As President Obama's make-or-break health care speech to Congress approaches, the focus of media tea leaf readers is on what specifically he will say. Will the President overcome his marketing failures to date and commit his political capital to a reform plan? Will he draw a line in the sand on the public option, viewed by most of his allies as essential to reining in costs and crucial to making insurance mandates possible?
But perhaps just as telling as what President Obama says is what his Republican opponent will not say. In their response, to be delivered by Louisiana Rep. Charles Boustany and echoed by the legions of right-wing water carriers deployed across the airwaves, Republicans will deploy their focus group-tested fearmongering to block reform at any cost. But to preserve the dismal health care status quo, the GOP must ignore it.
Here, then, are the 10 missing Republican talking points on health care:

1. 50 Million Uninsured in America
2. Another 25 Million Underinsured
3. Employer-Based Coverage Plummets Below 60%
4. Employer Health Costs to Jump by 9% in 2010
5. One in Five Americans Forced to Postpone Care
6. 62% of U.S. Bankruptcies Involve Medical Bills
7. Current Health Care Costs Already Fueling Job Losses
8. 94% of Health Insurance Markets in U.S Nearing Monopolization
9. Dramatic Decline in Emergency Room Capacity
10. Perpetuating Red State Health Care Failure

1. 50 Million Uninsured in America
Despite Senate Minority Leader Mitch McConnell's oft-repeated claim that Americans don't want health care reform that "reform that denies, delays, or rations health care," de facto rationing is precisely what defines the U.S. system today.
The latest U.S. Census Bureau in 2007 placed the number of uninsured* in America at 45.7 million, up from 37 million since the last time Republicans successfully blocked health care reform in 1993. But a February analysis by the Center for American Progress found that the recession added four million more to the rolls of the uninsured, a group which a study by Families USA in March found included 86.7 million Americans over a two-year span. And a recent Gallup poll revealed the percentage of American adults without coverage catapulted to 16% from 14.8% since the start of the Bush recession in December 2007. All told, likely another five million people have pushed the ranks of the uninsured over 50 million.
2. Another 25 Million Underinsured
The crisis doesn't end there. In June 2007, a devastating assessment from the Commonwealth Fund showed fully 25 million more Americans were "underinsured," a staggering 60 percent jump since 2003. As the study showed, the number of "people who have health coverage that does not adequately protect them from high medical expenses" has skyrocketed:

As of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 percent from 2003.

Much of this growth comes from the ranks of the middle class. While low-income people remain vulnerable, middle-income families have been hit hardest. For adults with incomes above 200 percent of the federal poverty level (about $40,000 per year for a family), the underinsured rates nearly tripled since 2003.

All in all, 75 million Americans - 42% of the people in the United States under age 65- have insufficient insurance or simply none at all.
3. Employer-Based Coverage Plummets Below 60%
Making matters much worse is the rapid deterioration of employer-provided health insurance coverage. A 2007 report from the Economic Policy Institute showed a dramatic decline in employer-provided health care. That drop-off from 64.2% of Americans covered through workplace insurance in 2000 to just 59.7% in 2006 alone added 2.3 million more people to those without coverage. Census data since showed workplace coverage dipped further in 2007, down to an alarming 59.3%. (A recent Thomson Reuters survey put the figure for 2009 at a stunning 54.6%.)
4. Employer Health Costs to Jump by 9% in 2010
To be sure, Americans' health care expenditures are spiraling out of control, expanding at triple the rate of wages. That annual tab now tops $12,000. Of that, a recent analysis by the Center for American Progress found that "8 percent of families' 2009 health care premiums--approximately $1,100 a year--is due to our broken system that fails to cover the uninsured."
And with successful Republican obstruction of Democratic health care initiatives, those jaw-dropping costs would only continue their steep climb. A new report from the consulting firm PricewaterhouseCoopers forecast employers will face a 9% increase in health insurance costs in 2010. 42% of those business surveyed will pass at least some the new burden on to their workers. As PWC's Michael Thompson concluded:

"If the underlying costs go up by 9%, employees' costs actually go up by double digits," he said, noting that will have a "major, major impact" when many employers also are freezing or cutting pay.

