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The uninsured rate is recovering from four years of Donald Trump

Here's the latest estimate of the percentage of Americans who lack health insurance:

Starting in 2018 the number of uninsured started to creep up, but starting in 2021 it began to creep back down and is now at about the same level as it was during the Obama years. Next up: Finally insuring that last 10%.

14 thoughts on “The uninsured rate is recovering from four years of Donald Trump

  1. kylemeister

    Reminds me of a KD post saying that the US was at 11% uninsured and $11K per-capita spending. I believe Belgium had the second-highest uninsured rate (among OECD countries or some such) at 1%.

  2. sturestahle

    We all knows it’s a proud American tradition to have people dying in the gutter due to lack of basic healthcare.
    One can often find articles on how many citizens who are totally lacking insurance but what isn’t highlighted is the quality of the insurances the majority is having compared to the insurances their peers are having elsewhere.
    50% Of Americans now carry medical debts ..a new chronic condition . I have also seen statistics on “medical bankruptcy” and it’s ugly (don’t have a kid diagnosed with leukemia)
    I guess one could use this slogan when advertising US healthcare:
    “Pay double the price get half the value “
    … but it’s only those pesky “progressives” who are trying to address this and they are told to sit down and keep quiet by the elite of the Democratic Party
    A comment from your favorite Swedish troll
    … and a good night to you all

    1. KawSunflower

      As I understand it, people in need of emergency care aren't turned away from hospitals for lack of insurance if those facilities are funded with any public funds, as a legal matter.. We do need to do much better by people lacking homes (as I once was, to save my life when neither police nor a judge would provide protection required by the law), but your reference (not the first time?) to people "dying in the gutter" is more a reference to unhoused individuals who did not go to a hospital. Care by individual doctors usually would require insurance, except for some clinics aiding those without resources. Having previously been a regular volunteer at a large live-in shelter (not a nights-only, short-duratiion one), I have known such individuals & their situations.

      Please stop your condescension & schadenfreude. Sweden has its own problems, which you prefer to not acknowledge, plus some gray areas in its own history. I wonder what you have done about any deficiencies in your own country, including any adverse reactions to immigrants or any ultra-conservative activities.

  3. middleoftheroaddem

    On the one hand progress is good. On the other hand, this just shows how limited the ACA is in practice....

  4. SC-Dem

    The net cost of a comprehensive, world class, single payer system to the Federal government is less than zero. Two proofs:
    1. Total government spending on healthcare in the US is about 67% of the total. The asymptotic limit on the percentage of government healthcare spending is about 90%. (Canada only covers about 74%.) The US spends more than twice as much on healthcare per capita as peer countries with much better health outcomes. 67% x 2/90% = 1.49 Government in the US is already spending 1.49 times as much as is necessary to pay for world class universal healthcare.
    2. Let’s assume the $3,500 Billion figure for cost of healthcare in the US thrown around in the last election is about right. The biggest single cost in the US healthcare system is administration which includes the costs and profits of the insurance companies as well as the sums providers expend in trying to pry payment out of insurers and indigent patients. This is about 1/3 or our costs or $1,167 B. It seems entirely reasonable that we can reduce this by $800 B. Almost everyone not employed by a drug company agrees we can cut our pharmaceutical costs by $250 B or more. (Maybe a lot more.) Fraud is not well studied or quantified, but 10% of the total or $350 B/yr is likely; say we can save $150 B of this.

    We’ve identified savings of $800 B + $250 B + $150 B = $1,200 B per year. Our shortfall is $3,500 x (90% -67%) = $805 B. $1200 B - $805 B = $395 B in savings. If Medicare for All reduces State and local spending from $300 B to $100 B per year, then the Federal government only comes out $195 B ahead.

    I realize that it is an awful prospect to extend universal coverage, end healthcare bankruptcy, reduce insecurity, and broaden personal and career opportunities while only improving State and Federal budgets to the tune of $395 B per year. It would mean government could do something good. Maybe we should privatize the Fire Departments instead.

    1. Jasper_in_Boston

      The biggest single cost in the US healthcare system is administration.

      Um, no, not even close. The biggest single cost in the US healthcare system (or any healthcare system AFAIK) is the wages of healthcare workers.

      America should adopt a genuinely universal, truly robust government-guaranteed healthcare coverage system for a number of reasons, most importantly because it would improve the lives of Americans.

      But in fact doing this would tend to cost more, not less, than what we're currently spending, because:

      A) A lot of Americans are currently un/under insured, and thus they under-consume healthcare. Bringing them in from the cold will cost many tens of billions annually (likely well over $100 billion). This is going to eat most or all of any administrative savings.*

      B) Unit costs—the prime base driver of excessive US healthcare spending—can't be magically ratcheted downwards. We're already having trouble keeping our healthcare sector adequately staffed: telling healthcare workers to take big pay cuts is flatly infeasible. (The adoption of some form of all payer rate setting should be helpful in holding down costs moving forward, but that's not the same thing as achieving cost decreases.)

      America definitely ought to be getting better outcomes given the eye-watering sums—some 18% of GDP—it devotes to healthcare. A rational, truly 100% universal healthcare system is the way to get those better results. But it's not a way to decrease that 18% to 16% or 14% or 11% or what have you. For better or worse the United States is going to remain a big spender on healthcare by rich country standards for the foreseeable future.

