Ken Terry is a former senior editor at Medical Economics Magazine, the leading business publication for physicians. Terry has received journalism awards from the American Society of Business Publication Editors (2000), the American Society of Healthcare Publication Editors (2001-2002), and the American Business Media. He was a finalist for the latter organization's prestigious Neal Award in 2003 and 2006, and he won a Neal Award in 2007. Ken Terry is the author of Rx for Health Care Reform; Recent-- San Francisco Chronicle

Terry has contributed to: The New York Times, The Village Voice, Rolling Stone, Health, Inc., Men's Health, Parenting, Downbeat, The Progressive, and The Nation. Recently he was a presenter regarding health care reform at the National Congress on the Un- and Underinsured (Dec '07) and at the East Coast annual conference of the New York State Osteopathic Medical Society (Apr '07).

Guest Blogger Ken Terry--

At last count, 47 million Americans were uninsured. Those people paid for part of their own care, and the rest of us paid for the “free” services they received in emergency rooms and hospitals in the form of higher insurance rates and taxes. If you deduct those outlays from the cost of covering the uninsured in good private plans, a 2003 study estimated, it would cost about $69 billion to insure them. Uwe Reinhardt, a health economist at Princeton University, said that estimate was too low for several technical reasons I won’t go into here. He figured it would cost around $100 billion to cover everyone. Since U.S. health spending has increased by about 30 percent since then, we can assume that universal coverage would now cost around $130 billion.

(It would be more accurate to update the calculation using the cost per capita. But with the number of unemployed growing twice as fast as the population, the cost of covering them would be at least this high.)

The Presidential candidates’ estimates are in the same ballpark. Former candidate John Edwards says his universal coverage proposal would cost up to $120 billion per year, and Hillary Clinton estimates hers would come in at $110 billion. Barack Obama’s plan would cost half as much, but he doesn’t claim it would achieve universal coverage in the short term. John McCain isn’t seeking to insure everyone.

One problem with all of these estimates is that they’re based on current, not future health care costs. So they’d be obsolete as soon as we covered everybody. The very next year, health spending would grow seven or eight percent, and we’d either have to raise insurance premiums and taxes or cut benefits to maintain universal coverage.

Also, estimates like these don’t consider how many people are underinsured: that is, they have some insurance, but still have trouble paying their medical bills. Using rigorous standards, experts have calculated that 16 to 19 million people are underinsured. But, given how much deductibles and copayments have risen in recent years, the real number might be much higher. According to a new AFL-CIO survey, more than half of people in insured families say their insurance doesn’t cover all the care they need at a price they can afford.

Finally, let’s not forget about the 43 million people on Medicaid. Most states pay providers so little for these patients that many physicians won’t see them. So while Medicaid recipients—most of them poor women and children—have insurance, they don’t have good access to care.

To provide comprehensive coverage to everyone—which is what’s required to guarantee access—will cost a lot more than $130 billion. How large that price tag might be isn’t clear, and won’t be until we start facing facts.

Related: Universal Coverage is a Three-Legged Stool

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Update on Apr 14, 2008 by Editor

Seen at Reuters!   Fox Business!