Who are these 46 million who are not insured?

Posted on October 30th, 2009 by ecthompson md

health insurance
Liberals have been accused of misrepresenting the data on those who are uninsured. So, I thought I’d take a couple of seconds and set the record straight. The U.S. Census has released a report on income, poverty and health insurance status a couple of months ago. The data is from 2008.

There are 46.3 million people in the United States who do not have health insurance. This has increased from 45.7 million people in 2007. 34 million of these people are American citizens. 9.5 million are not American citizens. This leaves approximately 2.7 million Americans who don’t have health insurance who have become naturalized citizens. So, it is not correct to call them all illegal aliens. (I hate that term. I’ve been pushing “economic refugees” because that accurately describes why they are here.) On the other hand, it is not correct to call them all American citizens. I think this is important. The vast majority of the 46 million Americans without health insurance are American citizens!

Now, to jump into the mess, what shall we do with 9.5 million economic refugees were not citizens? Some have suggested we do nothing. Others have said if there’s an emergency, send them to the emergency room; otherwise, do nothing. Here’s my thought. As a surgeon, if I’m at a football game watching my Dallas Cowboys and the guy next to me is coughing up some infectious disease — tuberculosis, influenza, etc… — his health is affecting me. If I’m in New York on a subway or in an elevator, his health affects me and those around me. Also, if these economic refugees get brought into the healthcare system, it will cost me and you less in the long run. Complications of disease always cost more. Preventing those complications should be our goal.

I know that this is a contentious issue. I also know that we need to fix this problem that has been created by corporate greed. If corporations weren’t hiring economic refugees, they wouldn’t be here.

Tags: Healthcare, Immigration // 19 Comments »

  • Don Schenck

    Simple: Implement a single-payer system and cover anyone who walks into a health care facility in this country.

    Health care and immigration reform (and border control) are, or should be, two entirely different subjects. Mingling them only benefits those who would use immigration “problems” as a smokescreen to cloud every issue.

    That’s my opinion.

  • Joe White

    Yes, 36 million of the 46 million are American citizens.

    7 million of those 36 million make over $75,000 per year

    an ADDITIONAL 7 million of those 36 million make over $50,000 per year ( I have purchased insurance for my family for 20 years on less income. If you make $50k , you can afford it IMHO)

    That leaves 22 million

    13 million of the 22 million make less than $25,000. So a large number of those are going to ALREADY qualify for Medicaid.

    The remainder are the group in the middle, making $25-50k per year. As I said, I am one of those (on the lower end of the group actually) and I buy insurance, so I know that many in that group can do so.

    Why are so many uninsured in America?

    Well, 18 million of the 46 million uninsured are in the 18-34 age bracket, a group notorious for large numbers of healthy single people who don’t want to pay for insurance that they don’t think they need at the moment. Call them crazy but they are young and healthy. Is it a gamble? Sure, and one that many are willing to take. And honestly most of them will win that bet. A smaller number wont and it will be a hard lesson for them. Should these younger people be forced to buy something they dont want? We give no other industry the right to indirectly tax the American public, and an individual mandate is basically that. So we better think long and hard about that.

    The point of going thru these numbers is that there are not anywhere close to ’46 million American citizens in crisis’

    The dishonesty of elected Democrats in continuing to push this propaganda is staggering. It is only surpassed by the number of rank and file Democrats who silently allow it to go forward in their name.

    The relatively small percentage of Americans who are truly in crisis does not justify the wholesale destruction of the health insurance industry to allow for a government takeover.

    Its like doing a heart transplant to heal a broken arm.

    Reforms that make it easier and less expensive for the uninsured to enroll can happen without destroying the insurance coverage that overwhelming majority (over 80%) want to keep.

  • ecthompson

    i agree. 

  • ecthompson

    Joe - 

    You can’t just write off those 7 million people. There is a reason that they don’t have insurance. You can’t just say well they should buy it – so there. The fact is that they don’t have insurance. If they get sick it will cost you and I more money to care for them. 

    Finally, I would like to point out that this is about more than just covering 46 million people. It is also about controlling healthcare costs. It is about delivering better medical care to everyone. 

