Guaranteed Healthcare

In an ocean of sobering reports on the collapse of the U.S. healthcare system, this just released report from The  Center for Studying Health System Change, is among the most horrifying I've seen.

Falling Behind: Americans' Access to Medical Care Deteriorates, 2003-2007

The number and proportion of Americans reporting going without or delaying needed medical care increased sharply between 2003 and 2007, according to findings from the Center for Studying Health System Change’s (HSC) nationally representative 2007 Health Tracking Household Survey. One in five Americans—59 million people—reported not getting or delaying needed medical care in 2007, up from one in seven—36 million people—in 2003. <u>While access deteriorated for both insured and uninsured people, insured people experienced a larger relative increase in access problems compared with uninsured people.

Here are some of the astonishing highlights.

Access to Needed Medical Care Declines:

 In 2007, approximately 20 percent of the U.S. population—one in five people—reported not getting or delaying needed medical care at some point in the previous 12 months, up significantly from 14 percent—one in seven—in 2003. The dramatic decline in access between 2003 and 2007 signals a sharp change in Americans’ access to care, which was relatively stable between 1997 and 2003, including some gains.1 Increased health care costs, along with health insurance-related and health system-related problems, appear to be the major contributor to Americans’ declining access to care.

Access Deteriorates for Insured and Uninsured:

Uninsured people continue to have much higher levels of unmet medical need and delayed care compared with insured people, and access for the uninsured decreased between 2003 and 2007 for both uninsured people with incomes below 200 percent of poverty—$41,300 for a family of four in 2007—and above (see Table 1).

. . .However, insured people also faced large increases in unmet need between 2003 and 2007. In fact, insured people experienced a greater percentage increase in unmet medical needs compared with uninsured people—a 62 percent increase for the insured vs. a 33 percent increase for the uninsured.

. . .Other HSC research confirms that insured people with greater out-of-pocket medical costs are more likely to delay or go without needed care.4

Sickest Face More Access Problems:

Unmet medical needs are greater for people in poor or fair health compared with people in good, very good or excellent health. Sicker people use more health care and, therefore, have more chances to encounter obstacles in getting care.

There are other areas I'm going to skip, I do suggest you read the entire report

Let's move to the end, Implications.

 The sharp increase in access problems for insured people strongly suggests that the access to medical care that insurance coverage previously guaranteed is declining. Insured people are facing growing cost pressures, including higher out-of-pocket spending for care, more difficulties finding providers who will accept their insurance and renewed limits on what their insurance will cover. An alternative interpretation of these results is that as individuals are exposed to more of the costs of care, they are becoming more efficient users by delaying or forgoing care that may be of low marginal value, which is the key rationale for consumer-directed health care.

This, by the way, was the response of the monster who runs AHIP to this report

Karen Ignagni, president and CEO, America's Health Insurance Plans, www.ahip.org

"Health care reform needs to be a top priority to ensure that nobody falls through the cracks. We have offered proposals to shore up the health care safety net, give working families a helping hand to afford health care coverage, and to address the cost-drivers that are making health care coverage unaffordable for many Americans."

Many Republican health analysts argue shifting health costs onto you and me will make us less profligate in our health spending. The self-serving insanity goes something like this, we'll become more aware healthcare consumers, we'll forego all those delightful Frankenstein inspired medical tests which we beg for and over consume. This is undoubtedly true, especially when Americans can barely put food on the table or afford gas to drive to work.

But, at the end of the day, these findings are a stark (and I would say, grim) wake up call that when you and I are required to pay more for healthcare, we will put off care, or skip it altogether. Small cheap health problems, become big expensive crises.

Let me end by returning to insured Americans and the huge issue of insurance company denials which this report only reviews in a tangential fashion.

Those of us able to write huge checks every month in order to maintain our for-profit insurance coverage, find when we become ill, that it's a virtual guarantee that we'll face an onslaught of insurance company denials for medically necessary and appropriate care.  This is standard insurance industry practice in the United States.

 This reality is what we were protesting last week in San Francisco at the AHIP freak show.

If you've ever been sick, you know the meaning of fear. Fear of dying, fear of becoming a burden on your family, fear of disfigurement. Add to that fear of the brutality of the Murder By Spreadhseet insurance industry.