Getting medical coverage to all
Posted on Thu, Mar. 13, 2003
Too many fall through the cracks of inadequate insurance programs.
By Gene Bishop
http://www.philly.com/mld/inquirer/news/opinion/local2/5378484.htm
The Philadelphia Enquirer
More than 18,000 young adults died last year in a major epidemic in the United States that managed to escape the headlines.
Those 18,000 - six times the number who were killed in the attacks on the World Trade Center - died, according to an Institute of Medicine report, because they lacked health insurance. No alert has been issued to help those who daily live in terror of becoming sick and being unable to pay.
There is the college graduate working as a waiter while trying to succeed as an artist. At work he has a seizure and is rushed to a hospital. He is discharged two days later with a prescription for medication and instructions to make an appointment to see a neurologist.
Although emergency medical assistance (Medicaid) may pay for the hospitalization, he is not eligible for Medicaid once outside the hospital because he is able to work. An appointment with a neurologist in Philadelphia could cost $250 or more, in addition to the cost of medications, blood work, and further diagnostic testing. He doesn't have the money.
His is hardly an isolated story. As a physician who cares about access to health care, I consider myself knowledgeable about health-system problems. But having spent the last 18 months working with the Pennsylvania Health Law Project, a statewide legal services organization, I am overwhelmed. I am filled with anger as I hear story after story about Pennsylvanians who are struggling to take care of themselves or their families, but are unable to pay for doctors, hospitals or medicine.
The Health Law Project's toll-free helpline for low-income Pennsylvanians having difficulty accessing or using the health system documents a system that is falling apart. There is the call from the social worker at a low-cost clinic. Her client has been diagnosed with a brain tumor and needs radiation therapy. The woman's income is too high for Medicaid, and three hospitals have refused to register her for a specialist appointment because she is uninsured.
Or the man with diabetes, employed and uninsured, who sees a physician at a low-cost community health center where he pays for his medicines and physician visits. When his doctor tells him he needs an eye specialist and possible laser treatments to prevent blindness from diabetes, he doesn't have the money. He and his lawyer make numerous phone calls trying to obtain affordable care. One hospital says it has "used up all the charity care for the year." He becomes overwhelmed by the obstacles in his path, and the possibility of large debt. He takes his chances with his sight.
Few uninsured people come to my practice, but the underinsured are plentiful. Every day, people tell me they aren't taking their medications because they can't afford them. Insurance companies have shifted the cost of care to consumers.
Low-cost coverage now available to a limited number of Pennsylvanians is also inadequate. Special Care insurance, sold by Independence Blue Cross, allows four physician visits per year and doesn't cover medications. One serious illness or accident can use up those visits. Adult Basic Coverage - funded by the tobacco settlement and run across the state by private insurers - began in July and filled its 48,000 capacity almost immediately. Even without coverage for prescriptions, mental health or drug and alcohol treatment, it has a long waiting list.
During this national "Covering the Uninsured Week," it is time to focus again on providing universal coverage for all Americans. We already have more than enough resources in our health-care system to provide comprehensive health-care benefits to all. A national health insurance program, which would eliminate the high overhead and profits of insurance companies, offers the promise of adequate health care for all Americans.
U.S. Rep. John Conyers (D., Mich.) recently introduced a resolution calling for a national health program. On the Web, there is a national physicians' proposal backing such a program (www.physiciansproposal.org).
As a physician in such a system, I could treat patients without checking on the rules, medication lists, or billing requirements of 10 to 20 insurers. As a patient in such a system, you or I could visit any doctor or hospital we choose, rather than the ones chosen for us by our employer, our insurer or our income. Only national health insurance allows us to expand coverage without expanding costs.
A patchwork quilt of inadequate insurance programs, each with its own set of rules and administrative costs, is not the answer. It is time to trade this torn quilt for a well-sewn blanket of universal coverage. It is time to save 18,000 lives - and save ourselves.