Plight of the Uninsured: What would it take to solve it?

First in a series of occasional pieces on health-care policy.

My friend could have been a poster boy for the health-care industry. “Running is my health insurance,” he’d tell me as he set off for another run or signed up for a 10-K race. Another frequent refrain: “I’m in charge of my health.”

My friend died this month of colon cancer. He was 60.

He was self-employed and he was uninsured.

I’m not going to use his name because he wouldn’t want to be remembered for his lack of health insurance. He was not proud of it, but he was trying to make the best of it with a little bravado.

“My running is my health insurance. I’m in charge of my health.”

He just couldn’t afford the usual health insurance.

One among 374,000

Some might well say he couldn’t afford not to have it. Yet he was among the 374,000 Minnesotans who didn’t have health insurance in 2007, which statistically translates to 7.2 percent of the state’s population – reportedly among the lowest uninsured rates in the nation. Of that uninsured group, he was among the 20.6 percent called self-employed, the 3.7 percent with postgraduate degrees and the 68.3 percent who were unmarried. Though a Minnesota Department of Health Fact Sheet (PDF) has a lot of details, bar graphs and pie charts on the state’s comparatively good statistics, this fact stands out: My friend was 100 percent uninsured.

So, he ran, he played tennis, he swam, he lifted weights. He quit smoking decades ago. He appeared to be in great physical shape most of the time, though he liked to eat the foods we probably shouldn’t eat that often.

“Running is my health insurance. I’m in charge of my health.”

But because he didn’t have health insurance, he probably didn’t undergo the colonoscopy recommended at age 50 by the American Medical Association, the screening procedure covered by insurance. He ignored the symptoms until it was too late.

“I started feeling bad in March,” he told me a few days before he died, “but I didn’t do anything about it for a while.” 

Once diagnosed, little time
By the time he was diagnosed, he was given six weeks to live. The cancer had metastasized into his liver. He was turning yellow with jaundice, and his once-trim belly and muscular legs were bloated.

The discussion turned to whether chemotherapy would buy him time to settle his affairs and whether he had enough money on hand to pay for a round or two of treatment and how much he’d have to spend down what he had in the bank to qualify for Medical Assistance. He invested in prescriptions for morphine and diuretics instead.

I’m in charge of my health.”
 
He outlived the six-week, or 43-day, diagnosis by two days. Those 48 hours bought him enough time to enjoy a party in his honor, to see family, friends and clients gathered on a cool spring evening in a friend’s backyard, to let us wait on him hand and foot, to admire photos of him through his life, to listen to live Irish music once more with him, this time the plaintive wails wishing him farewell.   

When I share my friend’s story, people are visibly shaken. I’ve seen and heard enough reactions that I can confidently report the consensus: He didn’t have health insurance? What is wrong with our country’s health system?! Why don’t we as a nation, with all our wealth, have some form of universal health care for our citizens? Why is health care/insurance so expensive?

Looking for answers
Provocative questions. I’ll explore them in the coming weeks in a series of posts and stories.

Since 2001, I’ve been reading and collecting reports from various publications on our nation’s health-care issues, hoping somehow that I (an editor most of this time) could persuade others to report a public-service project asking these questions: What would it take to get universal health care in our state? What are the pros and cons? How would it work?

Trying to connect all those dots sounds daunting, doesn’t it? But now I must try to make sense of this predicament – for my friend and others like him. I have a lot of questions. I need some answers. 
 
A week after my friend’s death, presidential candidate John McCain was in St. Paul for a town hall meeting and I wondered if he might have some answers as I read MinnPost writer G.R. Anderson Jr.’s report on the event:

“The second question came from a woman whose son has a ‘chronic disease’ and the family’s health insurance can’t keep up with the bills. McCain looked positively morose, but offered nothing concrete on health care, other than saying to people who want socialized medicine, ‘I suggest you go to Canada or England.’ “

If only my friend had thought of that option.

Next: Minnesota’s 374,000 uninsured people could fill a city close to the size of Minneapolis. Who are the people in this population? Please feel free to pose some of your own questions for our ongoing series in the comments section below.

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Comments (7)

  1. Submitted by Bernice Vetsch on 06/25/2008 - 01:15 pm.

    I think the tide is turning and that those who have been saying that single-payer is “unachievable” will soon be proved wrong. Perhaps next year!

    In Minnesota, Senator John Marty has introduced a tax-supported single-payer plan (SF 2324) that would provide health care, preventive care, dental, mental, eyeglasses — everything necessary to good health — to every person in Minnesota WHILE COSTING LESS THAN WHAT WE NOW SPEND. See http://www.mnhealthplan.org.

    Nationally, John Conyers has several times introduced HR 676, the national version of the Minnesota plan. It would provide all necessary care to every person in the United States…like Medicare for All. See his web site for a full description (www.house.gov).

    Our system is now, in effect, managed by the insurance and drug companies that benefit from it. Much of the insurance companies’ profit comes from denying coverage wherever possible. Administrative costs are about 31 percent of dollars spent, while Medicare’s costs are between 2 and 3 percent. What in the world are we waiting for?? Perhaps for Minnesota to show the way!

  2. Submitted by Bernice Vetsch on 06/25/2008 - 01:19 pm.

    I should have mentioned that single-payer is NOT socialized medicine. Patients have complete choice of providers, who are all private, but only one insurance company/payer – the government. Our police and fire departments are socialized; all cops and fire fighters are government employees and all answer our calls to 911.

