There must be a better way to fill health care void
Kate Scannell, The Oakland Tribune
Sunday, October 12, 2003

BEING No. 1 is not always a good thing. In fact, it is downright unhealthy when it comes to ranking as the state with the largest number of people who lack health insurance.

According to the 2002 U.S. census figures released in September, California earned first-place status with about 6.4 million people lacking coverage last year. When that number is adjusted for the considerable size of our population, still 18.2 percent of Californians were without coverage, ranking us as sixth in the nation.

Overall, the nationwide census data highlight the sobering reality that our country's deplorable health insurance crisis continues to worsen. As people lost jobs and as the cost of their insurance premiums increased, the number of Americans living without insurance rose an additional 6 percent in the year 2002 alone. Currently, 43.6 million persons in the U.S. -- or 15.2 percent of Americans -- are living without health insurance.

And still, these disturbing numbers under-represent our health insurance crisis. Notably, they do not figure in the problem of the "under-insured" who can afford only bare bones or catastrophic coverage through skimpy insurance policies. They also do not figure in the problems faced by the "quasi-insured" who cannot afford the insurance co-pays for their medical care or pharmaceuticals.

Findings from the 2002 census furthermore indicate that the risk of being uninsured in America is refracted through age, income and race. For example, the data reveal that over 11 percent of children and almost 30 percent of Americans aged 18 to 24 years are uninsured. About 23 percent of households with an annual income under $25,000 lacked health insurance, compared with only 8 percent of households earning at least $75,000. A differential risk of being uninsured was glaringly manifest according to race, with about 30 percent of Latinos, 20 percent of African Americans, 18 percent of Asians, and 14 percent of whites lacking insurance.

These grim findings from the census report additionally undermine the prevailing myth that the lack of health insurance is a problem of the poor or unemployed. Indeed, owning health insurance has become a major financial burden for lower middle class American workers earning between

$25,000 and $50,000 per year, and up to 20 million full-time workers lack any coverage.

It is both stunning and shameful that our country does not offer a fair and humane health care system to all its citizens. Clearly, the social, political and philosophical foundations that support and sustain the current flawed system need to be reexamined. In this regard, one of the fundamental questions we must ask is why our insurance status should continue to depend so heavily upon our job status. It has been pointed out that the idiosyncratic legacy of employer-provided insurance began during World War II when employers, facing wartime anti-inflation controls that limited wage hikes, offered health insurance as a supplemental benefit in order to attract workers. But this old scheme prevails today, and its firm entrenchment within our health care system undermines attempts to create any new arrangement. As an example, mandatory employer-provided health insurance was supported by President Nixon in the 1970s in a successful attempt to silence Senator Edward Kennedy's urgings for a national health care program.

Soon-to-be-ex-Governor Gray Davis recently signed the Health Insurance Act of 2003. This Act will require employers with at least 20 employees to pay at least 80 percent of their workers' health care coverage. Critics warn that the variously predicted $1.3 billion to

$5.7 billion cost to business will prove to be unsustainable, encourage more companies to cut jobs in order to maintain workforces beneath the threshold for providing mandated coverage, and discourage out-of-state businesses from relocation to California.

Proponents of the act declare that 1 million more Californians will be provided with coverage. They also laud the act as a step towards universal health care. But in my view, if this is a step, it is a lateral one, not a forward one. To me, it looks like another measure that reinforces the status quo in which health care coverage remains problematically dependent upon employment.

As bad as our health insurance crisis may be, it is expected to worsen as employers clamp down on the quality and range of health insurance benefits, as retirees face the increasing likelihood that health insurance will be erased from their benefits package, as the number of unemployed Americans expands in our jobless recovery, and as our health care costs continue to soar.

A clean overhaul of our system is necessary. Paradigm shifts in our thinking about health care are required. Primarily, we need to question why we structure our health care as a for-profit enterprise in the first place, why we treat it as a commodity that is filtered through a complex, multi-tiered network of for-profit agencies (like insurance companies).

Secondly, we need to ask why our health insurance status remains so linked to our employment status, why it depends on whether we are lucky enough to find a job, and fortunate enough to work for a company with at least 20 employees. Most importantly, we need to question why we maintain a health care system that blatantly discriminates amongst our fellow beings according to the color of money.

Kate Scannell is an East Bay physician and the author of "Death of the Good Doctor."