According to a new study by the Robert Wood Johnson Foundation, upwards of 8.4 million children went uninsured in the United States last year, and as one would expect, many of those go without medical care or fail to go see a doctor when they need one. That’s appalling, sure, but what really stands out here is that over 70 percent of these children could enroll in public health care programs—such as Medicaid or SCHiP—but don’t, likely because their parents don’t even know that their children are eligible.
Part of the blame here rests with state governments, which don’t exactly walk the extra mile to alert people to these programs, or else make the requirements bewildering, in order to keep costs down. But setting that aside, this also highlights the fact that, very often, improving health care for the poor depends less on expanding insurance and more on making health care more convenient. In his book, The Escape From Hunger and Premature Death, 1700-2100, Robert Fogel notes:
Keep in mind that the poor are already entitled to health care under Medicaid and that the near poor often receive free health care through county or city hospitals and emergency rooms. Most proposals for extending health insurance involve taxing their wages for services they already receive. Such insurance may relieve the pressure on the public purse, but it will not guarantee better health care. I believe that screening in schools and community clinics has a better chance at success than unexercised theoretical entitlements.
As an argument against universal health care, this seems a bit tendentious. But as an argument that policymakers need to think less about the bewildering world of health insurance and more about making health care accessible—say, improving prenatal care, or free screening at schools, or community health centers—Fogel’s on the right path.
