A few months before I left my job in the insurance industry in 2008, I was working on a "white paper" to try to persuade people -- especially lawmakers and candidates running for office that year -- that the problem of the uninsured in this country was not a big deal.
At that time, according to the U.S. Census Bureau, there were an estimated 47 million Americans who were uninsured, a number that has increased since then by about 4 million. My job was to slice and dice the Census data in such a way to convince people that most of those without coverage were just shirking their personal responsibility to buy it.
One of the statistics I used in the paper was that more than 40 percent of the uninsured are young adults who probably consider themselves sufficiently healthy and bullet proof to make insurance a needless expense. Another was that more than 35 percent of the uninsured earn at least $50,000 and consequently should be able to afford coverage.
What I didn't note in the paper, of course, was that many of the young adults are unemployed or earn so little money that sending monthly premiums to a health insurance company is not a possibility. I also didn't note that many of the people who earn $50,000 or more are considered by insurance companies to be "uninsurable" because of prior illnesses. Insurers, including the nonprofit Blue Cross plans, maintain a long list of "pre-existing conditions" they use to deny coverage.
As Congress debated reform, it became clear to me that many lawmakers were buying what I and others in the insurance industry were selling. They also seemed to believe another fabrication opponents of reform were peddling: that for those who were uninsured for reasons other than irresponsibility, there was an adequate safety net in place. That's when I decided to quit my job and begin explaining how the insurance industry and other special interests have made it impossible for millions of Americans to have access to affordable and quality care.
The myth that the U.S. has a reliable safety net continues to be accepted as truth by many people, as I learned when I was in Chicago a few days ago for Remote Area Medical's first free medical clinic in that city. Since it was founded in 1985 to provide health care services to people in remote areas of Africa and South America, Remote Area Medical (RAM) has provided care to more than half a million people, although since the 1990s most of those people are U.S. citizens. While RAM still flies doctors and other caregivers to nearly inaccessible villages abroad, the majority of its clinics are now held in this country.
At RAM clinics, which have become annual or semiannual events in a growing number of small towns and big cities in the U.S., thousands of people line up before dawn to get care that is provided free by doctors who volunteer their time, often for several days.
One of the volunteers in Chicago was Tres Savage, executive director of RAM's affiliate organization in Oklahoma, which hosted a three-day clinic at the state fairgrounds in Oklahoma City in July 2010. Savage was one of several doctors from outside Illinois -- others came from as far away as Maine and Washington state -- who traveled to Chicago to help treat thousands of area residents who came to Malcolm X College for free medical, dental and vision care.
(Illinois recently passed legislation allowing doctors from other states to volunteer for RAM clinics and others like them. Most states have not yet done so, which limits the number of patients who can be treated. As a consequence, people are frequently turned away because there are not enough doctors, dentists, ophthalmologists and optometrists to meet the growing demand.)
Savage told me that as he and others were planning the Oklahoma clinic, many political and business leaders would make it clear that they had no clue just how shredded the safety net really is in the U.S.
"Inevitably, people would say, 'See this is what we need, organizations like Remote Area Medical,'" Savage said. "They would say, 'What you're doing is great. This is the solution (to our health care problems).'"
"And I would tell them, well let's say we're going to get 2,000 patients treated this weekend, and let's say that we could do that every weekend of the year in Oklahoma. So we're going to do this 52 weeks a year, which is impossible, but let's just say that if we could do it, that would be 104,000 people that we could see. Well, there are 604,000 uninsured Oklahomans. So if we did one of these (clinics) every weekend of the year, we could help one-sixth of just the uninsured. That doesn't count the underinsured and the people who have some medical insurance but no coverage for dental care or vision care."
As it turns out, Oklahomans are luckier than folks in most states. RAM and similar organizations that rely exclusively on volunteers and donated money and supplies can operate in only a limited number of states every year. As much good as they do, they simply don't have the resources to make much more than a dent.
The health care reform law, when fully implemented, will go a long way toward solving the access problem in this country. When fully implemented, the number of uninsured Americans will drop by an estimated 30 million. But more than 20 million others will still be uninsured.
The reform law is already providing money to enable community organizations to provide needed care to the underserved, and those and other grants will help mend the safety net. As helpful as that is, Savage and others who volunteer at RAM's clinics don't expect the need for their services to disappear any time soon.
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Thank you
Clare
Well, here's a thought. Since many states are so politically influenced by their state medical societies, why not pass national legislation empowering nurse practitioners to fully function as primary care providers. inclusion of prescriptive authority. We have 40 years of research to show why it's a good idea.
The Federal government can use Title 18 languaging to remove the "protocol" requirement for NP's. They could also include NP's in the definition of Primary Care Provider.
I'm not even an NP and it makes logical sense to me.
....Second...why do you think that those who suffer the most (esp. in Poor areas) where you are from....vote against thier own interests??????
It's sad to hear -- but not surprising -- that so many people who should know better think we can run the ridiculously costly medical system that we have along with a parellel system for the uninsured.
It's all a mess. If there's a comprehensive solution that does not involve revamping our system and getting the federal government involved as a rulemaker and major payer, I don't know what that would be.
