Uninsured figures show mandate-based health reforms don’t work

17,000-member organization of physicians says latest numbers show urgent need for single-payer health reform

Official estimates released this morning by the Census Bureau showing a marginal increase in the number of Americans without health insurance in 2008 – now estimated at 46.3 million, up from 45.7 million in 2007 – masks the true dimensions of the problem, a national doctors’ group said.

Significantly, in Massachusetts, where an individual-mandate health reform law, much like what President Obama is proposing on a national scale, was passed in 2006, at least 352,000 people, or 5.5 percent of the population, remained uninsured in 2008. That number was actually (but non-significantly) higher than the number of uninsured in 2007, before strict enforcement of the individual and employer mandates went into effect.

“The legislation championed by the president and the congressional leadership is a virtual clone of the Massachusetts plan,” said Dr. Steffie Woolhandler, professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP). “Today’s numbers show that plans that require people to buy private insurance don’t work. Obama’s plan to replicate Massachusetts’ reform nationally risks failure on a massive scale.”

Woolhandler said last year’s job losses in the recession, and the corresponding loss of health coverage by many workers and their families, are inadequately reflected in the new data. An estimated 2.6 million people lost their jobs in 2008, most of them toward the end of the year. Those who lost insurance at the end of the year would probably be counted as insured in the Census data, she said.

Census officials cited a drop of 1.1 million in the number of persons who were covered by employer-based insurance, continuing an 8-year trend. Whereas 64 percent of Americans had employer-based coverage in 1999, only 58.5 percent had such coverage in 2008.

Dr. Quentin Young, national coordinator of PNHP, said had it not been for a leap of approximately 4.4 million people newly covered by government programs like Medicaid and Medicare, the overall uninsured rate would have set a new record.

Young said the “tragic and painful persistence” of tens of millions of uninsured persons in the country is “completely unacceptable” and underscores the urgency of enacting a Medicare-for-all program.

“The only way to solve this problem is to insure everyone,” he said. “And the only way to insure everyone is to enact single-payer national health insurance, an improved Medicare for all. Even President Obama has acknowledged this fact.”Young noted that Rep. Anthony Weiner, D-N.Y., is introducing an amendment to the House leadership’s health reform bill, H.R. 3200, which would essentially delete its present language and substitute the language of Rep. John Conyers’ single-payer bill, H.R. 676. “It’s not too late for Congress to do the right thing,” Young said.

Dr. Don McCanne, senior policy fellow at PNHP, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.” People are usually defined as underinsured if they spend 10 percent or more of their income (or 5 percent if they are low-income) on out-of-pocket medical expenses in the course of a year.

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress, anguish and poor medical outcomes for people across our country,” McCanne said. He noted that a recent study showed 62 percent of personal bankruptcies in the U.S. are now linked to medical bills or illness and three-quarters of those who went bankrupt had insurance when they got sick.


  1. MaineBob on September 11, 2009 at 2:33 pm

    I’m looking forward to Single Payer HR676 to be scored by the CBO… Is the scoring really in the works? If not, who do we put pressure on?

    • Healthcare-NOW! on September 11, 2009 at 4:49 pm

      The last we heard, it’s in the works. Weiner asked for it to be scored because he’s proposing it as an amendment. We’ll keep you up to date as we get more information. As for now, it looks like it’s happening.

  2. Maria on December 11, 2012 at 3:10 am

    I’m sorry you find it oneffsive, Brian. I truly am. I find it oneffsive that my doctor asked me take a stress test in her office without first informing me of the price tag ($1200). (Wouldn’t it be better to tell patients about that aspect of a test before it’s sold to them?)I find it oneffsive that I’ve witnessed pharmaceutical company representatives lunch appointments in every physician’s office I’ve visited in the last few years. I find it oneffsive that physicians I’ve visited do not offer to provide me with a copy of my test results automatically, without being prodded. I find it oneffsive that medical boards use the law to restrict practitioners with alternative approaches to cancer treatment (Burzynski, for example), naturopaths, acupuncturists, chiropractors, etc. I find it oneffsive that doctors who treat Crohn’s disease continue to insist to their patients that diet modification provides little or no benefit, preferring instead to use surgery, or steroids like prednisone or risky drugs like humira. This is especially oneffsive in the face of a growing collection of crohns patients who have used dietary modification to bring themselves into remission? (Why don’t doctors take a look at this phenomenon and get behind it?)I find it oneffsive that many MDs remain willfully ignorant of the benefits of nutritional approaches to the treatment and prevention of various diseases despite the publication of scientific studies in peer reviewed journals and patient case histories that demonstrate such therapies are useful, safe and often inexpensive. (Are you familiar with the history of folic acid supplementation for the prevention of neural tube defects during pregnancy and how long it took the government and doctors to recognize its benefits? Do you know about the value of niacin and fish oil for the regulation of serum cholesterol, or the value of deglycyrrhizinated licorice root for GERD? Do you use these things in your practice? How many physicians do you know who do?) Brian, there’s plenty to be offended by. But the reality is, the disease management system we have in America today is not working as well as it could, and there are no good reasons for it.