Posted on September 10, 2007

Medicare-for-all would keep everyone covered


Aaron E. Carroll, M.D.
The Indianapolis Star
Sunday, September 9 2007

One year ago, when the U.S. Census Bureau released its figures on Americans lacking health insurance in 2005, I wrote a piece here describing the sad state of the health care system in America. Recently, the 2006 numbers were released, and things have only gotten worse.

The number of uninsured Americans has jumped by 2.2 million to 47 million. This rise in the number of people without health insurance is the biggest jump reported by the Census Bureau since 1992. There are now more uninsured people in the United States than at any time since the passage of Medicare and Medicaid in the mid-1960s.

Amazingly, this deplorable situation has not been met with righteous anger or shock. It barely made a splash in the news. Yet, these numbers represent extraordinary suffering, unnecessary disability and premature deaths — at least 18,000 deaths per year, according to the Institute of Medicine.

Before we jump to conclusions about who is uninsured in America, some of the facts in the Census Bureau’s report deserve closer attention.

More than 90 percent of the newly uninsured are families with middle or high incomes. Some 1.4 million of the newly uninsured, accounting for 64 percent of the increase, are in families making more than $75,000 per year. An additional 633,000 new uninsured, 29 percent of the increase, are in families earning between $50,000 and $75,000. More than half the newly uninsured are full-time workers.

This divergence between poverty and uninsurance is relatively new and striking. Until now, as poverty went down, uninsurance fell. Now this has changed. Health insurance is so expensive (more than $11,000 for a family policy) that even middle-class families potentially face financial ruin along with illness and injury.

Do not be fooled into thinking any of the incremental changes we have been making are going to solve this problem. They are Band-aids on a gaping wound. In Massachusetts, often cited as a model for reform, the number of uninsured increased from 583,000 in 2005 to 657,000 in 2006. In Indiana, with a population less than that of Massachusetts, 12 percent, or 748,000 people, went a whole year without health insurance in 2006.

As those in Washington dither over the expansion of programs like State Children’s Health Insurance Program (SCHIP) to nip at the edges of this problem, the number of uninsured children rose by 611,000 between 2005 and 2006. As the president decries an SCHIP expansion as harmful to private insurers, the percentage of people covered by employment-based insurance actually decreased from 60.2 percent to 59.7 percent. As he claims that SCHIP expansion will encourage people to abandon private insurance for government programs, the number of Americans covered by such public programs actually decreased. Private health coverage is deteriorating rapidly, and the safety net, or what is left of it, cannot keep up.

In fact, the Bush administration wants to scale back the SCHIP program by insisting that states must enroll 95 percent of the lowest-income, and therefore eligible, children before more can be added. Nearly all state administrators have insisted that this goal is impossible to achieve. Make no mistake — this is an admission that incremental programs can never achieve universal coverage.

There is one sure-fire way to make these numbers come down. It worked for seniors in the 1960s and it still works for them today. You may hear politicians demonizing government-run health insurance, but you will hear none run on a platform of eradicating Medicare; nor will any turn it down for themselves when they turn 65. Call it whatever you want: National health insurance, Medicare-for-all, “single-payer” or socialized health insurance; it doesn’t matter. Research shows that Medicare-for-all could save enough on administrative waste ($350 billion) to cover all the 47 million uninsured and improve coverage for everyone else. A single-payer national health insurance system is the only way to drop the number of people lacking health insurance to zero.

Wouldn’t that be nice to read in next year’s Census statistics?