Himmelstein D U, Woolhandler S, Wolfe S M
Center for National Health Program Studies, Harvard Medical School, Cambridge Hospital, MA 02139.
Int J Health Serv. 1992;22(3):381-96. doi: 10.2190/5FBA-VEKK-K2DK-JF8V.
New data obtained from the Census Bureau shows that the number of Americans without any health insurance increased by 1.3 million between 1989 and 1990, bringing the total number of uninsured to 34.7 million, more than at any time since the passage of Medicare and Medicaid 25 years ago. This increase coincided with a 10.5 percent increase in health spending, the second largest in the past three decades. The number of people covered by Medicaid grew by 3.1 million, due to a one-time expansion of eligibility mandated by Congress, but this was more than counter-balanced by a population growth of 3 million and a decrease of 1.3 million in people covered by private insurance. Had Medicaid not been expanded, the number of uninsured would have increased by 4.4 million. The increase in the uninsured affected virtually all parts of the nation. Seven states had increases of more than 100,000 persons each. Only Texas experienced a decrease of that magnitude, but still had the second highest rate of uninsurance of any state. Of the 1.3 million additional uninsured in 1990, 77 percent were male, 32 percent had family incomes in excess of $50,000 per year, and 74 percent had annual family incomes above $25,000. Fewer than 9 percent had incomes below the poverty line. The numbers of uninsured children and senior citizens fell slightly (but not significantly), while the number of uninsured working-age adults rose by 1.4 million. The number of uninsured workers in each of four of 20 major industry groups increased by more than 100,000 in 1990. None of the industry groups showed a significant decline in the number of uninsured. Among professionals, there were substantial numbers of uninsured doctors, engineers, teachers, college professors, clergy, and others, but all legislators and judges were insured. The data presented here largely predate the recession and understate current problems. In 1991 the number of uninsured will likely reach nearly 40 million. Also, these estimates are based on the number of people uninsured at a single time during 1990; a far higher number were temporarily uninsured at some point during the year. Moreover the Census Bureau survey ignores the problem of the underinsurance of at least 50 million insured Americans. Patchwork public programs are grossly inadequate to plug the holes. A national health program covering all Americans could assure access to care and contain costs.
美国人口普查局获取的新数据显示，1989年至1990年间，没有任何医疗保险的美国人数量增加了130万，使未参保总人数达到3470万，比25年前医疗保险和医疗补助计划通过以来的任何时候都多。这一增长与医疗支出增长10.5%同时出现，这是过去三十年中第二大增幅。医疗补助计划覆盖的人数增加了310万，这是由于国会强制要求的一次性资格扩大，但这一增长被300万的人口增长以及私人保险覆盖人数减少130万所抵消。如果医疗补助计划没有扩大，未参保人数将增加440万。未参保人数的增加几乎影响到了全国所有地区。有七个州每个州的增加人数都超过了10万。只有得克萨斯州出现了如此规模的减少，但该州的未参保率在所有州中仍位居第二。在1990年新增的130万未参保者中（指全年都未参保），77%为男性，32%的家庭年收入超过5万美元，74%的家庭年收入高于2.5万美元。收入低于贫困线的人数不到9%。未参保儿童和老年人的数量略有下降（但不显著），而未参保的劳动年龄成年人数量增加了140万。20个主要行业组中有四个行业组的未参保工人数量在1990年增加了超过10万。没有一个行业组的未参保人数出现显著下降。在专业人员中，有大量未参保的医生、工程师、教师、大学教授、神职人员及其他人员，但所有立法者和法官都有保险。这里呈现的数据大多早于经济衰退，低估了当前的问题。1991年，未参保人数可能会接近4000万。此外，这些估计是基于1990年某个时间点未参保的人数；一年中在某些时候暂时未参保的人数要高得多。而且人口普查局的调查忽略了至少5000万参保美国人的保险不足问题。拼凑的公共项目远远不足以填补这些漏洞。一个覆盖所有美国人的全国性医疗项目可以确保人们获得医疗服务并控制成本。
