By C.V. Allen, M.D.
The Modesto Bee
They are one American in six. They range in age from newborn to 65. They might be anyone – even your neighbor. They are America’s problem and America’s shame. They are America’s 47 million medically uninsured.
Contrary to public perception, the uninsured are, for the most part, not the lowest on the economic ladder. They are more likely to be one step up – too well off to qualify for Medicaid, too young for Medicare and too financially stretched to cover even moderate costs of illness.
According to the California HealthCare Foundation, here’s what the uninsured look like:
• 62 percent of the uninsured are employed.
• 32 percent of the uninsured have incomes below the poverty rate ($22,000 for a family of four)
• 28 percent have incomes greater than $50,000
• 10 percent are eligible for Medicaid (for minors the rate is 75 percent)
• 7 percent have incomes greater than $75,000
• 1 percent of elderly over 65 are uninsured (thanks to Medicare).
Large companies of over 500 employees have a 14 percent uninsured rate. That rate rises to 36 percent for companies with fewer than 10 employees and is at 30 percent for the self-employed.
This is changing. The number of employers providing medical insurance is declining while employee co-pays and deductibles are rising. About half of America’s annual 1.5 million personal bankruptcies are due to an inability to pay medical costs.
It is well documented that care of the uninsured is most often late, less than adequate and lacks follow-up. The results are predictable, including a higher death rate than for the insured. The great perversity here is that the uninsured are confronted with charges well in excess of real costs, charges paid by no one else since Medicare, Medicaid and private insurers all contract for services at far lower rates.
The results are nonpayments, which shift the costs to the rest of us, or financial destruction of the individual whose only crime was getting sick.
There are other nations like ours – industrialized, democratic, first-world nations functioning well in a free enterprise universe – who believe providing medical care to all, or seeing that it is provided, is not only a legitimate function of government but also a moral obligation. Despite system flaws and imperfections, they do so at slightly over half our cost, with medical outcomes equal to or superior to ours and with greater public support.
Critics say we are culturally “different” – that our violent society, highway fatalities, obesity and sloth explain the difference. But the facts suggest otherwise. When the richest country in the world combines a high level of poverty with the highest cost and highest uninsured population, the results are inevitable.
The problem is not cultural; it is political. So is the solution.