One of the tricky questions in health policy is how to delineate between different types of the insured. We talk a lot about those without any coverage, but a fair portion are hurtling through life with all the protection afforded by a rusted, rattling Kia. In some ways, these underinsured can be worse off than the uninsured, as they think, and even act, like they have coverage, only to find themselves financially ruined or totally betrayed when a medical calamity hits. Last month, the Commonwealth Fund released a study trying to count the number of underinsured. They chose, as their cutoff point, spending 10 percent of more of income (percent if low-income) on out-of-pocket medical expenses, or having deductibles above 5 percent income. On first read, I was a bit unconvinced by that definition. But it turns out that the experience of folks who fit that description is a whole lot closer to the experience of the uninsured than the insured. Just ask the graph:
The Commonwealth Fund estimates that about 14 percent of the population was underinsured in 2007. That sounds about right, and it's a useful reminder that insurance isn't binary, wherein you have it or you don't. Rather, it exists on a continuum, with some folks being totally insured, some folks being half insured and half uninsured, some folks being totally uninsured but having access to emergency rooms, and so forth. This is how American rationing actually manifests. Canada might have waiting times for non-essential treatments, but we have cost barriers to all manner of treatments. Some can't afford the care, and so they go into debt, or have to sell their home. Others can't afford the care, and so they never get it. We count that waiting time as zero rather than infinity, but that's just a bad faith numbers trick meant to make us feel better.
The Commonwealth Fund estimates that about 14 percent of the population was underinsured in 2007. That sounds about right, and it's a useful reminder that insurance isn't binary, wherein you have it or you don't. Rather, it exists on a continuum, with some folks being totally insured, some folks being half insured and half uninsured, some folks being totally uninsured but having access to emergency rooms, and so forth. This is how American rationing actually manifests. Canada might have waiting times for non-essential treatments, but we have cost barriers to all manner of treatments. Some can't afford the care, and so they go into debt, or have to sell their home. Others can't afford the care, and so they never get it. We count that waiting time as zero rather than infinity, but that's just a bad faith numbers trick meant to make us feel better. 
