The High Cost of Not Reforming Health Care.

A lot of the debate about reforming health care revolves around a false choice — the simplistic idea that transforming the health system would be far more expensive than sticking with the current system.

A growing body of scholarly evidence points to the fallacy of that argument. Two new studies underscore that doing nothing would carry significant new costs in both the short and long terms.

A study in the journal Health Affairs estimates that by next year, the number of uninsured Americans could top 52 million — not counting those who lost coverage when they lost their jobs in the current recession.

A second study predicts that figure probably will reach at least 57 million people in a decade, about 10 million more than were uninsured in 2007. That research, by the Robert Wood Johnson Foundation, suggests the number of uninsured could easily reach 66 million by 2019 if worst-case assumptions about the economy are met.

Meanwhile, business spending on health insurance for workers would more than double, as would spending for Medicaid and the State Children's Health Insurance Program.

Most Americans get private health insurance through their jobs. But most uninsured Americans come from families with at least one full-time worker. So why are they uninsured?

The most important factor, it turns out, is the relationship between overall health spending, health insurance premiums and earnings.

As spending — and premiums — rise, it becomes prohibitively expensive for employers to offer coverage to low-wage workers. The number of uninsured workers goes up as a result.

The Health Affairs study found that the number of uninsured workers rose from about 15 percent of the workforce in 1980 to 25 percent in 2006.

It probably will reach 26.4 percent next year, meaning almost 7 million more Americans will be uninsured.

If you add in those Americans who lost their health insurance when they lost their jobs in the current recession, the number of uninsured would be about 57 million in 2010.

The Robert Wood Johnson Foundation predicts that the number of middle-class families without health insurance probably will jump 45 percent by 2019. That would drastically increase the amount of uncompensated care — medical treatment provided by doctors and hospitals without getting paid. Those costs would jump by at least 72 percent, and perhaps by as much as 128 percent over the next decade.

Much of that will be shifted onto those with private insurance. A new analysis by the group Families USA estimates that people with family health insurance coverage are already paying an extra $1,000 a year to help pay for treatment provided to the uninsured.

The Johnson Foundation study estimates that individuals and family spending on premiums and out-of-pocket costs will increase between 46 and 68 percent over the next decade — much faster than the overall economy is expected to grow.

The amount businesses spend probably would double, putting American companies at a greater disadvantage when competing with foreign firms.

Simply extending coverage to the uninsured won't be enough to rein in costs. Study after study has shown that in parts of the country where spending is highest — St. Louis ranks in the top 20 percent for Medicare spending — patients are less likely to get inexpensive treatments that have been shown to improve outcomes. Instead, doctors are more likely to prescribe extra tests and expensive treatments simply because they're available.

More care is not necessarily better care, and it may lead to fewer people getting any care. Understanding this is difficult; not understanding it will bankrupt us all.

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