In 1996, approximately 6 million employees rejected employer-funded insurance, and 4.6 million of those remained uninsured. A higher salary is frequently offered in lieu of insurance, so some may have chosen to take their chances and pocket the difference. In addition, 1 million employees had a low enough income to qualify for Medicaid. But it seems that most understood that there are many ways to obtain health care. They knew where to find the hidden subsidized medical care.

Of course, people can obtain health care by paying in full for services; getting a fee reduced or waived; visiting the emergency department of a hospital; or using community health center services, which are common places to get free or inexpensive health care. For example, the Philadelphia Black Women's Health Project offers to educate neighborhood women about breast cancer and instruct uninsured women about how to obtain preventive and other health care. In addition, most states have free care available to the uninsured. For instance, MinnesotaCare is a state-run program that contributes toward insurance premiums and prescriptions for almost 90 000 state residents. It seems that health care is available for those who have no insurance. The trick is knowing where to find it.

In a reader poll conducted by Money magazine in 1994, the heyday of President Clinton's initial health care reform proposals, almost two thirds of respondents opposed a federal health care system. Poll results reflected fears that federal health care reform would mean higher taxes. The truth is, taxpayers are paying anyway. Those who want an account of how much a national health insurance plan would represent in exact tax dollars are usually those who have no idea how much they are paying to support free health care for targeted groups. They also seem uninterested in finding out how much the lack of health care costs; illness and disease are costlier in the long run. Any investment in guaranteed health care, even if just for children, would have an invaluable return. The hidden subsidized medical system is already costing taxpayers, but Americans are more willing to pay for it because the taxes are hidden in the federal income tax that is deducted from each worker's paycheck.

State funding, Medicare, Medicaid, CHIP, and HIPAA make up a subsidized system that targets specific needy groups and may be a gradual approach to U.S. health care coverage for all citizens. For now, however, it seems that anyone who knows the ins and outs of the health care system can obtain health care regardless of whether he or she has insurance.

We pay for community outreach programs, state and federal programs, Medicaid, Medicare, and tax breaks for large corporations. However, although the movement toward a national health insurance system is inching forward, it would immediately halt if people saw a paycheck deduction labeled "tax money to fund health insurance for those who do not have it."

Linda Gundersen