      *I'm aware there may be administrative savings to be had by switching to some variation of single payer. There are other ways the US should be able to save money over the longer term, as well: treating health problems before they become expensive, chronic diseases would be one example. So, sure, expanding coverage in the US so that it reaches a level of universality equal to that of other high income countries need not translate into an increase (at least not a sizeable increase) in healthcare's share of the economy. I'm just pushing back against the notion—so beloved by the progressive left—that it will translate into a decrease. It won't. Which is fine! Doing worthwhile things—and it's hard to imagine something more worthwhile than giving every American the peace of mind that accompanies cradle-to-grave, quality healthcare coverage—usually isn't free.

      1. SC-Dem

        Just noticed a couple of days ago that there was a reply to my comment. It's too late, but here's my reply:
        First let me say that most of my comments that are being contested are largely based on this paper: https://hca-mn.org/wp-content/uploads/2020/01/Adm-Costs-2017.pdf Per this paper, data was available on the administrative percentage of medical costs in only some sectors of the medical industry. For example, sufficient data doesn’t exist to tease out the administrative costs associated with the $143 billion dental sector in the US. Administrative costs were determinable for 68% of US healthcare costs and 61.2% of Canadian healthcare costs. For the sectors where administrative costs could be determined, they amounted to 34.2% of costs in the US and 17% of costs in Canada.
        Adjusting for differing labor costs, the authors estimate the savings in administrative costs that would accrue if the US adopted a Canadian healthcare system are about $605 Billion out of the $812 Billion in administrative costs that can be identified.
        If we assume that the 34.2% share of administrative costs applied to the $1,117 Billion in US healthcare spending where data hasn’t been found, then total US spending on such costs is about $1,194 Billion and the presumed potential savings would be $890 Billion. Moreover, while Canada is doing much better than the US, the Canadian government’s Medicare program only covers about 70-74% of healthcare expenses. Their program is administered by the provinces and some are more generous than others in what they cover. This means there is still quite a bit of employer provided private health insurance in Canada and it is very nearly as inefficient there as it is here.
        A comprehensive, Federally administered, universal single payer system (such as Sanders’ Medicare for All) would have lower administrative costs than Canada’s admirable system. I was being conservative in estimating $800 Billion administrative savings.
        I could have put it better, so I will now: Administrative costs are where most of our potential healthcare savings lie. We have 3 million people working for health insurance companies. There are very large numbers of people who work for medical providers in billing and collections. These people need computers, phones, desks, and buildings to put them in. They work for companies where the CEOS are paid tens of millions and the shareholders expect big profits.
        In addition, many people who would not be considered as in healthcare administration spend much of their time not delivering healthcare, but acting as administrators. Doctors, nurses, and office staff spend time dealing with insurance companies, creating documents required by insurance companies, collecting insurance information from patients, and collecting payments. Pharmacy employees help people figure out what their insurance will pay and return to the shelf the ones they can’t afford.
        A generous single payer system would curtail most of this activity. It would free up many people to do their main jobs better. It would also cause 2 or 3 million to become unemployed. This is not by any means a comment on the worth of the prospective unemployed as human beings, but their current work is as useful to society as if they were digging holes and filling them in.
        A lot of people believe that US healthcare costs are driven by the salaries of doctors. Even doctors seem to believe this; they know that US doctors make two or three times as much as doctors in peer countries, There are two problems with this. The first is that doctors in peer countries get their education for little or nothing while doctors in the US spend hundreds of thousands. If a US medical student decides medicine isn’t really for him or he can’t hack it after a couple of years of med school, he’s stuck with a crippling debt. An American who decides to study medicine has got to be a risk taker and they rightfully expect a reward. It’s a stupid way to do things and it ought to be changed, but don’t blame the doctors for the system.
        The second is that doctors' compensation only accounts for about $280 billion or so in US healthcare costs. Cut it in half and you only save $140 Billion. Peanuts. Besides what we want our healthcare dollars to go for is doctors, nurses, orderlies, x-ray technicians, dentists, hygienists, janitorial staff, etc.

  5. Jasper_in_Boston

    Percentage of US population uninsured

    That "10.7%" figure represents the share of legal US residents who aren't covered, not true "US population" as a whole. I'm simply mentioning this for sake of clarity (I don't favor insuring the undocumented population).

    1. Jasper_in_Boston

      The lack of an edit figure strikes again: the moment I posted the above comment I regretted the emphatic nature of my words (due to some faulty mental ballparking). Anyway, most estimates suggest the current undocumented share of the population is about 3%. So, if the 10.7% figure is accurate, it would suggest that about 8% of the US population constitutes "legal residents who lack health insurance." I *think* my original comment is valid, but I'm less certain, upon reflection.

  6. johnbroughton2013

    In December 2017, a Republican-controlled Congress repealed the health care mandate - penalties for those who didn't have health insurance. The repeal of the mandate/penalties took effect on January 1, 2019. That was one reason why the percentage of uninsured rose.

    More details: I'm not aware of any national statistics, but certainly there were a lot of places where buying the cheapest Bronze policy - terrible insurance if you were unhealthy (https://www.healthcare.gov/glossary/bronze-health-plan/ ) was less expensive than paying the penalty.

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