Friday, March 28, 2008

Who are the Uninsured in America?

The uninsured are tossed around like pawns on a chess board, but most do not have an idea of who the uninsured are and how they became part of this faceless roll that houses these people. In order to understand why it is imperative that legislation be put in place that assist them, let’s take time to pull back the curtain of mystique on globally grouping the uninsured as the “have” and “have nots” and hear the story of my patient Ms. G. Ms. G is a 59-year-old African-American woman who works as a cook at a local day care here in Baton Rouge, LA.

Contrary to public opinion, Ms. G has been employed all of her life as a cook and has held her current job for thirteen years. She was referred to me after being evaluated in the emergency room for an elevated blood pressure, elevated blood sugar, and headaches. The emergency room doctor insisted that she seek the services of a primary care physician and get her blood pressure and blood sugar under control, or suffer the repercussions of these health conditions- a heart attack or stroke. Physically, Ms. G is in poor health but with some changes her health outlook could improve. She is a slightly over weight smoker with a strong family history of heart disease and diabetes. Her mother and father died from complications of heart disease, and her younger sister recently died from a massive heart attack.

Her options for treatment were limited to the local charity hospital, which has eliminated the outpatient family practice clinic due to budget cuts. Before the clinic discontinued its services there was a typical wait of four to six months for a routine appointment. This wait was so prohibitive she has never followed up with a physician for “scheduled visits” after her initial emergency room visits. In addition to simply accessing healthcare, the price tag for maintenance of ones health is unreasonable. The average cost for an appointment with a primary care doctor for cash-paying patients that includes blood work and other tests ranges from $200-400 dollars, but I have seen her in my office free of charge.

Prior to her visit at my office, the emergency room had become her primary care doctor and she was very appreciative of seeing a “regular” doctor. Because Ms. G lives just above the poverty level and, as she puts it, “robs Peter to pay Paul”, she has never been able to afford health care insurance and has placed eating, paying the bills, and helping to raise her grandchildren as a priority over her own health. “I gotta live Doc. Maybe I will get some insurance later; but right now, I gotta live.” Later may just be “too late” for Ms. G. Without medical intervention and a consistent health care program maintained by a physician, her risk for heart disease and stroke are high.

Although Ms. G’s story is sad, unfortunately, her story is a very common and frustrating problem for both physicians and patients. There are more than forty million uninsured people that live in the United States, which is twenty- percent of the U. S. population. In 2005, one in five Americans under the age of sixty-five did not have health insurance. This number has continued to increase which was reinforced by findings released on December 3, 2007 by the CDC entitled Health United States 2007, which showed that one-fifth of Americans could not afford one or more of the following services: medical care, mental health services, prescription medicines, eyeglasses, or dental care.

Since the release of Michael Moore’s controversial and thought provoking documentary Sicko which addresses the state of health care in the United States, this topic has spawned much debate: how many people are uninsured in America, forty-seven million or thirty-seven million; does that include the illegal immigrants; is universal health care really cost effective; who’s healthier, Michael Moore or Sanjay Gupta? Who cares! One uninsured or under-insured American is one too many!

The face of the uninsured may not be what you think. Those without health insurance do live significantly below the poverty level, however nearly seventy- percent live in homes with at least one full-time worker. Health insurance is either not offered by the employer or the percentage that the worker is asked to pay towards insurance premiums is too expensive. Medicaid and the State Children’s Health Insurance Program have reduced the number of uninsured children under the age of nineteen; nevertheless, more than eight million children, three-quarters of whom qualify for these programs, still are not insured. Young adults between the ages of nineteen and twenty-nine with low income and unstable jobs are the fastest growing population of uninsured in America.

In a poll by the Henry J. Kaiser Family Foundation, voters rated health care second only to the war in Iraq as the issue they most wanted the presidential candidates to address. Seventy-four percent of voters supported a reform plan that provided health insurance for everyone. The time has come for universal and affordable health care. I don’t have all the answers, but this crisis needs to be addressed and should be of the highest priority for the presidential candidates as these nameless people are their constituents and an integral part of the fabric of this country. (c) 2008 Rani Whitfield. This article was published March 2008 at