Politics & Power Quote by Gary Miller

Twenty-one billion dollars is a policy number dressed up as a moral alarm bell. In Gary Miller's framing, “uncompensated” isn’t a neutral accounting term; it’s a cue for indignation. Hospitals “provided” care, but no one “paid” for it, and that gap implies a culprit just offstage: the uninsured, the underinsured, immigrants, government mandates, or some vague culture of irresponsibility, depending on the audience he’s courting. The sentence works because it turns a complex system failure into a single, heavy figure that feels like waste.

The timing matters. In 2001, the U.S. sat in the uneasy space between the Clinton-era insurance battles and the post-2008 push that would become the ACA. Uncompensated care was real, rising, and unevenly distributed: safety-net hospitals and emergency rooms became the country’s default backstop. But the statistic’s power is selective. It invites listeners to think of hospitals as victims and taxpayers as inevitable payers, while sidestepping why people end up uninsured: employer-based coverage’s holes, premium inflation, state-level Medicaid gaps, and the blunt reality that medical billing often bears little resemblance to actual costs.

Miller’s intent is less to map the problem than to narrow the menu of solutions. A big number like $21 billion can justify tightening eligibility, expanding private insurance, or attacking “cost-shifting,” all without committing to the politically harder claim: that the nation already pays for care, just in the most expensive, chaotic way possible. The subtext is discipline. The context is leverage.