If we had adopted a system like those in other First World countries years ago, just think of the difference. We'd have tremendous financial savings, healthcare for all as well as peace of mind.
What we'd done by delaying has caused so much needless pain, worry and tragedy for millions of Americans.
I just don't support a mandate requiring people to buy private insurance with no choice of a public option.
but did you see
http://www.bluecross-blue-shield.org? which is related to you.
Thanks to conservatives, America is 37th in the world and dropping.
Unfortunately, for every shill who steps up and out of the health insurance industry, there are dozens waiting to fill the vacancy.
While I respect and appreciate your new found integrity and desire to alter course, I disagree that dumping 30 million marginally insured patients into an overburdened health care system is going to create anything less than chaos. At the present time there are an insufficient number of primary care practitioners to handle the current patient load.......hence the need for physician extenders (physician assistants and nurse practitioners) to provide surrogate but not equivalent care.
The reason is simple; low reimbursement rates for primary care are driving good medical students into alternative and more lucrative careers. Most medical students have no choice. After paying for college and then medical school, plus several years of poorly paid internship and residency, they are deeply in debt at a time in their life when they are looking forward to starting a family. The loans come due during residency, not years down the road.
When 30 million patients get added and projected reimbursement will be less than the current abysmal Medicaid payment, you will see physicians refusing to take these patients into their practice and patients will continue to use the expensive ER as their site for medical care.
Health care reform does not address the profit motive behind every stakeholder, which drives costs up. Universal health care does address that..
Are you a member of Physicians for a National Health Program
http://www.pnhp.org/
Physicians for a National Health Program
The medical schools need to take a haircut as well, the costs have risen so outrageously with the intended purpose to restrict the field of applicants, which causes a "fake shortage". I'm not saying make medical school open to *anyone* (keep admission standards high as far as academics and skill) but to rein in the costs of schooling so as not to discount otherwise qualified applicants from attending, and thus creating unnecessary provider shortages. It seems the medical schools may intend to create the shortage, which allows for providers to raise costs based on their scare supply for a high demand.
I wouldn't worry about any of it to much, since the "mandate" is so laughably unconstitutional that the Supremes are sure to kill it, which will collapse the CrapCare program, entirely.
Here's the issue: the majority of Americans that currently "approve" of the current health insurance situation tend to be those covered by employer provided coverage. Reason being is that employer provided coverage is provided without the underwriting process that is required for "individual" market based coverage. It is also, for the most part, subsidized by the employer and within large employer groups, more closely mimics what a national single payer system would behave like. In so far, that there are no underwriting conditions to be met, coverage is allocated on a group level with pre-set payments and a responsiveness of the system that must satisfy all payers in the group in order to maintain the insurance company as a competent administrator. Most large group coverage plans are actually self-insured, the insurance company simply functions as an administrator. None of the claims are paid out of the insurance coffers, they are instead paid a flat fee for administrating the plan. The claims are paid out of the coverage pool of premiums.
I completely agree that insurance is a poor model for administrating health care. Insurance is intended for rare, yet costly, and typically one time occurrences. Think flood, hurricane, fire insurance. It cannot efficiently addres ps the plain fact that health care is not rare or a one time occurrence in a sizable amount of the population. Nor can it address the truth that human beings cannot be "indemnified" to the a previous condition. The aging process alone defies this logic. In any other insurance model. Property can either repaired to the original condition or "totaled" out for the value of the property which sets an end-point for insurance liability. This can't be done with health care so the industry imposes artificial caps on care that don't synch with the reality of the care required.
Doctors in other nations with universal coverage of any form still make high incomes and live well in a high position in their societies. They may not be millionaires on average but at some point we have to question is the primary purpose of the health care system to make some doctors insanely rich or is it to disseminate health care? Any doctor getting in the field soley for the money should probably look to other, just as or more, lucrative fields that don't necessitate creating vast disparities of accessbility of medical care in order to maintain a desired income level.
Well said kind sir.
And may I add that that may be because business (including insurance company oficers) and political leaders are much more interested in next quarter's earnings and the next electon.
We as a country are learning that unchecked self-interest does not further the common good despite what free market creeds tell us.It was not a solution in product safety,consumer protection,bank regulation, financial speculation or health care. Our economic crisis was man-made and so is our health care crisis.Both are "fixable" with a serious dose of honesty and dedication to the truth. Do we as a people have the courage to put our bias aside to save our country? I sure hope so.
Yeah, he gives a good explanation of things in this clip, along with Daschle and Howard Dean: http://www.youtube.com/watch?v=5PwqSCJmbxk
We could spend our entire GDP on health care, and have nothing left for anything else. What would we do then?
What is actually strangling governments is the practice of luring large companies (who promise jobs in the area) into an area with tax breaks.
http://www.cms.gov/MedicaidEligibility/02_AreYouEligible_.asp#TopOfPage
Would YOU qualify?
So we should spend a couple of trillion more, and help those who don't qualify? Where does it end?
I'm qualified to pay taxes to help with this, but if taxes go to 100%, I'll stop working.