Probably the single most publicized healthcare statistic is “46 million uninsured Americans.” But who are these people? I’ll bet you don’t know, for a simple reason. Television and newspaper stories almost never explain where the 46 million uninsured number originated, nor how it was calculated.

Thus, an essay in last week’s Wall Street Journal was enlightening. Titled “What Do We Know about the Uninsured?”, it was written by William Snyder, a policy advisor to the Heartland Institute of Chicago, Illinois. He observed that President-Elect Barack Obama is expected to move quickly on healthcare legislation, including the possibility of “government-mandated health insurance. One justification for such legislative action is the claim that the existing healthcare system is somehow failing these 46 million uninsured Americans.” Snyder then prepared to offer some information about who these 46 million Americans are. He wrote “Most people have an incomplete understanding of the uninsured population, which can lead to bad policy choices.”

First fact about the uninsured offered by Snyder was that, based on a study published in Health Affairs in November 2006, an estimated “25% of uninsured were in fact eligible for public [health] coverage and another 20% could probably afford coverage on their own.” Subtracting this people from the 46 million, noted Snyder, would leave roughly 25 million people who would require assistance to obtain health insurance. “That’s a major concern,” continued Snyder. “But the notion that there are 46 million Americans who can’t get the healthcare they need for lack of money or public assistance is a myth.”

Snyder next raised two issues-he called them “misperceptions”-that the uninsured don’t get healthcare and “that, when they do, they’re ‘free riders,’ i.e., they don’t pay for the care they get. He wrote that, in April 2000, the California HealthCare Foundation (CHCF) determined that, “of the California residents whose household income was at least twice the poverty level, 50% (about 1.3 million) had received care in the last year for which they were charged and another 8% had received care for which they weren’t charged.” By the way, this same study discovered that 89% of these people were either somewhat or very satisfied with their care! Further, 85% of these people had gone to a doctor’s office or clinic for their care-not an emergency room.

In answering the “free-rider” myth, Snyder pointed out that the CHCF study had learned that, of the 1.3 million uninsured in California who received care for which they were charged, 80% had paid for that care and half of the remaining 20% of the people were paying off their healthcare by installment payments. He next quoted a study published in Health Affairs in August 2008. This study said that uninsured Americans will receive approximately $86 billion of healthcare this year. Of that amount, Health Affairs estimated that the uninsured would pay $30 million out of pocket, which is about one-third of the total cost.

Observed Snyder, “For the millions of uninsured, then, who are getting and paying for satisfactory care on their own, foregoing needed care and sticking the public with huge ER bills is a myth.” His recommendation was “perhaps we should look for ways to encourage the millions of people who are currently eligible for existing government programs to enroll before we expand programs to include people that may not need assistance.”

In highlighting these studies about uninsured Americans, Dark Daily’s point is that a simple statistic-46 million Americans lack health insurance-fails to tell the entire story. It seems an odd circumstance that, with detailed data available on a myriad of aspects of the American healthcare service, accurate and comprehensive information about the 46 million Americans who lack health insurance is not easy to find. Dark Daily readers can draw their own conclusions on this matter. With a new administration and a new Congress taking office on January 20, expect the debate on how to cover the 46 million uninsured to be vigorous.