US Medicare and the Myth of "the 46 Million Uninsured"

Here is another Snapshot from The Trouble With Canada ... Still! - to appear this fall with Key Porter Books.

It speaks to the background truth of the recent US medicare debates 

The Power of Symbolic Numbers

              One of the most effective sound-bites – snatched from data originally published, with public reservation, by the US Census Bureau – but soon widely and irresponsibly used to criticize the American health care system, was the belief that “46 Million Americans are chronically uninsured.” At first, you could find “the 46 million” factoid even on President Barack Obama’s website where, like so many others, he made very effective but dishonest use of it.

             Was it ever true?

             During the intense national marketing phase of Obama’s Bill this number was critiqued so heavily that it was quietly knocked down to “32 million uninsured,” though no one ever explained what happened to the 14 million-people difference in these numbers. They simply evaporated. But was even that lower number true? Even though, as anyone can see from this Snapshot there are indeed about 8 million Americans who obviously need help - either financially to purchase basic medical insurance, or in qualifying and enrolling for free medical care to which they are already entitled – this Snapshot helps us understand the true background to one of the most successful political marketing events in recent history.

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                                                     Snapshot

                          The Facts on the Myth of the 46 Million Uninsured

* Any poor person can walk into any hospital in America and be treated “free” for an accident, injury, or disease. Under the federal Emergency Medical Treatment and Active Labor Act, passed in 1986, hospitals are not allowed to deny treatment to patients with no health insurance. (Such costs are routinely absorbed into a hospital’s operating costs.). However, hospitals are not obligated to continue with free care after an emergency is treated. 

* The U.S. Census Bureau States that more than 10 million of the 46 million uninsured (1 in 4) are not U.S. citizens. They are illegal immigrants. Which raises the question: why should American taxpayers provide free medical care for the citizens of other countries?

* Another 14.7 million (or one third of the mythical 46 million number) “are fully eligible for generous government assistance programs like Medicare, Medicaid, and SCHIP [State Children’s Health Insurance Program]. The problem is, they just haven’t bothered to enroll in these programs.”

* A “whopping 70 percent of ‘uninsured’ children are in fact eligible for either Medicaid, or SCHIP, or both programs.” [in other words, five million of the eight million American children Barack Obama has said are uninsured, are in the large group that simply hasn’t bothered to enroll].

* Medicaid, set up only as a safety net in 1965, “has grown into an enormous welfare program serving 53 million [poor] Americans.” Some $338 Billion dollars are spent annually to cover “15 million more people than the 37 million Americans estimated to be living in poverty.”

* The Urban Institute says that “roughly 27 percent of non-elderly Americans who are eligible for Medicaid simply haven’t enrolled, and live their lives without health insurance.”

So Health critic Sally Pipes asks: “Have we reached a stage where the government has to force people to show up for a free lunch?” [Pipes wrote this a year before Obama passed a law indeed forcing people to buy health insurance]

* Many of the uninsured argue that if State insurance companies are mandated by government to cover them even if they are already sick, then why buy insurance until they are sick?

* 28 million of the 46 million earn more than $50,000 per year.

* The fastest growing segment of the uninsured, is households making over $75,000 per year.

* The “uninsured” are a churning number: fully half of all the people who lacked health insurance at a given time, had full health insurance 5 months later (Gratzer, The Cure, p.86).

* 60 percent of Americans get their medical insurance as a tax-free benefit from their employers. The median duration of unemployment (and of being uninsured due to unemployment, or due to job change) is 7 weeks (Gratzer, p.86).

 * A full 93 percent of Americans are insured or, if not, could afford to buy insurance if they so chose (Gratzer, p. 82).

* In a study of the uninsured in California earning twice poverty-level income, 40% owned their own homes, and more than half owned a personal computer. Sixty percent reported they were in excellent health, and almost half had not seen a single health professional in the previous year. Of this group, 57% disagreed with the Statement: “Health insurance ranks very high on my list of priorities for where to spend my money.” (Gratzer, p. 88)

* About 15% of Americans are uninsured, a percentage that has remained constant over two decades or more (Gratzer, p.86)

* Conclusion? America indeed has a problem: There are about 8 million “chronically-uninsured” working poor, who really do need help. They earn less than $50,000 per year, but too much to qualify as “poor” and get free government care. So they have “slipped between the cracks,” and Pipes argues these should be the focus of any solution for the uninsured.

* Health economists from the Urban Institute published a study in Health stating that “no coverage” is not synonymous with “no care.” In 2001, for example, the total spent on health care for the uninsured, from all private, public, and charitable sources, was $98.9 Billion, which worked out to an average of $1,586 a year, compared to the $2,484 spent on each insured person (from all public and private insurance sources)..

* Medicaid is already gobbling up State tax revenues in America at an unsustainable rate, estimated to be 60% of State expenditures in places like Florida (where there are lots of retirees) by 2015.  [This is also the situation in Canada, where Medicare will be 50% of Ontario’s spending by 2036 or earlier.]

Quotation in this Snapshot are from Sally Pipes, The Top Ten Myths of American Health Care: a Citizen’s Guide (San Francisco: Pacific Research Institute, 2008), Ch. 3. Facts or quotes from David Gratzer, The Cure (New York: Encounter Books, 2008) are as noted.

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