Myth #2: Our biggest problem in health care is that we have 46,000,000 uninsured people who either can’t get insurance or can’t afford it.

The Census Bureau estimates we have 47 million Americans with no health insurance. Most pundits seem to think all these folks either have no access to coverage or simply can’t afford it. That is not true. Many reform advocates claim that this is our biggest problem in health care. That also is not true.

My own analysis of the data indicates that nearly two-thirds of the 47 million uninsured actually have access to affordable insurance, but have chosen not to purchase it, due to indifference, lack of perceived need, or different personal priorities. They include 13.9 million who are eligible for Medicaid, but haven’t signed up. There are another 9.9 million who are eligible for individual health insurance and able to afford it. Finally, there are 6.9 million workers who are eligible for employer-subsidized coverage, but who haven’t opted for it. These people, some 31 million strong, are the voluntarily uninsured.

That leaves 16 million people who are involuntarily uninsured. And only 7 million of those are truly the hardcore uninsured. That’s because the 16 million includes another 9 million people who would be able to afford insurance if the states dropped their laws that require health insurance to cover services of doubtful medical necessity--such as chiropractors, social workers, massage therapists, dental anesthesia, infertility treatments, acupuncture, wigs, and drug and alcohol abuse treatment. These benefit mandates increase insurance premiums by 20% to 50%, depending on the state. We don’t need radical national health care reform to solve this problem. The states can do it themselves, if they stand up to the special interests that demanded these additions in the first place.

The 7 million hardcore uninsured Americans (2.4% of the population) either don’t have access to insurance on any basis or couldn’t afford it even if the states were more reasonable about mandates. If this were the only problem in health care, it could be readily resolved by a judicious expansion of existing government health programs that already cover well over 100 million people.

Unfortunately, our dysfunctional health care system suffers from much deeper problems, including rapidly escalating and uncontrolled costs; unreliable quality that is killing more than 300,000 Americans every year; a looming pandemic of preventable diseases of people who refuse to live healthy lifestyles; and the uninsured. Any attempt to reform health care that deals only with the uninsured--without simultaneously addressing these larger issues--will be like replacing a leaky faucet on the Titanic.

There is a way to fix these problems, but it won’t come from any of the proposals you’ve seen coming from presidential candidates, congressmen, newspaper columnists, or any of the other reform proposals you’ve seen to date.

Copyright 2008 by Stephen S. S. Hyde. All rights reserved. Quotation of excerpts permitted with attribution.