Americans who go without health insurance for any part of 2008 will spend $30 billion out of pocket for health care and they will get $56 billion worth of free care, according to a report released on Monday.

Government programs pay for about three-quarters, or roughly $43 billion, of the bills for these uninsured people, Jack Hadley of George Mason University in Virginia and a team at the Urban Institute reported.

"Physicians' donated time and forgone profits amount to $7.8 billion. After government payments to hospitals are subtracted, private philanthropy and profit margins are responsible for at least an additional $6.3 billion," they wrote in the report, published on the Internet at www.healthaffairs.org/.

"From society's perspective, covering the uninsured is still a good investment. Failure to act in the near term will only make it more expensive to cover the uninsured in the future, while adding to the amount of lost productivity from not insuring all Americans," Hadley said in a statement.

On average, an uninsured American pays $583 out of pocket toward average annual medical costs of $1,686 per person, Hadley's team reported in the journal Health Affairs. The annual medical costs of Americans with private insurance average far more -- $3,915, with $681, or 17 percent, paid out of pocket, the report found.

"The uninsured receive a lot less care than the insured, and they pay a greater percentage of it out of pocket. Contrary to popular myth, they are not all free riders," Hadley said.

Current estimates show that 47 million Americans lack any health insurance, and 28 million have gone without for some part of the year. The U.S. Census bureau is scheduled to release new estimates on Tuesday.

If these people were better covered, they would spend more on health care, the researchers predicted.

"Adding the cost of the additional care to current spending by or for the uninsured, total medical care costs for newly insured people will be about $208.6 billion (roughly $3,800 per full-year-equivalent newly insured person), consisting of $122.6 billion in new spending on top of the $86 billion already in the system," Hadley's team wrote.