| Until last week, most estimates of the number of Americans who lack health care insurance stood at 41 million. Now that total must be adjusted upward, and sharply so. According to the latest Census Bureau data, the ranks of the uninsured climbed to 43.6 million in 2002, the largest increase in a decade. The numbers are as startling as they are shameful.
Providing health care to all Americans has long been a theme of political candidates. But the latest figures show how empty those promises have been.
It's easy to explain the sudden jump in the uninsured. Some 2.7 million workers have lost their jobs since George Bush became President. Those who had health coverage at work lost that benefit when they lost their jobs. At the same time, millions more workers had to decide if they could afford their co-payments and deductibles. With household incomes falling the last three years in a row, there was more than a bit of sticker shock: Premiums rose 14 percent this year, to an average of $9,000 a year for family coverage. It was the third year in a row of double-digit increases.
But the story doesn't end with the unemployed and low-income households. Indeed, the Census Bureau reported an alarming number of uninsured -- about 20 million -- are working full time. Moreover, 19 percent of those without coverage live in households with incomes between $25,000 and $50,000.
The health insurance issue helped propel the candidacy of Bill Clinton in 1992. Given the rising numbers of uninsured since then, it is certain to be a major, if not dominating, issue in the 2004 presidential election.
President Clinton was never able to keep his promise of national health insurance, in large part because critics claimed he would greatly enlarge the government bureaucracy, and to a lesser degree because of then-First Lady Hillary Rodham Clinton's preference for molding a national policy in secret meetings. But at least it was an attempt to forge national policy on health care.
By contrast, the Bush administration has proposed only piecemeal approaches -- medical savings accounts, for example, and Medicare prescription drug coverage. Another proposal would aim at reducing health insurance costs by capping medical malpractice jury awards.
None of these steps would be of much help to a laid-off worker who can't afford to put money into a medical savings account and who is too young to qualify for Medicare. And even if capping malpractice awards were to help drive down costs -- a premise that has yet to be substantiated by hard data -- it would take years before its impact would take effect. In the meantime, the health insurance crisis would continue.
Already some of the Democratic hopefuls are seizing on the health coverage issue and offering solutions. Some are suggesting that by simply repealing Mr. Bush's income tax cuts for the wealthy, there would be enough money to provide coverage for all. Others are arguing that if the nation can afford $87 billion, and likely more, to rebuild Iraq, it can afford some form of national health insurance, whether administered by the private or public sector.
Both are compelling arguments for change. But even more compelling are the census numbers. They are added evidence, if more were needed, that the crisis is only getting worse. | 
