THE UNINSURED ARE A SMALLER PROBLEM THAN IT SEEMS

Forty million people uninsured. Or is it fifty? Both numbers have the virtues of being both memorable and round. However, when lying with statistics, precision also matters. The currently fashionable number of people without medical insurance, beloved of politicians, talking heads, social critics, whining journalists, state medicine advocates, and everybody else with an agenda, is currently 45 million in 2003, a rise of 1.4 million over 2002, and precisely 15.6 percent of the population. And, so they tell us, this number can only increase as escalating premiums (now rising faster than at any time since 1991) drive more employers out of the market entirely.

And everybody's wondering, "Why can't a country that presumes to take care of the world, take care of itself?" The answer is, "We can." But understanding the answer requires a basic understanding of the obvious. And that, neither the chattering classes nor the government nor the insurance companies wants you to do. To get at the problem, it's necessary first to "disaggregate" the pool of the uninsured, figure out who and what they really are and whether or not they're really quite so uninsured.

First of all, everybody is "insured" in the sense that you cannot be legally turned away from an emergency room (assuming you can find one) in life-threatening situations. Also, Medicaid insures 13.3 million poor Americans; various state programs provide some sort of coverage for millions more. So, by and large, if people aren't insured, there must be other factors at work.....

The result is that, today, the health care market is not for health care, or between doctors and patients, at all. It's between large employers and large insurers, negotiating large blocks of employee policies. But even this wouldn't be so bad, were the system not a bizarre caricature of capitalism, hard-wired to keep costing more. Today's health insurance isn't really insurance by definition, the pooling of risk against unlikely but predictable events at all. It's the payment of a flat fee for potentially limitless services. Obviously, beyond a certain point, the only way insurance companies and HMOs can make money is to raise premiums, reduce care, or both. That point was crossed long ago.

So what to do? First, recognize that the problem of the uninsured is much smaller and more manageable than the inflated numbers suggest. You don't wreck the health care system for tens of millions in order to help a small minority. You bring them into the system. This you do by breaking the link between health care and employment(and government!), permitting groups to form for the sole purpose of buying insurance. And you regain the distinction between insurance, in this case "major medical," and purchase of service.

So what we have — de facto — is less of a crisis and more a problem that can be solved. The first step is to admit that the widely advocated 50 million uninsured is a medical myth.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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