Insurance may not be enough
By Dr. Susanne King
Berkshire Eagle
Wednesday, March 28
IT IS now common knowledge that 47 million people are uninsured in the United States, an increase of 5 million during the time President Bush has been in office. This health care issue is already a focus for the upcoming national election, as well as the impetus for health care reform in individual states. Massachusetts is currently implementing legislation to reduce the number of uninsured in our state, and to mandate universal health care coverage.
The plight of the underinsured is less well-known. “Underinsured” means insurance coverage is inadequate, or out-of-pocket costs are excessive. The Massachusetts Connector Board, created to implement the state health care
reform bill, has been struggling with the impossible — how to get insurance companies to offer health insurance policies that are affordable, yet also provide adequate health care coverage.
The Connector has decided that health care policies with individual medical deductibles of $2,000, and $250 prescription deductibles, meet these criteria. In the array of policies offered, there is a no-deductible plan, but patients would have to pay 35 percent of the total cost of hospitalization, x-rays, lab tests or outpatient surgery. This means that many people will be unable to afford to use their insurance, and therefore will be underinsured.
Health insurance companies have high administrative costs, which include marketing, shareholder profits, and exorbitant CEO salaries. The Springfield Republican reported this week that the CEO of Aetna received compensation in 2006 which was valued at $31 million. The reality is that insurance companies are not able to create affordable health plans. The current health care reform in Massachusetts is demonstrating just that — patients are socked with either high deductibles or high co-payments.
Meanwhile the Journal of the American Medical Association (JAMA) has published a timely study titled “Financial Barriers to Health Care and Outcomes After Acute Myocardial Infarction.” (A myocardial infarction or MI is the medical term for a “heart attack.”) The authors found that 1 in 5 patients reported they were unable to afford recommended health care after an acute MI, and that these patients had a higher prevalence of severe chest pain, a poorer quality of life, and a much greater risk of being hospitalized again.
But the most stunning finding was that two-thirds of those who reported avoiding health care services or medication because of cost, were insured. The bottom line is that high deductibles and co-payments deter people from seeking needed health care or buying medications, and this results in poorer outcomes for patients when they become ill.
The answer to underinsurance is single-payer health care, funded and administered by the state or federal government. A single-payer health care system would remove financial barriers to health care, and provide the same comprehensive care to everyone. Eliminating the insurance companies with their excessive administrative costs, would provide the funds ($300 billion) to pay for this universal comprehensive health care.
Physicians for a National Health Program (PNHP) and Healthcare-NOW are national organizations that advocate for federal legislation for single-payer health care (the bill is HR 676). During the month of April, there will be meetings across the country to support this legislation, and to educate citizens about single-payer national health care.
A meeting will be held in Lenox on April 4 at 7 p.m. at the Lenox Community Center. April has been chosen as National Healthcare Month, to advocate for HR 676 and to commemorate Rev. Martin Luther King, who said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”