Everyone knows the American health-care system is a disaster, but surprisingly few realize just how much of a disaster it really is. One reason for this is that the statistics we use to measure it completely miss how much anguish is caused by people constantly cycling in and out of insurance plans. In prior posts, I have tried to produce some figures that help illuminate the immense degree of “churn” in our system. In this post, I do the same thing, but with a new data source. What this source reveals is that, in a given twelve-month period, one in four adults between the ages of eighteen and sixty-four — 50 million people — face a spell of uninsurance.

Normal estimates of uninsurance miss this fact because those estimates are either annual surveys that ask individuals if they were uninsured for the entire year (Census) or point-in-time surveys that ask people if they are currently uninsured (Gallup). These are useful statistics to have, but they do not really capture how prevalent uninsurance is. To capture that, you need to ask people if they were uninsured at any point over some period of time, such as over the last year.

The Behavioral Risk Factor Surveillance System (BRFSS), a massive ongoing public health survey, asked precisely this question in 2014: “In the PAST 12 MONTHS was there any time when you did NOT have ANY health insurance or coverage?”