An unhealthy trend continues Increasingly, Americans are going without medical insurance

October 11, 1998|By Ron Pollack

THE REPORTS from our nation's economic front appear rosy. Unemployment is at an all-time low. Incomes are rising. The poverty rate has declined. Interest rates have plummeted. The federal budget is in surplus for the first time in decades. With increased financial security and steady jobs, America's families seem to be enjoying the best of times.

To those buoyed by the good economic news, two recent unheralded reports will come as an icy, sobering shower.

The first, from the Census Bureau's Current Population Survey, tells us that the number of Americans without health insurance is growing rapidly.

In 1997, 43.4 million people were without insurance, an increase of approximately 1.7 million from the year before. A decade earlier, fewer than 32 million Americans lacked health insurance. Each year this decade, the number of people without insurance has gone up.

The second Census Bureau report is no less shocking. This study found that approximately 71.5 million people lacked health insurance for at least one month during the most recent three-year period examined by the bureau.

As a result, nearly three out of every 10 Americans experienced a significant period without health insurance. Most lost coverage for more than five months.

Significantly, most of the people without health insurance are in working families. They are the breadwinners, spouses and children of families for whom work, not welfare, is the norm.

They are the young couple with children, with dad working full-time, but dad's employer doesn't offer health care coverage. They put off their daughter's doctors' visits, hoping that an ear infection or a fever won't turn more serious.

They are the family whose breadwinner was laid off several months ago and cannot afford to pay for COBRA coverage. The medical attention for mom's abdominal pain is deferred until it becomes severe - and possibly life-threatening.

They are the low-wage worker whose employer offers health insurance, but the premiums, deductibles and co-payments are unaffordable. If that worker's family gets health care, it is usually in an emergency room.

For a surprisingly large and growing portion of America, insecurity about health care is a daily fact of life. In the country with the most advanced medical technology in the world, tens of millions of people are scared that their families won't get the health care they need.

The National Center for Health Statistics confirms that these people have good reason to be scared. Compared with insured children, uninsured youths have less than half the number of doctor visits and only 42 percent of the number of inpatient days in the hospital.

Comparing those uninsured and insured children who are in fair or poor health, analysts found that the uninsured are five times as likely not to have a usual provider of care; four times as likely to have needed medical or surgical care and been unable to get it; almost five times as likely to have needed dental care and been unable to get it; 4.5 times as likely to have needed prescription medicines or eyeglasses and been unable to get them; and more than 1.5 times as likely to be missing all or some of their immunizations.

This problem will only get worse in the years ahead. America's rosy economic picture cannot be sustained forever. When the economic downturn occurs, and when more people join the ranks of the unemployed or become part-time workers, the number of uninsured families will probably increase.

Similarly, health care costs are projected to accelerate, making health care more expensive and less affordable for everyone.

It is remarkable that the most recent increases in the numbers of uninsured people occurred when health care costs slowed down. But health care spending has begun to escalate, and that trend is likely to continue.

In 1997, health care spending amounted to $1.1 trillion. In 10 years, the Department of Health and Human Services projects that annual health spending will almost double, reaching $2.1 trillion.

As costs increase, businesses will feel growing pressures to reduce the level of health care coverage for their employees. Businesses have converted to managed care to keep costs down. The results are one-time savings that cannot be duplicated.

HMO and managed care premiums are rising sharply. Businesses seeking protection from accelerating health care inflation will turn to a tried-and-true way of keeping corporate health care costs down - passing along those costs to their employees.

Inevitably, employees and retirees will be asked to pay larger portions of their health insurance premiums, deductibles and co-payments. As those costs get passed on to working families and grow faster than general inflation and wages, increasing numbers of people will be priced out of health care coverage.

During the last surge in health costs, such a shifting of expenses occurred and resulted in a large decrease in employer-provided health coverage.

As the numbers of people without health coverage grow, it is high time that we reflect on several questions:

At what point will we, as citizens of the richest nation on the planet, agree that too many people are uninsured? How many additional tens of millions of people need to experience a loss of health coverage before we act? Why are we, the most technologically advanced and medically proficient country in the world, virtually the only industrialized nation without health coverage for all of our people?

As other countries have shown, there are alternative ways to achieve improved health care coverage. In these strong economic times, while the numbers of uninsured Americans continue to rise, the job must be started.

Ron Pollack is the executive director of Families USA, a national organization for health care consumers. This article first appeared in the Hartford Courant.

Pub Date: 10/11/98

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