Like a bunch of carnival barkers, the advocates of “single-payer� health care are loudly touting the Census Bureau’s latest claims about the uninsured. So, I guess it’s once again time to point out that this statistic has very little meaning in the larger context of health care reform.

First, it isn’t by any means clear that the figures released yesterday are accurate. In March, the Census Bureau had to revise its 2004 and 2005 figures downward because it had exaggerated the number of uninsured Americans. A similar revision will no doubt be required to fix yesterday’s stats.

Moreover, as I have pointed out here, the total number of uninsured reported by the Census Bureau significantly overstates the number of chronically uninsured. The actual number of year-round uninsured is about half of the 47 million figure reported yesterday.

Also, as I have pointed out here, lack of insurance doesn’t mean lack of care. EMTALA guarantees that all patients who seek care in America’s ERs will be treated.  And, the erroneous claims of the single-payer crowd notwithstanding, free hospital and primary care are also widely available.

But the real problem with focusing so heavily on the plight of the uninsured is that it is a symptom. The actual disease is a morass of perverse incentives created by the very government that single-payer advocates would put in charge of our entire health care system.

If covering “the uninsured� is the primary focus of our attempts at health care reform, the real disease will continue to metastasize.

Comments 6

  1. Marc Brown wrote:

    Actually, the number of Americans without insurance at some point in the year is more like 60 million. Do you think it’s good that so mnay people drop in and out of such a vital service?

    And no, ER is not an ‘efficient’ use of health resoureces for the uninsured, and yes, you do have some (but not nearly enough) decent primary and health centre coverage – which guess what is mostly state provided.

    Posted 29 Aug 2007 at 10:51 am
  2. Catron wrote:

    You have (once again) missed the point. It is as follows: If we treat the REAL disease (via free market reforms), the “uninsured problem” will go away.

    If we go along with more government meddling, neither the disease nor the symptom will be cured (as Massachusetts demonstrates).

    Posted 29 Aug 2007 at 10:58 am
  3. Kevin wrote:

    Maybe you should cancel your insurance and go a couple of years as one of the “uninsured”. Since you seem to think it’s no big deal being uninsured it won’t be too much of a hardship for you. Then come back here and tell us what it’s really like.

    I’d bet that after a while you wish you were somewhere like the UK, France, or Canada where the health care system works better and cheaper than ours.

    Posted 30 Aug 2007 at 11:48 am
  4. Matt wrote:

    And actually, not all hospitals are required to comply with EMTALA. It’s only if they take Medicare money. From your link:

    “In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.”

    Posted 30 Aug 2007 at 5:10 pm
  5. Catron wrote:

    Not all hospitals are required to comply with EMTALA.

    80% of community hospitals would go out of business overnight if they stopped participating in Medicare. So, if you’re suggesting that any statistically significant number turn uninsured patients away by forgoing participation in Medicare, it’s nonsense.

    Posted 30 Aug 2007 at 8:20 pm
  6. Dennis wrote:

    I am astounded by anyone, including the President, who asserts that Americans have access to health care via ERs, as assured by EMTALA. I wonder how long such persons would hold that view if (1) they were to be without health insurance coverage, and (2) diagnosed in the ER as having a malignancy that without agressive treatment would be fatal. That treatment won’t be done in the ER, nor will it be done by any provider without a significant — and likley financially crippling — out-of-pocket expense — if such treatment is available, at all. Change the scenario just a bit. The uninsured person, let’s say a 55-year old man who works for a small repair shop that does not offer health insurance coverage, has serious heart disease and for whom a transplant would be the only effective treatment. Such treatment for that man will never happen. He will likely cease working, apply for social security disability benefits, likely get them, wait 24-months for Medicare coverage to begin — and if he survives the 2-year wait, qualify for a medically necessary transplant. But another 55-year old man with the same condition, who happens to work for a company that offers health insurance coverage, including medically necessary transpants, will receive that care if a replacement heart is available. That is a crazy, grossly inequitable, and mean system for which Americans should be ashamed.

    Posted 03 Sep 2007 at 11:16 am

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