Part of virtually every discussion concerning the state of health care in the United States is a reference to the uninsured. Given that, we assume that the group of uninsured must be a very important part of the problem.
We need to better understand just what is meant by the ubiquitous "uninsured." We’ll likely all agree that it is a very serious part of the problem confronting us as a nation.
We hear of the ever-increasing number of uninsured. The former top number for the United States was 46 million…until it became 47 million. That seemed to occur overnight. I don’t know who is responsible for keeping track of that number, but they sure seem on top of their game!
Let’s take a look at what comprises the "uninsured." First, this is not a static group of people. Instead, the number of "uninsured" is an estimate…a snapshot…of the number of folks thought to be without health insurance on any given day of the year.
Please also note that I used the phrase, "without health insurance." That is a much different phrase than had I said "without access to health care." Every person in the United States has access to health care…by virtue of federal law.
It is true, however, that much of that health care is received in emergency rooms, and that is a significant part of our nation’s problem.
The care is received too late in the wrong setting to be of lasting value to the individual. The care is also delivered in the most expensive possible setting, and much of that cost is unreimbursed and therefore is ultimately "shifted" to the insurance premiums paid by individuals and employers.
The current estimate for the number of uninsured in Wisconsin is 546,870. That number has increased each year but has remained fairly constant so far, as it’s comparison to the total population of the state; about 9.9 percent. Using the most recent Census numbers for Wisconsin, coupled with an analysis by the Blue Cross Blue Shield Association and the Congressional Budget Office estimates of the make-up of the group called "uninsured," we see an emerging picture made up of these parts:
- People who are eligible for existing government programs but who have failed to enroll.
- Middle-class people who earn more than $50,000 per year and who cannot afford or choose not to buy insurance.
- People who are classified as the short-term uninsured (up to two years without insurance, recent college graduates, seasonal workers and those who are invincible).
- The long-term uninsured who simply have fallen between the cracks and remain uninsured for a long time.
What is the number of Wisconsin citizens that fall into each category? It is quite surprising to me.
First, the group that already qualifies for government programs but has failed to enroll represents an estimated 204,529 people.
Second, the group classified as middle-class who either cannot afford to or have chosen not to buy insurance is estimated at 174,998 people.
Third, the short-term uninsured is estimated to contain 68,359 people.
Based on these estimates, the long-term uninsured group is comprised of an estimated 98,984 people, or about 1.8 percent of Wisconsin’s population.
Does this mean we still have a serious problem as far as the number of uninsured in Wisconsin and the country? Absolutely we do. Does it mean that we have to turn the present system on its head and move to "universal health care" (the euphemism for single-payer coverage)? Absolutely not.
It does mean that we need to bring all those who do not have insurance into the insurance system.
It means that costs incurred by those providers who are not paid for the services rendered are being shifted to the third-party reimbursement system. That simply magnifies the increases in health care costs and, thus, insurance premiums, year over year.
It also points up the truth that many do not want to accept: our problem is a health care cost problem and not a health insurance cost problem. Health insurance premium increases mirror the increased costs of health care, not the other way around.
Insurance by its nature was always intended to help each of us defray the unexpected catastrophic expenses we might incur.
We have come to expect that health insurance will cover everything.
It’s as if our auto insurance covered the cost of gasoline and oil changes, in addition to collision and comprehensive damage expense. It’s as if our homeowners’ coverage covered the cost of a new garage door opener when it quit working or a new coat of paint for the house every few years.
Reform of our health care delivery system is too important to permit ourselves to be confused by sleight of hand. We have to get it right, for we’ll most likely not have another opportunity to do so!
Al Campbell is a licensed insurance intermediary who has been involved in a wide range of health care industry positions in more than 34 years in the industry. He is a former president of the Wisconsin Health Underwriters Association and is president of United Resource Group, a company providing online enrollment services for agents and their employer clients.
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