In humble attempt at casting this in the tradition of Socrates, a (slightly altered) quote:

"The unexamined vote is not worth casting."

Sunday, December 23, 2007

IS There a Problem With Health Care in America?

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

-Martin Luther King, Jr.

I think there's undoubtedly a problem with health care in America--a huge one--as my posts (and this quote) imply, but I don't want to take it for granted that others have the same perspective and/or understanding of things.

For me, the logic goes like this:

-Are there many who are uninsured?
-If so, does it matter? (i.e., does it affect their ability to live a normal, healthy life?)
-If it does matter, are there any ways the current system can be changed to help ameliorate the problem?

If so, it becomes a question of what the options are, and which make the most sense. So, I'll take those bullets one at a time, offering the bit I've been able to find, and then at the end provide a few videos I found when I did a quick search on this issue. So, to start...

-Are there many who are uninsured?

The basic figure that is often talked about is 47 million Americans. That number is astronomical. However, it looks like there's even more than that. A September 2007 study by a health care-advocacy organization, Families USA, showed that over the two year period between 2006 and 2007, 89.6 million Americans actually went without health insurance for some period of time (an increase of over 17 million since 2000). The difference in the commonly quoted 47 million and this 89 million is due to the fact that the former only counts those Americans who were without health insurance for a full calendar year; conversely, the Families USA figure of 89.6 million adds in anyone who was without insurance for a period of 1-11 months in the two year time frame of their study. A quick quote from the study helps illustrate what that means:

"Our methodology includes, for
example, a person who was uninsured
from August 1, 2006, to April 1, 2007. This
person would not be counted as uninsured in
either 2006 or 2007 by the Census Bureau’s
Current Population Survey [the 47 million]. Similarly, a
person who was uninsured from January 1,
2006, until November 1, 2007—22 months
without health insurance—would be counted
by the Census Bureau as uninsured in 2006
but not counted as uninsured in 2007 (even
though the person was uninsured for 10 months of 2007)."

Of that 89.6 million figure, two-thirds were uninsured for six months or more, while over half were uninsured for over nine months. Furthermore, to answer what I think is a valid question on these individuals' responsibility in their situation, four out of five, or 79.3 percent, were from working families. "Only 16.5 percent were not in the labor force—because they were disabled, chronically ill, family caregivers, or were not looking for employment for other reasons." Also, that 89.6 million accounts for one out of every three Americans under the age of 65 (over that age you qualify for Medicare, so we're talking about one out of every three who are not already covered by Medicare). Further, more than nine million of the uninsured are children. So that clearly answers the question of how many are uninsured, on to the next question...

-If so, does it matter? (i.e., does it affect their ability to live a normal, healthy life?)

I think the simplest question to start with in this respect is whether it matters to you that you have health insurance (if you do). To answer that question from my perspective, and provide some anecdotal evidence here, I have had some health issues this year, having to do with occasional irregular heartbeats and chest pains. My health insurance allowed me to see a primary care doctor, who then referred me to two specialists, which did: one EKG; a second EKG while running on a treadmill; and an echocardiogram--none of which would have been cheap, and all of which, thankfully, were covered by my insurance (although I have major qualms with my health insurance provider, Kaiser Permanente, part of which relate to the time they are willing to spend with patients, but also related to the overall issue of for-profit insurance companies' roles in providing health care, which I will have to go into some more in a later post). Thankfully though, they did cover me, and many, as the above numbers emphasize, do not have that luxury (for those of you who know me, those tests they did on me did not find any problems yet). Among other stories, I also have a friend who does not have health insurance, and, upon breaking his leg a few years ago, was faced with thousands of dollars in medical bills; the state of Virginia gave him a loan to cover the surgery and metal plate he needed, but he will be paying it off for many, many years.

To provide some basic facts in answer to this question though, of why lack of insurance matters, here are a few, directly taken from this PDF from the Institute of Medicine (IOM; a part of the National Academies); they are broken into a few categories by IOM, but I just include two here, check the PDF for more.

The uninsured use less health care:

• On average, uninsured persons use one-half to two-thirds the number and value of services compared with their privately insured counterparts and are more likely to use no health services at all.
• In the last year, 43 percent of working-age adults without health insurance reported that they did not seek a physician’s care when they had a medical problem, compared to 10 percent of those who had coverage all year.

Lack of Health Insurance Undermines Health on Multiple Levels:

• Uninsured people are more likely to receive too little medical care and receive it too late; as a result, they are sicker and die sooner.
• Uninsured adults have a 25 percent greater mortality risk than adults with coverage. About 18,000 excess deaths among people younger than 65 are attributed to lack of coverage every year. This mortality figure is similar to the 17,500 deaths from diabetes and 19,000 deaths from stroke within the same age group in 2001.
• Uninsured women with breast cancer have a risk of dying that is between 30 percent and 50 percent higher than for insured women.
• Uninsured car crash victims were found to receive less care in the hospital and had a 37 percent higher mortality rate than privately insured patients.
• Uninsured individuals with diabetes, cardiovascular disease, end-stage renal disease, HIV infection, and mental illness have consistently less access to preventive care and have worse clinical outcomes than do insured patients.
• If common childhood conditions such as asthma, anemia, and middle-ear infections are left untreated or improperly controlled — which can happen if a family lacks insurance — they can affect mental and language development, school performance, and hearing.
• In 1996 and 1997, 15 percent of uninsured pregnant women never went to the doctor before giving birth, compared with 4 percent of women with private or public coverage. Figure 2 outlines the related consequences: more low-birth-weight babies and increased infant mortality.

There are numerous studies, but that's a good overview of the issue, pointing out that, in answer to my question, there are clear hindrances to a healthy, normal lifestyle when one does not have insurance. So on to the last question of mine...

-If it does matter, are there any ways the current system can be changed to help ameliorate the problem?

This question is one that lies at the heart of the debates, particularly among Democratic Presidential candidates, regarding what should be done. Almost all are suggesting huge streamlining efforts to standardize record keeping and introduce technological efficiencies to the overall health care delivery and management system in the US. Other more fundamental changes within the design of the basic system are also being discussed, with the end goal, purportedly, of making health care affordable to all Americans. Of course, as I noted in my last post on the idea of mandating health care, there are even greater changes suggested by many, such as converting the entire system to a non-profit, single payer model. As I also mentioned, that is the model Presidential candidate Dennis Kucinich is proposing, however, all the other models which involve public-private combination systems, are laid out pretty clearly on almost all the other Democratic candidates' sites in their "issues" sections.

In the mean time, feel free to share any health care insurance stories through the comments button below, as well as any other thoughts for or against the points I made here. Also, here are a few short videos that I found doing a cursory search, that I think give a helpful perspective on the issue:

From Sicko (clips 1 and 2 below are from Sicko and as controversial as Moore's work may be, it is no less significant in my view):

Clip 1

Clip 2 (more related to those who have insurance, and the shortcomings that can be involved):

Other Resources:

-The Citizens' Health Care Working Group: A group that, over the last year and a half or so, sought to ask the American people about their perspective on health care issues in America, and report to Congress and the President; the site has lots of videos and other resources:
-Study by the American College of Physicians: "No Health Insurance? It's Enough to Make You Sick - Scientific Research Linking the Lack of Health Coverage to Poor Health":

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