Any way you slice it, 45 million people is a big number. Yet, according to the most recent report from United States Census Bureau, this was how many people were without health insurance in 2003. And that staggering total was 1.4 million more than the previous year.

Actually, I think it does those individual lives included in the 45 million a disservice to lump them all together. Its very hard for most people to get their minds around 45 million of anything (except perhaps 45 million dollars) and so the tendency is to yawn, say yeah its a big number and then shift your focus to something else.

Ive already gone public about being a statistics freak, so heres one way Ive come up with for putting it in perspective. Lets look at that number in terms of how different the United States would look without 45 million people. One example: To get to 45 million you could lop off the entire West CoastCalifornia (hasta la vista, Arnold), Oregon and Washingtonand youd still come up short, so youd have to throw in New Mexico, too.

Too fond of the Coast to get behind that example? Lets move to the great heartland of our country. Start with Ohio, Illinois and Indiana. Youve got to be kidding. Those three only bring you to just shy of 30 million (all figures are from the 2002 census). Toss in Michigan and youre still short. Wisconsin will do the trick, however, bringing us up to the magic 45 million. But you say youd miss the Rust Belt?

Then head further south, where you could start with Texas and go straight across to Louisiana, Mississippi, Alabama and Georgia. Lop them off and youd still be well shy of 45 million. So youd have to throw in South Carolina, too.

OK, you say, enough of this. You get the idea and you dont want to waste time theorizing about a United States that would be without Texas, Louisiana, Mississippi, Alabama, Georgia and South Carolina.

Neither do most people. But these examples do give an idea of how catastrophically large a number that 45 million is.

This is an untenable situation. (I was going to say “obviously an untenable situation,” but weve been looking at similarly catastrophic totals for years without doing too much about them, so how obvious can they be?)

And it is not just for the uninsured that the current situation is untenable. The zooming hikes in insurance premiums are making all those who are covered hold their breath. The truth is that health insurance is sucking all the oxygen out of the benefits arena. People dread losing their health insurance. They know that wading into health care without health insurance is the sure road to depleting assets faster than you can say Magnetic Resonance Imaging.

I know the industry has been pushing Congress to do something for the uninsured. Its been coming up with proposals for years with little or nothing to show for it. And it seems foolhardy to expect this Congress to do much of anything about the uninsured.

The industry is in a tough spotas its fond of saying, its only the messenger after all, the conduit for wildly inflating medical cost increases beyond its control. But because it is the largely for-profit intermediary between that medical system and the systems users and because it is the mechanism that insulates people from going bare and because there is such widespread dread over losing it and because its public image is so disliked, the industry needs to push harder than ever. And needs to be seen pushing.

Conventional wisdom says its to no avail killing the messenger, but that doesnt stop people from sometimes doing it, just the same.

Steve Piontek


Reproduced from National Underwriter Life & Health/Financial Services Edition, September 3, 2004. Copyright 2004 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.