When large numbers of people don’t have health insurance, it hurts us all. The consequences are sometimes indirect, so that hasn’t been an easy message to convey.

In 1987, 29.5 million Americans were without health insurance. In 1992, the issue rose to the center of the presidential election, but it receded when President Clinton’s plan for universal coverage failed to gain support. Back then, “managed care” via health maintenance organizations was thought to be a partial solution to skyrocketing costs, but that hasn’t worked out either.

Today, more than 43 million Americans are uninsured, and rising health-care costs have resulted in employers paying a smaller share of employee costs. Some businesses have dropped coverage altogether. Since 2001, the percentage of workers getting their health insurance through employers has dropped from 67 percent to 63 percent, according to a survey financed by the Robert Wood Johnson Foundation that was released this month.

That’s certainly depressing – and deadly – for those left without insurance, but, as the report shows, it’s also bad news overall, especially for low-wage communities such as Spokane and Coeur d’Alene.

The report, conducted by the Center for Studying Health System Change, found that high rates of uninsured people take a toll on health-care institutions and providers. That’s a big deal in the Inland Northwest, where the health-care industry accounts for one-fifth of all jobs.

That’s hardly a news flash for the region’s health-care providers, which recently issued a dour financial prognosis. Deaconess Medical Center, Valley Hospital and Medical Center, and Sacred Heart Medical Center all have announced layoffs. Kootenai Medical Center is struggling, too.

Health care isn’t like other consumer goods. If a consumer decides not to purchase a television, he goes without. If he decides not to purchase health insurance, he still must get care if he visits an emergency department. Hospital executives estimate that the cost of this care could reach $70 million this year in the Inland Northwest.

And before blaming people for not getting insurance, consider this: The median household income for a family of four in Kootenai and Spokane counties is about $37,000. Such a family would have to spend one-quarter of its income for health insurance that is comparable to what employers provide. Even those who are covered are finding they can’t afford their share of the costs. The average monthly family premium increased from $530 to $850, and the deductible doubled to $400.

Yes, improving Medicare and Medicaid reimbursements would help and so would reining in medical malpractice costs, but the report notes that incremental changes would be rapidly erased by rising health-care costs and the swelling ranks of the uninsured.

Radical reform is needed, and, as the report’s authors say, that change doesn’t necessarily have to be managed by government, but it has to be initiated by government.

We don’t endorse a government-run health care system, but we do support affordable coverage for all. The cost of inaction is too high.