15 September 2009

Defining the scope of the problem: the uninsured

Last week, in his Big Speech, it was noticed that President Obama hedged a little bit in his language regarding the numbers of the uninsured. Despite the fact that the newly-released Census data reflects conventional wisdom, that the number of uninsured totals around 46 million people, the President cited "over 30 million" as the number of the uninsured.  OMB director Peter Orzag has a typically wonkish post explaining their numbers -- about 39 million uninsured citizens & legal residents.  Some of those -- a few million, it seems -- are eligible for various public health care insurance programs but for a variety of reasons are not enrolled.  So they settled on the vague but defensible "over 30 million."

Anthony Wright expands on this a bit over at TNR's The Treatment, pointing out that, depending on how you count, the numbers could be much higher indeed.  For example, the "millions" of people who are not enrolled in Medicaid and CHIP often are not because the states that administer the programs have in many cases raised administrative obstacles to enrollment, delayed enrollment and even closed enrollment, in order to reduce the strain on their budgets.  And if you count the number of non-elderly Americans who at some point in the past two years were uninsured, the number is over 86 million -- one out of three people.   While at any given point in time, the numbers may be much lower, overall, the population of people at risk of being without healthcare coverage is quite large.

Yet, voices from the right continue to dispute even the more conservative census figures.

Yes, Those Uninsured Numbers Are Legit | The New Republic
It seems the attack on the 46.5 million doesn’t just seek to undermine the facts; it seeks to both minimize the problem, and place the blame for being without coverage on the uninsured themselves. [...] But this pervasive argument by health reform opponents, made by Sen. Orrin Hatch on Meet the Press, or Rep. Dan Lungren at a town hall meeting here in Northern California, suggests their true stance… that most of the opponents simply don’t see a big problem in the first place.  President Obama should not avoid this rhetorical fight. If opponents
want to deny the established Census figures describing the health
crisis, to minimize that the problem isn’t that bad, or to blame the
victims of our broken health care system, that’s a debate I am
confident health reform supporters will win.
I think this is right.  The uninsured may not be the best sales pitch, because most people don't see themselves as a member of that group, but reminding people that reform offers security & stability in healthcare coverage is a compelling promise.  Moreover, as opponents of reform try to resurrect the "America has the best health care" argument, it's handy to remind them that the health care system in the US really is terribly broken and in need of reform.  As the specter of rationing is raised to scare voters, the fact that we are already rationing by income should not be forgotten.

1 comment:

Healthcare Observer said...

Isn't one of the defining issues with the US healthcare debate that you don't really know pretty accurately how many people don't have insurance? Observing from the UK it makes the US look rather amateurish.

BTW, have a look at this ER tale:

http://content.healthaffairs.org/cgi/content/full/28/5/1509

http://www.healthbeatblog.com/2009/09/the-great-er-caper.html#comments