America: Land of the Uninsured

The number of uninsured Americans is staggering, and just like an untreated infection, tends to keep growing. In 2005, the number of uninsured Americans topped charts at 41.2 million people, 14.2 % of the population. Although some of the individual that are uninsured refuse coverage due to high costs or decreased adverse selection, it is important to note that a percentage of the uninsured are children. In 2006, the number of uninsured Americans rose from 41.2 million to 47 million people, and 11 million of which are children.

According to the United States 2004 Consensus Bureau Twenty seven percent of the populations have insurance from government funded programs like Medicare and Medicaid. Medicare provides coverage to people over 65 years old by acting as a single payer through a private insurance company. The insurance company covers the individual and then gets reimbursed by the government plus a service of fee. Medicaid works the same way except it is aimed at the poor rather then the old. Medicaid offers coverage to uninsured people who have an income of 120 - 130 percent of the poverty line. Approximately four percent of the population receives medical care from military services, and nine percent of the people choose to pay directly for healthcare, this might include the uninsured individuals who are young and healthy. But the source of the problem displays proximity to employment. Sixty percent of all the insured individuals in the country received medical benefits from their work. The insurance is discounted by the work place and the work place receives a tax break on the insurance they provide. It is a common misconception that all work places will provide their employees with health insurance. Small businesses are now refusing their employees coverage, and force them to seek other routes of insurance, mostly from private health insurance companies, such as a HMO or PPO. This leads approximately sixteen percent of the population to insurance-less.

As compared to other countries, America spends a staggering 16 % of the gross domestic product on healthcare; the highest in the world. This statistic includes prescription drugs, regular doctors' visits, surgical procedures, lasiks, plastic surgery, and dental. It is easy to see where the 16 % GDP comes from; with all the medical expenses Americans undertake its no wonder why it is the best in the world, because Americans pay more. Unfortunately the number is so staggering that it leaves some Americans without coverage and in financial fear of becoming ill. This fear might actually drive some uninsured Americans to live better lives, filled with more exercise and better overall healthcare of oneself. Unfortunately, children don't contain such knowledge, and have an increased moral hazard even with no health coverage.

The real problem in this country can be divided. There are individuals who are uninsured and choose to be that way, and then there are people who are uninsured because they have no choice, they have to choose whether to eat today or go the dentist. The American health system is so good that only the richest can benefit from it. Uninsured people who refuse coverage tend to be younger and in better health, they have a decreased adverse selection and usually live in sunnier places like the south and west. Other uninsured individuals include poor people who make enough money just to be above the poverty line and are refused Medicaid and are transferred to a Medically Needy program "The Medicaid Medically Needy program serves chronically ill people with low incomes
that aren't quite low enough to qualify them for full Medicaid benefits. The program
Subsidizes such patients only when their monthly medical bills climb high enough" (Dolinsk). Even when more problems arise, "For many such patients who also qualify for the federal Medicare program, Medicare Part D has made it almost impossible to qualify as Medically Needy. The state requires such patients to get their drugs through the Medicare Part D drug program now, and no longer factors drugs bills into those patients' total monthly medical cost. Some such patients still need help paying other medical bills, but cannot qualify as Medically Needy because their monthly costs are no longer high enough" (Dolinsk). At least there is always the Emergency Room.

Hospitals have extended their ER privileges in anticipation to help people with Medicaid or poorly covered citizens and children, "You can always get care somewhere, but you will not have a medical home," said Dr. John Ritrosky, a Lee County pediatrician who oversees the state's Children's Medical Services for disabled children who are on Medicaid. "You can always go to the emergency room," he said. "The emergency room will not turn anyone away, but the emergency room is the least desirable place to receive care unless you have a real emergency"(Reed). But unfortunately this kindness doesn't stretch to private practices; private medical practices can still refuse coverage to uninsured individuals and children. The major private practice involved is dental practice. Leaving uninsured individuals somewhat healthy but with bad teeth, the hallmark of American business and customer relations. Bad teeth usually are in equilibrium with bad jobs (Gladwell).

Now that the problem in this country has been identified, what can be done to improve national healthcare? Unfortunately, this plan has to involve some sort of payment; otherwise healthcare will be inexpensive and will become overused, much like a National Health Service Plan in Great Britain. The goal here is to not make health insurance mandatory like socialized medicine, but still provide coverage to people who need it, like the children and the individuals who really make the tough decision, not the CEOs, the poor people who must decide between food and healthcare.

