The Deadly Cost of being Uninsured

[acri1]

OPINION
THE DEADLY COST OF BEING UNINSURED
FABIENNE FAUR/AFP/GETTY IMAGES

Those without insurance have fewer doctor visits, receive less preventive care and have worse health outcomes

April 24, 2014 4:15AM ET
by Joe Feinglass


On average, Americans spend more than twice as much on health care costs per person each year than do people in 34 other countries, according to the Organization for Economic Cooperation and Development. That’s $8,233 spent on health care costs per individual in the United States, versus $3,268 elsewhere.

The U.S. nonetheless remains the only wealthy country that fails to provide universal health insurance. And only in the U.S. is there a serious debate about the value of insurance coverage for protecting health.

Eight million Americans nationwide have signed up for insurance on the exchanges through the Affordable Care Act (ACA). Millions more not entitled to subsidies have enrolled directly with insurance companies, and several million Americans have gained coverage through Medicaid in Democratic-led states.

A Gallup poll out this week shows an additional 12 million Americans are newly insured in 2014 — and yet 48 million are still not covered. The extended sign-up period for the ACA expired this week in some states, including California, and some of these uninsured will face tax penalties for not enrolling.

But 24 Republican-led states also declined federally financed Medicaid expansion for their low-income, uninsured residents in 2014. ACA critics have renewed their argument that Medicaid coverage actually “harms the poor.”

An enormous body of research shows this is false. In fact, this growth in coverage from the ACA is likely to have a dramatic effect on the health of the previously uninsured.


Life of the uninsured
For more than 40 years, studies have documented that continuously or intermittently uninsured adults have fewer doctor visits and receive less preventive care, such as blood pressure screening, Pap tests, cholesterol testing or influenza vaccinations.

A recent study of preventable leg amputations describes an uninsured 53-year-old woman with undiagnosed diabetes who was regularly drinking six-packs of ginger ale and other sweetened beverages. She reported that she “felt like a junkie looking for something to quench [her] thirst.” She went into a diabetic coma and wound up hospitalized. Her infected toes required an amputation.

Prevention of this outcome could have been achieved through regular checkups and diabetes medications. But what if doctors’ visits, tests and drugs are unaffordable? Similarly, screening colonoscopies to detect colon cancer and mammograms for breast cancer cost hundreds of dollars and are often unavailable or require years on a waiting list at public hospitals or clinics.

It is not surprising, then, that the uninsured are diagnosed at more advanced stages of cancer, especially for cancers that are detectable by screening. The uninsured have much higher rates of undiagnosed high blood pressure and high cholesterol, are at higher risk for more severe strokes and have poorer control of diabetes.

After the age of 50, major declines in general health and physical functioning for the uninsured as compared with the continuously insured become most significant, as that is when health complications become more common. After the age of 65, when they finally become eligible for Medicare, the uninsured then have disproportionally greater gains in health.

Because seriously ill patients cannot be turned away from the emergency room, many uninsured get hospitalized, but have consistently poorer outcomes. For instance, one study of unconscious patients hospitalized after severe motor vehicle crashes found that the uninsured received less care and had a 40 percent higher mortality rate than insured patients. That higher rate exists even after controlling for type of vehicle, injury, auto insurance, income, neighborhood and hospital characteristics.


Premature death
The uninsured not only suffer from health declines — they also die earlier.

Studies following older middle-aged (ages 51–64) adults into old age demonstrated that individuals who were uninsured died at younger ages when compared with those of the same age and original health status who were privately insured.

The one-third greater mortality of older adults who lacked health insurance was roughly equivalent to the risk of smoking. The lack of health insurance in older middle age could rank as the third leading cause of death, behind heart disease and cancer.

A 2009 study based on a representative sample of the U.S. population and adjusted for detailed health information estimated that between 35,000 and 45,000 Americans ages 18–64 die annually due to lack of health insurance.

It is difficult to detect the health effects of being uninsured, because at any point most of the uninsured are healthy. When major health declines or illnesses do occur, previously uninsured individuals then qualify for disability and Medicaid.

Being uninsured is often a temporary condition, with individuals cycling in and out of employment-based insurance as they change or lose jobs. And the uninsured do receive health care at public hospitals, clinics and hospital emergency rooms. It has thus remained difficult to demonstrate convincingly that providing health insurance to the uninsured will have a major effect.

The deadly cost of being uninsured | Al Jazeera America


Damn...if I didn't know better I'd think Romney's comment about the ER being good enough coverage for the uninsured was inaccurate or something.

