Health Affairs, a journal that often publishes interesting work on topics like insurance is running a web article today reporting that the ranks of the uninsured increased by 6 million, to 45.8 million, between 2000 and 2004.
The authors site erosion in employer-sponsored insurance coverage as the major driver.
Now some will see this as further evidence of the wind blowing the Democrats' direction, but I think this kind of bad news data actually flags one of our key problems (discussed more below).
From the summary:
A shift in the workforce away from large and medium-size firms and toward small firms and self-employment, as well as a shift from industries with historically high rates of employer coverage also led to lower rates of health insurance coverage, according to the paper by John Holahan, director of the Health Policy Center at the Urban Institute in Washington, and Allison Cook, a research assistant at the center. The authors write that U.S. Census Bureau data show that the number of uninsured Americans rose by 6 million, to 45.8 million, between 2000 and 2004, a period of recession followed by slow economic growth. Employer-sponsored coverage rates among the nonelderly fell 4.6 percentage points to 63.3 percent between 2000 and 2004. Medicaid picked up some of the slack, increasing its coverage rate 2.4 percentage points. The authors conclude by saying the decline in coverage is likely to continue as employers try to reduce health insurance costs and governments experience deficits and accelerating Medicaid costs.
The full article is available here
A few more details:
Between 2000 and 2004, the number of uninsured Americans increased by six million, primarily because of a decline in employer-sponsored insurance. All of the increase occurred among adults, for whom the drop in employer coverage was not offset by an increase in public coverage. The number of uninsured children fell slightly. About two-thirds of the growth in the uninsured was among Americans below 200 percent of the federal poverty level. Coverage rates have also fallen among higher-income Americans. About half of the growth in the uninsured was among young adults ages 19-34, about 55 percent among whites, and 73 percent among native-born citizens.
Hey -- this means people should vote "blue" right? We believe in giving people health care!
We do? How?
Democrats have never fundamentally agreed how affordable health care should be provided. Most Dems timidly hide out among stall-and-distract conservatives arguing that some kind of "market-based" solution needs to be developed.
Market-based, of course, has always meant almost complete reliance on private insurers, who divert vast financial resources toward bureaucracy (notably the armies trying to avoid paying claims), put no curbs on the enormously costly, almost pointless procedures many people undergo in their last few weeks of life, and show stunningly little ability to leverage bargaining power to reduce provider costs or to improve quality.
Note: Market forces can play a huge role in improving health care, but we've never had a real discussion about how to harness them in the public's interest. You would get mugged by lobbyists if you even opened your mouth on the subject in Republican-controlled Washington.
John Kerry floated a health care plan in 2004 that was so complicated that even someone like me (I read a lot about this stuff) could not understand it, let alone explain it.
We tie ourselves in knots worrying about the costs. But notice, the Republicans have never paid more than bemused lip-service to the costs of implementing their destructive agenda. We get lost in the mechanics. Republicans have never let mechanics get in their way, either (witness the disaster we'll watch unfold in 2006 vis Medicare Part D).
Our talking points should always reduce the mechanics to simple themes, and focus on the benefits.
But we do have to agree first on what we're talking about. I would argue that we should work toward a single-payer model, which is effectively how most other rich democracies work (the new study that prompted this diary, along with crises at companies like GM and Ford, suggests that trying to compel employers to provide health care is fighting an uphill, losing battle).
But my fundamental point: If health care is going to work for Democrats as an issue, we need a much clearer, simpler story about what kind of a system we are talking about, and what benefits the average voter would get out of it.