Monday, August 10, 2009

A right to health care? Just whom are the uninsured?

Assuming that health care is a right, how far should we go to provide it to the uninsured. And, just who are the uninsured and why can't they pay for at least basic coverage? Russ Coff over at Organizations and Markets is asking the right questions.
...many believe that healthcare is a right. Certainly there is an ethical and moral obligation to help those who are ill: it is part of the oath to which all physicians pledge as well as the UN charter.

But how far does this right extend? What level of healthcare is a human right and what level becomes a luxury? This is a very practical question. Currently there is a proposal for a luxury tax on insurance plans that offer too much coverage (Listen on NPR). Clearly some believe it is no longer a human right at that level. . . .

But let’s unpack the 46 million uninsured. A Kaiser commission report estimates that about 10 million of the uninsured are illegal aliens. This is conservative — it suggests that quite a few illegal aliens actually are covered. An NCHC report uses a similar estimate. Should they get free coverage? I’ll tip my hand here, I’m not opposed to covering illegal aliens if they are on a path to citizenship (which I also would support under the right conditions). However, it seems implausible to do either without first securing borders. Imagine the cost to taxpayers if sick people all over the world have incentives to enter the U.S. illegally? Even if this is desirable as a policy objective, is it sustainable?

Another issue is what portion of the uninsured could actually afford insurance but choose not to buy it? A paper by Bundorf and Pauly uses multiple methods to assess whether people can pay. The conclusion is that 25–75% of the uninsured can afford to buy at least basic coverage. In the same vein, the NCHC reports that nearly 40% of the uninsured reside in households that earn $50,000 or more.

Using conservative estimates, then, 50% of the uninsured are either illegal aliens or choose not to buy insurance. Probably another 25% are temporarily uninsured because they are between jobs or changing insurance vendors. As such, one can imagine that reasonable and ethical people may question whether the taxpayer should foot the bill for all of the uninsured.

Taxes (that would fund universal coverage) are not optional so the fact that people may legitimately differ in their beliefs is important. It is therefore a worthy effort to put some clarity around the extent and nature of the moral and ethical responsibilities. From a practical standpoint, since at least 90% of voters are insured, it is important to know how much they are willing to pay for the remaining 10%.

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