First, let me state that there are lots of numbers swirling around and it is not always possible to pull out discrete data or disaggregate specific figures from total amounts. Whenever possible I have used official figures and always gone with reputable sources for estimates. Some numbers have been repeated so often in so many different places without contradiction (such as the number uninsured) that I adopt those numbers without attribution. With that explanation, let us proceed.
First, it is accepted that 47 million in this country are uninsured. However, with the increasing numbers of unemployed, that number is probably low and will certainly increase for at least the next year when we may start to see an uptick in employment. When assessing that number, we need to also keep in mind that there are 45 million enrolled in Medicare, most of whom could not find private insurance because of pre-existing conditions. Additionally, even if they could find private insurance, the cost would probably be prohibitive for 90% of them. There are 42 + million receiving Medicaid (42 million as of 2006, the latest figure I could find), people who can't afford private insurance. Some of the people receiving Medicaid also receive Medicare. The number is probably relatively small, but to be conservative, I will estimate that 35 million are receiving Medicaid but not Medicare. The bottom line is that, in addition to the 47 million who don't have health insurance, another 77 million are receiving government insurance because they can't get private insurance. Thus, if we look at the number of uninsured against the number of people who are in the private insurance pool, it is 47 million out of about 223 million, not 47 out of 300 (the US population). This means that 21% of the people in the eligible population are uninsured, not the 16% usually cited. Medicare and Medicaid figures come from cms.hhs.gov/medicare and questionsmedicare.gov. Additionally, the Commonwealth Fund in June, 2007 estimated that 25 million are underinsured. If you add that to the 47 million uninsured, that means that the percentage of people who are uninsured or under insured, as a proportion of the private pool, is 32% (72 million out of 223 million). CONCLUSION--Almost one in three people who are in the private pool are either uninsured or underinsured. I hope these numbers do not confuse you, but they do indicate that the problem is greater than usually supposed.
Next, let's look at the effects of uninsurance and underinsurance. A 2007 Harvard study (see Business Week, 1/4/09) found that 62% of bankruptcies are due to medical expenses. There are approximately 1 million bankruptcies (certain to be higher this year), so that means over 600,000 bankruptcies a year are due to medical expenses. Further, the Harvard study found that 60% of these bankruptcies struck families who had (inadequate) medical insurance. This means that about 360,000 bankruptcies are due to medical expenses which hit people with insurance (the underinsured). Additionally, it is estimated that 1.5 million lose their home to foreclosure due to health costs (National Coalition on Health Care, web site cited below).
In a 2002 study (Institute of Medicine, Care Without Coverage, pp. 161-165), it was estimated that 18,000 people die each year because of lack of medical insurance.
Because the uninsured go to emergency rooms for much of their care and most of the time they can't pay, it has been estimated that this additional cost adds approximately $1100 per year to the average insurance premium.
Even if you are covered with an excellent plan, expect the cost of that plan to continue to rise until it is unaffordable for the average American family. Most of the following information can be found at nchc.org/facts/cost.shtml which has a lot of interesting data. Since 1999, the cost of employment based premiums has increased 120%, compared to a 44% increase in inflation and a 29% increase in average wages. By 2017, the cost of premiums will take from 40 to 50% of the average family's income if nothing is changed. Not surprisingly, the primary reason for non insurance is the high cost of health insurance. The Kaiser Commission study found that 80% of the uninsured are "working poor." Unless you are rich or in Medicare or Medicaid, you, too may join the ranks of the working poor unless something is done. Think your employer will cover the increased cost? Fewer are doing so every year or are passing along increases to their employees. The number of employees getting their insurance through their employers went from 66% in 2000 to 61% in 2004 (Kaiser Commission study). It is certain to be declining more and more rapidly with the recession.
Next, let's look at the overall national picture. Nation-wide, total health care expenses are estimated at $2.5 trillion, which is approximately 17% of Gross Domestic Product. It is projected that that total will reach 20% by 2017 (nchc.org). By way of comparison, the country which is second highest in spending as a percentage of their GDP is Switzerland which spends about 11% of their GDP on health care. If we spent the same percentage in the US as Switzerland does, we would spend about $800 billion less per year on health care. On a per capita basis, we spend approximately twice as much as other developed countries such as Canada, England, Germany, France, etc. Despite spending half as much, the citizens in those countries live longer on average and they cover everybody in their country.
Next, problems and solutions.
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