Recently, during the State of the Union Address, George Bush proposed a tax break that will "tackle the rising costs of healthcare with a one-two punch" (Stolberg and Pear, 2007). George Bush proposes "a fixed health insurance tax deduction of $7,500 for individuals and $15,000 for families, regardless of whether they buy their own health insurance or receive work from coverage, but people with insurance plans worth more than their deduction would pay income taxes on the difference" (Stolberg and Pear, 2007). This may sound confusing, but in actuality this plan might benefit uninsured Americans. The plan is aimed at making basic private insurance more affordable to the poor individuals by taxing people who spend too much on healthcare. The cap limit has not been set yet, but if the limit was set at $12,000 a person with coverage costing $13,000 would pay taxes on $1,000 (Stolberg and Pear, 2007). This plan has of chance of going into effect but is in constant scrutiny from the democrats.

It's extremely difficult to conquest the un-insurance that runs a rampage over the poor individuals of the United States. Every victory over one obstacle opens up a door for another. Currently I have talked about the many in this country that are uninsured. In addition I have covered the many programs that the government has assigned to help relief at least some strain on the situation, but the main government programs will always hold the sword that will lead us to victory over un-insurance.

Medicaid and Medicare are the true main governmentally funded programs that help Americans the most, but they are becoming less and less desirable by the patients because doctors and dentists are refusing more and more patients who receive coverage from these programs. The sole reason for this is money. Medicaid is a program that reimburses doctors for their services to the patients under its coverage. Only one problem, it does not reimburse in full but rather only some, "It costs a primary care doctor about $70 to see a patient. The fee covers salaries for the doctor and his staff, utilities, rent and other expenses associated with running a practice. It does not include profits. If the patient were a Medicaid child, the doctor could expect to get $32. If the patient were a Medicare-age senior, however, the doctor would be paid about $58" (Reed). Either way the primary car physician is losing money and has to end up turning many of the Medicaid and Medicare insured away from his/her services.

Recently the government was passed another helpful act towards prescription coverage under the name Medicare part D. This program allows elderly to receive prescription coverage of almost full reimbursement for approximately $2,500 dollars. At this point there is a "donut hole" in the prescription plan, meaning there is a $1,000 amount which must come from the customer rather than be reimbursed by the government. After the $1,000 the government continues to pay for the prescription coverage. Working with many Pharmacy students, I have asked and been told that this plan has actually helped people while placing a minimal burden on the government. Unfortunately, the plan has also hurts some people, the people who are under the Medically Needy program as described previously.

It seems to me that the government is doing the most it can, but with problems coming up constantly it is difficulty to help everyone. There will always be problems of healthcare in this country, even if America was to adopt a socialized healthcare plan. There can never be a perfect plan that suits everyone's needs; this is a utopia which does not exist. I believe that most people know this but it is still difficult to accept. The only true way to battle high healthcare costs is to find a way to make more money, achieve a greater education and become financially able to pay for the high healthcare Americans endure.
Although this is not an option for many people, they can still count on the government to provide at least some sort coverage, with strings naturally attached, but at least it is something. The ER rooms in hospitals are mandated by the government to provide you with coverage. If this is not an option, charity organizations such as St. Vincent's are able to be of further help. Sometimes even Doctors of private practices will remember their Hippocratic Oath and will help. So keep that chin up America, because things will never get better, there will always be problems to endure no matter what direction we take.

REFERENCES

Center on Budget Policies and Control "THE NUMBER OF UNINSURED AMERICANS IS AT AN ALL-TIME HIGH" http://www.cbpp.org/8-29-06health.htm (August 2006).

Dolinsk, Catherine. "'Medically Needy' Program Requires Overhaul, Patients Say" The New York Times. < http://www.tbo.com/news/metro/MGBELCB2MZE.html> (April 9 2007).

Gladwell, Malcom. "The Moral-Hazard Myth" The New Yorker.
(Aug 29 2005).

Overview of the Uninsured in the United States: An analysis of the 2005 Current Population Survey (Sep 22, 2005).

Reed, Jennifer B. "Medicaid for kids under fire" The New York Times.
(March 25 2007)

"Single Payer FAQ" Physicians for a national Health program (Mar 2007).

Stolberg and Pear. "Bush's new health proposal" The Plain Dealer. (Jan 21, 2007).