To my surprise, the most popular blogs I’ve ever written are on healthcare reform. So, now that we are on the eve of the Senate unveiling its healthcare proposal, I want to put you in the decision-maker’s seat. Which of the uninsured would you cover, if you could make the decision? I hope you’ll take the time to consider this blog and then post your vote in the comment section below.
To quickly review the topic, here’s an analysis (that I’ve slightly adapted) from iReport. You can view the original report here:
Now, to be blunt (and, as a policy matter), we really should NOT care about the number of uninsured. Rather, we should be most concerned about the subset of the uninsured that we think “deserves” or “should have” taxpayer-subsidized health insurance.
This is a judgment call that involves some value choices.
I think most of us would agree that a person who is already enrolled in or eligible for one free or heavily subsidized health insurance program, we can rule them out as needing a second. This simple step reduces the 45.7 million number down to 35 million. This step excludes the Medicaid undercount and Medicaid/SCHIP eligible from our potential target population.
This may be the calculation of President Obama who used to use the 46 or 47 million uninsured number, and in his speech to Congress and the nation dropped the number to 35 million.
And, I think that most of us would agree that the 10.6 million labeled above as the “remaining uninsured” are the most sympathetic target population. I think most Americans would want them covered.
However, now it gets tricky. So, put on your thinking cap:
There is no clear right or wrong answer to the above questions. But, as a country, we need to make these value choices. So, if you’ve made your decision, let’s look at the effects on the totals for several hypothetical answers to these questions.
Which of the following is closest to your view:
1) Ann wants to subsidize everybody, but agrees that we don’t need to double-subsidize. She excludes the Medicaid undercount and Medicaid/SHIP eligible from her target population and ends up with 35 million people. That is still an enormous amount, but the number she heard in the President’s speech to Congress. Her target population is now 11.7% of the total U.S. population, down from 15%. Put another way, she would like taxpayers to help between 1 in 8 and 1 in 9 Americans who she feels are deserving of subsidies to buy health insurance, rather than the 1 in 6 (46 or 47 million) she has heard before.
2) Bob agrees with Ann, but thinks that subsidies should go to the poor, or at least not to those who have above the median (or near median) incomes. His target population is therefore about 25 million people, way down from 46 million. That is 8.4% of the total U.S. population, or 1 in 12 Americans. That is still a huge number, but it is very different from 1 in 6.
3) Carla agrees with Bob that subsidies should not go to those with incomes near or above the national median. She also thinks that undocumented citizens should get emergency medical care, but not taxpayer-subsidized pre-paid health insurance. If we guess a 50/50 split between documented and undocumented of the 9.3 million uninsured non-citizen, Carla’s target population is about 21 million, or 7% of the total U.S. population. That is roughly 1 in 14 Americans.
4) Doug thinks only American citizens with incomes below the national median (and who are not already eligible for another program) should be eligible for additional aid. His target population is therefore 15.6 million people. That is 5.2% of the U.S. population, or 1 in 19 Americans. If Doug were to further limit subsidies to those below 200% of poverty or 150%, his target population would be a few million people smaller.
5) Edie agrees with Doug, but thinks that if you are a young adult without kids, you should fend for yourself. Her target population is 10.6 million people, or 3.5% of the total U.S. population. That is 1 in 28 Americans.
These are, of course, not the only possible answers, but they are a representative.
Even for the most “liberal” set of answers (Ann’s), the headline numbers we hear in the press overstate the extent of the problem by more than 10 million people.
And, even Edie’s narrowest 10.6 million target population is still a lot of people who lack health insurance.
So why does it matter that the press and policymakers get the numbers right?
When you hear “46 million uninsured,” or “47 million uninsured,” or “1 in 6 Americans don’t have health insurance,” remember that this is technically correct but misleading.
I think the more important question is, “How many uninsured people who already qualify for tax-subsidized programs need additional help from taxpayers?” But, more importantly, what do you think?
Again, thanks to iReport for this excellent analysis. You can view the original report here. And, here are the topics for my series on Health Myths: