The report released today by the Hoover Institution confirms that insured families across California pay a "hidden tax" to provide uncompensated health care to the uninsured. The existence of this "hidden tax" is no longer in dispute; what's under debate is its magnitude, which is hard to measure precisely because it is "hidden."

This memo describes the range of estimates that various experts have made, highlights some of the reasons for differing judgments, and then lets the reader draw his or her own conclusions about the reasonable range of hidden tax estimates.

Health insurance is the primary method Californians use to access and pay for health care. However, millions of Californians have inadequate health insurance or lack coverage entirely. When care is needed, the first inclination for these families is to delay treatment that is too costly and then hope for the best. And when hope is not enough, these families are forced to seek treatment that they often cannot afford. When medical bills go unpaid, many health care providers shift the cost onto those who can pay -- the those with health insurance...

Fear is a powerful force. Families fear the disappearance of affordable health insurance, employers fear international competition while financing high and rising health care costs at home, and providers fear that they will not be able to deliver needed care for lack of funding. In short, just about everyone fears that our system will fall apart. Instead of taking action, many politicians remain fearful of tackling health care reform, since it crushed the Clintons and others before them.

Health care in America is in a state of crisis. Collectively, we spend a far higher percentage of our GDP on health care than other industrial nations, yet tens of thousands of Americans are dying prematurely each year due to inadequate access to high quality care. Our crisis is rooted in part in how we pay for health care, leaving 45 million Americans without adequate insurance or access to providers, and in what we pay for, getting uneven and low quality -- and low clinical value -- for our expenditures.