Health Care: a Crisis for Everyone

July 14, 1991|By JONATHAN BOR | JONATHAN BOR,The Sun's medical reporter.

Only a few years ago, it would have been unthinkable. Who would have thought that the American Medical Association, Lee Iacocca and the Heritage Foundation -- not a radical tendency among them -- would be joining unions and assorted leftists in calling for an overhaul of America's health-care system?

Hardly anyone agrees on the exact prescription. But across industry, academia, organized labor and politics, a rising chorus is warning of calamity if serious medicine isn't found for the growing ranks of Americans who are walking around without health insurance, justifiably afraid that they are just an ambulance ride away from financial ruin.

Commit this statistic to memory: In America, between 31 million and 38 million people have no health insurance. Many of them do without such basics as prenatal care, immunizations and cancer screenings. Often, they stay home until they are desperately ill. And then, the hospital emergency room becomes their family doctor.

A 1987 survey by the Robert Wood Johnson Foundation found that two-thirds of the uninsured with serious symptoms -- loss of consciousness, bleeding and chest pains, to name a few -- didn't go to the doctor at all.

The problem is likely to get worse. Dr. George D. Lundberg, editor of the Journal of the American Medical Association, says it is reasonable to think that 75 million people -- more than twice the current number -- will be uninsured in five years if the nation doesn't find an effective way to stem health-care costs and insure everyone.

Twenty years ago, Sen. Edward M. Kennedy, D-Mass, proposed national health insurance. But it remained a fringe issue, perceived as too esoteric or too distant a problem to concern a broad spectrum of the electorate. It was a problem of the poor. Now, the issue has emerged into what Alex Gage, a Republican political pollster, calls ''a very dominant second-tier issue'' -- dwarfed only by foreign policy and recession as the 1992 elections loom.

''It's not too esoteric,'' says Mr. Gage. ''People are so confused. They go [to the doctor] and get 15 bills, and there's a sense that everybody is raping everybody.''

Proposals for national health insurance abound in Congress. Sen. Jay Rockefeller, D-W.Va., may make his a launching pad for a presidential run. In May, JAMA and nine specialty journals published by the staid AMA devoted all their pages to proposals for insurance reform. The proposals ran the spectrum, from tinkering with the insurance industry to dismantling private insurance and establishing a Canadian-style system that covers everyone with tax dollars. But they all agree: The current system is failing.

It's doubtful that corporations, doctors and political leaders have suddenly been struck with an overwhelming sense of altruism. They have simply found that when it comes to health care, ''poor'' describes not only the underclass but the middle class as well. The uninsured have become so numerous -- and the cost of insuring people so exorbitant -- that the problem suddenly belongs to everyone.

The uninsured have grown from an estimated 28.4 million in 1979 to about 37 million by the mid-1980s. The Census Bureau shows a decline by a few million since then, but some experts believe that the difference may lie only in the way we measure and count the uninsured. Over the same period, coverage gaps have grown: People are paying larger deductibles and getting fewer services.

True, many of the uninsured families are impoverished, making less than the federal poverty level of $13,000 per year for a family of four but too much to qualify for Medicaid.

Others fit squarely in the middle class: They are working people whose employers have bailed out of health insurance; people who don't qualify for insurance because they work part-time; employees of small businesses who can't afford to offer insurance; people who work for themselves.

''There's also a growing concern on the part of many people with insurance that they could lose theirs, or that it just isn't as reliable as it used to be,'' says Dr. Karen Davis, an authority on health insurance at the Johns Hopkins School of Hygiene and Public Health.

It's a fear grounded in reality: While 15 percent of Americans are uninsured at any given time, 25 percent are uninsured at some point over the course of a year due to job changes, layoffs and the like.

Just as important, spiraling insurance premiums have hit business hard, forcing many companies either to absorb the increase, stop providing insurance or sock workers with a greater share of the cost. In 1989, health insurance accounted for 7.6 percent of company payroll costs -- a leap of 23 percent in just three years.

The problem has Lee Iacocca calling for the adoption of something akin to Canada's national health insurance. For every vehicle built in the United States, he points out, Chrysler spends $700 on employee health care -- more than triple the amount paid by manufacturers in Canada and Japan.

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