The Uninsured: 40 Million & Counting Means a Big Problem that‘s Getting Bigger

Michele Guest knows how tough it is to keep her health care insurance. A single woman with sole coverage, she pays $307 per month for Blue Cross Blue Shield of Michigan out of her paycheck as a food services employee with the Traverse City School District. Although the school district pays a portion of that amount, Michele shoulders the vast burden of a bill that seems to go up each year.
“It went up more than 30 percent this year on top of a big increase last year,“ she says. “It‘s great insurance and I have a $10 co-pay for doctor‘s visits, but it‘s a lot to pay each month.“
She knows of a cook with the school district who was paying $756 per month to cover her husband and three children. “She said we‘re basically working to pay for our benefits.“
Every two weeks, she sees more than $100 taken out of her paycheck just for the insurance premium. “It looks like I‘m making $6 an hour by the time the insurance is taken out.“

60 MILLION
But at least Guest and her co-workers have insurance, which is more than 40 million Americans can say, and those numbers are rising. By the estimate of Deborah Steelman, a member of President Bush‘s own health care team, there are 45 million Americans without health insurance and the number is expected to rise to as many as 60 million by the end of the decade.
Sixty million Americans without health insurance by 2010 will be nearly double the 33 million Americans who went begging as the decade began, when election-year promises were made by both candidates Bush and Gore to address the problem.
Closer to home, there were 1.1 million uninsured Michigan citizens as of 1999, according to the Michigan Hospital Association (MHA). A recent Grand Traverse County Health Department study found that 10% of those living in a five-county area are uninsured.
Even those who receive health insurance through the workplace are increasingly being asked by employers to pay larger portions of their premiums. In 1990, third parties paid for 95 percent of American health care bills, making it nearly free, according to a Cato Institute study. Between 1965 and 1990, however, hospitalization expenses rose 350% and the trend towards higher costs has continued into 2002, the result being that employers and insurers aren‘t as generous with benefits as in the past. And a current flap over Blue Cross/Blue Shield‘s refusal to pay for digital mammograms underlines the fact that health insurance isn‘t all it‘s cracked up to be.
“So many of my friends have no insurance at all,“ Guest says. “They just hope that nothing will happen. But I guess to me health is the most important thing -- I don‘t want to be thousands of dollars in debt if there‘s a medical problem.“
Guest has one friend who pays $50 per month for catastrophic medical insurance with a $5,000 deductible. But as her friend ages, she worries about the onset of medical problems and the bills they bring.

A DEATH SENTENCE
It‘s difficult to nail down the cost of an average 5.2-day acute care hospital stay -- the Michigan Hospital Association has no ready figures, since there can be a universe of charges relating to surgery, chemotherapy, diagnostic tests, radiology, ultrasound, drugs, outpatient services, home health care, physical therapy and rehabilitation, depending on what ails you.
But there are plenty of horror stories involving the uninsured. Consumers Union tells the tale of an uninsured contractor who fell off a roof last November and was taken to the hospital with severe brain damage. Initially, his wife charged $14,000 in bills to her credit card, but the final tally came to $278,000. Then there‘s the story of a 21-year-old student from Los Angeles who became dizzy, fainted and was taken to Coast Plaza Doctors Hospital for treatment of a kidney infection. Her six-hour visit to the emergency room cost $4,000.
Of course, a $10,000 heart surgery procedure is money well spent if it means saving one‘s life, but many of the uninsured never make it to the operating table.
In fact, according to a new study by the National Academie‘s Institute of Medicine in Washington, D.C., lack of health insurance can literally be a death sentence as uninsured patients put off the kind of early diagnosis and treatment which save lives.
“Americans without health insurance are more likely to have poorer health and die prematurely than those with insurance,“ states the report. “Uninsured patients with colon or breast cancer face up to a 50 percent greater chance of dying than patients with private coverage. Uninsured victims of trauma also are more likely to die from their injuries. Being uninsured for even a year appears to diminish a person‘s general health.“
The uninsured lose out across the board on such life-threatening health problems as diabetes, cancer, HIV and heart problems.
“Uninsured cancer patients die sooner than people with insurance do, largely because of delayed diagnosis. The uninsured are less likely to receive timely screening services such as mammograms, Pap tests, and colon exams. By the time cancer is diagnosed in uninsured patients, it is more likely to be at an advanced, often fatal, stage.“

