Gaps in Health Insurance: An All-American Problem
By Sara R. Collins, Ph.D., Karen Davis, Ph.D., Michelle M. Doty, Ph.D., Jennifer L. Kriss, and Alyssa L. Holmgren
The Commonwealth Fund
April 2006
Gaps in health insurance coverage – a problem that has long afflicted lower-income U.S. families – is increasingly becoming an all-American problem.
Percent of working-age adults in 2005 who were uninsured at some time in the past year, including those currently uninsured, by income level:
53% of low income (<$20,000) 41% of moderate income ($20,000-$39,999) 18% of middle income ($40,000-$59,999) 7% of high income ($60,000 or more) Rates of medical bill problems and debt were high among people in both lower-income and higher-income households who experienced a time uninsured. Indeed, rates were highest among those with higher incomes. Nearly three of five (59%) adults with incomes of $40,000 or more reported difficulties with medical bills or accrued debt. Forty-six percent of adults with higher incomes were paying off unpaid medical bills over time. More than one-third (34%) of adults ages 19 to 64 (both insured and uninsured) either had medical bill problems in the past year or were paying off accrued medical debt. Executive summary: http://www.cmwf.org/publications/publications_show.htm?doc_id=367876
Full report:
http://www.cmwf.org/usr_doc/Collins_gapshltins_920.pdf
Comment:
By Don McCanne, M.D.
The problem of potentially being uninsured now has become a major concern for the average American. Even being insured is not protecting Americans from medical debt. Can we cover everyone and prevent medical debt at the same time?
The authors of this report call for building on “group forms of coverage already in place, including employer plans, Medicare, Medicaid, the State Children’s Health Insurance Program, and state and federal employee benefits plans.” Such expansions would increase costs at a time when individuals and employers already are finding it difficult to meet the current level of spending. Consumer-directed models would be even worse since, in shifting costs to patients, the problem of medical debt would be further compounded.
The government is the only payer that could manage equitably the costs of comprehensive care for everyone. If the government is to foot the bill, it needs to fulfill its fiduciary responsibility by demanding efficiency and value. That can be achieved through a single payer system, but not through an industry that spends so much in devising and executing ways to not pay for essential health care.
Single payer is the solution that Americans are seeking. Most just don’t realize it yet. It’s our job to explain it to them.