Some people argue that there are not 47 million uninsured in this country because they are not uninsured the entire year. I came across a NACHC report that suggests that more than 56 million are disenfranchised. I suspect even more are poorly insured and vulnerable.
The denial of the existence of the uninsured is puzzling. Presumably and by implication, the uninsured are just good old upper middle class Americans who can afford to COBRA their insurance between jobs and just elect not to. They live in nice suburban neighborhoods and commute past the golf courses and malls, all the way to shiny office towers where they put in an honest day's work and make a value decision on their way home.
Well, maybe this is just a fantasy, but I'm not sure where people come off denying the existence of things they cannot possibly see on their own commutes or social circles. You do not see uninsured Americans if you hang out in Georgetown and don't travel to Southeast, the capital's crime-ridden center of ghetto violence. The uninsured are invisible on the beaches of Florida or on adventure tours of Bryce Canyon or the San Juan Islands.
The fact is many of my insured patients are the same ones that were uninsured two months ago and will be uninsured in a few more months because they got this plan temporarily as they worked their way through school. Or they just couldn't afford their premiums once they got to their new job that was supposed to be a great step up for them. The uninsured, as well as Medicaid patients, tend to bounce on and off the rolls every few months or years. I would argue that financial stability is not usually to be had for 2 to 3 years, so would count anyone who has been uninsured for any period of time over the past several years. Anyone who has ever tried to get off the ground after a fall, knows you are the most off-balance as you're trying to get back on your feet.
Yes, I know SCHIP is being extended to individuals over 300% of poverty, but has anyone noticed that the official federal term is "Federal Poverty Guideline", a term chosen specifically because nothing can strictly define poverty. The US does not have a poverty level, in part because of regional variation in what would be a basic subsistence income.
Living in the Washington metro area, I can assure everyone that 300% of poverty is less than subsistence in these parts.
What does this mean for the uninsured? It means 47 million is an underestimate of the vulnerable population. Yes they deserve access. I'm not sure they deserve everything that medicine possibly has to offer. The practicalities of life is that there are financial limitations to everything and as several commenters have observed on this blog, health care does not necessarily contribute all that much to overall health status as measured by crude population vital statistics. I think this is the law of diminishing returns at work, but is insufficient reason to offer nothing.
Community Health Centers [disclosure: I am the medical director of one] can provide quality health care, usually better than "private" practices for lower cost. A follow-up study, conducted with the Graham Center, a policy think-tank that supports the interests of primary care, points to the economic benefits to be had by assuring access to health care through low-cost, high-quality centers.
The rest of the health consumers out there can make their own decisions where to go and how to spend their dollars. Community Health Centers generally don't turn away patients with insurance.