KIE: An estimated 31 to 36 million Americans currently lack any form of health insurance, and underinsurance is also a chronic problem. In 1989, only 40% of the poverty population was covered by Medicaid. Employer-subsidized insurance has also seen gradual erosion over the years. Friedman warns that the issue of health care coverage, if not yet at a critical level, soon will be, for five reasons: coverage is a key factor in health improvement; health care institutions suffer increasingly from patients' uninsured care; fewer employers are offering coverage, due to the increasing costs of insurance; primary care in the emergency setting is inefficient, forcing society to pay dearly for care for the uninsured; and an industrialized democracy cannot justify such an overly selective and self-destructive health care system.