Americans are Uncommitted on Universal Health Coverage

January 1, 2010

3/6/08 - Providing uninsured Americans with health coverage is proving to be a complicated issue. Despite a number of revised state programs and a flood of new research and information on the issue, there is less consensus of public opinion on an approach to the problem than ever before. Meanwhile the number of uninsured has remained relatively unchanged at about 60 million people, or 1 out of every 6 Americans.

Public Opinion Research

A recent poll conducted by National Public Radio, Kaiser Family Foundation and Harvard School of Public Health found that Americans are divided as to whether we should require uninsured Americans to obtain health insurance. The results of the poll were reported in "Morning Edition" on 2/29/08. While 93 percent of those polled said the issue of uninsured is "serious", there is much less agreement on the approach we should take to tackle the problem. The survey asked what role the government should play in resolving this issue. Only about half of Americans support the idea of forcing uninsured adults to buy insurance or using public funds or tax subsidies to get coverage for the uninsured.

A number of earlier studies show that most uninsured individuals lose coverage due to normal life transitions (job changes, student graduations, and waiting periods for other coverage to start) but then find new coverage in less than a year without government intervention. Only a minority of these without health coverage are chronically uninsured without available affordable coverage options. The majority of uninsured individuals could find and pay for coverage, but do not choose to do so.

Federal Programs

The federal government's efforts have focused largely on getting children insured. Yet despite years of promoting free or low cost health coverage for children, recent statistics indicate that the number of uninsured children remains level. While these programs have undoubtedly had some good results, it is not clear that additional funding of this program will continue to result in lowering the number of uninsured children. Legislative proposals to expand this government-subsidized program to adults have not gained widespread political support.

Requiring Universal Coverage

The health care and insurance industries support proposals to force Americans to carry health insurance by instituting penalties to those who fail to enroll for coverage. Americans are still unwilling to support legislation that forces adults to buy health insurance coverage. Recent legislation in Massachusetts that penalizes those who do not enroll in coverage is cited as an example of an approach that most Americans want to avoid. Opponents of this type of reform say the proposal is similar to attempting to solve the issue of homelessness by requiring everyone to buy a house. This approach completely ignores the underlying cause for the gap in insurance.

Insurance Industry Response to Universal Care

Over the past two years the insurance industry has responded to the call for universal affordable coverage by introducing a wide range of less expensive limited benefit health insurance plans. These plans have grown in popularity but the number of uninsured majority of consumers continue to choose to avoid purchasing health insurance as a free market economic decision after weighing the costs and benefits of this option. A 2005 survey by MedSave.com showed that more than nine out of 10 people who shop for health or dental insurance online ultimately do not make a purchase even though coverage is available in a price range that would be considered affordable. The reason for this behavior is that consumers are looking for health plans that immediate transfer the cost of current or anticipated treatment to a third party so that they can escape the financial responsibility. Consumers are less concerned with using insurance to cover the long term risk of unknown health expenses. In other words, shoppers are seeking subsidized plans to cover the cost of treating pre-existing medical conditions. Insurance, in contrast, is primarily intended to cover unknown costs over the long term and is not intended to financially subsidize consumers who cannot afford to pay for their current treatment. It is clear that making health insurance more affordable is not the answer to solving the uninsured problem.

Consumer Education

Some consumer advocate say that a more successful and cost-effective approach is to educate consumers on the affordable health insurance options that already exist and calling attention to the risk voided and other benefits of voluntarily purchasing health insurance. While this approach will not achieve 100 percent coverage, it will significantly reduce the problem at minimal public expense without the need to pass additional legislation to modify the rights of individual citizens. Insurance industry executives estimate that at least half of the uninsured Americans could easily obtain coverage if they received appropriate education and financial counseling. Unfortunately there are few of these services in the public sector or in private industry. One leading service called OnlineAdviser curtailed its free consumer health insurance advisory service last year for lack of funding and qualified volunteers after assisting over 40,000 health insurance consumers nationwide since 1997.

Taking the opposite position, recent publications like "Your Money and Your Brain" by Martin Zweig focuses on the neurology of consumer behavior and suggests that consumers are acting naturally and logically in choosing to avoid purchasing health insurance. Consumer behavior may be guided by legislation and financial motivation, but the underlying function of the human brain remains fundamentally opposed to the concept of insurance for many people facing life's other financial challenges.

Four Options Remain 

American embrace the fuzzy warm concept of universal coverage for the 60 million without health insurance, yet over half of the uninsured are unwilling to spend even $100 per month of their own money to buy basic health insurance when it is available. More than half of us do not think that the government should help pay the cost of that coverage. Until we are willing to change the behavior of individuals either with a) public education programs, b) paying for coverage, c) providing incentives to be insured, or d) penalizing those without coverage, then resolution of this issue is not going to happen. The issue appears to be unlikely to be resolved in the foreseeable future.


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