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Where To Begin? Part 1
In speeches and through spokesmen, President Barack Obama has been laying out the case for government-centric health care reform, and Congressional Democrats have been crafting legislation to make it possible. The ostensible goal is to expand access by providing "universal" health care coverage, extending insurance to the supposed 40-50 million Americans who currently do not have it, while simultaneous cutting costs and improving efficiency. Unfortunately, "health care reform" that relies on more government interference in individual choice and the free market is exactly the wrong approach — so wrong in so many ways that it is difficult to know where to begin criticism of the various plans. While different in some of the details, each of the plans expands the government intrusion and restricts individual liberty; each of the proposals provides the wrong incentives to improving affordability; each of the proposals involves a massive increase in government spending — spending that has to be paid for somehow.
Let's start with one of the main postulates used as justification for government involvement: the number of uninsured Americans. While claims by various groups vary, the official estimate by the Centers for Disease Control and Prevention is 43.6 million. This doesn't mean those people are unable to access any health care; rather, it means that medical care must either be paid for out-of-pocket, by charities, or the cost spread around paying customers (typically insurance companies) when bills go unpaid. The common narrative is that because health insurance is unavailable, uninsured sick people tend to visit emergency rooms, an option that is no one would consider efficient or economical.
However, looking closer at the numbers is instructive. According to a Department of Homeland Security estimate, there were approximately 11.6 million illegal immigrants in the United States in January 2006. It would seem reasonable to suggest that the overwhelming majority of illegal immigrants would be uninsured. Should government policy seeking to increase health insurance coverage be based on providing coverage to people who came to this country illegally? While I disagree with much of the anti-immigration sentiment that seems to pervade much debate about border security, I certainly don't find it acceptable to reward people who come here illegally with health coverage. Therefore, it seems reasonable to subtract the population of illegal immigrants from the number of people to which health coverage should be extended.
So suddenly our 43.6 million uninsured Americans has decreased by nearly 27% without spending a penny of tax dollars or enacting a single government program. Not a bad start.
A common reason given for going uninsured is that people can't afford the insurance, so it seems reasonable to look at income demographics. As it turns out, according to US Census data, 7.2% of uninsured Americans have family incomes of more than $75,000 per year. As with the illegal immigrant situation, it would seem reasonable that government policy need not be focused on providing insurance to people in the top 20% of all income earners. We've now reduced our "target group" by another 3.1 million. If you want to take the uninsured in families with incomes above $50,000 per year, you could subtract another 5.6 million. Where we draw the line is obviously a point of legitimate debate, so for now we'll keep the cutoff at $75,000 per year.
What we've also not mentioned are younger workers who might not make large sums of money, but make a choice not to buy medical coverage; perhaps some of these workers are healthy, perhaps some have access to wealthy family members, perhaps many are just young and unwise. I don't really know how to count the number of people in this group, so they won't be included in the overall calculations, but I wouldn't be surprised if there are at least 1-5 million people that fall into this group — somewhere between 1-10%.
Even accepting that there's probably some overlap in the numbers presented above, it is at least a reasonable assumption that we are now working with a smaller, more manageable number of uninsured people — approximately 15 million people less than previously thought. The task of increasing access to medical insurance to the uninsured is less daunting at least. What methods are there for reducing barriers to these individuals and families acquiring health care coverage? Does it require government restrictions, mandates, and expansion? We'll cover that issue in Part 2 to follow.
Let's start with one of the main postulates used as justification for government involvement: the number of uninsured Americans. While claims by various groups vary, the official estimate by the Centers for Disease Control and Prevention is 43.6 million. This doesn't mean those people are unable to access any health care; rather, it means that medical care must either be paid for out-of-pocket, by charities, or the cost spread around paying customers (typically insurance companies) when bills go unpaid. The common narrative is that because health insurance is unavailable, uninsured sick people tend to visit emergency rooms, an option that is no one would consider efficient or economical.
However, looking closer at the numbers is instructive. According to a Department of Homeland Security estimate, there were approximately 11.6 million illegal immigrants in the United States in January 2006. It would seem reasonable to suggest that the overwhelming majority of illegal immigrants would be uninsured. Should government policy seeking to increase health insurance coverage be based on providing coverage to people who came to this country illegally? While I disagree with much of the anti-immigration sentiment that seems to pervade much debate about border security, I certainly don't find it acceptable to reward people who come here illegally with health coverage. Therefore, it seems reasonable to subtract the population of illegal immigrants from the number of people to which health coverage should be extended.
So suddenly our 43.6 million uninsured Americans has decreased by nearly 27% without spending a penny of tax dollars or enacting a single government program. Not a bad start.
A common reason given for going uninsured is that people can't afford the insurance, so it seems reasonable to look at income demographics. As it turns out, according to US Census data, 7.2% of uninsured Americans have family incomes of more than $75,000 per year. As with the illegal immigrant situation, it would seem reasonable that government policy need not be focused on providing insurance to people in the top 20% of all income earners. We've now reduced our "target group" by another 3.1 million. If you want to take the uninsured in families with incomes above $50,000 per year, you could subtract another 5.6 million. Where we draw the line is obviously a point of legitimate debate, so for now we'll keep the cutoff at $75,000 per year.
What we've also not mentioned are younger workers who might not make large sums of money, but make a choice not to buy medical coverage; perhaps some of these workers are healthy, perhaps some have access to wealthy family members, perhaps many are just young and unwise. I don't really know how to count the number of people in this group, so they won't be included in the overall calculations, but I wouldn't be surprised if there are at least 1-5 million people that fall into this group — somewhere between 1-10%.
Even accepting that there's probably some overlap in the numbers presented above, it is at least a reasonable assumption that we are now working with a smaller, more manageable number of uninsured people — approximately 15 million people less than previously thought. The task of increasing access to medical insurance to the uninsured is less daunting at least. What methods are there for reducing barriers to these individuals and families acquiring health care coverage? Does it require government restrictions, mandates, and expansion? We'll cover that issue in Part 2 to follow.
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