(Up front admission: this is an updated version of a diary I posted in March 2008)
As a pediatrician, day after day and often several times a day I listen as yet another parent repeats this now all-too-familiar line. "We don’t have insurance."
My pen, set to write a prescription for an antibiotic to treat this child’s pneumonia, or sinus infection, or bladder infection, pauses. The prescription pad is put back into the drawer. I hand the child a treasure chest, and ask them to pick out a prize. I tell the parent that I’ll be right back.
I scrounge my sample cabinet, sparse though it is because my partners and I refuse to take enticements from pharmaceutical reps. As punishment, they stop by infrequently. Antibiotics samples are hard to come by, anyway, except for those most expensive. I reach for our stash of generics that we buy for our clinic, for situations such as this. Or I (gulp) pull out my Wal-Mart $4 prescription list, to see if the medication the child needs is listed.
It’s no secret that our health care system is sick. The U.S. health-care system is so dysfunctional, so unbalanced, that we have come as a nation to holding garage sales and charity breakfasts to help a family with medical expenses.
My daughters and I make bracelets. Bead bracelets, and we’ve gotten quite at good at them. We buy nice beads from a local wholesaler, and enjoy the time spent together creating patterns and assembling our works of art. Then we sell them, at my office, ten dollars each, month on month, a continual fundraiser for needy families in my practice.
Thus far in 2009 we’ve raised over $400. In 2008, we raised nearly $2000.
That’s what it’s come to. Selling bracelets. Or bartering; some parents, unable to pay their already-reduced medical office bill, will pay with services in kind. One father built a wheelchair and stroller ramp for our office, after we bought the materials. Another helped with some indoor repairs.
Or hosting parties at the local pizza parlor. Recently, thanks to the incredible generosity of a local pizza parlor chain, our community raised over $35,000 for the medical fund of a ten year-old patient of mine badly injured in a terrible automobile accident in which his mother and three others were killed, by a drunk driver speeding through a red light at more than 70 mph.
Sigh.
The number of Americans without health insurance is growing, not declining. Forty-seven million Americans, according to the Census Bureau, had no insurance for all or part of 2006. Forty-seven million Americans - likely fifty million given our nation's recent hemorrhage of good paying jobs - lack health coverage, being neither poor nor old enough to qualify for government-funded insurance, and having neither a generous enough employer not sufficient resources of their own to pay for private health insurance.
Some nine million of these Americans are children.
Millions more have benefits so insufficient that they are not able to meet the financial consequences of major illness. Unanticipated medical costs are the leading cause of personal bankruptcies in the U.S.
That so many people should be without medical coverage in the world’s richest country is a disgrace. It blights the lives of the uninsured, who suffer by being unable to get access to affordable treatment at an early stage. And it casts a shadow of fear well beyond, to America’s middle classes, who worry about losing not just their jobs, but also their health-care benefits.
Millions of Americans are going without needed care because of cost. Forty percent of Americans surveyed in late 2007 admitted failing to fill a prescription because of cost. A third of those surveyed admitted having been deterred by cost from seeing a doctor when sick or from getting recommended testing, treatment, or follow-up.
Being without health care coverage means that when their children get sick, parents don’t take them to the doctor. They wait, and hope their child will get better. People without health care don’t treat their diabetes. They don’t get a Pap smear, or a mammogram. They ignore the pain in their chest.
Nagging conditions go untreated until they explode into medical catastrophes. Simple high blood pressure, which could have been controlled by medication, leads to a stroke. Uncontrolled diabetes results in a coma, and expensive hospitalization. When death is the result, a medical condition may be listed, but delay was the true cause.
Lack of health care is quite simply killing more Americans than terrorism. The real wolf at the door is not hiding in a cave in the mountains of Pakistan.
The number of excess deaths among uninsured adults is in the range of 18,000 a year, according to the National Academy of Sciences' Institute of Medicine. Many experts feel this number a very low-ball estimate. All would agree thatuninsured Americans get about half the medical care of those with insurance. They receive too little care, too late, get sicker and die sooner.
Our health care system is so dysfunctional and unjust that we spend more and get less than most other countries. At $6697 per capita in 2007, the U.S. medical bill is the highest in the world, and a full twenty percent higher than Luxembourg’s, the next highest. The U.S. average is more than twice the average of the 30 wealthy countries in the Organization for Economic Cooperation and Development. If only it bought better care.
With five percent of the world’s population, the U.S. accounts for nearly fifty percent of the world’s health care spending, and yet one-sixth of our population lacks medical coverage. Private health insurance now costs a national average of nearly $13,000 a year for a family of four, higher in some regions, and Americans are far and away the most likely citizens of any nation to spend more than $1000 out of pocket on medical expenses over the course of a year.
We spend up to twice as much per person on health care as citizens of other advanced nations, yet by most measures we are less healthy. A spate of recent research shows the United States well behind other developed countries on measures from infant and child mortality, to cancer survival to diabetes care and, finally, to life expectancy. We’re paying more and dying more, or at least sooner. This is craziness!
Our nation has the worst of both worlds: complexity, restrictions, and skyrocketing cost increases without the redeeming benefit of universal coverage. Neither our families nor our firms can prosper in an economy with so much uncertainty around health care. Americans deserve and want a better system.
We need a universal and affordable system of health insurance – available to everyone regardless of how much they earn, where they work, or even whether they have a job. The United States is the only industrialized nation without universal entitlement to health care services, and yet polls consistently show that over two-thirds of Americans want universal tax-supported health coverage. Gallup found that 79 percent of Americans want coverage for all, and 67% don’t mind if taxes are raised to do it.
But beware the familiar conservative bogeyman: "socialized" medicine. What’s interesting, however, is that none of the soldiers in the war against "socialized" medicine ever calls for the abolition of the Veterans Affairs hospital system, or the military health care program, or Medicare, or Medicaid, or the vast network of city, county, and state government-run hospitals throughout the nation. The fact of the matter is that 45 cents of every health care dollar in the U.S. come, in one form or another, from the government.
And besides, we don’t call other vital public services "socialized fire departments", or "socialized law enforcement".
Supporters of universal health care must take care not to be fooled when single-payer systems are labeled "socialized" medicine, an attempted pejorative term often combined with "European-style" or "Canadian-style" to associate it with publicly administered universal health care programs in, well, just about every other modern nation in the world. In truly "socialized" systems, like Great Britain’s National Health Service, or our own Veterans Affairs system, the government employs the doctors and owns the hospitals. In a single-payer system, they stay private.
As the Obama administration begins work sometime this year (we must hope) on national health care reform, supporters must beware the backers of commercialized, for-profit health care, who will use FUD (fear, uncertainty, and doubt) to maintain the status quo. They will claim that there will be rationing of care and long waits under a universal system.
Of course, they will neglect to mention that this is exactly what we have now!
The truth is that the U.S. rations health care more harshly than any other country. A minimum of eighteen-thousand Americans dying annually from lack of health care, and millions more going without needed care because of cost. Now that’s rationing!
I suppose they are free to go to the emergency rooms of America to get health care the old-fashioned way. By begging for it. After all, as George W. Bush so ineloquently said in the summer of 2007:
People have access to health care in America. After all, you just go to an emergency room.