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6.6 million uninsured in nation's
largest state
San Francisco Chronicle
May 1, 2005
By Risa Lavizzo-Mourey
Ronald Reagan used to say that "status
quo" is Latin for "the mess that we're in."
Well, for too many working Americans and their families,
the health care status quo is a real mess.
What makes it such a mess? More than 45 million
Americans (6.6 million Californians, including 779,000 children)
do not have health insurance. These men, women, and children
make up nearly 16 percent of our population.
Who are the uninsured? Eight in 10 are in
working families with modest incomes. More than 1 in 10 children
go without coverage. Why? Their parents earn too much to be
enrolled in public programs. Yet these working moms and dads
do not earn enough to buy private coverage for their kids.
When many low- and middle-income Americans
lose their jobs, they lose their health insurance, which they
find it nearly impossible to replace on their own. They can't
afford to pay $10,000 a year, the average price for a family
policy for four.
It is by economics that we ration care today.
We do it by pricing out working Americans who are neither
prosperous nor impoverished. This is a true mess, and it is
simply unacceptable.
Not being able to afford insurance has serious
health consequences. Uninsured Americans cannot always see
a doctor when they need to, and they do not get the care they
should.
A report released last week analyzing data
from the federal Centers for Disease Control and Prevention
found that at least 20 million working Americans do not have
medical insurance of any kind.
These uninsured adults are going without needed
medical care -- 41 percent of uninsured adults report being
unable to see a doctor when needed in the past 12 months because
of cost. Only 9 percent who have coverage found themselves
in that bind.
In addition, 56 percent of uninsured adults
without health insurance say they do not have a personal doctor
or health care provider, compared with just 16 percent of
people with coverage. The problem is pervasive in every state.
Without proper preventive care, adults with
chronic conditions are less likely to get the routine care
that keeps them active, productive, even alive. According
to the Institute of Medicine, people without health insurance
are four times more likely to experience an avoidable hospital
or emergency room visit. Even worse, an estimated 18,000 Americans
die prematurely each year because they don't have health insurance.
This isn't surprising when you consider, as
the New England Journal of Medicine reported, that uninsured
women with breast cancer have a 30 to 50 percent higher risk
of dying than do women with private coverage. According to
the Journal of National Cancer Institute, uninsured patients
with colorectal cancer are about 50 percent more likely to
die than patients with private coverage, even when the cancer
is diagnosed at similar stages.
We know the status quo is a mess, but what
do we do about it?
Many of us have our fix, the choice we prefer
over all others: tax credits, public programs, business mandates,
individual mandates, association health plans, a combination
of some or all of these options, or a completely public program
like Canada's.
But every time we get serious about changing
the status quo, too many of us stick to our own fix and refuse
to budge. The only consensus we reach is that the status quo
-- the mess we are in -- is the least objectionable choice
to the most people.
This may sound idealistic, even naive, but
something has to give. The mess must be solved. Health care
is not a policy, product or political gotcha -- it is something
everyone needs.
There is no responsible reason for not acting.
The main thing we are missing is leadership.
Accepting the status quo isn't an alternative.
The number of uninsured Americans is too large. The number
of people at risk of losing their coverage is too great. The
consequences of inaction for everyone are too serious.
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