Crazy that being uninsured is about as bad for your health as smoking.

 

[acri1]

Medicaid lottery study
One widely publicized study published in The New England Journal of Medicine in 2013 attempted to do just that: It analyzed the health and financial effects of expanding Medicaid for the uninsured in Oregon. The study was based on the state’s decision to conduct a lottery to fill 10,000 additional Medicaid slots for low-income, uninsured residents.

Researchers were able to compare health and financial outcomes of Medicaid lottery winners to lottery losers over the next two years. Individuals who won the lottery had a greater chance of having a physician visit, getting blood cholesterol or blood sugar tests, and receiving a diagnosis of diabetes and thus obtaining diabetes medications.

Although blood pressure, cholesterol and diabetes control were not significantly different, there was a 30 percent reduction in symptoms of depression among insurance lottery winners. Significantly more of these lottery winners reported that their health was the same as or better than the previous year. Lottery winners had a 25 percent lower rate of unpaid medical bills sent to collection agencies, and catastrophic medical expenditures were reduced by more than 80 percent, compared with lottery losers.

Critics of the study pointed to the lack of short-term clinical differences between winners and losers and dismissed lottery winners’ gains in self-reported quality of life as mere perceptions.

However, a longer-term, earlier study, also published in NEJM, compared states providing expanded Medicaid coverage to low-income, childless adults between 1997 and 2007 with neighboring states that did not expand Medicaid.

The study found that states that expanded Medicaid decreased lack of insurance by 15 percent. And these expansion states had a 6 percent decline in deaths of adults ages 20–64 in the five years after Medicaid expansion. The study concluded that only 176 additional adults would have to be covered by Medicaid to prevent one death per year.

The political debate over the Affordable Care Act has reached ludicrous proportions, as Republican politicians attempt to block national surveys that collect data about insurance coverage rates, presumably to prevent President Barack Obama’s administration from taking credit for what will be major declines in lack of insurance.

But whether to provide coverage for the low-income uninsured is not simply a matter of politics — it is about saving lives and needless suffering.

 

[joeychizzle]

Medical care in America seems to be a business rather than a basic human right like most other parts of the world. You wouldn't see no Walter White type shyt in the UK or France because that shyt is paid for.

 

[DEAD7]

Now, I’m not going to drone on tonight about Locke and Bastiat and Nozick and Rawls, but I do want to address the difference between negative rights and positive rights(health care being a negative right IMHO). I know that those on the left side of this House do not necessarily accept that there is a meaningful difference between negative and positive rights. So let’s talk about the progressive conception that we all have a positive right to health care, care largely paid for by other people.

It makes liberals feel good to say “health care is a universal human right.”

But, what is health care?

Let’s say there’s a new treatment for terminal prostate cancer, one that extends your life, on average, by two months. The treatment costs two million dollars per patient. Does every American have a right to that treatment? Is two months of life worth two million dollars?
What if I smoke two packs a day, and I come down with chronic obstructive pulmonary disease, a costly chronic condition. Do I have a right to the money of other people, in order to care for a disease that I, in all likelihood, brought upon myself?


A progressive might respond that we need to provide basic health care to everyone, so that no one is left dying on the street after getting hit by a bus.
But we already provide “free” emergency care to every American. So what else counts as basic health care? Is Viagra health care? Is all health care a right, or just some? And who decides? These are the questions that no feel good punchline can adequately answer.

In Great Britain, the moral logic of the progressive right to health care is carried to its conclusion. In Britain, a bureaucracy called the National Institute for Health and Clinical Excellence, or NICE, has determined that a new treatment that extends life by something called a “quality-adjusted life year” is only worth paying for if it costs less than £20-30,000, or about $30-$45,000. This formula leads NICE to make, from time to time, some interesting decisions.

In 2005, Genentech, the pioneering biotechnology company, announced impressive clinical trial results for a new drug called Lucentis, that treated the leading cause of blindness in the elderly, a disease called age-related macular degeneration, or AMD. Genentech sought to charge £2,000 a month for Lucentis, amounting to £28,000 for a 14-month course of treatment. NICE, however, thought this too expensive, and decided to only recommend payment for Lucentis if a patient was already blind in one eye. NICE’s logic being that a person who has two eyes, and loses one, is not that badly off; whereas a person who has one eye, and loses that one, is completely blind, and that’s no good.

Literally, England has become the land of the blind, in which the one-eyed man is king.