    You can’t just write off the 

  • Joe White

    ‘You can’t just write off those 7 million people’

    Dr Thompson, there are 7 million people who make more than $75,000 a year that don’t buy insurance.

    If these people stop buying their own food, is it society’s responsibility to send a grocery boy out to stock their cupboard on a weekly basis to make sure they don’t starve?

    ‘ I would like to point out that this is about more than just covering 46 million people.’

    I agree.

    Paperwork and admin costs are nearly 20% of the health care dollar. This is the obvious place to start.

    The insurance industry should standardize all forms and information systems to bring this down to a reasonable figure. A target of 5% is reasonable IMHO. Cost to government = $0

    And it doesn’t take an act of Congress to do it.

    And it doesn’t take stripping the rest of the country of the insurance coverage they like (over 80% in the most recent polls like their current coverage) in order to facilitate a government takeover.

    Maybe if the industry didn’t have to spend millions on lobbyists and public relations/advertising to fend off the government’s attempts to destroy them…….

    Maybe if the industry didn’t have to spend millions on campaign contributions that are extorted from them by the threat of Congressmen who hold the power of life and death……….

    ……maybe they could actually get back to the business of streamlining their business model and trim the inefficiencies that cause the 20% costs for admin and paperwork.

    Also, increasing the number of paying insureds would bring down the cost of insurance for everyone. Allowing individuals to band together to buy group health insurance (without being an employment based group) is a move that would cost the government $0 and benefit everyone.

    The problem is that the only solution that elected Democrats care to talk about is one that gives them control.

    Right now there is financial incentive to control costs based on competition.

    Under a single payer plan there would be zero incentive to control costs. No competition , no worries.

    Do you really want government allocating health care resources in pork bills like they do roads and bridges? It will happen.

    Liberals used to believe that the government didn’t belong in the room when a patient and his doctor were making medical decisions.

    But if government holds the purse strings, they will ALWAYS be in the room.

    It’s odd. When it comes to abortion, liberals are all ‘get your laws off my body’.

    But when it comes to every other medical decision, now liberals are all ‘put your laws all over my body and on my neighbors body whether they like it or not’.

    What has happened to the liberals?

  • Guest

    Even people with insurance get denied care based on the whims of the HMOs and health insurers.  We need single payer now.

  • Guest

    You aren’t even making sense.

  • Joe White

    If an insuror violates it’s contract and denies care, that’s already illegal.

    I am not excusing illegal behavior, they should be held accountable.

  • Angie

    So, if “The Industry” didn’t have to spend so much money to defend its right to screw its customers it would actually do its job?  Good one.

    I live under universal healthcare and never has “The Government” interfered in my health treatment.  How paranoid.

  • Joe White

    I don’t know where you live Angie. But if the government holds the purse strings to your health care, they control it whether you’ll admit it or not.

    That can add up to disastrous consequences , such as in BC where they are considering reducing necessary surgeries due to budget constraints.

    “Dr. Brian Brodie, president of the BC Medical Association, called the proposed surgical cuts “a nightmare.”
    “Why would you begin your cost-cutting measures on medically necessary surgery? I just can’t think of a worse place,” Brodie said” http://www.vancouversun.com/story_print.html?id=1878506

  • ecthompson

    yes, it may be illegal but as an average citizen, we have little or no recourse against the insurance company. Taking them to court is a waste of our time and money. without adequate regulations, it is then possible to keep large corporations at bay.

    Thanks for your comments.

  • Joe White

    State insurance regulations are, in most cases, very good.

    One of the problems is that, as I have pointed out, many employers ‘self insure’ and are exempt from much of the state insurance regulation that is there to protect consumers.

    The exemption should be ended, IMHO. If an employer wants to ‘play insurance company’ he should be regulated like one.

  • Angie

    Nothing to “admit”, all I know is that, even with the government “controlling” healthcare, I get the best treatment when I need it.  Not much more to it really.

    Our system in Australia is far from perfect but it works pretty well.  When healthcare is not an issue that needs to be debated so intensely (as it is in the US) then it can’t be that bad.

  • Joe White

    Angie, we in the US do not want to lose the level of care that we have. Do folks in single payer utopias have it better? I don’t think so.

