The Dwindling Uninsured

For the past two decades, the ever-rising tens of millions of uninsured have become an accepted premise of America’s political and academic elites but they may be as overcounted as the 57 stars on the U. S. flag. Google the phrase “college courses on the uninsured” and you get 300,000 entries. Although this total includes many extraneous references, we do nonetheless learn that the University of Florida has a Center for Medicaid and the Uninsured.

Moreover, we also get observations such as this one from a first-year medical student at Florida State University: “Currently, 47 million Americans, including more than 9 million children, are living without health insurance.” Many of these numbers come from the Census Bureau’s Current Population Survey.

“However, the Current Population Survey estimates of the number of people lacking coverage for all of last year are much higher than other surveys’ all-year insurance estimates,” a team of researchers reported in the September 2009 issue of Health Affairs. “The estimate for people under age sixty-five lacking insurance coverage all year in 2005 was 44.4 million; in the National Health Interview Survey conducted by the Centers for Disease Control and Prevention, the estimate was only 29.0 million.”

“The estimate in the Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality, was 34.8 million for the same year.” Among the five researchers, two were professors at the University of Minnesota, one was a senior economist at the Rand Corporation and one a research associate at the Urban Institute.

“In fact, the Current Population Survey estimate is closer in magnitude to the other surveys’ point-in-time (reflecting insurance status at the time of interview) estimate of uninsurance,” they note. In turn, not cross-checking Medicaid recipients further inflates estimates of the uninsured poor.

“The widely cited Census Bureau estimates of the number of uninsured people, based on the Current Population Survey, probably overstate the number of uninsured people,” the researchers report. “This is because of a Medicaid ‘undercount’: Fewer people report to survey takers that they’re covered by Medicaid than program administrative data show are enrolled.”

“Our study finds that the undercount can be explained by the inability of people to recall their insurance status accurately from the previous year.” In the past decade, two former heads of the Congressional Budget Office have cautioned against overestimating the number of uninsured.

Last July, as American Journalism Center intern Mytheos Holt reported, former CBO chief June O’Neill claimed, “That number grossly misrepresents the size of the problem,” of the 47 million figure, adding that “the number of uninsured is not synonymous with those who lack health care because they can’t afford it.”

“Truth is, the number of chronically uninsured—for this exercise, let’s say, at least 12 months without insurance—is substantially lower, perhaps 20 million lower, when you examine other surveys that are likely to produce better results on this issue,” former CBO director Dan Crippen told the Senate Committee on Aging in 2003.

Nor is public insurance the silver bullet its proponents claim it to be, at least not in the manner in which they advertise it. “While the involuntarily uninsured were 7.1 percent more likely to die than the average, those with public insurance were 17.4 percent more likely to die than the average, with a death rate of 29.3 percent in 2002 and 39.7 percent in 2006,” Holt reported. “Those with public insurance were ten percent more likely to die than those who are involuntarily insured,” O’Neill said.

In fact, Americans do better with their patchwork system of health care than other nationalities do with “comprehensive” coverage. “Many European countries have organized screening programs, whereas the U. S. approach is relatively decentralized,” another team of researchers reported in the December 2009 issue of Health Affairs of international efforts at cancer detection. “Many European countries, unlike the United States, also impose upper age limits on screening.”

“Overall, European screening rates were 22-88 percent of the corresponding U. S. rates.” This report was conducted by David H. Howard, a professor at Emory, Kenneth E. Thorpe, a professor at the Rollins School, and Lisa C. Richardson, of the CDC.

Malcolm A. Kline is the Executive Director of Accuracy in Academia.