Can we afford not to insure the uninsured?
Can we afford not to insure the uninsured?
ARNOLD BIRENBAUM
(Original publication: March 8, 2004)
The Journal News
The online information source for Westchester, Rockland, and Putnam
(The writer, a Larchmont resident, is a professor of pediatrics at Albert Einstein College of Medicine, Bronx.)
Sen. Bill Frist, U.S. Senate majority leader and a thoracic surgeon, recently predicted that many of the 43 million in America without insurance will remain uninsured. Dr. Frist believes that it is too expensive for the government to cover the entire population of the United States, particularly following the new expansion of Medicare-based drug benefits, the creation of financial incentives for managed-care plans to enroll senior citizens, and the taxes lost through the promotion of health savings accounts.
As a man with religious faith in the free market, he has seen a rosy future, but it does not work for the uninsured.
Other public leaders with less of a will to believe have seen further and call for action now with regard to the uninsured. In January, the Institute of Medicine, one of three congressionally chartered national academies functioning since 1970 as an adviser to the federal government, issued “Insuring America’s Health: Principles and Recommendations,” the last in a series of five reports on uninsurance — a social condition resulting from the rising cost of health care and increased family stress, as well as the individual health risks of having one out of seven Americans without insurance. These well-crafted studies and their recommendations were subject to review by national experts.
The status quo second, even third-class status for the uninsured is an unsustainable option for our society. What we see now are the lowlights of our health-care system.
People without insurance find private insurance unaffordable and put off necessary visits to the doctor. While they may be young and relatively healthy, they sometimes, like most of the insured, need access to care. Additionally, the uninsured do not seek preventive care or screening for disease. When hospitalized, those without insurance may not receive all the tests that the insured get.
Clearly, the quality of care of the uninsured does not match that received by those with private or public insurance.
The presence of uninsured patients in the health-care system is now more than ever destabilizing since cross-funding is no longer available. Private insurance payments became less generous when medicine entered the era of managed care. Inpatient and outpatient providers had to offer deep discounts to gain contracts from insurance plans. Thinner margins made charity care less possible.
Consequently, there is a personal and societal price for lack of access. The authors of “Insuring America’s Health” estimate that the cost of poorer health and shorter lives is somewhere between $65 billion and $130 billion, a bill that comes due down the road. Some of this extraordinary cost is the result of discontinuities in coverage — gaps that arise when workers lose their coverage when they become unemployed or beneficiaries are removed from state Medicaid rolls.
Other countries do more with less money. Most of the advanced industrial nations to which the United States is compared have universal coverage, either through a social insurance system or progressive taxation. Currently, the United States spends almost 14 percent of its gross domestic product on health care, and that is expected to increase by 2013 to more than 18 percent! No other country comes close to this share of GDP.
How long can we afford to ignore the conclusion that these costs are unsustainable in the long run?
And, by all standard public-health measures (e.g., infant mortality, life expectancy), these systems of financing found in Canada, Great Britain, France or Japan, to name but a few countries, do just as well as we do, or better. Continuity of coverage means better access to health care. Changing jobs or losing jobs does not mean that a German citizen, for example, has to go without health insurance and access to care.
Our country, unlike other advanced societies, does not have in place safety nets that generate cost benefits to society as well as to its citizens. There is no universal entitlement to health-insurance coverage in the United States. The recent recession has led more employers to eliminate health-care benefits for their employees and/or their dependents. This trend will only lead to more churning and reduced access to needed care.
There are long-run savings from universalizing coverage, even with subsidies for low-income workers. Otherwise, we will pay for the neglect of the health care of the growing number the uninsured in coming decades.
What kind of a future is that, Senator? Shall the last to gain insight into our predicament be the Frist?