Reform Health Care Now: 87 million uninsured, and growing
Filed under: Columns, Healthcare
A few months ago, one of my patients approached me with a dilemma. She had been laid off from her job, but had let her employer-sponsored health insurance lapse without signing up for COBRA, which allows terminated employees to pay to continue their health insurance coverage with their previous employer for up to 18 months. She didn't qualify for government-sponsored insurance because she had a small family savings account. And she was unable to get an individual policy because at that moment she had what insurers classify a "pre-existing condition": She was pregnant.
When my patient asked me how much it would cost to deliver her baby in the hospital, I explained that a normal delivery would cost about $15,000, but if she ended up having a C-section she could easily wind up with a $30,000 bill. And her tab could top $100,000 if she had a premature baby requiring care in the NICU. Having a baby could not only wipe out her savings, it could land her in bankruptcy.
My patient was so distraught that she seriously considered having a home birth despite the fact that she had a high-risk pregnancy. Fortunately, towards the end of the pregnancy, she married the father of the baby and qualified for his insurance plan. She delivered a healthy baby in March.
The number of uninsured in this country has risen steadily for the past 10 years. During the last survey, in 2007, the total reached about 46 million Americans, or roughly 15 percent of the population. But that figure is misleading. According to the President's health care reform website, there were actually 87 million Americans who went without insurance at some point during the year. And that was before the recent surge in unemployment, which is expected to add many tens of millions to those figures.
How did we get to the point where one out of every three Americans is regularly going without health insurance? Well, for starters, many businesses can no longer afford the cost of employer-sponsored health care coverage, as I described in the first installment in this series. Instead, they get around the law requiring coverage for full-time workers by hiring more part-time employees.
Another factor is that insurers have made it virtually impossible for individuals to purchase their own health care plans if they have a preexisting condition. Or if they do find a plan, it's inevitably expensive and offers inadequate coverage.
Part of the problem, too, is simply that our current system was patched together from a time when there was far less mobility in the American workforce. Tying the continuity of a person's health coverage to his or her job security made more sense when many more people spent their careers with the same company, but has become increasingly awkward and inefficient in the digital era when the average American changes jobs 10 times (and has three or four different careers).
Even if you don't agree that we have a moral obligation to provide all Americans with access to quality affordable health care, it's become pretty clear that the rising number of uninsured burdens our health care system and economy, and needs to be addressed in any legislation drafted by Congress this spring. In his book, Sick: The Untold Story of America's Health Care Crisis and the People Who Pay the Price, author Jonathan Cohn eloquently explains why health care reform must include a provision to provide universal health care to all Americans: "Universal health care is really about finding collective strength in our individual vulnerabilities -- about helping a family member a neighbor, or a fellow citizen, because next time, any one of us could be the person who needs help. It isn't about them. It's about us. One day enough people will realize this to make universal health care a reality. The only question is how many more must learn it firsthand -- and suffer the consequence -- before that happens." I think we have our answer.
Russell Turk, M.D. is an obstetrician and gynecologist in Fairfield County, CT.
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Reader Comments (Page 1 of 1)
5-07-2009 @ 3:05PM
Jeremy said...
I'd like to check your facts here, but the website link is broken. Where did you get the "87 million" uninsured number?
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5-13-2009 @ 4:09PM
Russ Turk, MD said...
I found the statistic on the President's health care reform web site, www.healthreform.gov, but it was widely reported in March. Here is a link to a Reuters article:
http://www.reuters.com/article/topNews/idUSTRE5233QM20090304
5-07-2009 @ 3:41PM
Iridium said...
I have to call one big BS on this story.
Nearly all insurance companies are barred from using pregnancy as a pre-existing condition to deny coverage. Many states have laws that forbid that.
There are also a wide variety of programs that cover women and thier children during and after birth. My wife lost her job and her OBGYN gave her a list of programs she could qualify for if she wasn't married to me. Most hospitals will also work with a pregnant woman to lower the costs if they can not afford treatment.
I think rather than say we need to cover people, you need to ask yourself why it costs $15,000 to deliver a baby. It only cost $1000 a few years ago. $15,000 to deliver a baby. That is insane and there is no way a hospital can ever justify that charge in a million years.
One of the biggest villians in the whole uninsured story is the hospitals themselves. A visit to the emergency room when there are no other health care facilities open, like a Sunday afternoon, can result in a $6000 bill for bad heartburn.
Yes that is right $6000 for some Mylanta. Hospital charges are way out of whack. In fact they are downright criminal.
It is also criminal to charge so much for insurance coverage in the first place. Between me and the company I work for a payment of over $5000 a year is made to the insurance company. In four years I have used $250 worth of that insurance for one doctors visit. $20,000 went to the insurance company to pay for $250. I would much rather have that $20k in my pocket. I would have paid for the doctors visit myself.