DRAMATIZING THE ISSUE
A recent film called “John Q,“ starring Denzel Washington, dramatized the plight of the uninsured with the story of a father whose son collapses at a baseball game. John Q. rushes his son to the hospital where he learns that his child faces certain death -- he needs a heart transplant and the family‘s HMO refuses to cover the cost. The father is told to send his child to a hospice for a death watch. Desperate, John Q. takes the hospital hostage, demanding a transplant for his son.
For Americans who aren‘t part of a screen fantasy, however, taking hospitals hostage at gunpoint isn‘t an option. Nor are there any seemingly easy answers, as Hillary Clinton found out when the First Lady tried to reform health care in 1994.
The health insurance lobby, labor unions and conservatives opposed to higher taxes waged a successful campaign to scuttle Clinton‘s health reform package which was considering a Canadian-style “single-payer“ plan that would have provided universal health care. Critics of the plan said it would be too expensive and inefficient and would lower the quality of medical care in America.
Indeed, the costs are great. Americans spent $1.06 trillion on health care in 1999, or $3,808 per person, according to the MHA. Those costs, and who will pay for them, generate a deep political divide on what to do about the uninsured.

UNHEALTHY STATE OF AFFAIRS
The problem goes deeper than costs, however, in that many Americans contribute to their own ill health through poor lifestyle choices. According to the MHA, one in four Michigan citizens smokes, one-third of the state‘s population is overweight, one-third have high cholesterol in part due to poor nutrition, and more than 25 percent have high blood pressure.
“An estimated 84.1 percent of Michigan adults had at least one risk factor for cardiovascular disease,“ an MHA notes. “The risk factors are cigarette smoking, sedentary lifestyle, overweight, diabetes, high blood pressure, and high cholesterol.“
Critics of universal health care say that if government were footing all the bills, costs would spiral out of control, particularly with a population that has no self-control. Studies by conservative think tanks, such as the Cato Institute, claim that Americans are already over-using the most expensive health care system in the world.
As an example, Raymond J. Keating, an economist with the national Small Business Survival Committee, forecasts what could happen with current efforts to reform prescription drug coverage:
“When the government picks up the tab for a health care service, the
consumer and the provider have no reason to be concerned about costs,“ he says.
“For good measure, no one inside government has any incentive to control
costs either.
“With government coverage, utilization will jump. Increased demand will
translate into higher costs and more spending. Higher demand and prices
will affect the entire drug market, raising prices for all consumers and
boosting health care premiums paid by employers offering drug coverage
to their employees. Seeking more votes, politicians will broaden
prescription drug coverage and force taxpayers to pick up a bigger share
of the bill.“

DODGING THE ISSUE
From a liberal viewpoint, however, all of the above is dodging the issue of 40 million Americans who have no hope of obtaining health insurance.
“The New Deal‘s greatest failure was not providing access to health care for all Americans,“ writes J. Carlos Jiacinto on www.democraticunderground.com. “The far right of the Republican Party refuses to compromise on this issue because it undermines their electoral base: the uneducated middle class voter who lives in the states of the ‘sun belt‘. Across the world the first institutions that dictators undermine are often those organizations that provide for the general welfare: public schools, public health departments, and institutes of higher education. They thrive - and need - an ignorant populace to remain in power.“
Jiacinto claims that conservatives keep Americans distracted from concrete issues such as universal health care by painting the working poor as “lazy“ and “slothful“ and diverting the wrath of voters into issues involving gays, immigrants, universities and racial minorities.
“I admit that I am not sure what the solution to the health care crisis,“ he says. “but I do know that the current system subjects millions of Americans to an uncertain future and needless suffering. I am not advocating national health insurance necessarily, but I believe that some option should be available to the working poor that provides at least some level of care.“
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