40 Million Without Health Insurance?


The figure of 40 million lacking health insurance in the USA keeps being bandied about so much that it deserves to be thought about a bit, even for us non-experts. What exactly does it mean? The implication for most who mention this figure is that the federal government must do something to insure all these 40 million people. That's, of course, a blatant non-sequitur. Given that getting health insurance costs money'-it is the money that enables people to pay for visits to doctors, hospital stays, laboratory tests and so forth, which supposedly help combat illnesses'-the government would have to obtain the funds from citizens, via taxes, to provide it to the 40 million. So, this figure is usually deployed so as to advocate more spending by the federal government based on more taxation of the citizenry. That alone should make one suspicious about the figure itself, since in the service of more government largess, advocacy groups-'be they farmers, businesses, artists, educators'-tend to exaggerate their needs.

But, hey, let us leave aside the veracity of the figure itself. The first question that can be raised, then, is how long are the 40 million uninsured? I used to be uninsured all through my adolescence, after I ran away from home, until I enlisted in the Air Force. Then after I got out, I was again uninsured for years. Only once I got a steady job did health insurance benefits come along, usually for a reasonable price.

But what if one is paranoid about getting sick? Or what if one is quite healthy? That would mean one is buying insurance one probably doesn't yet need in one's life. Sure, some unexpected illness could strike, and that's in part what insurance is for. But it is not clear that everyone, even those with robust health, require insurance rather than savings so as to prepare for such unexpected illnesses.

Then, also, some folks do not work hard enough to be able to afford to take care of their health needs. This is an idea that many public-minded people may find odd, but getting insurance, like getting anything else, costs money, and if you do not make any, well you must do without. Most of us do not have enough money for a boat and for going skiing and hundreds of other things, but because we work steadily enough'-which is not an effortless feat and one that many refuse to attain, actually, you've heard of laggards and procrastinators and such'-we manage to afford health insurance. How many folks refuse to get into 'the rat race' or to embark upon that dreaded money grubbing bourgeois lifestyle, preferring instead to live the Bohemian way, which then leads to, among other things, their not having health insurance?

Of course, as usual, there is the problem with children. Kids are often brought into the world by utterly irresponsible parents who cannot afford to care for them, which includes the inability to provide sufficient health care for them. So, while these parents ordinarily deserve zero tolerance as far as pity and compassion are concerned, the kids are another story entirely. Here is where charity, generosity, philanthropy and other kinds of voluntary aid come into the picture. But this isn't a task for our legal authorities, who already have a job to perform and do it rather ineptly, sad to say.

I am sure this approach will not solve the problem for all. Yes, a part of the solution is to acknowledge that some folks do not deserve health insurance, so we shouldn't consider it some kind of societal failure that they have none. But there may well be some left, even if we factor in all the relevant considerations, who are doing their best and still are uninsured. And even the charitable organizations may not be up to helping some of these.

Life does not guarantee perfect satisfaction for all, even in the department of meeting elementary needs. But before we conclude that our society is in desperate straits because 40 million lack health insurance, let's look at the figure in full context and consider what it may or may not mean. It may well be that those 40 million people are not the same ones from month to month, year to year, but switch places all of the time. (This is true about poverty, for example, where on average people remain poor for only about five years.) So, very possibly, the many of the 40 million uninsured are, in fact, uninsured for good reasons'-they fail to work hard enough to afford it or they really don't need it for significant stretches of their lives.

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Tibor R. Machan's picture
Columns on STR: 70

Tibor Machan is a professor of business ethics and Western Civilization at Chapman University in Orange, Calif., and recent author of Neither Left Nor Right: Selected Columns (Hoover Institution Press, 2004).  He is a research fellow at the Hoover Institution, Stanford University.