05/03/2006 09:31 am ET | Updated May 25, 2011

No Health Insurance: It's Not Just for the Poor Anymore

Not too long ago if you were a middle class American you could feel secure in the knowledge that although healthcare costs were rising, as long as you held a steady paying job you wouldn't have to face the daunting prospect of living in this country without health insurance.

Well, not anymore - and not by a long shot.

A recent study by the Commonwealth Fund called "Gaps In Health Insurance: An All American Problem" shows that over the past few years living without health insurance has become a serious middle class issue.

Sadly, as would be expected, the study, which the group conducts every two years, vividly displays the staggering health insurance crisis faced by this country's working poor. More than half of all "low income" U.S. workers, which the survey defines as those earning less than $20,000 a year, currently have no health insurance or spent time without it in the past year.

But while those figures are deeply troubling, the fact is they're essentially unchanged from 2001. Meanwhile the percentage of traditional middle class Americans living without health insurance has increased dramatically in just a few years. There are nearly 46 million uninsured Americans today. Roughly two-thirds of all adults without health coverage are members of working families, and more than half of all working adults without insurance are employed by firms with fewer than 100 employees.

Last year, 41 percent of all moderate income American workers, which the survey defines as those earning between $20,000 and $35,000 a year, didn't have health insurance or had spent some time without it in the preceding 12 months. The number was 28 percent in 2001. And last year 18 percent of all middle income workers, those making between $35,000 and $60,000 a year, didn't have health insurance or had spent some time without it in the preceding 12 months. The figure was 13 percent in 2001.

This means that in 2005 almost half of all moderate income American workers and nearly a fifth of all middle income American workers were living without health insurance or had been forced to do without it at some point in the preceding year.

And as crazy as those numbers may be, if you want to see some real growth in the trend take a look at what's happening to high income workers, which the survey defines as those earning more than $60,000 a year. In 2001 and 2003, just 4 percent of these workers didn't have health insurance or had spent some time without it in the preceding 12 months. But in 2005, just two years later, the figure nearly doubled to 7 percent.

At this rate, in the very near future one in ten American workers earning more than $60,000 a year will be living without health insurance.

Why do we as a society put up with this?

In an earlier post I talked about how wildly inefficient our healthcare system is. In short, according to the most recent calculations we spend more than $5,600 per person a year on healthcare, or 15 percent of our gross domestic product. That makes our system by far the most expensive in the developed world. Looking at the 30 countries in the Organisation for Economic Co-operation and Development, or OECD, the average annual healthcare expenditure is just over $2,000, or 8.6 percent of GDP.

For all that money you'd think the U.S. would enjoy stellar health statistics. But you'd be wrong. Our life expectancy of 77.2 years is below the OECD average of 77.8, and our rate of infant mortality, seven deaths per 1,000 live births, is higher than the OECD average of 6.1 deaths per 1,000 live births. If you want further comparisons, there are a host of other figures in this report showing that our healthcare system is severely lagging in terms of quality and efficiency.

To make matters worse, now it turns out we're also failing to provide health insurance to an ever increasing portion of our population. And not only that, but the crisis has crept up the economic totem pole and is directlly cutting into America's middle class.

For decades we've been scared off of truly reforming our healthcare system by politicians and others who use loaded terms like "socialized medicine" and "Hillary Care" to frighten us into believing that our healthcare will suffer from any change. Ignorant anecdotal horror stories about how receiving medical treatment in other countries can be a nightmare somehow are spread - even though those stories rarely are based in fact. Still, we become paralyzed by fear into inaction, and as a result nothing changes.

The fact is, if you have the traditional capitalist competitive concerns that the quality of healthcare will suffer in a single-payer system or if a government entity is given control, you needn't worry. According to this recent story in the New York Times, the healthcare industry enjoys monopolistic conditions in much of the country, so we already have a system that's essentially devoid of capitalist competition. And if you're worried that your access to treatments will be reduced in a single-payer system, you shouldn't fret. After all, you're already being denied access to certain treatments by your capricious health insurance provider.

For instance, Aetna recently decided not to cover a new government-approved treatment for severe depression that involves implanting a nerve-stimulating device in a patient's upper chest. I don't know if the treatment works or not, but I do know that if you belong to one of the 163 U.S. health plans that will pay for the treatment you can give it a try without breaking the bank. But if your carrier is one of the 650 or so other health plans that won't cover it, you're on your own.

Does that make any sense?

Clearly we're dealing with a healthcare system run amok. The only question is when we'll finally reach an inflection point where the need to bring the system under control no longer can be ignored. And based on the numbers, that probably isn't too far off.