Fear of losing what we have. In America, that fear has kept us from fixing our broken health-care system. Opponents nurture that fear by arguing that if we insure more Americans, those of us already with coverage will be much worse off. But the respected National Academy of Sciences own Institute of Medicine (IOM) blew holes in that boogeyman with the release today of its latest report on the uninsured.
The IOM actually found the opposite: Having more uninsured people negatively impacts the health of those with insurance. Costs go up, quality of care goes down.
“When a community has a high rate of uninsurance, the financial impact on health care providers may be large enough to affect the availability, quality, and cost of local services for everyone, even people who have insurance.
“For example, survey data show that privately insured, working-age adults in areas with higher uninsurance rates are less likely to report having a place to go for care when sick, getting a checkup or routine preventive care, and seeing a specialist when needed. They are also less likely to be satisfied with their choice of physicians or to trust their doctors' decisions.”
The IOM was unwavering in its urgent recommendation that the President, Congress and private sector achieve health insurance coverage for all that is sustainable by reducing costs. “Simply stated,” the committee wrote, “health insurance coverage matters.”
But wait, if we reform health care, won’t we lose the really good coverage we have now? Shouldn’t we be afraid of losing what we have now?
In testimony today before the Senate HELP Committee, Consumers Union’s Gail Shearer, with 35 years of health-policy expertise, explains that many Americans with health insurance already are getting much less and paying much more. It even has a name: The underinsured. You’re underinsured if you have insurance, but it covers so little that you end up paying more than 10 percent of your income for health care, and that’s not including the premium. Nearly four out of 10 Americans lack adequate health coverage.
Underinsurance comes in many forms. High deductibles that force you to pay the first $5,000 in medical expenses, a nearly impossible feat on a $50,000 annual income. Capping benefits at $100,000 – forcing many long-term cancer patients with higher bills into bankruptcy. And the infamous “out-of-network” charges, which sock insured patients with huge bills because a health provider, often one they had no control in selecting, was not part of their plan.
Consider the case of John, 23, from Alabama, who was in an accident in a remote area. As he explains in this video, the ambulance tech who arrived on the scene decided John needed to be air lifted to the hospital. He spent three days in the hospital, and left with a $9,000 bill. His insurance company said the ambulance and helicopter, which John had no control in selecting, were not “preferred providers.”
The end result of being underinsured is more damage to our economy. As Shearer points out, a recent Consumer Reports survey found that 9 percent of the underinsured took “extraordinary measures” to pay medical bills – dipping into IRAs, 401(k)s or pension funds, or selling whatever assets they had. Three percent reported taking on home equity or second mortgage loans, selling homes, or even declaring bankruptcy.
A health care system with tricks and traps that can force Americans into bankruptcy isn’t something we should be afraid to change. “The reality is that in this country – and in this economy – just about all of us are at risk of becoming underinsured,” Shearer tells Congress. “The cause might be a pink slip, a major accident, pregnancy, a serious illness such as cancer, or being eligible only for a loophole-laden individual policy. The issue for your consideration is not whether the count of the underinsured is 15 million or 25 million. The real issue is the growth of health care costs…and the responses of payers to increase deductibles and decrease coverage.”
We know fear works in defeating change. But when it comes to our health care, the only thing we have to fear is continuing to accept an insurance-industry controlled system that costs far too much for far too little, and covers far too few.
UPDATE: Video of the hearing is now posted.
2 Posted by Lorraine Browning at 03/23/09 02:55 PMI continue to be amazed that no plan refers to the reservoir of healthcare professionals who have retired from active clinical practice. These doctors, nurses, dentists and other healthcare professionals could be mobilized into a structured organization that could add dramatically and immediately to meet the health care needs of the uninsured and others in our population without ready access. These professionals could be mobilized into existing practices, free clinics or into the rapidly increasing numbers of retail Clinics. In my experience, the state medical boards form the greatest obstacle to the utilization of this vast resource by not facilitating the granting of volunteer licenses. These could be limited in scope until competency was established. Some of the greatest impact could be for the management of patients with chronic medical conditions. For that population, evidence-based protocols are available that could assure best practices.
I am in my 25th year of serving the indigent in a free clinic setting. Along with a superb nurse practitioner, and 3 retired RNs, we hold regular clinics to manage insulin dependent diabetics, patients with resistant hypertension and dyslipidemia. The future benefits of such care have a predicable benefit for the health and costs. In other words, provide care now or pay many $ in the future for the neglect. In addition, our free clinic location houses a community pharmacy to serve the indigent. Volunteer pharmacists are essential to the provision of optimal services. If medications are not available, the glass is half filled! I applaud Wal-Mart, Walgreens and others who provide $4 generic prescriptions.
I can treat the usual Type 2 diabetic with 3 generic drugs for $12 per month with excellent control of A1C, BP and lipids!
Why do we continue to waste this opportunity and enormous resource for our nation’s patients in need??? If it becomes necessary to incentivize these healthcare professionals, the government might consider some tax incentives, such as tax credits for the hours spent in delivery of patient care.
I am an AMA and ACC member, retired from active cardiology practice.
However, I continue to care about the heath care of our nation’s population!Frederic G Jones ,Sr. MD, FACP, FACC
Consultative Cardiology
140 The Pinnacle
Sapphire NC 28774
twitty@citcom.net
828-883-2668
No one can get excellent health care when insurance accuaries are making medical decisions. What kind of insane system is this? Why have all those medical professionals left active practice? Maybe thet just couldn't stand the idiocy any more. Why don't we just nationaloize all health insurance companies and run them as non-profits? It's what the greedy and the heartless deswerve.
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