Health Policy and the Uninsured (review)
Buy Issue for $25 at JHUPHealth Policy and the Uninsured, edited by Catherine G. McLaughlin of the University of Michigan School of Public Health, is a compilation of six articles by experts in economics, health economics, public policy, and health policy, including Linda Blumberg, Michael Chernew, Sara Crow, Jonathan Gruber, Mary Harrington, Richard Hirth, Karl Kronebusch, Hanns Kuttner, Helen G. Levy, Brigitte Madrian, David O. Meltzer, Len Nichols, Harold Pollack, and Pamela Farley Short. The book is an ambitious attempt to identify what causes over 45 million individuals in the United States of America to be uninsured every year. [End Page 672]
Taking a multidisciplinary approach to portraying the uninsurance in America today, this book is an excellent source of information for policymakers and researchers alike. This book is not intended for the general reader but for people competent in the disciplines of health economics, health, and public policy.
The authors thoroughly review the literature and provide statistics to illuminate health policy vis a vis the uninsured in America today. The writing style is extremely technical (including many mathematical equations) making the text a challenge for anyone but experts. The method used—introducing information and then juxtaposing it with opposing information—is quite useful (if occasionally frustrating for a reader looking for plain answers to plain questions). If we have a complaint, it is that the book maps the problem of the uninsured rather than painting a picture of the people who are uninsured; the book would have benefited from bringing at least some qualitative data to bear (whether from an ethnographic approach, focus groups, or in-depth interviews) on such questions as, "Why don't welfare mothers consider health care when moving from welfare to work?" However, what the book does, it generally does very well. The chapters differ in quality but complement each other in creating a detailed map of the uninsured. In what follows, we provide a summary of each chapter.
Chapter 1: Counting and Characterizing the Uninsured
The chapter illustrates how the different definitions of health insurances affect the classification of the uninsured, critiquing the different survey methods used to collate information on this population. The most widely used surveys (National Health Interview Survey (NHIS), Medical Expenditure Panel Survey (MEPS), Current Population Survey (CPS), Survey of Income and Program Participation (SIPP), Community Tracking Study (CTS), and National Survey of America's Families (NSAF)) are subject to biases (e.g., recall bias) as well as underreporting. The analysis also point to limitations of the administrative records, including their limitations on their reliability and validity. However, these surveys are the best that are available and, when combined, they illustrate the most complete picture of the uninsured presently possible. The authors go on to illustrate how age, race, ethnicity, income, marital status, and employment status relate to the likelihood that a person will or will not have health insurance coverage. It seems important to note from this chapter that the likelihood of regaining coverage after losing it is minuscule. This chapter focuses tightly on data analysis, indicating which groups are identified in each major survey and the most useful methods for future data collection.
Chapter 2: Why Are So Many Americans Uninsured?
The author contends that two groups drive the demand for health insurance: people wanting to protect what they have (financially) and people wanting the best medical care. (People appear to be well aware of the potential for tremendous financial loss from a catastrophic illness.) This chapter provides a framework for [End Page 673] understanding the way people perceive their need for insurance or their failure to have insurance.
Chapter 3: Health Insurance, Labor Supply, and Job Mobility
Chapter 3 delves into the relationships between employment and health insurance. Some of the points covered are...
