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Sunday, May 29th 2005

The Uninsured & Universal Healthcare: The figures (Part 1)

The issue of the millions of uninsured Americans and the most vocalized solution to the situation (further government subsidization of health care, which in some people’s opinions should carry to government guaranteed universal healthcare) really consist of two distinct issues, like so many political problems.

There is the pragmatic side of the problem, which I have broken down into two posts. This is the first. Then, there is the political philosophy of the issue, which I’ll lay out in the third post.

The side talked about in this post consists of the debatable figures and costs and questions about the uninsured in this country. For all the nitpicking over it, this isn’t really at the heart of the issue (at least for me), but there are some facts and figures that should be mentioned. Proponents of universal healthcare often quotes a census bureau figure from 2003 which put the number of uninsured at over 43 million.

This number has been overstated and corrected figures as reported by nonpartisan research groups here and here drop the number of uninsured in this country to 36 or perhaps 37 million.

Even this number however needs to be understood. This is a slice of the 280 million Americans, who at any point in the last year did not have health insurance. The debate over the number of people who go an entire year without health insurance is more muddy. To report the facts, the highest estimate I’ve seen is about 30 million. The lowest estimate is 19 million.

The other question, beyond the size of the uninsured problem, is just who these people are. There is a conservative, yet plausible and intelligent, argument that many of these uninsured fall into two distinct classes that are not the concern of the federal government. The first group consists of people of resources who make the choice to simply not pay for insurance. Such people may include a large number of university students who appear on the uninsured rolls and the middle class self employed, or those whose companies don’t provide insurance, who have the resources for health insurance but choose to spend the money on other things. Figures for how many such people appear on the rolls is debatable but surely they account for millions of at least the 36 million Americans who didn’t have insurance at some point in the past year.

The other group that conservatives bring out to argue that roll of the uninsured is inflated is illegal immigrants. Surprisingly, uninsured estimates include such people. Now, a sound estimate of the number of illegal immigrants in this country is probably between 9 and 11 million. I imagine its safe to assume well over a majority of these individuals lack health insurance. There is some evidence for such.

Not even most proponents of universal healthcare deny that non-citizens (both legal and illegal immigrants) account for between 40 and 45% of the nation’s uninsured, obviously far beyond their representation as a percentage of the population as a whole. As well, the problem appears to be persistent amongst both legal and illegal immigrants. A study of legal immigrants who entered in the 1980s found that by 1998, nearly 30 years after some of them had entered, almost 40% of them had never acquired health insurance. This may raise all sorts of issues about the economic equality and opportunities afforded to legal immigrants, and may indeed be an argument in and of itself for socialized medicine. However, it is of note that natural born citizens faired better over the same time period in procuring health insurance. It seems reasonable to assume that illegal immigrants would fare even worse in acquiring health insurance.

It appears reasonable that illegal immigrants would also be more likely to appear amongst the most risk situated individuals in the debate; the 19 million who have failed to acquire health insurance in the past 12 months. To be conservative, let us imagine the number of illegal immigrants in this country is on the low end of estimates at 9 million and that only 50% of them have gone the past 12 months without insurance (although it seems likely that the number would be much higher). Under such circumstances it may be that only 14 or 15 million legal immigrants and American citizens went without health insurance over the past twelve months. That’s approximately five percent of the population.

We’re working under the implicit understanding that this, and all nations, exist to provide protection and services for their citizens and legal aliens. I will not even take the time to offer a response to those who would argue that full non-emergent healthcare is a government responsibility for those who enter this country illegally.

From a pragmatic standpoint consider that as it stands the government already reimburses hospitals for the 1.5 billion a year they spend treating emergency cases involving uninsured illegal immigrants. This is money taken from the Medicare budget. As Rep. Dana Rohrabacher points out, so eloquently, “[taking money from] the American people and legal residents in order to provide a health-care system for people who come here illegally is the most stupid thing I can think of.”

More on the impact of immigrants on the uninsured debate can be found at Marginal Revolution.

I’ve tried here to show that a large portion of the 36 million uninsured, who are quoted, are really without significant risk. That’s a vague undefined term. I’m sure that term, “significant risk”, and even the figures cited here, can be effectively debated by intelligent proponents of socialized medicine (there actually are some). The real fact however, is that 14 million people is still a lot. Indeed, one person who gets seriously ill without health insurance is a problem. And so, the debate continues.

Tomorrow, I talk about the view amongst the general public that the uninsured are provided care by ‘safety-net’ features (such as the 1.5 billion spent treating illegal immigrant health emergencies). Researchers at Harvard Medical School said that view was faulty in 2000 and so did the Institute of Medicine in 2002.