In Texas, the health care crisis is only getting worse

Census statistics show state's children at risk

Houston Chronicle
Monday, September 8, 2008

TEXANS had little to cheer about in the recent report by the U.S. Census Bureau that the number of Americans without health insurance dipped slightly in 2007.

Instead of the 47 million uninsured in 2006, last year our nation had "only" 45.7 million who lacked health insurance, a drop of a half percentage point from 2006 (from 15.8 percent of the population to 15.3 percent). Most of the dip was due to an expansion of government programs like Medicaid, especially among children.

So instead of running a fever of 107 degrees, the patient's temperature dropped to 106.8 - better, yes, but only marginally.

In Texas, however, the temperature actually rose. The number of uninsured- went up by 258,000, yielding a total of nearly 6 million residents with no health coverage at all during 2007. That translates into an uninsured rate of 25 percent, the highest in the nation. It also translates into mounting financial stress, deferred medical care, untreated illness and in some cases premature death for millions of Texans from one end of the state to the other.

Keep in mind that these figures don't reflect this year's economic downturn, in which employers are shedding workers and benefits, and state governments are cutting health programs. And they don't reflect the additional tens of millions in our country who are "underinsured," meaning they would be hard pressed financially if they were to get sick, oven though they have some kind of insurance.

It is clear that last year's gain in the number of insured people was entirely due to an expansion of government programs like Medicare, Medicaid and the Children's Health Insurance Program (S-CHIP). While the number of uninsured in the country decreased by 1.3 million, the number of people covered by government health programs increased by 2.7 million. Had these public programs not been there to catch those falling off the rolls of employer-sponsored health insurance, the number of uninsured would have increased.

But in states like Texas, where the average annual growth in Medicaid has been low, the number of uninsured went up, not down. Furthermore, eligibility criteria in Texas for adults make it nearly impossible for working adults, even at minimum wage, to qualify for Medicaid. In Texas, a working parent of two making more than $6,000 per year makes too much to qualify for Medicaid! As fewer and fewer employers offer health insurance, individuals in Texas, where enrollment in public programs is not keeping up, are faced with only one alternative: joining the swelling ranks of the uninsured.

This is happening with children in Texas, whose working parents are losing health insurance. According to the census, the number of uninsured children in Texas soared to 1.5 million. These children will be at higher risk of getting sick from preventable illnesses, will visit the doctor less and will die prematurely. Certainly not good news for the children of Texas.

But enlarging Medicaid is not the answer. Texas ranks 49th in terms of its Medicaid reimbursement rates. In fact, many health providers routinely shun Medicaid patients because they know the government will shortchange them on payment for services rendered. And further cuts in these rates are on the way. This is a prescription for disaster.

As a physician, I am committed to practicing evidence-based medicine. I know you can't close your eyes to a problem and pretend it doesn't exist. If someone has a fever, yes, I can prescribe medication to bring the temperature down. But I'm obliged to look for the deeper cause. Otherwise I'm merely prescribing a placebo, not a cure.

The problems of our state and nation's health care are systemic. They are a result of a defective model of financing health care, a model based on the investor-owned private health insurance industry, which adds no value to health care.

The private health insurers make profits by enrolling the healthy, screening out the sick and denying claims. I see the destructive results of this "non-system" every day. It is simply not sustainable economically nor justifiable morally.

The cure is a single-payer national health insurance program, an improved and expanded Medicare for all. Cut the administrative waste and profits of the insurance companies out of the picture. Let people go to the doctors and hospitals of their choice. Give everyone, without exception, access to the medically necessary care they need. We don't need to spend a penny more than we spend right now if we take insurance companies out of the equation.

An old Chinese proverb goes: If we keep going in the same direction, we will end up exactly where we are going. What are we waiting for?

Malinow, a pediatrician at Ben Taub General Hospital, is President of Physicians for a National Health program..