Uninsured are more than just numbers

The annual U.S. Census Bureau report on the number of people without health insurance always attracts a good bit of attention, certainly no less so in the midst of an already contentious debate about health system reform.

The Census report, released in September, counted 46.3 million uninsured in 2008. As in the past, there are those who will dispute the number. The argument is that the situation isn't as dire as it might appear, for example, based on critics' assumptions about those who can afford insurance but won't get it, or estimates of individuals who have opted out of available public and private options.

Yet no matter what rationalization is applied to discredit the number, millions of Americans who should be covered are not covered. And on that count, the latest Census report and current events do not provide encouraging news.

On the surface, it appears the percentage of Americans without insurance was virtually unchanged -- 15.4% in 2008, up from 15.3% in 2007, when the uninsured tally was 45.7 million. But what those numbers don't show is the erosion of private insurance coverage, and this is even before the teeth of the recession really bit down this year.

For the eighth straight year, the percentage of individuals enrolled in employer-sponsored plans went down, to 58.5% in 2008 from 59.3% in 2007. The peak, in 2001, was nearly five percentage points higher, 63.2%.

Government plans picked up some of the slack, including coverage for 800,000 additional children. Some became insured because of the expansion of the Children's Health Insurance Program. But many got insurance through Medicaid for the first time because of their parents' job losses or decreases in pay.

All told, the total ranks of the uninsured went up by about 600,000 in 2008. There is well-founded belief that the situation has become worse since then. A monthly Gallup-Healthways Well-Being poll found a 16% uninsured rate in June, up from 14.4% a year earlier. This was as unemployment crept upward from 7.2% at the end of 2008 to 9.5% in that month. (Unemployment reached a 25-year high of 9.7% in August.) For too many Americans, losing a job means losing health insurance.

Even for those who have held on to a job, especially at small businesses, rising employer premium rates have made coverage less attainable. A Robert Wood Johnson Foundation study concluded that if reform doesn't happen, the cost of health care for businesses would double, and the number of uninsured Americans could reach 65.7 million in 10 years.

No matter how persuasively the case is made that millions of Americans are uninsured and that many have no reasonable hope under the current system of finding coverage, the precise number of those without coverage is a secondary concern. As the AMA has pointed out throughout the debate, people in America going without insurance are living sicker and dying younger because they cannot obtain access to high-quality, affordable health coverage.

That includes the regular doctor visits and preventive care that would ward off problems.

The result is uninsured patients who have waited until it's too late to get treated, meaning they need more intense and expensive care. Add to that those uninsured who enter the system following an injury or sudden onset of illness.

In financial terms, when those patients aren't able to pay, the cost ends up being spread throughout the health care system. It is one more big number in a health care system so vast and complex there are no little numbers. But behind the numbers are individual stories of those who would have had longer or better lives for want of achievable reforms.