Dont get me wrong I find it appalling that we a quote/unquote capitalist nation spend more on healthcare per capita than socialist dystopias.

I just find it odd that liberals point to cost and coverage as key talking points, when Singapore spends one-seventh of what we spend on health care, and one-quarter of what Europeans do. And yet Singapore has managed to cover everyone, with health outcomes that are as good or better than the rest of the world. They’ve done it through a system of universal health savings accounts, in which every Singaporean saves for his own routine health expenses, while gaining insurance coverage for catastrophic events.

All I can summize is that liberals arent in this for cheaper more comprehensive coverage, but to push a specific socialist agenda...

 

[acri1]

Now, I’m not going to drone on tonight about Locke and Bastiat and Nozick and Rawls, but I do want to address the difference between negative rights and positive rights(health care being a negative right IMHO). I know that those on the left side of this House do not necessarily accept that there is a meaningful difference between negative and positive rights. So let’s talk about the progressive conception that we all have a positive right to health care, care largely paid for by other people.

It makes liberals feel good to say “health care is a universal human right.”

But, what is health care?

Let’s say there’s a new treatment for terminal prostate cancer, one that extends your life, on average, by two months. The treatment costs two million dollars per patient. Does every American have a right to that treatment? Is two months of life worth two million dollars?
What if I smoke two packs a day, and I come down with chronic obstructive pulmonary disease, a costly chronic condition. Do I have a right to the money of other people, in order to care for a disease that I, in all likelihood, brought upon myself?


A progressive might respond that we need to provide basic health care to everyone, so that no one is left dying on the street after getting hit by a bus.
But we already provide “free” emergency care to every American. So what else counts as basic health care? Is Viagra health care? Is all health care a right, or just some? And who decides? These are the questions that no feel good punchline can adequately answer.

First off, there's no such thing as "free" emergency care. In all actuality, emergency care is by FAR the most expensive form of healthcare.

When your average poor/uninsured person gets sick enough (often with a condition that could have been prevented with regular checkups) or gets a life threatening injury, it's true that they usually have no alternative but to go to the ER, and that the ER has to treat them to the point that they're "stable". What happens after that is that said person usually gets an enormous medical bill that they can't possibly pay. There are government programs to help them pay the bills (which I'm sure you're against) but all in all, what usually happens is that the bill doesn't get paid and the hospital passes the costs onto everyone else (ie. you).

So your complaints about being "forced" to pay for other people's medical care are stupid because you're already doing that. In fact you're paying for more expensive forms of medical care than what you yourself usually get. So miss me with that. In your example about the person with chronic obstructive pulmonary disease, in the current system, most likely the person just gets no treatment until they have to go to the ER. The ER by law has to treat them, but the person won't be able to pay the bill. The hospital makes up for this by increasing the costs of all of it's services, which in turn causes insurance companies to raise their rates for everyone, including you. So miss me about not being "forced" to pay for other people.

The arguments about whether health care is "a right" or whether someone "brought a disease on themselves" are way too vague and subjective to be useful. If a person has high blood pressure or diabetes and is obese it'd be easy for you to say it's their own fault, but what if they're skinny? What if a person who doesn't smoke gets lung cancer? How do you measure whether or not that's the case? There's nothing useful to be gained from going off on that tangent.


Rather than "rights" or "blame" the question is what would benefit society the most. The issue is that most people (not sure if you're one of them) would agree that it's immoral to let people die in the streets because they can't pay for treatment. If that's the case, then there's no way around the fact that society will have to pay for some people's health care. After all there will always be people who don't have any money and get sick or injured.

So the question is whether it makes more sense to lock them out of the system until they get sick enough to need emergency treatment (which, again, is the most expensive form of treatment), or to set up a system that covers everybody so that people can get preventative care and try to avoid as many ER trips/surgeries/expensive treatments as possible, thus cutting the overall cost of care.


But keep thinking you don't already pay for other people's medical care

 

[TLR Is Mental Poison]

Now, I’m not going to drone on tonight about Locke and Bastiat and Nozick and Rawls, but I do want to address the difference between negative rights and positive rights(health care being a negative right IMHO). I know that those on the left side of this House do not necessarily accept that there is a meaningful difference between negative and positive rights. So let’s talk about the progressive conception that we all have a positive right to health care, care largely paid for by other people.

It makes liberals feel good to say “health care is a universal human right.”

But, what is health care?

