Reform Health Care Now: 87 million uninsured, and growing

A few months ago, one of my patients approached me with a dilemma. She had been laid off from her job, but had let her employer-sponsored health insurance lapse without signing up for COBRA, which allows terminated employees to pay to continue their health insurance coverage with their previous employer for up to 18 months. She didn't qualify for government-sponsored insurance because she had a small family savings account. And she was unable to get an individual policy because at that moment she had what insurers classify a "pre-existing condition": She was pregnant.

When my patient asked me how much it would cost to deliver her baby in the hospital, I explained that a normal delivery would cost about $15,000, but if she ended up having a C-section she could easily wind up with a $30,000 bill. And her tab could top $100,000 if she had a premature baby requiring care in the NICU. Having a baby could not only wipe out her savings, it could land her in bankruptcy.

My patient was so distraught that she seriously considered having a home birth despite the fact that she had a high-risk pregnancy. Fortunately, towards the end of the pregnancy, she married the father of the baby and qualified for his insurance plan. She delivered a healthy baby in March.

The number of uninsured in this country has risen steadily for the past 10 years. During the last survey, in 2007, the total reached about 46 million Americans, or roughly 15 percent of the population. But that figure is misleading. According to the President's health care reform website, there were actually 87 million Americans who went without insurance at some point during the year. And that was before the recent surge in unemployment, which is expected to add many tens of millions to those figures.

How did we get to the point where one out of every three Americans is regularly going without health insurance? Well, for starters, many businesses can no longer afford the cost of employer-sponsored health care coverage, as I described in the first installment in this series. Instead, they get around the law requiring coverage for full-time workers by hiring more part-time employees.

Another factor is that insurers have made it virtually impossible for individuals to purchase their own health care plans if they have a preexisting condition. Or if they do find a plan, it's inevitably expensive and offers inadequate coverage.

Part of the problem, too, is simply that our current system was patched together from a time when there was far less mobility in the American workforce. Tying the continuity of a person's health coverage to his or her job security made more sense when many more people spent their careers with the same company, but has become increasingly awkward and inefficient in the digital era when the average American changes jobs 10 times (and has three or four different careers).

Even if you don't agree that we have a moral obligation to provide all Americans with access to quality affordable health care, it's become pretty clear that the rising number of uninsured burdens our health care system and economy, and needs to be addressed in any legislation drafted by Congress this spring. In his book, Sick: The Untold Story of America's Health Care Crisis and the People Who Pay the Price, author Jonathan Cohn eloquently explains why health care reform must include a provision to provide universal health care to all Americans: "Universal health care is really about finding collective strength in our individual vulnerabilities -- about helping a family member a neighbor, or a fellow citizen, because next time, any one of us could be the person who needs help. It isn't about them. It's about us. One day enough people will realize this to make universal health care a reality. The only question is how many more must learn it firsthand -- and suffer the consequence -- before that happens." I think we have our answer.

Russell Turk, M.D. is an obstetrician and gynecologist in Fairfield County, CT.

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