What Should Be Done About the Uninsured Poor?

Abstract

WITH THE number of uninsured persons in our society growing by 25% since 1980, presidential candidates, congress\x=req-\ men, and state legislators are once again confronting the plight of those without insurance gaining access to adequate medical care.1 In a recent study supported by The Robert Wood Johnson Foundation, those who were uninsured reported fewer physician visits and hospitalizations than insured persons, despite suffering from higher rates of ill health. In addition, an estimated 1 million individuals reported that they actually tried to obtain needed care, but did not receive it for economic reasons.2 On the face of it, this should be an issue where the popular mandate leads to prompt remedies. Opinion polls repeatedly attest to the public belief that everyone has a right to adequate health care (82% of those responding to the question)3,4 and that the federal government has the responsibility for guaranteeing it (76%).5 A substantial majority (68%) favor the adoption of a tax-funded program of universal health insurance to accomplish these goals.6 Howev¬ er, despite years of strong public support for the expansion of access to medical care, we as a nation have been unable to come to a consensus about the best solution to the problems of the uninsured. What has prevented agreement in the past and may continue to thwart current approaches, despite active public support, is the fact that Americans hold equally strong views about two of the alternatives for extending coverage to the uninsured.The first alternative is increasing taxes to cover the cost of health care for those who cannot afford it. Most Americans (55%) have indicated a willingness to fund expanded coverage from an increase in taxes.4,6 When questioned further, howev¬ er, less than 30% are willing to pay more than $50 per year in new taxes to see this happen.4,6 This general response has not changed in a decade.7 Thus, expanding health insurance for the uninsured is supported by the public in principle but not as a fiscal reality, for it would require between $150 and $200 per year from each federal taxpayer to make this feasible.8,9 (Esti¬ mates are based on Congressional Budget Office projections, less an adjustment for the likely reduction in current hospital uncompensated care outlays,8 also from unpublished data

NHS: a time to choose.

“…The result is that growing numbers of the poor and unemployed are not insured and insurance does not cover even the middle classes against all possible contingencies. 10 Serious, chronic illness can still bankrupt a family in the richest country in the world. And health indices show wide contrasts across social classes and between ethnic groups.…”