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Although critics of the U.S. health care system speak of 46 million uninsured, the vast majority of them are middle-to-upper income people who self-insure, healthy young people who don't buy insurance, and lower-income people who are eligible for other health care programs.  There are about eight million people who are chronically uninsured and have few alternatives.

The problem of no insurance obviously is most acute in states where health insurance is most expensive.  Like New York.  The New York Times recently wrote about young adults who can't afford health insurance:

"My first reaction was to start laughing - I just kept saying, ‘No way, no way,' " Alanna Boyd, a 28-year-old receptionist, recalled of the $17,398 - including $13 for the use of a television - that she was charged after spending 46 hours in October at Beth Israel Medical Center in Manhattan with diverticulitis, a digestive illness. "I could have gone to a major university for a year. Instead, I went to the hospital for two days."

In the parlance of the health care industry, Ms. Boyd, whose case remains unresolved, is among the "young invincibles" - people in their 20s who shun insurance either because their age makes them feel invulnerable or because expensive policies are out of reach. Young adults are the nation's largest group of uninsured - there were 13.2 million of them nationally in 2007, or 29 percent, according to the latest figures from the Commonwealth Fund, a nonprofit research group in New York.

Gov. David A. Paterson of New York has proposed allowing parents to claim these young adults as dependents for insurance purposes up to age 29, as more than two dozen other states have done in the past decade. Community Catalyst, a Boston-based health care consumer advocacy group, released a report this month urging states to ease eligibility requirements to allow adult children access to their parents' coverage.

"There's a big sense of urgency," said Susan Sherry, the deputy director of Community Catalyst. She described uninsured young adults as especially vulnerable. "People are losing their jobs, and a lot of jobs don't carry health insurance. They're new to the work force, they've been covered under their parents or school plans, and then they drop off the cliff."

It's a genuine problem, but the Times didn't bother to explain why health insurance is so expensive in New York.  First, the state mandates coverage of lots of conditions that don't interest most young people, raising costs.  Indeed, nationwide there are more than 1000 mandates, for everything from hair transplants to Viagra.  Second, New York engages in community rating, that it, the state forbids insurers from adjusting premiums for risk.  So healthy 21-year-olds pay the same as unhealthy 55-year-olds, which in practice means the former subsidize the latter--who usually are making a lot more money.  And for every 21-year-old who steps out of the health care marketplace, like those mentioned in the Times story, the cost rises for the ones who remain.

Fixing the health care system won't be easy, but adding government controls and mandates surely is not the answer.