you pontificate on this subject the more I think you're being willfully obtuse or outright dishonest.

    Which might be acceptable if it were not for his snarky forked tongued references.

    I don't have time to go into it tonight but isn't it time we call Jazz's post what they are?

    Here in Texas it has an acronym you know.

    Why does Astrazeneca decide to locate one of it's major drug development labs in Canada?

    Why is Jazz ignoring this?

    You make the call.

  26. Signing off before posting comments which, while true, may be less than generous.

    Forked tongued indeed.

    I don't have time to truly cover this issue, but then, I'm not subsidized by other industries.

  27. “No one is hurrying to enact bad legislation.”

    And you *** dare *** make false accusations that others are Spamming?

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