Investors Business Daily, September 14, 2004

Health Care: Just because 45 million people are uninsured doesn't mean they're going without health care. And the truth is, many of the uninsured choose to be.

As IBD Braintruster Sally Pipes of the Pacific Research Institute points out, a fourth of the 35 million uninsured adults are under 24, and half are under 35. Thinking like young adults, rather than presidential candidates, many of the young and healthy with limited resources and a sense of invincibility choose not to purchase health insurance. They have other priorities. One in five workers with access to employer-subsidized insurance actually decline it.

And the uninsured aren't the same people from year to year or even month to month. Three-quarters of the uninsured remain so for less than a year. That doesn't mean they're going without care. Americans without health insurance actually spend roughly the same amount of their own money on health care ($242) as do the fully insured ($211).

The uninsured who do land in a hospital pay on average a mere 9% of the costs of their treatment after factoring in the average three hours a week doctors treat patients for free and the $21 billion in costs hospitals write off annually.

Census data show that the number of uninsured has grown for the third straight year. Look a little deeper and they also tell us the number of insured has grown to 243.3 million, just as the total population has grown. The fact is, everything has grown. But the percentage of uninsured Americans remains at 15.6%, the same as in 1996, and lower than in 1997 and 1998, when Bill Clinton was president.

One of every three uninsured live in households with incomes of more than $50,000 a year. One in seven live in households with annual incomes that top $75,000. And the Census Bureau counts as "uninsured" individuals who are eligible for Medicaid and the State Children's Health Insurance Program but are not enrolled. Deven Herrick of the National Center for Policy Analysis estimates that as many as 14 million children and adults fall into this category.

There are individuals who genuinely cannot afford or cannot get health insurance. But part of the problem is one-size-fits-all state mandates that require young men to pay for coverage that includes mammograms, or young women to pay for prostate exams.

Tailoring health insurance to the needs of the insured would help, as would Congress in freeing up interstate commerce in insurance.

And we may have already fixed the "problem" of the uninsured. Tucked away in last year's prescription drug benefit bill was a provision establishing Health Savings Accounts. HSAs combine a high-deductible catastrophic health insurance policy with a tax-free medical savings account to cover routine expenses.

Because they also offer portability and ownership, HSAs can pay for health care and insurance between jobs. The cash accounts belong to the individual forever, whether he or she changes jobs, loses jobs or retires. They encourage people to be health-conscious and cost-conscious and don't increase the federal budget by a single dime. And there's the rub.

The only downside to HSAs is that the idea of people providing for their own health care with their own money is frightening to those who like big, expensive government subsidies that bribe voters with their own tax dollars. It's enough to make you sick.