by Carol Kirschenbaum, MD
"Health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize this right."
This was written by Cardinal Joseph Bernardin in October 1995. There are certain things that are correct, that most people accept as fair and equitable. One of these should be access to health care. It is outrageous in a country such as ours, where there is so much wealth, that 42 million people are entirely without regular access to health care.
In North Carolina we were offered the opportunity to extend health coverage to children this past year. The federal government would provide millions of dollars if the states could come up with a plan. In the end a plan was developed in North Carolina to insure 70,000 children. Unfortunately two-thirds of the North Carolina children now uninsured will remain so.
Many adults work in settings where health insurance is not offered, working part time or on contract. Some are self employers in a small business. Health insurance is often unaffordable. Even those people who are offered insurance through their job may find it unaffordable. The portion of the premium paid to insurance companies by the employee is rising. In the US the average premium paid by workers for family coverage increased by 146% between 1988 and 1996, to $1,615 annually. In 1995 more than 60% of adults without insurance in NC were employed. Benefits afforded through COBRA for people who are recently unemployed are often too expensive. The Kennedy-Kassebaum Act was designed to prevent insurance companies from denying coverage to people switching jobs and insurance coverage. However it is proving to be ineffective. There is no limitation placed on what the insurance company can charge and significant financial barriers are placed in the way of someone with a preexisting condition. Applicants are often unaware that there cannot be a lapse in coverage of more than 63 days.
Even insured people face barriers to care. Co-pays for doctor visits and prescriptions are rising. The new Children's Health Insurance Program in NC requires both premiums and co-pays. Studies have shown these only delay contact with a physician and in the end raise the total cost to society. In the US 11.6% of families experienced difficulty obtaining medical care or did not get the care they needed in 1996. Of these 12.8 million families, only 3.3 million were completely uninsured. Cost was the most common barrier.
There are huge barriers to mental health care with 68% of primary care physicians reporting that they can neither "always" nor "almost always" obtain needed high quality outpatient mental health care for their patients. An even higher proportion (72%) cannot obtain needed inpatient mental health care. Again cost is almost always the primary barrier.
The May 17 News and Observer had a piece entitled "Drug insurance sends prescription prices soaring." This issue is a large barrier to health care affecting not only the uninsured, but also the older population who are covered by Medicare as pointed out in the article. Medicare does not cover prescriptions. Individuals with several medical problems, for instance, diabetes, hypertension, high cholesterol, can have bills amounting to hundreds of dollars a month just for medication. We are lucky in Durham to have a program called Senior Pharm Assist, and there are programs through drug companies to assist individuals that fall within their criteria for free medication. Unfortunately these charity programs fall far short of dealing with all those in need.
There are frequent news items regarding the problems related to our current system of managed care. Milliman and Robertson, a consulting firm that advises thousands of US hospitals and managed care plans, suggests the length of hospital stays for baby deliveries and mastectomies. In addition, they also recommend against performing cataract surgery in more than one eye unless the patient is young and needs both eyes to work.
Benefits provided to those with insurance are not uniform. Lack of insurance or barriers for those who are insured lead to delays in needed care. The child whose earache is not treated, the teenager whose asthma is not controlled, the pap smear that is delayed or not obtained and the adult whose blood pressure goes untreated all result in complications which are much costlier in suffering as well as in dollar value to the individual and society. The uninsured poor are twice as likely as those with private insurance to delay hospital care. Among those delaying care, hospital stays are longer and death rates higher. Patient protection legislation was in the NC court system last year and additional bills are pending in the US Congress.
The US is the only industrialized country that does not have some form of universal health care. When asked why we cannot develop a more equitable and efficient system to meet the needs of our population the answer is usually "it is too expensive." In fact a universal system (say, one generally similar to the current Canadian system) could be both less expensive and equal or better in quality outcomes than what we now have. Compared to other industrialized countries we have the highest overall expenditure for health care, the highest administrative costs, yet the highest number of uninsured citizens. Our system leaves many hard-working and dependent individuals entirely outside any provision. The piecemeal approach to fixing the present system, while politically expedient will not adequately serve the nation's need for adequate health services; the bottom line is corporate profit not health care. This article is far from comprehensive in analyzing the problems or solutions but it focuses on one central point. The present system has placed barriers in the way of access to quality health care for the uninsured as well as those with insurance, so that health care remains a privilege rather than a right.
|Dr. Kirschenbaum is a physician in Durham specializing in Internal Medicine. Please send her information you may have regarding impediments to receiving health care, financial or otherwise, for you, a family member or friend. Examples are being compiled to show how our present system of health care does not work. If you want a speaker to present information to your group regarding the issue of universal health care, write to: 306 Monticello Avenue, Durham, NC, 27707.|
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