I paid for the misuse of insurance by other people and for the blank check a hospital sees when a patient walks through the door. I should be entitled to get the money back if I do not use the insurance. In fact I wouldn't even have insurance were it not for the fact that if something ever did happen I would be wiped out.
The answer is not universal insurance. The answer is no insurance for anyone. The hospitals should be forced to charge a sum people can pay. That might mean that the hosiptals would have to stop building $250 million clinics everywhere, but that would be a good thing. Alogn with that all frivilous lawsuits need to be barred as well.
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5-07-2009 @ 5:24PM
Gloria said...
Being a Canadian citizen living in the U.S. I can truly say "I'm going back to Canada, as the health care system here is barbaric, noncompassionate, and built from greed". I have health insurance here and it costs $393/month. From that I have been given nothing, zero. I have paid for everything out of pocket, not been reimbursed, my GP has not been reimbursed for over a year. This is a health care system!!!, this is fraud and greed, for medical insurance companies. I have never had to "negotiate" as they call it for my health. I see people laying here. in paradise (Hawaii) in the parks, bus stops, who are very ill and left to die. People treat their pets better, ridiculous LV bags for their dog, while they step over someone suffering in the streets. This is inhuman, disgusting, for a civilized country. The U.S. needs to take care of it's own people, and stop bullying other countries to behave like they want them to. Have a look around what's happening in the U.S., it's not pretty. I wouldn't want my family and friends treated like this. I'm a nurse here and I've seen such medical abuse and neglect, it is terrifying. Everyone covers up their abuse and are protected by the hospitals, because they bring in the "paying patients, with the good insurance." People are not commodities, we have families, a soul, beating hearts. I'm booked to go back, to take care of my own, with even more heart and soul for my country!
5-11-2009 @ 5:04PM
Russ Turk, MD said...
Federal law bans group health insurers from considering pregnancy a pre-existing condition. However, my patient was denied coverage when she applied for an individual health insurance policy, and different rules apply. People applying for these policies are turned down all the time for all sorts of conditions, including pregnancy.
7-09-2009 @ 12:05PM
Laura said...
You obviously do not understand how insurance pools work. Even if everything is done very fairly, insurance does not work on a dollar for dollar pay in and consumption. It works based on statisitics and risk pools. Some of the insured have to be like you-healthy, low consumers of healthcare in order for the cost of a high consumer who exceeds what is paid in in consumption.
You would be making a bad bet if you had an accident that required ER, surgery and hospital care. Your 20K would evaporate very fast and you would be deep in debt.
5-11-2009 @ 11:02AM
Carrie said...
I actually liked how you blogged unlike others I've came across. According to the Nursing Zone, the number of people w/out health care access skyrocketed from 56 mil. to 60 mil in just 2 yrs. In addition, a Fidelity survey finds almost half of U.S. employees believe their employers won’t provide health insurance, 2019.
Like other middle-class uninsured Americans, prescription costs have become increasingly difficult to manage. Therefore, I had to go online to search for money saving options. I found Medtipster.com which is a helpful medical drug search engine that told me where to get generics for most of my brand named prescriptions. Medtipster allows you to type in your drug name, dosage and zip code to search for and locate prescription drugs that are available on discount generic programs across the United States; many of which are available for as little as $4. Prescriptions that are not available on a discounted program often have therapeutic alternatives on a discounted generic program, which are also available on Medtipster search engine. I have told my friends and families about www.Medtipster.com
visit Medtipster
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5-13-2009 @ 10:39PM
j said...
War stories are told and dramatized. thousands of people get great care on a daily basis in this country. An arthritic knee is replaced, a cancerous lesion removed, a ruptured tendon repaired everyday. Thousands of people seek the doc they want and he/she can treat immediately. For most the bills are paid by their insurance.
The biggest reason costs are so high is because in the US we allow so many people to be irresponsible at the cost of the productive citizens. Thousands of lazy, drug abusers, criminals, heavy smokers, heavy obese eaters are unemployed but recieve care that cost us billions. How many thugs are shot during a crime and recieve life saving surgery that night and a 2 week hospital stay in intensive care. They pay not one penny towards it but recieve lefe saving care. How many people choose not to work, collect welfare, buy cigarettes, smoke a pack a day, have a heart attack or stroke and have medicaid pay for their extensive bypass surgery, hospital stay and visiting nurses for the next 8 weeks. How many people neglect their diabetes and get kidney disease and then recieve dialysis 3x/week from a very expensive machine operated by a skillled nurse on medicaid. They pay not one dime. Thousands of people 3x/week for many years in some cases
We pay for the loosers, we cant deny them care. the problem is that the number or percentage of loosers is increasing every decade.
