What do 56 million Americans have in common?


Landing in my inbox just now is a grim new report from Health Affairs, noting that by 2013, 56 million Americans will be uninsured. One-fourth of all workers. Most of this, by the way, will be due to strained budgets and unaffordable health care costs for low- and middle-income people.

The interesting thing in the report—well, interesting to health care wonks, depressing to everyone else—is that the researchers found a “remarkably tight relationship” between affordability and coverage. It doesn’t matter whether workers are covered by their employers or pay out-of-pocket. When premiums go up, fewer Americans get coverage, period. As one would expect.

So there are two things to conclude here. One, covering the uninsured is going to cost both employers and taxpayers a lot of money—a good rule of thumb is about $200 billion per year, which is relative peanuts in the cost of total health care spending (roughly $29 trillion over the next decade), but a lot of money all the same. There’s no way of getting around this, and it does no good to pretend, as the president does, that spending just a little bit of money will solve the problem. Second, universal coverage, so long as it involves the private insurance industry, simply isn’t going to work without serious cost containment measures that keep premiums from rising faster than income. Unfortunately there seem to be far more calls to do this sort of thing—usually involving completely unrelated cuts for Medicare or Medicaid—than there are actual solutions. Still, before anyone proposes anything, it never hurts to understand the problem, so for a good primer on why health care costs are so high in America, I suggest another old Health Affairs report (pdf) on the matter.