In this chapter the Committee considers costs other than the direct costs of health care—opportunity losses—that uninsured individuals, their families, local communities, and the nation bear due to the lack of continuous and permanent health insurance coverage for the entire population. In contrast with the estimates of the costs of medical care provided to those without insurance, the costs considered in this chapter have not, in most cases, been studied systematically. The Committee has developed quantified estimates only for two kinds of internal or private opportunity losses: the worse health attributable to lacking coverage and the financial “exposure” faced by uninsured individuals that would be eliminated by health insurance.

The Committee reserves one important, noneconomic opportunity loss for consideration in Chapter 6. In its conclusion to the report, the Committee examines the implications of extensive uninsurance nationally for American social and political values and ideals, including those of mutual caring and concern, equality of respect among members of a democracy, and equality of opportunity. This normative discussion is cast in terms of the benefits that could be expected if everyone had comparable financial access to care and the security afforded by health insurance.

Box 4.1 provides a roadmap to the organization of the chapter.

Following the schema of consequences of uninsurance that are presented in Figures 2.1 and 2.2, here the Committee relates its findings from previous reports and considers additional information from cost-of-illness and productivity studies to draw qualitative conclusions about certain economic impacts of lacking coverage and of relatively high rates of uninsurance within communities. The first two sections present quantified findings and the last four sections qualitative findings.