In June of 2003, Maine enacted a law creating Dirigo Health, which is Maine’s attempt to provide free or heavily subsidized health insurance coverage for the estimated 136,000 citizens who do not have health insurance. As of the end of 2005, there were reportedly less than 2,000 previously uninsured individuals who had signed up for Dirigo Health. How can it be that less than 2% of the uninsured population of Maine has taken advantage of this bonanza? In the case of the uninsured, reality falls far short of perception.
Explore This IssueApril 2006
How Myth Became Fact
Throughout our national discourse on universal health-care initiatives, one statement has been repeated so often that both sides arguing this issue have accepted it as fact. The comment that there are 40 million Americans with no access to health care has been accepted a priori. Seldom does one ever see any analysis of this fact. This is more than just an academic point since, as in the case of Maine, health-care policies and significant amounts of taxpayer monies have been directed at this issue.
Just where did this 40 million number come from anyway? Who are these Americans with no health insurance? Most people think of the elderly, the disabled, and the indigent. However, physicians realize that these groups of people are insured through Medicare and Medicaid. As it turns out, the 40 million people quoted as being the uninsured in America are a very heterogeneous, fluid, and constantly changing group. The 40 million number is also misleading.
The 40 million people quoted as being the uninsured in America are a very heterogeneous, fluid, and constantly changing group. The 40 million number is also misleading.
In May 2003, the Congressional Budget Office (CBO) published a paper on the uninsured, which revealed that between 39 and 42.6 million people lack health insurance at a specific point in time during the year. However, the CBO paper also reports that one-half to two-thirds of these people had health-care insurance during other parts of the year. Forty-five percent were lacking insurance coverage for less than four months.
Confessions of an Uninsured Doctor
Confession time. I have been among the 40 million uninsured Americans-several times. In the years 1986, 1992, 1994, 1995, and 2000 I would have been included among the 40 million uninsured Americans for at least part of the year. It sounds outright scandalous that a physician would be among the uninsured for 5 of the last 20 years. That’s one out of every four years without health insurance!