Healthcare Hadley, Jack, John Holahan, Teresa Coughlin,

Healthcare

Hadley, Jack, John Holahan, Teresa Coughlin, & Dawn Miller. (2008). Covering the uninsured in 2008: Current costs, sources of payment, and incremental costs. Health Affairs, Web

Exclusive, 399-415.

According to Hadley (et al. 2008), "the cost of expanding coverage to the 16% of Americans who are uninsured would add 5% to national health spending" (Hadley 2008: 399). This cost is considerable, yet the cost of allowing the status quo to remain is far greater. In the article, "Covering the uninsured" the authors use quantitative analysis to determine how much care uninsured persons currently receive, how much of it remains uncompensated because of an inability to pay, and how much more coverage would be consumed if all Americans did have health insurance (Hadley 2008: 399). Their data encompasses interviews of 102,000 people who were part of the Medical Expenditure Panel Surveys; data from government budgets and health care providers; surveys of private physicians; and budget and program data from government programs that serve the uninsured.

Unsurprisingly, the uninsured were found to contribute considerably more out-of-pocket to subsidize their own healthcare than the insured. Uninsured persons paid 35% of the costs of their own care, versus 17% of insured persons. This amounts to $536 per capita for the uninsured. In terms of insurance coverage, patients with private insurance spend the least ($3,915); while "Medicaid recipients spend about 23% more; and those with Medicare only or various combinations of coverage spend the most for care" (Hadley 2008: 402). This is attributed to the difference in health status between the populations, although it could also be noted that Medicaid and particularly Medicare contain many exceptions to the types of coverage and treatments they will cover, versus the most comprehensive private health insurance policies.

There is a clear financial burden borne by the system because of the lack of health insurance in terms of the uncompensated care that is dispensed, through the care subsidized through Medicaid and Medicare and donations by physicians and other sources of private fund (Hadley 2008: 405). "The full-year uninsured receive 85% of all uncompensated care and 81% of all implicitly subsidized care" (Hadley 2008: 403). But one of the more interesting findings by the study was that there was relatively less cost-shifting than expected -- that is the costs of the uninsured being 'passed on' to the insured in the form of higher premiums -- instead, it is the government who bears the lion's share of the burden of the care of the uninsured, nearly 75% (Hadley 2008: 411).

If all Americans were insured, spending would clearly increase an estimated 70%. But "various health system reforms, such as competing private health insurance plans within purchasing pools, greater use of public programs' fee schedules, or expanded use of health information technology, could reduce the estimated incremental resource cost of expanding coverage" (Hadley 2008: 412). Savings for the expected additional expenditures could also be found by redirecting the funds now used in programs to finance the care of the uninsured. Also, there would be savings generated for society that are not immediately apparent, such as the improvement of the public's health through preventative medicine and the reduction of chronic diseases.