U.S. Health Insurance Challenge Continuing

On March 23, President Obama signed the Patient Protection and Affordable Care Act into law when, according to Medical News Today, 59 million (or 20 percent) of all Americans were without any health insurance, the highest proportion among the economically developed countries.  Over the past decade, total health care spending in the U.S. has grown faster than inflation and the growth in national income.

Yet, the new law can diminish the plight of the uninsured only gradually, and most Republicans in Congress have vowed to overturn “Obamacare” because, in Congressman John Boehner’s words, “it is a job-killer, and our economy simply cannot afford this unprecedented, unconstitutional power grab by the federal government.”

In the meantime, the Center for Disease Control (CDC) reports that “a significant proportion” of the uninsured have chronic diseases that require medical treatment.  By March 23, roughly 32 percent of persons aged 18 to 64 with a family income of $43,000 to $65,000 had no insurance for part of the preceding twelve months, and 48 percent of Americans18 to 64 years old with diabetes and no health insurance said they would have to forgo urgent medical care, compared to 8 percent of those fully and uninterruptedly covered.  If more Americans had health care coverage, fewer would forego the treatment they badly need and thus reduce the complications and cost of their illnesses.

The uninsured come from every segment of our society.  You may have health insurance today but none tomorrow if you lose your job, if your employer has to reduce or drop work-based health coverage, or if the family’s primary insurance-holder dies.  In the U.S. today, the inability to pay medical bills is the second-leading cause of personal bankruptcy, second only to job loss, according to Kaiser Health News.

The Kaiser Commission on Medicaid and the Uninsured also found that 60 percent of all Americans reported problems with paying medical bills; 27 percent reported struggling to pay expenses such as food, rent, or heat; 44 percent said they were forced to use most or all of their savings to pay medical bills, and 20 percent had run up large credit card debts or taken out a home equity loan to pay medical expenses.  When they badly need it, people without insurance all too often use a hospital’s emergency room--the most expensive place of care--and so add unnecessary costs to the health care system.

With so many uninsured, how can America’s physicians and hospitals meet their financial needs?  Most often, by shifting the cost of care for the uninsured to patients with insurance, in the form of higher premiums, co-pays and deductibles.  Estimates indicate that the average insured American pays about $100 per month to cover the cost of care for the uninsured.  Employers who are faced with higher premium costs have to pass them on to employees, eliminating coverage for dependents, or eliminating work-based coverage altogether.

Americans do have "universal access" to health care but only inefficiently through the emergency room.  The Kaiser Commission estimates the average cost of one emergency room treatment to be roughly $1,100 for physicians, nurses, and supplies.  This does not include tests and follow-up care.  If x-rays are needed, the bill would increase by at least another $125 to $150.  X-ray computed tomography (cat scans) would add $1,200 and magnetic resonance imaging (MRIs) another $1,800 on average.

In a recent column in the Journal Courier, former Scripps Howard vice president Dan Thomasson argued for the opponents of the Affordable Care Act that making health insurance mandatory was “a flagrant violation” of our “constitutional liberties.”  One has to wonder whether Thomasson has ever heard of mandatory automobile insurance, safety requirements, and traffic regulations that curtail our freedom to operate motor vehicles, or building and sanitation codes governing our right to own private dwellings.

Prospective Speaker Boehner claims to have a plan that would not make health insurance mandatory.  He wants individuals and small businesses look for better insurance deals in other states, create insurance pools of the kind offered to large corporations, and institute tort reform.  Yet, not only Democrats but also many of Boehner’s Republican colleagues find his substitute for “Obamacare” unrealistic and altogether insufficient.