R. Mueller responds on the hidden costs of uninsurance
Rudolph Mueller, M.D., author of “As Sick As It Gets,” responds to the Institute of Medicine report on the hidden costs of uninsurance:
It’s interesting to see the IOM report showing that “the best available estimate of the value of uncompensated health care services provided to persons who lack health insurance … is roughly $35 billion annually…and the best estimate…of the diminished health and shorter life spans of Americans who lack health insurance is between $65 and $130 billion for each year of health insurance forgone.” Also estimates “of the cost of the additional health care …to the uninsured once they became insured range from $34 to $69 billion per year”. At least the report shows that lack of health coverage to the uninsured ends up costing society overall more than providing insurance to the uninsured. However I think the IOM significantly underestimated the problem.
What the IOM report failed to report was the extra medical costs sustained in our society from people being underinsured or also previously uninsured. I have seen many patients previously uninsured or underinsured who become seriously ill from lack of timely and affordable medical care. If they survive, they frequently fall into poverty and qualify for Medicaid. Should they live long enough, they reach or continue on in Medicare sicker and more costly to care for than if they had been previously “well insured” or “universally covered”. I now call these additional costs and illnesses “Care Denial Induced Effects” or “CDIE,” and in the book “As Sick As It Gets” these additional direct medical costs reached $160 billion in 1998. The costs of CDIE in 2003 are probably many billions more considering millions of even more Americans are uninsured and underinsured since 1998.
The IOM also recently estimated “18,000” young uninsured adults die from lack of health insurance. Again, I think they have significantly under estimated the losses in our nation. When one compares the potential years of life lost before age 70 in the US vs. the average of the next nine largest wealthy democracies, nearly 200,000 Americans die prematurely every year more than those wealthy nations that have had universal health systems in place for decades.
The people of the United States continue to suffer enormously high medical costs and only mediocre medical outcomes relative to the other wealthy nations. Unfortunately these costs to our society and the human losses are even much greater than what the IOM courageously reports.
Dr. Rudy Mueller