Here's a snapshot of just how "major" that impact will be for American families. Pointing to data from the actuaries at the Centers for Medicare and Medicaid Services, the Center for American Progress warns that per capita medical costs are forecast to rise by 71% over the next decade. That would catapult the cost of the average family's insurance policy from $13,000 a year to over $22,000 by 2019.
5. One in Five Americans Forced to Postpone Care
Of course, McConnell's dystopian future of health care delayed is already Americans' nightmare present. The Thomson Reuters survey released in April found that 1 in 5 Americans "have delayed or postponed medical care, mostly doctor visits, and many said cost was the main reason," a staggering jump from 15.9% in 2006. As study leader Gary Pickens summed up the grim findings:

"The results of this survey have serious implications for public health officials, hospital administrators, and healthcare consumers. We are seeing a positive correlation between Americans losing their access to employer-sponsored health insurance and deferral of healthcare."

6. 62% of U.S. Bankruptcies Involve Medical Bills
Given the deterioration of the employer-provided health coverage and the skyrocketing costs of out-of-pocket care, it's no wonder, as a June 2009 study funded by the Robert Wood Johnson Foundation determined, medical bills are involved in over 60% of U.S. personal bankruptcies:

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.

"Using a conservative definition, 62.1 percent of all bankruptcies in 2007 were medical; 92 percent of these medical debtors had medical debts over $5,000, or 10 percent of pretax family income," the researchers wrote. "Most medical debtors were well-educated, owned homes and had middle-class occupations."

7. Current Health Care Costs Already Fueling Job Losses
While John Boehner trumpets his claim that Democratic health care initiatives "will kill American jobs," a new analysis from the RAND Corporation found that current excess U.S. health care expenses are already having a devastating effect on the economy. As BusinessWeek noted (via The Plum Line):

In a first-of-its-kind study, the non-profit Rand Corp linked the rapid growth in U.S. health care costs to job losses and lower output. The study, published online by the journal Health Services Research, gives weight to President Barack Obama's dire warnings about the impact of rising costs if Congress does not enact health care reform.

As it turns out, today's stratospheric growth in health care costs has the most crippling effects in precisely those industries where more workers have employer-sponsored insurance (ESI):

For example, the study estimated that a 10% increase in excess health care costs would reduce employment by about 0.24 percent in an industry such as motor vehicles, where about 80% of workers have ESI, compared with about 0.13% percent drop in the retail trade, where about one-third of workers have ESI. Economy-wide across all the 38 industries, a 10% increase in excess health care costs growth would result in about 120,800 fewer jobs, $28 billion in lost revenues, and about $14 billion in lost value added.

8. 94% of Health Insurance Markets in U.S Now "Highly Concentrated"
Republican critics of a public option tout regulatory reforms - still undefined - which would allow "insurance companies compete for your business and you can shop around for the best coverage and price."
But as the Commonwealth Fund revealed in a report titled, "Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families," that is a far cry from today's actual private insurance market, one in which Americans are simply priced out:

Over the last three years, nearly three-quarters of people who tried to buy coverage in this market never actually purchased a plan, either because they could not find one that fit their needs or that they could afford, or because they were turned down due to a preexisting condition.

Behind that market failure is the rapid emergence of health insurance monopolies in most areas of the United States. The past 13 years have seen over 400 corporate mergers involving health insurers. As the American Medical Association found, "94 percent of insurance markets in the United States are now highly concentrated, and insurers are thriving in the anti-competitive marketplace, raking in enormous profits and paying out huge CEO salaries." As I noted in 2006:

In most states, the AMA concludes, the idea of choice among competing insurance providers is a myth. The study showed that in each of 43 states, a small group of insurers exerts such market dominance as to merit the Justice Department "highly concentrated" market methodology for assessing potential anti-trust action. In 166 of 294 metropolitan areas surveyed, a single insurer controls over half the preferred provider network and HMO underwriting. In North Dakota, for example, Blue Shield owns 90% of the market. It's no wonder that Jim Rohack, an AMA trustee, concluded, "This problem is widespread across the country, and it needs to be looked at."

