Why so many People in the USA Lack Medical Coverage

Medical coverage in the US is not universally available and, consequently, this has given rise to a situation where a significant percentage of the population lack such coverage, a position which in turn has given rise to the debate about why so many people in the US do not have medical insurance has been continuing for years, so much so that providing medical coverage for all became one of the central themes of Barak Obama’s presidential campaign back in 2008. Nevertheless, of itself this does resolve the central theme of the debate regarding the reasons why, according to a US Census Bureau report published in 2008, over 15% of Americans had no medical insurance and a further 35% were reported by CNN in 2009 to be underinsured. The answer to this question is particularly relevent when one sets it against the fact that in some US states around 62% or personal bankruptcies are caused by the individuals medical debt.

It is obviously apparent that perhaps the major reason for lack of medical insurance is related to cost. Unlike the UK where, ostensibly, health care is free, although part of this is funded from the taxes paid and things like prescriptions do incur a small cost, in the US healthcare has to be paid for. The cost of this insurance can variably considerably but, for an average family can be as much as $500 a month or more, providing they are all in good health and have no existing medical conditions. Add medical conditions to the equation and this cost would escalate considerably. Additionally, there is usually an excess that the insured family have to contribute. The difficulty that individuals and families face in this situation of course is that, unless the employer pays for this insurance, it has to be met from their own disposable income, which as we are all aware, might not provide sufficient spare capacity to be able to contemplate such an expense. Moreover, for the millions that are unemployed there is absolutely no way that they can even consider medical insurance.

Nevertheless, it would be wrong to assume that cost is the sole reason for lack of medical insurance in the US, anymore than it would be to assume that the reason why people in the UK don’t enhance the quality of the medical treatment they receive by taking out private medical insurance. There is an element of personal choice and perception that needs to be added to this debate. We all have to make choices about how we will spend the finance that is at our disposal. Therefore, there will be a percentage of the US population, however small, to whom spending on medical insurance is low on their list of spending priorities. One could suggest that such people suffer from the “it will never happen to me syndrome”. These are the people who will justify not having medical insurance by using the following perceptions to convince themselves that, in their case, they do not need it:

I am all right today, I will be all right tomorrow.
Heart attacks happen to other, not to me.
Cancer is shocking for others but I am immune
The person next door had an accident because they were careless, I wont be that careless.

However, most sane people realise that these are excuses rather than facts upon which to base rational decisions. Nevertheless, those who make decisions in this manner to take responsibility for their own actions.

Therefore, in terms of addressing the issue of why many people in the US do not have medical insurance consideration needs to be given to the following approach. For those who simply cannot afford the coverage, there is a need to devise a formula that allows them access to a sufficiency of care in a manner that both addresses their needs while at the same time does not impose an onerous tax burden upon the majority of the population that makes the effort to fund its own insurance. Conversely, for those who chose other ways of spending their income in preference to health care, there should perhaps be some element of compulsion to ensure that such a choice also does not become a burden on others. The graded contributory system of taxation that operates in the UK, though by no means perfect, might provide the US government with a framework within which they might be able to address this delicate balance.