September 8, 2004 | Commentary on Health Care
Let's face it: Everybody needs health insurance.
As someone who spent my college years uninsured, I learned what it's like to feel ill, yet wait as long as possible to go to see the doctor, hoping it will pass. Luckily I never had a serious health problem -- but millions of people aren't as fortunate. They need help. But Congress still hasn't done the obvious: Target help directly to the working uninsured so they can buy the health coverage of their choice.
Unreliable numbers hobble the current debate. The Census Bureau recently released its count of the uninsured in the United States: nearly 45 million people last year. This number will be repeated countless times over the next few months as one candidate accuses another of not doing enough to provide health insurance to these people. But that figure is way too high.
How do we know? For one thing, the Census last year "counted" roughly 35 million people on Medicaid, the joint federal-state program to provide health insurance to the poor and indigent. But the Centers for Medicare and Medicaid Services (CMS), the agency that actually runs Medicaid, says there are 53 million people in the program. Since CMS actually pays the bills, its number, one assumes, is more accurate.
That 18 million-person difference ought to raise a few eyebrows. And it did -- at the Census Bureau itself.
In its report, the bureau writes, "Health insurance is likely to be underreported." Well, if health insurance is underreported, the number of people without health insurance has to be over-reported. Census admits this, saying the survey on which federal research and federal policies are based is largely a labor force survey. It admits its interviewers receive less training on health insurance concepts.
Plus, "many people may not be aware that they or their children are covered by a health insurance program if they have not used covered services recently, and therefore, they would fail to report coverage." Oh.
Unfortunately the Census Bureau doesn't seem to be making much of an attempt to correct this problem. Virtually the same disclaimer appeared in last year's study.
Obviously, these numbers are grossly inflated. Yet because they come from Census, they become part of the national discourse and the basis of sensational press releases by groups who want the government to take over the health-care system, either immediately or on the installment plan.
But these groups and their political allies in Congress are actually advocating a radical solution to a problem that is far more manageable than they want us to believe. Every report, study or policy proposal that uses these inflated numbers does a disservice, not only to the uninsured, but also to the American public as a whole, because it brings us no closer to a sensible solution.
Serious policy-makers from both sides of the aisle need an accurate number so a responsible solution can target those in need without resorting to the failed policies of socialism.
In any case, we must solve the problem, because the plight of the uninsured touches everyone's lives. Even if you have insurance, you're paying higher insurance premiums and higher taxes because of the rising costs of uncompensated care administered to the uninsured. We never turn anyone away untreated, but somebody, often the taxpayer, ends up paying the bills.
Today, the vast majority of the uninsured are in working families, mostly employed by businesses that don't provide health insurance.
This should be the focus of members of Congress and state legislators. They should target help to working families with tax credits or subsidies for the poor to help offset the costs of health insurance. We could also broaden and improve the insurance market beyond employers, enabling associations, ethnic and fraternal organizations, faith-based organizations or other groups to sponsor coverage for their members. Meanwhile, Congress needs to pressure the bureaucrats at the Census Bureau to provide a complete and accurate picture of just who the uninsured are.
There are far fewer than 45 million Americans uninsured today. But there are still too many millions lacking coverage. This problem can be addressed efficiently through a generous, but targeted, health-care tax-credit system that is not dependent simply upon the vagaries of your place of employment.
Americans deserve better. Lawmakers should help uninsured families who need help, so no one else ever has to wait to seek treatment, or hope a medical problem goes away on its own.
Derek Hunter is a researcher in the Center for Health Policy Studies at The Heritage Foundation.
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