US healthcare... a National disgrace

an editorial in yesterday's St. Louis Post-Dispatch

The long goodbye

08/31/2006

The number of Americans without health insurance grew by nearly 1.3 million in 2005, the sixth straight year it has increased. Nearly 46.6 million people are now uninsured, the U.S. Census Bureau reported this week. If that doesn't push health care into the center ring of the 2008 election circus, it is hard to know what will. What this means is that about 16 percent of Americans had no health coverage in 2005. From 2000 to 2005, the number of Americans without health insurance grew by nearly 7 million. It is now inescapably clear that a structural change is underway in how Americans pay for health care:Employers want out from under the costs, and government can't afford them, either. That change will not be eased by an improving economy, it leaves increasing numbers of working people either without access to care or impoverished by its costs. In the absence of a national plan, these changes could sink the health care system we all depend upon. That's because the cost of caring for people without insurance is covered either by tax dollars (through Medicaid, which makes payments to hospitals based on their number of uninsured patients), or by "cost-shifting." That's a long-standing practice by hospitals of charging people with insurance slightly more than what to costs to care for them; the extra money covers care to those who can't pay. The fewer Americans without health insurance, the smaller the cost shift; conversely, the more Americans without health insurance, the greater the cost shift. Some experts estimate that the cost shift adds $900 a year to the premiums of those with health insurance. And as premiums increase, more individuals and employers can't afford them, feeding the vicious cycle. At some point -- no one knows exactly where -- the cost shift becomes unsustainable and hospitals can't stay in business. Most Americans still have access to health care, and most still get health insurance through their jobs. But that's changing rapidly. In 2000, 64 percent of Americans had employer-provided health coverage; last year, only 59.5 percent did. Demographers say the drop in employer-provided coverage accounts for most of the increase in the number of uninsured. As always, low-income, low-skill workers and their children are the hardest hit. About one child in five living in poverty has no health insurance. About one adult in four earning less than $25,000 a year has no health insurance. A study prepared for the Missouri Foundation For Health found that 178,000 Missourians, including 16,000 children, lost health insurance coverage between 2000 and 2004. That was before the big Medicaid cuts passed by the Legislature, which slashed 100,000 people from the Medicaid rolls. From 2000 to 2004, the same study found, the number of people making twice the federal poverty level or less in Missouri increased by 330,000. That's significant, because poor people are more likely to be uninsured since low-wage jobs often don't include health benefits. Meanwhile, Congress has voted to cut billions of dollars from Medicaid, which will further increase the ranks of the uninsured. It's long past the time for Congress, employers, insurance companies, workers and health care providers to come together and hammer out a viable, long-range health care strategy for all of America -- those with good benefits, those with dwindling benefits and those with none at all -- that spreads risk, pools resources and contains costs. The conversation should start now, while we still have a health care system to save.