A PROFILE OF THE UNINSURED AMERICAN

Q. Hello, Dr C. My name is Max, I am 48 yrs old, and I live in Savannah. I had to go to a local hospital emergency room two months ago because I had a terrible episode of chest pain that frightened me as well as my wife. I was hospitalized for three days and had numerous heart tests done by a specialist. I was told I had angina but did not have a heart attack. I received good care and am taking medications for high cholesterol, high blood pressure, and am on a diet. I suppose I should feel lucky but now the bills are coming in and I am in financial trouble. I do not have health insurance even though I work full-time. My wife works part-time to help make ends meet but with three children we barely scrape by. I have fair, but not great credit and the pressures to pay for the hospital, the doctor, and for the drugs are mounting. I am worried about the bill collectors in the coming months. What do you advise I do at this point for some help with my medical bills? Max, your situation as that of the uninsured adult is the elephant in the living room for American healthcare, a correct battleground for political skirmishes of the day, and the social issue in the country most in need of solution. I think your communication provides a great deal of information about the uninsured that all American citizens, tax payers, voters, and reasonably intelligent people should know with certainty as they consider the issue of solving the crisis of the uninsured in our country. While we have made progress in covering the children of America and Medicare covers the elderly, the crisis of coverage relates primarily to the non-elderly adults like you. In broad strokes that may come as somewhat of a surprise to many Americans, twenty percent of non-elderly adults do not have health insurance. That number is about forty-five million people. Only one third are unemployed; seventy percent are in the workforce full, part-time, and may have two members of a household that are employed such as is the case in your home. Regarding income status, one third are low to middle income adults; one third are at or below the poverty level .The vast majority of the uninsured, employed adults are American citizens , not illegal immigrants. The majority of employed, uninsured have not been offered employer supported plans or have declined the offer (about twenty percent) because it was too expensive. It is not a legal requirement to offer health insurance; more workers are being laid off as the economy cools; the premium costs for businesses are rising faster than inflation and other overhead items. Forty  five percent of smaller businesses (less than 200 employees) do not offer health insurance and that percentage is rising. For all these reasons, the pool of uninsured adults is rising and will likely sky-rocket again if recession becomes locked in for the coming year (s). It is not difficult to understand why you dont have insurance and are fully employed. Regarding your health status, your situation is an unfortunate blueprint for the uninsured adult. Compared to the insured, the uninsured are more likely to be hospitalized for preventable conditions, i.e. hypertensive heart disease (angina), high cholesterol, high blood pressure, are more likely to be diagnosed with later stage breast, colon, skin, and prostate cancer, and are more likely to die of late stage disease. For all causes of hospitalization, the uninsured are twice as likely to die in the hospital. This is due primarily to the burden of disease carried by the uninsured when they are eventually hospitalized. If all Americans were insured the death rate would likely fall by 10-15%. The total costs for health care for the uninsured is one hundred billion dollars annually. Like you, the uninsured do pay some of the tab. The patient will pay about thirty percent out of pocket. Another third is uncompensated care. The remainder is covered by private and public insurance plans for those who were insured when employed but are no longer employed for the latter part of the year. In your situation, the part of your bill that is at issue is that part that you cannot pay because of your financial situation. That component is the cost of the uncompensated care. What can you do personally at this time? First, your hospital dropped the ball when you were admitted. Every hospital has an Office of Financial Counseling. Their task is to interview every outpatient and inpatient uninsured patient, determine the patients exact financial and health situation and plot a strategy for payment. You may be a candidate for the Government Indigent Care Program, a charity community plan, other special programs, or Medicaid depending upon your income and family size. Hospitals bill the insured and the uninsured the same amount for equal services, but the hospital will accept a contracted amount from the insurance company. Similarly, there are numerous programs within the hospital system for which you may be a candidate. While most doctors will offer payment plans, they are less likely to provide free care as they do not have the systems or the financial business structure that allows other means of compensating for free care. Most private physicians practices are small businesses that are being squeezed by insurance companies to accept lower fees. Medicare is the leading insurance program that is cutting physicians fees. This is taking place while the costs of running an office are rising. Providing health insurance to the employees, paying salaries in a very competitive marketplace, and other overhead costs are making it more difficult for physicians to continue in private practice. This medical business dynamic is the part of the explanation for the majority support by the medical community for a national health insurance plan. It also explains why many physicians cannot participate in Medicaid programs and their consideration for opting out of Medicare. Regarding your drugs, check with the companies that make your prescriptions. Most have indigent care programs to at least temporarily eliminate or reduce these costs. Your prescribing physician can introduce you to these programs. In summary, your financial and health situations provides a clear profile of the uninsured adult in America. Your hospital, doctor, and pharmacy know the current system is inadequate and are working harder than your government in efforts to protect you, your family, your health, and your security. I hope this information is helpful.

Dr. Nicholas Costrini writes regularly for the Savannah Morning News. His articles occur every other week in the close-up section. He may be contacted at ncostrini@georgiagi.com.

The Savannah Morning News Good for What Ails You and Dr. Nicholas V. Costrini would appreciate hearing favorable comments. Please call: 912.652.0370 Vox Populi