    For instance:

    In the UK:
    A comparison of relevant UK studies indicates that about half of people who have a heart attack die within 28 days. from http://www.heartstats.org/datapage.asp?id=1590

    In the US:
    For instance, 18.9% of heart attack survivors aged 65 and older died from any cause in the first 30 days after being admitted to the hospital in 1995, compared to 16.1% in 2006. In 1995, 14.6% of heart attack patients died in the hospital; in 2006, about 10% died in the hospital.  from http://www.cbsnews.com/stories/2009/08/19/health/webmd/main5251873.shtml

    These are significant differences, measuring in tens of thousands of lives. We aren’t talking just a few percentage points here.

    You mention that people in Australia don’t debate intensely over their system and it ‘can’t be that bad’.

    Canadians may have much the same attitude. But as the head of the Canadian Medical Association said recently:
    “We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize”  from http://www.healthzone.ca/health/newsfeatures/article/681882–top-doctor-says-system-imploding

  • Angie

    Seriously?  You think you get better care?  Please, take the blinders off and look outside your bubble.  Yes, you have great medical treatment and facilities…for a minority of citizens.  But overall your system sucks.

    http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror–Mirror-on-the-Wall–An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx

    The bottom line is that government run systems do just fine in both coverage and outcomes.  Many US supporters of your current system need to spit out the Kool-Aid and do some research.

  • Joe White

    Maybe not everyone agrees with you.

    “The Royal Hobart Hospital is indicative of the decline of a once great public institution. The hospital board has been replaced by a state government bureaucracy whose prime purpose is to ration hospital care. Consequently, operating theatre time is regularly rationed and cancelled, elective surgery is regularly cancelled at the last minute aggravating patients and staff, the absolute number of hospital beds has declined over the last 10 years, (albeit official bed numbers and unofficial bed numbers rarely agree), staff overtime is limited or prohibited. In summary, productive capacity is continually disrupted lowering morale and increasing the frustration of those who attempt to work in such a system.” http://www.adf.com.au/archive.php?doc_id=157

    “According to the Australian Medical Association, every public hospital in New South Wales is dangerously overcrowded, causing 1,500 unnecessary deaths each year. Patients stack up in corridors and emergency rooms waiting for beds.” http://www.patientpowernow.org/2009/01/23/australia-health-care/

  • ecthompson

    Joe and Angie –

    I appreciate your passion. We need to be able to discuss these problems without escalating them to craziness.

    Joe, you’re right, probably everybody does not agree with Angie but she has the facts. She has the facts that haven’t been put through an ideological filter. We have this belief in our country that everything that we do is greater and better than anywhere else in the world. That simply isn’t true. We live in a great country but our healthcare system is a mess. Unless you have money to healthcare system does not work for you. This is simply the facts. The medical community has known this for over two decades. Anytime when you look at trauma victims and determinants of outcome like age, race and socioeconomic status take a backseat to insurance status that’s a problem. That’s a system in which being rich really pays off. We need to do better.

    I appreciate both of your comments.

  • Anonymous

    Dr Thompson,

    Can you tell me what ‘ideological filter’ was used by the Australian Medical Association and the Australian Doctors Fund when they posted the comments that I cited?

    Are they ‘crazy’?

    When the President of the Canadian Medical Association says their system is ‘imploding’ and states that ordinary Canadians do not realize how precarious the situation is, and that it is ‘not sustainable’, what ‘ideological filter’ is she using?

    Is she ‘crazy’ as well?

    I don’t disagree that we need to improve many aspects of the system, but destroying the insurance coverage that the overwhelming majority of Americans like and want to keep is not ‘fixing it’.

    Democrats are preventing real reform by trotting out myths about ’47 million American citizens in crisis’ and ’44,000 people dying each year because they have no insurance’.

    These myths have been debunked time and again, but continue to reappear in the political rhetoric from the left.

    I hope that you, as a physician and a man dedicated to science, will demand that ‘reformers’ use truthful information and not baldfaced lies.

    A productive discussion is hardly possible when one side clings to falsehoods to advance their case.

    Yes there are problems and many things that need correction. But you can’t give a car a tuneup if you run it thru the junkyard smasher.

    80% + of Americans like and want to keep their current coverage.

    Why would you deny their right to do so?

  • Joe White

    Sorry, posted too soon. That is my comment above.

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