The uninsured

Barack Obama, who will accept the Democratic nomination for president tonight at Denver's Invesco Field, favors an expansion of government-run health care to cover millions of uninsured Americans.

A Census Bureau report, released Tuesday, found that the number of Americans who went without health insurance at some point in 2007 dropped 3 percent when compared with 2006. The coverage gains were attributed to growth in government health insurance programs, which provided benefits to 83 million residents, about 3 million more than the year before. The number of uninsured children also fell in 2007 thanks to public health programs.

So Sen. Obama will call for spending billions of additional tax dollars to move more of the uninsured onto the government rolls. He wants to raise income taxes on the wealthy to cover the new costs. But before the electorate hops on this bandwagon, shouldn't more effort be made to define who, exactly, make up the 46 million uninsured at any given time?

Remember, the figure doesn't represent an entire class of permanently uninsured. A sizable share of these people lost their coverage between jobs, then enrolled in new health care plans.

A BlueCross BlueShield report estimates 14 million lower-middle-class adults and children qualify for existing public health programs but don't enroll. Other surveys have estimated that up to 10 million workers decline employer-subsidized coverage; that about 19 million of the uninsured are young adults in good health, willing to take the risk of going without coverage and pay for occasional doctor's office visits out of pocket; and that 12 million are immigrants, legal and illegal. Many uninsured residents fit into more than one of those classifications -- and some into all four.

When all these groups are considered -- along with those wealthy enough to pay all their medical bills in cash -- the number of perpetually uninsured drops closer to 15 million. That's around 5 percent of the population.

And how many of them might buy private, catastrophic health insurance if states dropped the multitude of mandates that send premium costs higher each year? How many could afford a policy if they could select "a la carte" coverage from anywhere in the country, instead of being limited to buying all-inclusive policies from companies within their own states?

These are the kinds of questions that should be answered before taxpayers are put on the hook for another massive expansion of government services -- and the higher taxes that would support it.