The Kaiser Commission on Medicaid and the Uninsured -
The Cost of NOT Covering the Uninsured Project
"Sicker and Poorer: The Consequences of Being Uninsured"
By Jack Hadley, Ph.D., Principal Research Associate, The Urban Institute
... this report focuses primarily on the relationship between health insurance and health outcomes, which has been addressed by a surprisingly large number of studies over the past 25 years, as well as the link between health and educational attainment and economic opportunity.
This review shows that there is a substantial body of research consistent with a model postulating positive relationships between health insurance, use of medical care, health, income, and education. However, as noted at the outset, none of these studies is definitive, nor are their findings universal. The literature also includes studies that have failed to find a positive relationship between good health and having health insurance or
using more medical care. While all of these studies suffer from methodological flaws of varying degrees, two general observations appear warranted. The first is the fairly remarkable degree of consistency across the studies that support the underlying conceptual model of the relationship between health insurance and health. Studies of different medical conditions, conducted at different times, using different data sets and statistical methods have produced quantitative estimates of the effects of having health insurance or using more medical care that are both consisten with each other and fall within a relatively narrow range. This degree of quantitative agreement across studies reinforces the implications of any single study taken by itself.
The second general observation, holding aside issues of potential
methodological weaknesses, is that many of the studies that failed to find a positive association between health insurance or medical care use and health do not obviously generalize to the current population of uninsured nonelderly adults and their families. Casual empirical observations of pre-Medicare/Medicaid data in the U.S., studies of inefficient medical care use by the elderly or privately insured, and studies of birth outcomes may
not be directly relevant to assessing the health benefits of extending health insurance to those who are currently without insurance coverage. Even if one accepts as valid the findings of the more methodologically sound studies that suggest little or no health benefit from additional medical care use by well-insured populations, it does not necessarily follow that the uninsured would not benefit both from health insurance coverage and from
greater medical care use. Holding both points of view would not be inconsistent. In fact, it would seem to be both inappropriate and unfair to argue on the basis of these studies that the uninsured should be penalized, i.e., denied help in obtaining insurance coverage, because of the inefficient or excessive use of medical care by the well insured.
This report concludes that a compelling case has been made that having health insurance does lead to improved health by means of better access to medical care. Furthermore, the available research on the links between health insurance, health status, and an individual's productivity begins to provide a reasonable basis for future economic analyses of the benefits of health insurance to the nation as a whole.
The next step for health services research is to estimate the size of the economic benefits of continuous health coverage. Estimates of the size of the potential economic benefits should become a prominent part of policy debates over expanding health insurance coverage. These estimates may help shift the current focus from the direct costs of health insurance expansions to the question of how much is likely to be saved by expanding coverage, and ultimately to policy decisions based on a truer sense of the net cost to the nation to cover all Americans.
(The comments above include excerpts from the Executive Summary and excerpts from the Full Report that have been commingled .)
Comment: This comprehensive review of the extensive research on the consequences of being uninsured is a very valuable resource that confirms that the lack of insurance has major negative impacts. This report can be used to refute the arguments of those that use isolated studies to suggest that the uninsured do receive the care that they really need. They clearly
May 24, '02
"Care Without Coverage: Too Little, Too Late"
Institute of Medicine National Academy Press
May 21, 2002
"... the overall mortality risk for uninsured adults, estimated here to be on the order of 18,000 excess deaths among uninsured adults annually, is comprised of elevated mortality rates across many disease categories. All of these excess deaths among uninsured adults occur among relatively young Americans, those under the age of 65."
Comment: Headline news: 18,000 YOUNG ADULTS KILLED
You didn't see this headline? Of course not. That's merely the number of young adults that die each year because they don't have health insurance. And besides, if we emphasized this tragedy, we would probably have to report the follow-up stories that demonstrate that these young adults (and everyone else) could have had life-saving insurance at no net additional cost to us.
We won't publish those stories. Instead, bland stories on the policy issues of the Institute of Medicine are the order of the day (not to mention that the media wouldn't want to risk losing advertising revenue from the private health plans). Then the administration wouldn't be pressured to renew its protest that it's un-American to have the government interfere with the
health insurance marketplace. And we won't have to see our
administration's typical rhetoric that "18,000 young Americans gave their lives for a free America, protecting the principles that make America the great nation that it is."
Since 9/11, our government is turning the world upside down because of the tragic loss of life that day. Yet just since 9/11, FOUR TIMES AS MANY YOUNG ADULTS HAVE DIED because of the lack of insurance. Each two months of inaction duplicates the loss of that tragic day. And our government remains silent. Our leaders won't even discuss real solutions because, "We don't want 'the government' involved in our health insurance."
Why does America tolerate this rhetoric? It's sick! Our health care system is sick! And our political leaders are doing nothing to cure the problems! It's time to grab the placards and take to the streets! Let's go!
Los Angeles Times
May 23, 2002
"County Health System Faces Dire Options"
By Nicholas Riccardi and Garrett Therolf
Under the most optimistic plan, the county would have to close the emergency room at Harbor-UCLA Medical Center near Torrance, eliminate trauma services at King/Drew....
The deficit stems largely from the fact that the county health system treats many of the nearly 3 million uninsured patients in Los Angeles County. Over the years, the county has lost funding while the number of uninsured people has grown.
Dr. Brian Johnston, past president of the Los Angeles County Medical Assn.and an emergency room physician:
"They should put out a public announcement in some of these communities that if something bad happens to you, you are on your own. That's a very busy trauma center. What's going to happen to those people?"
Comment: Most Americans are concerned about the problems of the uninsured. They do believe that measures should be taken to assure access to care for everyone. But they are uncomfortable about increasing taxes to pay for public programs for the medically indigent. And those that have health care coverage and comfortable incomes have even greater concerns about
proposals to replace their health plans with some type of government program. For these reasons there is very little pressure on legislators to seriously address the problems of the uninsured and under-insured. Most would prefer to keep their current secure status in health care even though they regret the problems of the less fortunate. But how secure is the current status of the affluent? What does it mean to shut down trauma centers?
The Institute of Medicine report released this week revealed that an uninsured auto accident victim is more likely to die than a patient with insurance, even though they both were transported to emergency facilities. If merely the insured status makes a difference, then what would be the impact of shutting down the trauma center? Obviously, they are both at much greater risk of dying if they have to be transferred to an over-crowded facility on the other side of a heavily congested city. The
affluent may be relatively complacent, but they shouldn't be.
Currently in California there are proposals to increase funding of trauma care systems by tax increases. But Gov. Davis' office responded that it is unlikely that the tax increase proposals would receive enough support from the state legislature to pass. Even if they did pass, would this small patch in the gigantic voids in our system really bring us health security?
The $1.5 trillion that we are already spending is enough to fund all care for everyone, but we lack an efficient system to properly direct those funds.
The solution is simple- Enact National Health Insurance now.
Last edit by fiestynurse on May 24, '02