HEALTH CARE CRISIS IN THE UNITED STATES The Uninsured Thirty-eight million people in the United States have no health care insurance and thus lack access to the most basic right: the right to affordable quality health care. An additional 56 million people are estimated to be underinsured or to lack health care insurance for some period of time in a given year, raising the specter of being without critical health care coverage when it may be most needed. Since 1980, the number of uninsured has risen by one million each year. Nine million women of childbearing age have no health insurance (Braveman et al. 1989). Twenty-three and 26 percent of black and Hispanic women, respectively, are uninsured. Fifteen percent of the nation's children--9.2 million--have no insurance. Employees of entire industries such as logging, hair stylists, roofing companies, taverns, mining, medical offices, entertainment, and sports are barred from insurance by the industry as high risk occupations. It is estimated that 20 percent of the American people are either totally without health coverage or lack coverage for some period of time in any given year (The Washington Post 1992). Three-quarters of the uninsured are employed or are dependents of employees. One-half of the working uninsured are employed by small businesses with ten or fewer employees. Many of the uninsured are self-employed, part-time and seasonal workers, or workers whose employers choose not to cover them. The Underinsured Even people who have health insurance coverage live in constant fear that when they will need their health insurance it will not cover their particular condition or the deductibles and copayments will be so great that they will not be able to afford the care needed. They are equally fearful that they will lose coverage if their employer or insurance company decides to change or withdraw their coverage, raises premiums, merges with another company, or goes out of business. In a recent poll, 30 percent of employees reported that they were afraid to change jobs for fear of losing their health insurance (The New York Times 1991b). For individuals, typically women and children, whose health insurance coverage is dependent on their working spouse or parent, any change in status--divorce, widowhood, or simply growing up--poses a constant threat to their health care coverage. Medicare and Medicaid Efforts by government to supplement the workplace oriented health care system have proved equally inadequate. Even with Medicare, the elderly are paying almost 20 percent of their incomes for medical expenses. The average Medicare household is spending $3,305 on out-of-pocket costs for insurance premiums compared with $1,589 in 1961 (measured in 1991 dollars). A major part of these expenses are for nursing homes. Expenditures on hospitals have declined since 1961 and for physicians have increased only slightly (The Washington Post 1991c). Many elderly cannot afford Medicare's copayments and deductibles. Medicaid covers 37 percent of the poor, down from 65 percent in the past decade (Who's to Blame 1991), and health care is available only from those physicians willing to accept Medicaid assignment (The Washington Post 1990). This is proving increasingly difficult for physicians as their reimbursements from Medicaid are substantially lower than for services to their other patients. Moreover, regardless of their incomes Medicaid excludes childless couples and able-bodied, childless, nonpregnant, single adults (EBRI 1990). Limitations of Benefits There are other barriers to health care in the United States. Today, most health care insurance is geared to acute illness, essentially covering hospital and skilled nursing care costs and associated physicians' and other health care professionals' fees. There is almost no reimbursement for home care and other outpatient procedures nor for preventive testing and screening. …
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Sep 25, 2023
Maya Weaver + 1
Open Access