Treatment Without Insurance
| Author | Jeffrey Wilson |
| Pages | 925-928 |
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Nearly 40 million Americans between the ages of 18 and 64 carry no health insurance coverage. In the past, only the poor or the unemployed faced this problem. Today, with health care costs rising dramatically each year, the threat of being uninsured now extends to low- and moderate-income people as well. Between 1980 and 1998, according to the Health Care Financing Administration, the amount of money Americans spent on health care quadrupled. In 1998 Americans spent $1.1 trillion on health care, roughly $4,000 for every person in the United States.
Health insurance costs have continued to rise, a problem that has been particularly difficult for small companies and the self-employed. Small companies often have less clout with insurers because they have a smaller premium base and thus cannot negotiate large-scale deals. For the self-employed it is worse. Insurance companies that in the past have offered health insurance policies to individuals have gradually been eliminating this coverage. Even if a person is willing to pay high premiums, there is simply less to choose from in the insurance market. Some people get around this dilemma by getting their insurance through professional associations; others get insurance through a spouse. Some take insurance policies with high deductibles of perhaps $5,000 or even $10,000. These are known as "catastrophic coverage" and are meant to protect individuals from unforeseen major medical events (such as cancer). An alarmingly large number of people, however, seem to be saying that it may be easier and more cost-effective to take their chances and go completely without coverage.
The number of uninsured people had actually been falling since the late 1990s, in response to the strong economy. But with the economic downturn beginning in 2000, the belief was that numbers would begin to rise again. Even if those numbers were to remain steady, the grim fact remains that the most recent figures translate into one in four working-age people.
Clearly the greatest danger in having no health insurance is that a serious illness could destroy one's finances. But there are other less obvious dangers whose combined effects can be quite dramatic.
Many who are uninsured may receive poorer quality health care simply because they do not carry insurance. According to the Employee Benefit Re-
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search Institute (EBRI) in its 2001 Health Confidence Survey, more than two-thirds of uninsured Americans are concerned that they will not get top quality care should they need medical treatment. Moreover, they worry about how they would pay for prescription medication (which can be an enormous expense, especially for a chronic condition) if they needed it.
Moreover, perhaps, about 44 percent of the uninsured have consciously delayed getting needed medical treatment or simply foregone care altogether. Not surprisingly, they may also fail to seek preventive care, such as check-ups or follow-up doctor's visits. The failure to seek needed care may cause the person to become sicker, until there is no choice but to seek care. By then, what might have been a minor or easily treatable problem may have turned into something more serious.
The fear of getting lesser care may not be without merit. A number of studies have shown that the uninsured are given less attention than those who have insurance. The Center for Studying Health System Change released a report in 1998 that showed the level of treatment for the uninsured varied depending in...
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