In his business section column today, Greg Mankiw raises some issues about several frequently cited U.S. health care statistics, notably the percentage of the population that is uninsured and the longer life expectancies enjoyed by Canadians. On the issue of the number of uninsured, Mr. Mankiw points out that many of the 47 million do in principle have access to Medicaid, that some are relatively well off and could afford insurance if they chose, and that roughly 10 million are illegal aliens who presumably would not be covered by a national health insurance plan. While these points are all accurate to some extent they don't negate the fact that 15 percent of the country did not have reliable health insurance last year. And, it is easy to point out ways in which this number -- 47 million uninsured -- understates the true size of the problem. First, this figure is the number of people who went the whole year without insurance. There were more than 80 million people who went without insurance for at least part of the year. Second, many of the insured are not really protected against catastrophic illness. If a worker is afflicted with a debilitating disease, she would eventually lose her job, which would mean that she would also lose her insurance. If she had sufficient savings, she could continue to buy insurance, but most workers do not have enough savings to pay for their insurance for very long, once they longer have a regular income. In principle, a disabled worker could qualify for Medicare through disability, but this is a long and uncertain process. As far as the non-coverage of people who are not in the country legally, it is reasonable to hope that Congress will at some point in the not too distant future normalize the status of those currently in the country, and create a legal mechanism for future immigrant workers, so that the country will not continue to have a large number of people who do not have legal residency. Mankiw notes that factors other than the quality of our health care system raise Canada's life expectancy relative to the United States. This is true, but it is worth noting that Canada and almost every other wealthy country enjoys longer life expectancies than the United States in spite of spending far less per person than the United States. In the case of Canada, per person expenses are 40 percent less, a savings of $2,700 per person per year. The United Kingdom has longer life expectancies than the United States and spends 60 percent less than the United States, a saving of $4,000 per person per year. If the longer life expectancies in other countries cannot be taken as compelling proof that they enjoy better health care systems than the United States, they can at least be taken as powerful evidence that they do not suffer from markedly worse health care systems. The fact that they are able to deliver comparable outcomes at a far lower cost suggests that the U.S. health care system suffers from very serious inefficiencies.
--Dean Baker
