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I started reading a book Uninsured in America. In 2003 and 2004, the authors traveled to several states to talk to uninsured. Americans.  

I'm most passionate about health care and poverty issues, so I wanted to write a diary about the book. This is a really emotional and moving book that lays out the plight of the uninsured.

One tragic term in the book is known as "the health care death spiral." Tragically, once a person enters the health care death spiral, it is difficult to escape.

From the introduction:

Individuals are pulled into the death spiral through many different portals. Corporate restructuring, outsourcing, divorce, family crises, chronic illness, serious accidents, and racial discrimination are some of the most recognizeable doors. Indeed, given the number and diversity of enterances, all Americans, except for a small number of extremely rich individuals are vulnerable to the death spiral's pull

These are all common reasons people lose their health care. We no doubt have kossacks who have lost their health care for all these reasons. When you lose your health care and can't afford prevenative care or needed care for illnesses such as diabetas, hypertension, cancer, HIV, mental health, etc. a person gets sicker and when you get even sicker it is that much harder to get gainful employment with health benefits. Some people have had their health permanently damaged to the point they are unemployable. Still, others have died. This is not only immoral, but I doubt it saves any money in the long run.

Sadly, there are more portals into the health care death spiral than out.

Am I exaggerating?  The authors note:

We don't see corpses on the streets of Chicago or Des Moines because when people get sick enough, they are hidden in emergency rooms and end stage treatment wards. In a bizzare economic and ethical twist, the chronically ill, if uninsured, are allowed to deteriorate to the point at which hospitals are legally required to take them in. They are covered if they have terminal cancer or renal failure, but not before

Another hideous practice by hospitals and medical providers mentioned in the book is where providers have arrested and jailed unisured patients who didn't show up at court hearings about their debt. Why didn't they show? Several reasons - people in lower wage and temporary jobs often have trouble getting and/or affording time off work, and they understandably feel the situation is hopeless and nothing can be done.

And as part of this downward spiral, America's uninsured are increasingly found in hospital emergency rooms, homeless shelters, and prisons. People who can't pay for prevenative care or necessary routine care are forced to wait until a potentially life threatening or irreversible medical emergency arises and seek care in an emergency room. Then, if they are considered disabled, they are eligible for Medicare.

The uninsured are increasingly losing their homes or are evicted from apartments and are now found in homeless shelters. And our prisons are increasingly filled with people who have committed petty, non-violent drug offenses. Because we classify substance abuse as a felony rather than a health issue, many former inmates can't find employment once released making it even harder to get out of the health care death spiral.

This book was written before the Affordable Care Act passed. This bill will help millions when fully implemented, but will still leave millions vulnerable and in need. The number of uninsured Americans is expected to drop from 50 million to about 21 million. And, if we hadn't passed ACA some estimates are the number of Americans without health insurance would have risen to 59.7 million by 2015 and 67.6 million by 2020.

In addition, one million more young adult are insured. More significantly, the ACA increased funding for Community Health Centers. These centers currently serve 20 million Americans. That number will hopefully double to 40 million by 2015.

I realize this community was divided about if the ACA was worth passing. Yes, the bill got watered down. I think the more important question is is where do we go from here?  How do we best finish the job so that health care is a right and not a privilege for EVERYONE? The provision to allow adult children to stay on a parent's policy until age 26 has proven both helpful and popular. Should we expand that to adult children and siblings of any age?  With subsidies to those families?  Could we get another couple million people covered that way?  What about even more funding for community health care centers which seem both popular and helpful?  Could the federal government forgive the student loan debt of both doctors and nurses who agree to spend X years treating patients in a Community Health Center?

And finally - The Road To Medicare For All May Be Paved Through The States.

In regard to the health care bill being watered down, the health care debate has gotten watered down or moved way to the political right for 30 years now. In the 1970's, the debate was between the Democrats single payer proposal and President Nixon's employer mandate. But the insurance industry fiercely opposed single payer and the business elites opposed the employer mandate. As corporations gained political influence, it became very difficult if not impossible to pass legislation unfriendly to them.

So the real debate is how do we take our country back especially in the Citizens United age?  The political right regrouped in the 1960's and accomplished just that. They moved the political debate way to the right. Ideas that were considered ultra right wing in the 1960's became centrist. We will succeed only when we moved the political debate to the left and what is progressive today becomes centrist tommorrow. And to do that we need to build a formidable political infrustructure - a whole separate diary. That will require a coalition and for progressives to be united!

Originally posted to joedemocrat on Sat Sep 24, 2011 at 07:26 PM PDT.

Also republished by March4Healthcare and Community Spotlight.

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