Let’s say there’s a new treatment for terminal prostate cancer, one that extends your life, on average, by two months. The treatment costs two million dollars per patient. Does every American have a right to that treatment? Is two months of life worth two million dollars?
What if I smoke two packs a day, and I come down with chronic obstructive pulmonary disease, a costly chronic condition. Do I have a right to the money of other people, in order to care for a disease that I, in all likelihood, brought upon myself?


A progressive might respond that we need to provide basic health care to everyone, so that no one is left dying on the street after getting hit by a bus.
But we already provide “free” emergency care to every American. So what else counts as basic health care? Is Viagra health care? Is all health care a right, or just some? And who decides? These are the questions that no feel good punchline can adequately answer.




Dont get me wrong I find it appalling that we a quote/unquote capitalist nation spend more on healthcare per capita than socialist dystopias.

I just find it odd that liberals point to cost and coverage as key talking points, when Singapore spends one-seventh of what we spend on health care, and one-quarter of what Europeans do. And yet Singapore has managed to cover everyone, with health outcomes that are as good or better than the rest of the world. They’ve done it through a system of universal health savings accounts, in which every Singaporean saves for his own routine health expenses, while gaining insurance coverage for catastrophic events.

All I can summize is that liberals arent in this for cheaper more comprehensive coverage, but to push a specific socialist agenda...

Emergency health care isn't free. And with a good healthcare system that prostate cancer would get found way before it got terminal, prolonging someone's life for a few decades at a fraction of that 2 million. As usual, you mask your inability and unwillingness to look at an issue objectively and launch into your stupid partisan talking points

We could def do a universal care system that finds savings through preventative care and incentivizing good lifestyle choices. Without health savings accounts. What if you don't have the disposable income to maintain an account? Etc. Of course you don't think about these things because you don't think.

 

[DEAD7]

Emergency health care isn't free. And with a good healthcare system that prostate cancer would get found way before it got terminal, prolonging someone's life for a few decades at a fraction of that 2 million. As usual, you mask your inability and unwillingness to look at an issue objectively and launch into your stupid partisan talking points

We could def do a universal care system that finds savings through preventative care and incentivizing good lifestyle choices. Without health savings accounts. What if you don't have the disposable income to maintain an account? Etc. Of course you don't think about these things because you don't think.

Its a viable model that has been proven(empirically) to be more cost effective than the European model. If cost and care were the real issue, we would be looking at that model and ways to improve it. Instead we are hung up on the socialist model...
There seems to be an agenda other than reducing cost IMHO

 

[DEAD7]

First off, there's no such thing as "free" emergency care. In all actuality, emergency care is by FAR the most expensive form of healthcare.

When your average poor/uninsured person gets sick enough (often with a condition that could have been prevented with regular checkups) or gets a life threatening injury, it's true that they usually have no alternative but to go to the ER, and that the ER has to treat them to the point that they're "stable". What happens after that is that said person usually gets an enormous medical bill that they can't possibly pay. There are government programs to help them pay the bills (which I'm sure you're against) but all in all, what usually happens is that the bill doesn't get paid and the hospital passes the costs onto everyone else (ie. you).

So your complaints about being "forced" to pay for other people's medical care are stupid because you're already doing that. In fact you're paying for more expensive forms of medical care than what you yourself usually get. So miss me with that. In your example about the person with chronic obstructive pulmonary disease, in the current system, most likely the person just gets no treatment until they have to go to the ER. The ER by law has to treat them, but the person won't be able to pay the bill. The hospital makes up for this by increasing the costs of all of it's services, which in turn causes insurance companies to raise their rates for everyone, including you. So miss me about not being "forced" to pay for other people.

The arguments about whether health care is "a right" or whether someone "brought a disease on themselves" are way too vague and subjective to be useful. If a person has high blood pressure or diabetes and is obese it'd be easy for you to say it's their own fault, but what if they're skinny? What if a person who doesn't smoke gets lung cancer? How do you measure whether or not that's the case? There's nothing useful to be gained from going off on that tangent.


Rather than "rights" or "blame" the question is what would benefit society the most. The issue is that most people (not sure if you're one of them) would agree that it's immoral to let people die in the streets because they can't pay for treatment. If that's the case, then there's no way around the fact that society will have to pay for some people's health care. After all there will always be people who don't have any money and get sick or injured.

So the question is whether it makes more sense to lock them out of the system until they get sick enough to need emergency treatment (which, again, is the most expensive form of treatment), or to set up a system that covers everybody so that people can get preventative care and try to avoid as many ER trips/surgeries/expensive treatments as possible, thus cutting the overall cost of care.