The near-monopolization of most health cae markets not only leaves consumers at the mercy of insurers when it comes to costs, but whether they can keep their policies at all. As Rep. Bart Stupak revealed in recent congressional hearings, the practice of "rescission" is widespead, as insurance companies cut loose policyholders precisely when they get sick. As President Obama noted in August:

"In the past three years, over 12 million Americans were discriminated against by insurance companies due to a preexisting condition, or saw their coverage denied or dropped just when they got sick and needed it most."

9. Dramatic Decline in Emergency Room Capacity
In July, Mitch McConnell reassured NBC's David Gregory's regarding the 47 million uninsured by announcing, "Well, they don't go without health care." With that asinine statement, McConnell was only following in the footsteps of Tom Delay and George W. Bush, who in July 2007 declared:

"I mean, people have access to health care in America. After all, you just go to an emergency room."

As it turns out, the disturbing trends above are having a cascading effect on waiting times and treatment at American emergency rooms. While high-profile cases of the deaths of untreated ER patients in Los Angeles and New York put a face on the crisis, a 2006 report by the Institute of Medicine revealed that U.S. emergency rooms can barely cope with the volume of patients in the best of circumstances, let alone in the wake of crises such as a terrorist attack or flu epidemic:

The study cited three contributing problems to the rise in emergency room visits: the aging of the baby boomers, the growing number of uninsured and underinsured patients, and the lack of access to primary care physicians.

The report found that 114 million people, including 30 million children, visited emergency rooms in 2003, compared with 90 million visits a decade ago. In that same period, the number of U.S. hospitals decreased by 703, the number of emergency rooms decreased by 425, and the total number of hospital beds dropped by 198,000, mainly because of the trend toward cheaper outpatient care, according to the report.

10. Perpetuating Red State Health Care Failure
In May, the Washington Post rightly noted it would be blue state residents funding health care reform for their more conservative cousins in an article titled, "A Red State Booster Shot." (The same one-way flow of taxpayer dollars from Washington to red states, of course, is a permanent feature of federal spending in general.)
As I detailed in 2007, Americans' health is worst in precisely those states that voted for George W. Bush:

The Commonwealth Fund report, "Aiming Higher: Results from a State Scorecard on Health System Performance," examined states' performance across 32 indicators of health care access, quality, outcomes and hospital use. Topping the list were Hawaii, Iowa, New Hampshire, Vermont and Maine. Bringing up the rear were the Bush bastions of Kentucky, Louisiana, Nevada, Arkansas, Texas, with Mississippi and Oklahoma. The 10 worst performing states were all solidly Republican in 2004.

The extremes in health care performance are startling. For example, 30% of adults and 20% of children in Texas lacked health insurance, compared to 11% in Minnesota and 5% in Vermont, respectively. Premature death rates from preventable conditions were almost double (141.7 per 100,000 people) in Tennessee, Arkansas, Louisiana and Mississippi compared to the top performing states (74.1 per 100,000). Adults over 50 receiving preventative care topped 50% in Minnesota compared to only 33% in Idaho. Childhood immunizations reached 94% in Massachusetts, compared to just 75% in the bottom five states. As the report details, federal and state policies including insurance requirements and Medicaid incentives clearly impact health care outcomes.

For more on the performance of the American health care system, including international comparisons, see "U.S. Health Care by the Numbers." For a further demolition of Republican talking points, see "Ten Myths About Health Care Reform" at ThinkProgress.
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* It's worth noting, as the Kaiser Family Foundation did in its analysis, that "although legal and undocumented non-citizens accounted for 22% of the nonelderly uninsured in 2006, citizens still made up the bulk of the uninsured (78%). Further, the majority (76%-80%) of the growth in the number of uninsured from 2000 to 2006 occurred among citizens, not legal and undocumented non-citizens."