No Coverage, No Security

[NRSKarenRN, BSN, RN]

Second Opinion: No Coverage, No Security

Abigail Trafford

Tuesday, June 18, 2002; Page HE01

http://www.washingtonpost.com/wp-dyn/articles/A64615-2002Jun17.html

There's no "homeland security" for Shawn and Greg Hegdal and their children in Bozeman, Mont. They don't have any health insurance.

There's no homeland security for Alice Gayley in the District. She's disabled by depression. While she's covered by Medicare, she was denied a standard supplemental policy to pay for prescription drugs -- because of her depression, which is why she needs medication.

There's no homeland security for Brian Tilbury in rural Virginia, who has a disabled 31-year-old son. Tilbury, retired military, can cover his son on his retiree health policy, but what will happen when he dies?

Not having coverage -- or being inadequately insured -- is a growing public health problem. An estimated 18,000 people a year die because they lack health insurance and don't get needed, timely care, concluded a recent report by the Institute of Medicine. The review demolishes the myth that if you don't have insurance, you can still get just-as-good care at public clinics and emergency rooms. In fact, being uninsured makes you separate and unequal to the vast majority of Americans who have coverage through their jobs or through government programs.

Yet the plight of the uninsured gets very little attention in Washington.

"I wish the health care advocates would take off the velvet gloves," says Tilbury, a former intelligence officer at the Pentagon. "Let's hear some comparative talk about how many people are killed by terrorism in the U.S.A. versus how many are killed by disease and illness that could be prevented -- prevented by universal health care, backed up by meaningful public health campaigns.

"I'll take my chances with the terrorists in return for universal health care."

It's not going to happen any time soon. The events of Sept. 11 have blown away the health agenda. There's little hope for prescription drug coverage for seniors. The Patients' Bill of Rights has all but disappeared. The uninsured remain invisible, even as their numbers increase.

The prognosis is getting worse. Rising medical costs mean that coverage will become less affordable. Still, it is rare for any politician to breathe the phrase "universal coverage."

"We're all hunting Osama and looking for dirty bombs. Not that this isn't important," says physician-lawyer M. Gregg Bloche, a professor at Georgetown University. But what is the greater threat to people's lives? "If 18,000 people had been killed in a terrorist attack, we'd be in quite a state," continues Bloche, co-director of the Georgetown-Johns Hopkins program in law and public health. "We'd be outraged. We'd go to war."

But there's little sign of outrage beyond the small circle of health care advocates.

To be sure, the victims of uninsurance are different from the victims of terrorism. The uninsured die prematurely because without coverage they don't get access to lifesaving medical care, should they need it. They die of cancer discovered too late, of high blood pressure that rages out of control. These illnesses tend to be slow and complex. It's not the same as being trapped in the World Trade Center on Sept. 11.

With each terrorist threat, the public's fear barometer rises. A massive attack, though unlikely, becomes more real. There is no such dread that the plague of uninsurance will spread.

The stories of the uninsured are complicated, too. Shawn and Greg Hegdal, both 42, checked around last month for coverage, but it would have cost about $700 a month to cover their family. Greg is a self-employed logger. Shawn works part time in the school district. Together they earn about $37,000 a year. But a $700 policy that doesn't include dental or optical? "It's not an option," says Shawn Hegdal, who has spoken out publicly on the problems of the uninsured. "I'd rather put a roof over my children's head."

Alice Gayley, 64, started getting depressed about a decade ago, when she was caring for her ailing father who lived on the family farm in Pennsylvania. After his death, her health and her job unraveled. Uncovered medical bills mounted and she filed for bankruptcy. She now receives disability benefits and her monthly income from Social Security is about $1,400. For a while, prescription drugs were costing her about $500 a month. After being turned down for supplemental coverage, she recently found a special, more expensive Medigap policy, though it has a six-month waiting period. "There are people who are needier than I," she says. "It's not fair."

Brian Tilbury, 63, is almost embarrassed that his health coverage is so good, thanks to special provisions passed by Congress for those who served in the military. "It's the government taking care of its own," he says. But he worries about his son and so many of his neighbors who go without coverage and care. Why can't all Americans get coverage as good as that of government workers?

Covering the uninsured is a moral imperative. It's also a practical one. Without action, the health care system will continue to deteriorate. As Tilbury warns: "It's going to blow up. It's going to be a bigger crisis than one 9/11 incident.

Abigail Trafford can be reached by e-mail at [email protected].