By BILL KING
By BILL KING
New York Times News Service
I recently wrote a column in which I argued that, absent a pressing national crisis, dramatic national policy changes should not be undertaken without a significant consensus of the American people and that the Democrats’ adoption of the Affordable Care Act (ACA) violated that principle.
A number of readers took exception to my implication that the state of American health care does not constitute a crisis, so I am going to explore that question.
To some degree, a debate over whether the state of our health care system is a crisis is a matter of semantics. Personally, I feel that the standard for calling something a crisis should be pretty high. I am weary of the disaster inflation of the cable news world where one must occur daily or true disaster would take place — i.e., falling ratings.
Most of the dictionary definitions of crisis contain two elements: an extreme or dramatic upheaval involving some kind of danger and the existence of a pivot point in a sequence of events. Using this definition in a national context, is the state of our current health care system a crisis?
There are several arguments used by the proponents of the ACA that a crisis now exists. The most frequent is that a record number of Americans, about 50 million, are uninsured. While that is true, it is also true that a record number of Americans are insured. A report issued by the Commerce Department in 2011 estimated that the total number of Americans with health insurance went up from 255 million in 2009 to 256 million in 2010, an all-time high.
The reason that both statistics can be true is that the population growth of the country is slowing and the percentage of insured and uninsured has remained relatively stable.
Currently, about 16 percent of Americans are uninsured. While that is the highest level in several decades, the increase has not been dramatic. In 1987, for example, 13 percent of Americans were uninsured. The percentage has been gradually creeping up for the last 30 years. This is a troubling trend, but can an incremental deterioration of the uninsured rate by 3 percent over 30 years be called a national crisis?
Further, it is not at all clear that the ACA was necessary to improve the rate. When you examine the crosstabs of the Commerce Department’s report, it becomes clear that most of the increase in the number of uninsured is attributable to the recent high unemployment rate and immigration over the last 20 years from Central and South America.
The impact of the immigration component is further bolstered by the fact that most of the states with the highest uninsured rates are on the southern border. If we had done something about the economy and comprehensive immigration reform, those would have probably more than reversed the current upward drift in the uninsured rate.
Another justification for calling our current situation a crisis is that Americans spend more than other countries on health care, but have poorer results in terms of average life expectancies. Depending on the list, the U.S. ranks about a quarter of the way down on both lists. Currently, U.S. life expectancy is a little more than 78, still significantly better than the world average of about 67.
Of the 40 to 50 countries that rank above the U.S., about half are tiny nation states, like Monaco, which hardly provide any meaningful basis for comparison. However, it is true that most of the other developed democracies, almost all of which have universal health care systems, are outperforming the U.S. by an average of a couple years on life expectancy and some, like Japan, by significantly longer than that.
Whether there is a meaningful causal link between universal insurance coverage and life expectancy is not clear. For example, the U.S. ranked in the top 10 of a recent list of the countries with the highest percentage of obese citizens.
All of the countries that ranked higher than the U.S. in life expectancies were well below it on the obesity list. My guess is that getting Americans to push back a bit from the dinner table would probably do more to extend life expectancies than providing health insurance.