Who are the uninsured and should we pay to cover them?

Keith Hennessey has analyzed 20 statements made by President Obama during the town hall meeting on health care at Portsmouth, New Hampshire. You can read Hennessey’s analysis at his home page.
One of the statements Hennessey examines pertains to what, for Obama and many others, is the starting point in the debate – the number of people who are uninsured.
In Portsmouth, Obama had this to say:

I don’t have to explain to you that nearly 46 million Americans don’t have health insurance coverage today. In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage. They are just vulnerable. If something happens, they go bankrupt, or they don’t get the care they need.

Hennessey breaks this group of nearly 46 million into five categories. The first, consisting of about 6.5 million, actually is insured. According to Hennessey, they are enrolled in Medicaid or S-CHIP but didn’t tell the census taker. This is called the “Medicaid undercount.”
The second group, about 4.5 million, consists of people who are eligible for Medicaid or S-CHIP but have not enrolled. If they need care, the hospital or clinic generally enrolls them. In other words, they do not (as Obama claims) go bankrupt or without treatment. In any case, it would be ridiculous to overhaul our healthcare system to provide insurance to people who are already eligible for government assistance but have failed to avail themselves of it.
The third group, about 9.5 million, is comprised of non-citizens. Hennessey notes that people will disagree about what portion of this group should receive government subsidized health insurance. In my view, none should.
And keep in mind that being uninsured is not the same as having to pay (or pay much) for treatment. I’ve heard illegal immigrants say that they find ways to receive free or inexpensive treatment for themselves and their children. In general, I’ve read (though I can’t find the source) that the uninsured receive about half the amount of money per capita to pay for medical treatment that the insured receive.
The fourth group, another 10 million, earns an income more than three times the poverty line. As such, they can afford to buy medical insurance. Taxpayers should not be required to buy it for them.
This leaves about 15.5 million (one-third of Obama’s 46 million) who actually are uninsured, cannot become insured simply by enrolling in a free program, are U.S. citizens, and cannot easily afford to purchase insurance. About 5 million members of this cohort are childless adults.
It is understandable that many Americans would like to see the government do something for this group, or at least those members who are not young, childless, healthy adults with decent starter salaries who simply think it makes economic sense to assume the small risk that they will incur large medical expenses. But it is also understandable that many Americans favor targeting this group through incremental measures to assist them in purchasing insurance, rather than through a radical overhaul of our healthcare system at a massive cost.
Obama knows he needs a big number of “uninsured” to even get in the vicinity of selling what he has in mind to a skeptical public. But the big number he has selected would not get him in the vicinity if the public better understood who it consists of.
JOHN adds: Many young, single people make a perfectly rational decision not to buy health insurance. Accidents are the biggest threat to their health; car accidents are covered by automobile insurance and work-related accidents are covered by workmen’s comp. The chance of a young person contracting a catastrophic disease (leukemia, say) is remote, and people aren’t stupid: they know that if they contract such a disease they will be treated whether they can pay or not. And young, single people have not acquired a substantial net worth that they could lose to medical bills. This is why, when Pizza Hut made cheap health insurance available to its part-time employees a few years ago, hardly any of them chose to take advantage of it.
One of the purposes of most health care “reform” proposals, stated or unstated, is to force these young people into the system–to force them, that is, to contribute money to pay the medical bills of others, beyond what they already pay in Medicare taxes. Whatever you think of either the justice or the wisdom of such a policy, it is not worth turning our health care system upside down in order to achieve.

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