  3. Submitted by Ed Stych on 06/25/2008 - 10:18 pm.

    Ms. Selix writes, “When I share my friend’s story, people are visibly shaken. I’ve seen and heard enough reactions that I can confidently report the consensus: He didn’t have health insurance? What is wrong with our country’s health system?!”

    I guess it all depends on who you hang out with. My first response was, “Why didn’t the guy care enough about his health to find the $400 or $500 a month to buy health insurance?”

    Many people gamble on their health by CHOOSING not to take medical insurance. As the owner of a small business, we offer our employees group health insurance and we pay a significant amount of the premium. Yet, on several occasions over 15 years I have had to beg — and in one case practically order — an employee to sign up for our plan. In most of those cases, these were young, single people making triple the minimum wage who just didn’t want to pay $50 or $75 or $100 a month for health insurance. They wanted to take the gamble and save their money for the tavern or some other form of entertainment.

    When I hire new employees, many have been out of work for a month or two and have CHOSEN not to take COBRA from their previous job. The explanation always is that they decided to take the gamble that nothing would happen in the couple of months they were without insurance.

    I know of a family who spent $20,000 a year to send three children to private schools. They CHOSE to go without health insurance for a period of time because they needed the money for tuition for Kid No. 3. It was that important to them.

    Yes, we have 374,000 people without health insurance. I assume they’re mostly not the same people year after year. People move in and out of the system, often at their own choosing. We certainly need to take care of the chronically poor, but I believe there are already federal and state programs for those people. The people we are trying to figure out how to cover are generally “middle class” who have chosen — at least for a time — to forego insurance. I assume that the friend in this story is middle class.

    Many of you think I’m crass. But my experience is that many people are making a conscious choice to forego health insurance in lieu of something that is less important than making the mortgage payment or going grocery shopping.

    I make choices, too. I choose to have health insurance, but I also have CHOSEN to eat too many pizzas and to not exercise enough. If I have a heart attack or colon cancer before I’m 60 or 70, I can only blame myself for my choices. And I do NOT want the government outlawing burgers or pizzas, or requiring me to go to the gym four times a week, even though those would be the right choices for living a healthy life.

    I empathize. But the answer is not to socialize medicine like Canada and much of Western Europe has done. We’ll regret that.

    On the other hand, 92.8 percent of Minnesotans have health insurance? Wow! That’s pretty good! What else do we do that is voluntary at such a high rate?

  4. Submitted by Karen Sandness on 06/25/2008 - 08:04 pm.

    I’m a middle-aged, single, self-employed person, and while I technically have health insurance, it’s virtually useless because of the high deductible. (High-deductible is the only kind of insurance I can afford.) As a first step, we should ban deductibles, because all they do is discourage people from getting needed care. Decades ago, I had opportunities to move to Japan, Norway, and Australia. I could kick myself for not taking those opportunities.

  5. Submitted by Gerald Abrahamson on 06/25/2008 - 11:09 am.

    This issue has been analyzed and discussed on the AARP message boards for some time now.

    It boils down to the desire of the people and the govt to get the most care for everyone at the lowest cost.

    That means changing to a SP-UHC (Single Payer-Universal Health Care) system of covering most medical expenses rather than private insurance. Private insurance could be bought to cover additional, optional, choices but the major expense of private insurance would be gone.

    Just cutting out the paperwork required for X insurance companies and replacing them with one form would save an estimated $1000/person per year in premiums.

    Then, eliminate the 30+% gross profit margin built into any premiums paid (company wants that profit !!). That reduces costs by another $500-$1000+/person per year.

    Then medical costs go down because doctors and hospitals get paid for everything they do–with virtually no uninsured being given free treatment. So, no need for a hidden markup to cover the cost of those who can’t or won’t pay–because everyone has health insurance and can pay.

    US healthcare costs are about double (per person) the cost of care in most other developed nations. Yet everyone is covered outside the US–while only those who can afford private insurance have coverage in the US.

    The quality of care under universal coverage is better than under the private system because the medical staff do not have to pinch pennies and thus put your life at risk to make a profit. They are then free to do what is needed to get the job done and do it as efficiently as they needed. Medical need (within reason), not cost, determines what treatment is given.

  6. Submitted by John Olson on 06/27/2008 - 12:29 pm.

    Ed, it’s not just the $400 or $500 per month. Unless you have a health insurance plan that is going to cover the vast majority of claims once the deductibles and copays are met, it would be a deal worth taking.

    The problem is that not everything is covered and despite paying that $400 or $500 a month in premiums, you are STILL going to have expenses excluded that are above and beyond the “usual and customary” charges. I doctor friends who discuss arguments with beancounters in these companies who are really making the health care decisions for their patients. They are not MDs, they are not nurses.

    If I am going to pay $400 or $500 a month and STILL have a five- or six-figure bill after the treatment/procedure is done, what has my insurance premium done for me?

    And before we wander down the yellow brick road of socialized medicine, keep in mind then that you will have government bureaucrats making decisions on what is allowed/disallowed.

  7. Submitted by Kassie Church on 06/26/2008 - 09:13 am.

    $100 a month is the difference between feeding your family and starving for a lot of people. Sure, we can all come up with antedotes about people making bad decisions, but that isn’t the normal case.

    If my husband and I had to pay for our insurance I would guess we would be uninsured. Even $300 a month would push us over the edge, and me make over $100,000 a year. We just have a lot of school and credit card debt that we are climbing out of. Thank god we both have union jobs.

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