I have a confession to make: I am an American who has no health insurance, and I have been so ever since my postdoctoral funding ended four years ago. But I am not alone: according to the most recently available statistics, somewhere between 45-47 million Americans are living without any sort health care coverage, and every year, more and more working adults and families join the ranks of the uninsured. Shockingly, according to the Urban Institute's estimate, 22,000 Americans actually died in 2006 because they dared to be uninsured! This should be an embarassment for such a wealthy nation, especially because it reveals Americans' true lack of ethics by underlining the astonishing level of greed that prevails here.
This point is further driven home by the recent decision of the Bush administration to socialize the losses of insurance giant American International Group Inc., and mortgage lenders Fannie Mae and Freddie Mac at an estimated cost to the taxpayers of more than $85 billion over the next two years while ignoring the plight of 47 million uninsured Americans -- because "socialized medicine is bad." (too expensive, etc.)
But wait, maybe there really aren't that many uninsured Americans? I mean, how many people does 45-47 million Americans translate into? Let's compare this number of Americans with no access to health care to something that most people can relate to;
- 12 million more people are uninsured in America than live in our Northern neighbor, Canada (population: 32.2 million)
- 20 million more people are uninsured in America than live in the country we are currently bombing, Iraq (population: 24.7 million)
- Nearly 150 uninsured Americans for each physician in America
- Nearly 7,500 uninsured Americans for each hospital in America
- Over 84,000 uninsured Americans for each Member of Congress
But let's bring this home, for some local context. There are ..
Wow, that last stat kinda makes you want to ask your congresscritters how they can face their constituencies knowing that, on average, 84,000 of them have not and cannot visit a doctor without incurring significant debt and potential financial ruin as a result. This is a truly an American version of the "your money or your life!" scenario.
But maybe uninsured Americans are just a bunch of whiny losers who deserve to be uninsured? Unfortunately, the lack of health insurance is a problem because it affects more than unemployed video-game addicted boyz who live in their mothers' basements: the vast majority of these uninsured Americans actually work (most work fulltime) and earn at least poverty level wages. But in reality, they are being punished for trying to remain employed because their meagre incomes effectively disqualify them from receiving government-sponsored health insurance without providing them enough income to pay for private health insurance on their own. However, if these same workers with families were unemployed, they would qualify for government-sponsored health insurance.
Since most of these uninsured Americans are employed, why don't their employers provide them with health insurance? Employers are not required to offer health coverage in this country, so employer-provided health coverage declined from 69% in 2000 to only 60% in 2007. At least part of the reason for this decline in employer-provided health insurance is due to dramatically increasing costs of health insurance, although unrestricted greed also plays a significant role. Unfortunately, this decline in employer-provided health insurance disproportionately affects society's most vulnerable: poor and almost-poor working Americans are stuck working at crappy jobs or in "temp" positions that are less likely to provide employer-provided health insurance. Worse, even when they are offered coverage, they much more likely to lose it.
As a result, the uninsured and their families typically postpone visiting a doctor or dentist when they develop minor (or chronic) health problems, thereby allowing these problems to escalate into serious and possibly life-threatening illnesses that require emergency care. When this happens, the uninsured end up facing debts that they cannot possibly pay, so their lack of health insurance not only threatens the continued health and well-being of millions of people and their families, but it also damages and destroys their financial security and their ability to rise out of poverty.
More than 60 million low-income or disabled Americans rely on public programs such as Medicaid and Medicare to provide them with health coverage. But these programs do not cover all low-income people nor does everyone who is eligible actually know they can obtain such coverage. On one hand, there has been a strong public education campaign to inform people that medical coverage is available for all low-income children, but eligibility for adults is much more restricted -- especially for those who are single and childless. For example, during these past four years, it has been my experience that most single childless adults are not eligible for any public programs, including Medicaid and food stamps, even when they have can document that their incomes are well below the federal poverty level -- unless they are homeless.
This is a travesty.
So what can we, as Americans in a presidential election year, do? We can ask very specific questions of our presidential candidates about their health insurance policies -- and we should not let them off the hook until they've actually answered our questions! These questions should include;
- How many uninsured would be covered by your proposal?
- How would your proposal affect those who already have health insurance?
- Does your proposal provide financial assistance to help people who could not otherwise afford to purchase health insurance? If so, is this subsidy sufficient to make coverage affordable? (Health insurance for the average healthy family of four costs roughly $12,500 per year -- more if they have chronic health problems). Does your proposal punish those who do not obtain health insurance? If so, how? (Remember that people can and do fall through the cracks -- people such as single childless adults who currently cannot get coverage, for example).
- What will your proposal do regarding the challenges that people with pre-existing or chronic health problems face in obtaining affordable health insurance? Will your plan provide adequate mental health care and cover the cost of psychiatric medications?
- Under your proposal, would the current health care system be completely reorganized or would the changes be smaller and more incremental? What role would government-supported health insurance programs, such as Medicaid and Medicare, play in providing health coverage? How would changes to the existing health care system affect these programs?
- How much would your proposal cost, and how would it be financed?
I think that all Americans should become more proactive (read: "aggressive") regarding the provision of health insurance to every American, regardless of their income, social status, and health situation. Further, I think that Americans should seriously rethink their aversion to "socialized medicine" -- this might in fact be the best and most cost-effective way to provide coverage for everyone in this nation. I mean, if this country can freely indulge in socialized business practices that cost the taxpayer far more than socialized health care, then what is the problem here?
NOTE: Original essay, which has plenty of interesting comments.
The Urban Institute's report: New Income and Poverty Statistics and the Social Safety Net (stats, information).
Cover the Uninsured (stats).
Uninsured America (stats).