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5-14-2009 @ 1:03AM
ruby2 said...
One of the reasons healthcare is so expensive is because of the increasing number of "illegal" immigrants in this country. This is a FACT which many (well-intentioned) people wish to IGNORE. These are men, women & children & grandparents who have never paid into the "system" at all. The average person has difficulty paying his/her own healthcare because of higher premiums, as a result.
Illegal immigration is a BIG problem that needs to be addressed - the sooner, the better! This administration is dragging its feet once again on a very important issue, which affects every aspect of our lives.
There are so many ways to make healthcare more affordable, but by throwing our taxdollars at it doesn't exactly make it "free healthcare" does it? Who is paying for it exactly and HOW? These are things we NEED to know!
We have a RIGHT to know!
We need to know exactly what's in this Health Care Reform Bill before Congress passes it - AND they ARE rushing it through in July - not much more than a month away and that's 3 months AHEAD of schedule! Why the rush?
Most doctors and clinics are fed up with Govt funded programs & refuse to accept patients under these programs because of all the bureaucratic bs and long delays in getting paid! The Gov't "dictates" what they will pay. Currently, the way Gov't funded healthcare works right now, you might not be fortunate enough to find a healthcare provider in your local area. You may not be able to go to the hospital that's closest to you. The Provider refers you to doctors in your area, only to find out that they're not "accepting" any new patients.
Things aren't always what they seem. This could be just ONE of our biggest nightmares just like Medicare - but we don't know.....
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5-26-2009 @ 12:18PM
Joe Guarino said...
Including "87 million uninsured" in your title and then stating you got that number from the President's Web site is erroneous, irresponsible, and misleading. If you go to www.healthreform.gov and type "87 million" in the search engine, you will receive ZERO pages found with that number. Even when the number 87 is used anywhere on the site, it is NOT connected with "million." Therefore, you must have collected various numbers and arrived at this new number to create yet another myth to misguide the American public.
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7-07-2009 @ 7:44AM
Rick said...
Beyond doubting the 87 million figure I would question the routinely press parroted 46, 48, 50 million. Pick your number. Are these the same people all the time. Surely some lose insurance then regain it in another job, become poor enough to get Medicaid or age into Medicare. All this is still a problem but a different problem from that defined by the doctor.
In reality the uninsured issue is a distraction from the real problem of the American Medical Industrial Complex. It's 16% of GDP and growing. The USA spends about double what other industrial countries spend on health care. Those with employer provided health insurance receive the most generous tax subsidy for that compensation but the hidden to them cost of their health care frees them to spend more freely on health care.
Yet we scapegoat the uninsured for going to the ER. How many primary care docs make house calls? Some still did when I was a kid in the 1950s.
End of life care is one of the most costly forms of care. However, how except in the case of terminal illness do you know that it is the end of life? You have extreme cases like Terry Schiavo who was brain dead for many years but kept on a ventilator for legal and political reasons.
Then there was my 91 year old aunt who developed pneumonia a month ago and had to be hospitalized. She didn't want to go but we her 84 year old sister and me her 59 year old nephew would have been guilty of neglect.
After treatment she was then sent, on my direction, to a nursing home for rehab which was largely useless but was cheaper than a hospital. An alternative would have been a 24/7 live-in aide with visiting nurses, meals on wheels etc. The overwhelmed social worker was pretty good at helping us through the process. Ten days ago she made her end of life care official.
Both Schiavo and my aunt were covered by some form of insurance. My aunt's was a combo of Medicare and her generous employer's retiree supplemental insurance.
The problem is this costly segment of the the health care system is complex even for those of us who accept death as part of life making decisions in difficult cases like my aunt's ... well ... difficult.
Like so many who have a financial stake in the health care debate the doctor defines health care reform as extending "affordable" health care to all Americans. What he means is health insurance with all its profits, administrative overhead and care disqualifying tripwires. What he and other providers mean is health care or we should say health insurance as assurance they will to be compensated at their current lucrative levels.
Like so many with employer based tax free compensation in the form of health insurance he sees the uninsured as unlucky dupes or irresponsible dopes who refuse to spend $300, $500 or even $800 for individual private insurance with after tax dollars.
Forcing Americans, actually tax filers, to refinance the already over financed health care system, via the inefficient screwball private health insurance system will not solve the real health care crisis which is its above average inflation and its excessive and growing share of GDP. This IRS enforced extortion is at the heart of the bills moving forward in congress and based on the Massachusetts Department of Revenue enforced extortion of uninsured Massachusetts middle income earners.
To do real reform hospitals, doctors, health care workers, device makers, drug companies and patients will have to give up a lot. Despite some recent news about these groups giving up large amounts to get a bill through these are voluntary offers over the next ten years. A decade is plenty of time to conveniently forget a promise.
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