The Scope of the Problem

I think that Greg Mankiw is on the right track in wondering about the scale of the problem of those who don’t have health insurance:

His [ed. Dick Morris’s] one-third figures [ed. the proportion of the uninsured who are illegal immigrants] seem a bit high to me, but he is right that 47 million substantially overestimates the magnitude of the problem. A serious estimate would take out both illegal immigrants and those who are eligible for Medicaid but have not applied. Those eligible for Medicaid can always enroll once they need significant medical care.

In addition, I would exclude those who were offered employer-provided health insurance but declined coverage, and those that are healthy and making more than, say, $50,000 a year. These two groups are choosing to roll the dice. According to estimates I have seen, they make up more than a quarter of the uninsured.*

I’d add at least one more point: just eight states with less than half of the country’s population among them have half of the uninsured. My tentative conclusion is that the problem of the uninsured is a local problem, best dealt with by means of local solutions.

Also, what proportion of the uninsured will remain that way under the various plans? I don’t think I’ve seen any plan that promises absolutely complete universal coverage.

Don’t confuse this post with my rejecting the idea of healthcare reform. A quick look at my many posts on the subject would show you that I believe that healthcare reform is necessary and inevitable. I just think that the real problem is that healthcare costs too much and that universal coverage is a sideshow.

Incremental reform (if that’s why universal coverage is currently the line of attack) is a lousy solution. The history of healthcare reform in this country is that the process is so painful that we only do it every so often. Additonally, my intuition is that universal coverage won’t achieve what it’s proponents claim and will leave a bad taste in people’s mouths, sapping rather than bolstering political support. We need to solve some of the pressing problems e.g. the pending shortfalls in Medicare long before we’ve recovered from the damaging battle that would take place over universal coverage.