But keep thinking you don't already pay for other people's medical care

You're paying for them through higher premiums if you chose(voluntarily) to have healthcare. Its not the same as being mandated. The difference obviously being of little to no consequence on the left, and a point of contention that we will never agree on.
I think it is immoral to let people die in the streets, and I also think its immoral to force some one to pay for some one else's care. and from the sounds of it, no one thinks the latter is moral either, its just considered "for the best".
I think fixing competition in healthcare, removing the ridiculous amount of overhead, and promoting a healthier lifestyle in this country are better options. The example I provided of Britain and its health panel deciding who gets what and how/when. Is where we are headed, and cant possibly be something you are looking forward too? Is it?

 

[TLR Is Mental Poison]

Its a viable model that has been proven(empirically) to be more cost effective than the European model. If cost and care were the real issue, we would be looking at that model and ways to improve it. Instead we are hung up on the socialist model...
There seems to be an agenda other than reducing cost IMHO

Yea other agendas like quality of care and dePth of coverage. I don't know Singapore's system but I doubt it has the range of procedures and cutting edge techniques common here in the US

We have to mitigate cost but not at the expense of everything else. Reflexively jumping on the Singapore wave without looking at the whole picture, as you are so eager to do, would be a mistake

 

[acri1]

You're paying for them through higher premiums if you chose(voluntarily) to have healthcare. Its not the same as being mandated. The difference obviously being of little to no consequence on the left, and a point of contention that we will never agree on.
I think it is immoral to let people die in the streets, and I also think its immoral to force some one to pay for some one else's care. and from the sounds of it, no one thinks the latter is moral either, its just considered "for the best".
I think fixing competition in healthcare, removing the ridiculous amount of overhead, and promoting a healthier lifestyle in this country are better options. The example I provided of Britain and its health panel deciding who gets what and how/when. Is where we are headed, and cant possibly be something you are looking forward too? Is it?

You're not addressing the issue tho...you have to make a choice. Either

1. Let poor/uninsured people die in the streets
2. Pay (as a society) for their healthcare/treatment

Assuming you agree with the latter, there's no alternative...somebody has to pay for their healthcare, it's just a matter of how. Everybody having their premiums driven up isn't really any more voluntary than a tax. It's not just a matter of driving up rates, hospitals have to actually raise the costs of their services to recoup. So it's really an indirect tax since everybody needing treatment (whether they have insurance or pay out of pocket) has to pay extra.

Furthermore, it's a very costly and inefficient way to pay for these people's healthcare. Because, like I said, ER trips are by far the most expensive type of medical care.

All the stuff about removing overhead, promoting healthier lifestyles, etc. is nice and all but it doesn't address the fundamental reason why costs are so high. And miss me with the stuff about health panels...if that bothers you then you should also be bothered by the fact that insurance companies make these types of decisions for people all the time. Or by the "if you're poor, you don't get shyt outside of the ER" determinant of who gets what and how/when. There's no reason that, in a single-payer system, someone wouldn't be able to pay out-of-pocket for a treatment that wasn't covered if they want.

 

[PikaDaDon]

All this Obamacare shyt sounds super complicated. Do you really have to sign up for it? I haven't seen a doctor in years. I have a great disdain for the healthcare system. It's an overcomplicated mess. I wish I could just walk in, see a doctor, and that's it. shyt is all a process like going to the DMV.

 

[acri1]

All this Obamacare shyt sounds super complicated. Do you really have to sign up for it? I haven't seen a doctor in years? I have a great disdain for the healthcare system. It's an overcomplicated mess. I wish I could just walk in, see a doctor, and that's it. shyt is all a process like going to the DMV.

You don't have to sign up for Obamacare, you just have to have some sort of insurance (through your employer or otherwise), if not you pay a tax penalty.

 

[Milk N Cookies]

First off, there's no such thing as "free" emergency care. In all actuality, emergency care is by FAR the most expensive form of healthcare.

Facts. Even with Affordable Care Act or Insurance period, those cost rack up like 3 times as more as you would pay if you had a doctors appointment. It's fukked up cause not everything can wait to be seen at a scheduled time. Emergency rooms &'urgent care is for help needed outside of the doctor office hours and they fukk you over for that.

So blessed that the moment I lost my Obama-care coverage my insurance through my job scooped me up.

 

[PikaDaDon]