HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, November 6, 2007

Reforming our Health Care System: The Need for Facts

Yesterday, N. Gregory Mankiw , a former adviser to George Bush, and current adviser to Mitt Romney, has an article in the New York Times business section discussing the future of health care in America and the need to examine the facts before considering reform efforts.  He then repeats and debunks what he believes are some false facts about America's health care system - a system that he believes works fine and will get better.  For example, he takes issue with the 47 million uninsured number that has been in the news for quite some time.  He states,

Some 47 million Americans do not have health insurance.

This number from the Census Bureau is often cited as evidence that the health system is failing for many American families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.

To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.

The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage. . . .

Concurring Opinions commentator Frank Pasquale disagrees with Mr. Mankiw and cites to a recent article by Professor Timothy Jost drawing some opposite conclusions about the stability and desirability of our current health care system.

But for now, I'm inclined to agree with the perspective of Tim Jost. He is a health law scholar who has thought seriously about comparative health systems, and does not share Mankiw's tendency to "look on the bright side:"

[A] series of studies over the past decade have shown that the quality of health care in the United States is seriously deficient, and, in particular, that medical errors are common and often have serious consequences. Indeed, the quality of the health care Americans receive is no better, and in some respects worse, than that provided in many other countries that spend far less on health care and yet provide it for all of their citizens.

DailyKos commentator Tonyahky also contains a sharp critique of the facts used by Mr. Mankiw.  Here is the response to the 47 million number:

Even if 10 million of the uninsured are illegal immigrants, what about the other 37 million? He doesn't tell you that 9 million of the uninsured are children. He also does not tell you that in general, the only adults who even qualify for Medicaid in most states are people receiving TANF and individuals who are eligible for SSI.

And what about those who declined coverage offered by their employers? I thought we could do a little bit of second grade math to illustrate why so many of these individuals opt out of employer sponsored health insurance I'm going to use a friend's earnings, living expenses, and her employer's insurance premiums to illustrate why many people opt not to receive health insurance: (see here for rest of discussion of cost of health insurance) . . .

In 1950, about 5 percent of United States national income was spent on health care, including both private and public health spending. Today the share is about 16 percent. Many pundits regard the increasing cost as evidence that the system is too expensive.

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