The medically “uninsured” are really a political category, not a financial one. Almost a third of the medically uninsured are in fact eligible for Medicaid and do not bother to apply. Some of the remainder have chosen not to purchase insurance which they could afford, projecting (generally correctly) that they will not require it. Because of the laws which require all hospitals receiving government funds (= all hospitals) to accept everyone with an emergency without respect to ability to pay, the uninsured all have access to emergency care.

There is a noticeable percentage which does not have Medicaid and does not have an emergency but nonetheless an important and treatable problem. However, ALL the schemes put forward for solving the problem of the “uninsured” are far more expensive than just paying for this group outright. (Not that I recommend that.

I believe that managing the problem of the uninsured is impossible if one defines the problem as “the uninsured.” It is categorically wrong.

  1. Indemnity insurance, which is the only real kind of insurance, must pass all of the several tests of “moral hazard,” known for several centuries.Medical care fails all these tests.
  2. The problem isn’t insurance, anyway.It is medical care. Having insurance does not guarantee good medical care, no matter who pays for it. Insurance just runs up the cost for everyone because it incentivizes poor discrimination in shopping.
  3. Another way to conceptualize the problem is to think of it as partly a problem of regulatory burden.Licensure, insane malpractice laws, FDA, HIPAA, OSHA, JCAHO, state insurance laws, etc. These regulators hugely run up the costs of care.
  4. Avoidance of truth in pricing.The “uninsured” are charged as much as seven times the actual charge to insured patients, though the charges on the bills of both may look the same at the top of the bill. Negotiated rates make the difference, but it is concealed from the uninsured and insured alike.
  5. The intrusion of Caesar into the ministry of mercy which medicine should be at base is reflected in the regulatory burden in #4 and in other ways as well.Voluntary mercy ministries, which once abounded, would take up much of the problem of the truly needy who are ill and cannot play. (Think “Shriners Hospitals.”) They have trouble today due to various rules plus the immense run-up in costs driven by rules and insurance.

In short, a truly free market, not extant in over a century in the U.S., would solve the medical cost problem as completely as is feasible, and far more cheaply than what is going on now. Only moves which are clearly in the direction of restoring a free market have any chance of making overall improvements. Any other attempts are doomed.