Changes in the Incidence and Duration of Periods without Insurance

Fascinating article which I'll need to dig deeper into. In short - David Cutler (Harvard health economist, advised Obama during campaign) has written an article in NEJM -- Changes in the Incidence and Duration of Periods without Insurance.

Key points in discussion are:
-Incidence of uninsured periods is rising over time

-When people become uninsured they are uninsured for shorter periods

-Uninsured periods are shorter because more people are obtaining public insurance

-From 2001-2004, persons in fair or poor health were substantially more likely to lose and to gain insurance as a result of the increase in public insurance

My thoughts:

-Time periods of comparison of 83-86 to 01-04. Uninsured periods were shorter likely due to expansion of economy which led to 1) greater employee health benefit access and 2) expansion of public health programs as tax base increases (and efforts to expand coverage for children)

-Incidence of uninsured periods rising maybe due to decreasing time with employer, leading to increasing periods of unemployment

- Rise of public insurance may crowd out private insurance

- The recession is going to have a profound impact on these trends. States can no longer continue to fund at the rates they have been - there will be likely reduction in public health benefits and programs. Unemployment is at some of the highest levels we have seen in recent history.

- This all makes me question the sustainability of current employer based health care:
*when patients are sick, they are more likely to lose their job
*the disabled account for I think approximately 10% of the uninsured but account for 50% of health care costs of the uninsured
*those who are employed are increasingly finding themselves "underinsured" - due to expansion of public health insurance and rising costs which limit the coverage that employees can provide

Thoughts that definitely need to be fleshed out and definitely need more of a fact base. Curious to hear your thoughts.