How many people are uninsured in Massachusetts? Each year around Labor Day we get dueling answers; one from the U.S. Census Bureau and another from the Massachusetts Division of Health Care Financing and Policy. Getting the right answer is crucial to the future of health reform in The Commonwealth.
Covering 651,000 (the U.S. Census Bureau’s estimate of the uninsured in 2006) is a lot harder and more expensive than covering 355,000 (our state government’s estimate for spring, 2007; their 2006 estimate was 395,000).
So whose number is correct? The Census Bureau sends surveyors door-to-door, with interviewers available for almost every language (including Portuguese and Haitian Creole, common languages in Massachusetts). The state survey calls people on the phone (land lines only, no cell phones) and has interviewers who speak Spanish and English – but no other languages. Anyone without a land-line telephone or who spoke another language was, in effect, counted as insured.
But we know from Census surveys that 43.9% of phoneless adults are uninsured. Moreover, immigrants are often stuck in low-paying jobs that don’t bring benefits, and hence have extraordinarily high uninsurance rates. Yet only 41% of the Commonwealth’s non-English speakers are Spanish speakers; the other 59% (about 530,000 people) vanish in the state survey. In sum, the state’s figures are unreliable – a fact confirmed by a third survey, carried out by the Urban Institute for the Blue Cross Foundation. This survey – also done on the telephone, but with statistical adjustments to avoid undercounting – confirmed the Census Bureau’s findings.
Why does it matter whether the state’s estimate or the Census Bureau’s is right? According to the state, we’re almost half way to covering the uninsured. 155,000 people who were previously uninsured had gained coverage under the health reform bill by July. But according to the Feds, the new sign-ups amount to less than one-quarter of the uninsured in 2006. Moreover, it’s likely that some of that gain has already been offset by shrinking coverage from employers.
So where does that leave us? We’ve made meager progress on covering the uninsured at great expense. And the half million or more who remain uninsured are threatened by the draconian cuts in the free care pool slated to begin October 1, and by budget woes at safety net institutions (a disaster I predicted in my March blog, which was pooh-poohed by a Health Care For All official).
Its high time we acknowledge that health reform built on private insurance is not working in our state. We need to enact real reform – a single payer system that would slash bureaucratic costs and insurance executive’s outrageous incomes, and use the savings to cover all of the uninsured and to eliminate co-payments and deductibles for the rest of us.
David Himmelstein is an associate professor of medicine at Harvard Medical School and
Co-founder of Physicians for a National Health Program
No need to worry Dr. Himmelstein, the insurance companies have hired only top notch people to create keywords and statistics to be spoon-fed to our legislators and state administrators. The illusion of health care for all that they’re creating daily is only something Potemkin could have only dreamt of.
The group I belong to, the uninsured making over 30K per year is a small group, perhaps 50k to 60k, or 1% of the state population. Hardly a political force, and that’s why the legislators had no fear in passing the mandate. The former free care pool current subsidized insurance pool which represents about 7% to 8% of state population is not a political force because more than 50% in that group are illegal or don’t speak English.
The critical mass that will affect political change will only be reached when the middle class see their insurance rates/health costs go through the roof.
Of course the top notch people the insurance companies have know this, so there will be a lot cutting back in services, deductables, drugs, etc… in the name of reforming health care and keeping costs down. The Potemkin ruse should continue for a few more years until it’s no longer sustainable.
Thank you Doctor Himmelstein, some truth finally about this sham law, people in this State have lost their decency. I am glad you haven’t.
A grand thanks from me as well for your realistic perspective regarding this sham law. It is truly an emperor-has-no-clothes operation.
Unfortunately, in order to save face, this crowd of powerbrokers and others will continue to spew their victory propaganda while they are careful not to disclose the details of this ugly decree to the general public.
However, in the not too distant future, more and more residents of MA will come to know what awaits them and the small percentage of low-to-middle income uninsured, who are considered at this point as nothing more than collateral damage, will be joined by an larger, outraged public.
Let the games begin!