Barely covered

Nothing better demonstrates the problem of leaving politics to politicians than the increasing number of Americans who lack health insurance. Ever since President Clinton’s failed reforms in his first term, Congress and the White House have been afraid to offer a comprehensive overhaul of this broken system. As a new report reveals, that has meant millions more without insurance and everybody else with higher premiums.

The single most significant failure of the health care system in the United States is that one American in six lacks coverage. The health care these citizens receive is often inadequate, often provided late and always more expensive than the preventive and primary care enjoyed by the covered. The American Journal of Public Health in its January issue reports that the number of Americans without health care rose from 33.4 million in 1989 to 41.7 million by ’97. Even more disturbing were Maine’s numbers – an increase of uninsured from 110,000 to 182,000 over that same period.

It could be worse. The number of people considered underinsured number 29 million nationwide. By stretching Medicaid in ways it was never intended to be stretched, states have covered an additional 11 million – relatively few of whom, the authors conclude, ended up with Medicaid coverage because a private system was “crowded out.”

The increase in the uninsured occurred during the longest peacetime economic expansion in U.S. history. It occurred despite nearly continuous government tinkering with the health insurance system and despite the growing awareness of the enormous cost of having a large number of Americans receive their health care through hospital emergency rooms.

In a recent news story, an author of the report was succinct in his conclusions. “What we’re expecting is that as the economy cools, we’re going to see a huge increase as employers cut back,” said Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School. For 33 years, he said, the nation has been “getting away from full coverage, not moving towards it. We need national health insurance.” Instead, Congress offers Band-Aids. Neither party’s Patient Bill of Rights will get at the underlying problem of health care coverage, which is that access to the system remains a burden of business rather than a right of citizenship.

Consider that the country would never leave its highways for private businesses to construct as they pleased. The national pavement is too important for that. But the actual health of citizens? Apparently a different story. Politicians will puff about the sanctity of competition and the free market, but they are increasingly talking to people who have been competed out of their health insurance and find nothing free about the market.

The problem in Maine is going to get worse whether or not the economy cools. Gone are the jobs that could support a family, had full benefits and lasted a lifetime. They are being replaced by low-pay, low-benefit transitional jobs that transition to … well, no one in Augusta seems to know where the Maine economy is supposed to go with this service-sector work – just don’t try to go to a doctor with it because you probably aren’t covered.

The lack of health care coverage is a national problem that demands a national solution. It has been laid out clearly by the American Journal of Public Health. Now it needs Congress to act as if the health of the American people mattered.