Financial Concerns Delay Heart Care

If you are uninsured or underinsured, worry about the cost of a possible false-alarm keeps people from getting to a hospital where immediate treatment can prevent more extensive and expensive treatment later.  A study released in yesterday's edition of the JAMA, The Journal of the American Medical Association, and described here, confirms what many physicians have known for years.  

For the millions of American adults who don't have health insurance, and those who have it but worry that illness might ruin them financially, the signs of an impending heart attack do not set in motion the kind of rapid, lifesaving response that medical professionals urge, according to a study conducted at 24 urban hospitals across the nation.

Instead, when uninsured or financially insecure adults feel stabbing chest pain, burning in the shoulders and jaw, or extreme pressure across the midsection, they are more likely than the reliably insured to consider the economic consequences of a false alarm and put off getting help .

Patients who delay getting immediate medical attention for a heart attack are more likely to be rehospitalized for heart problems, to go on to develop congestive heart failure, to suffer the ongoing chest pains called angina, and to have generally poorer health.  

While it isn't part of this study, the costs for some of the care of those who are uninsured or underinsured are passed on to those with health insurance, and those costs are higher because treatment was delayed.

This is just one area where recently passed health reform will bring important changes for the better:  costs will be lower and the care delivered will be more effective because treatment won't be delayed.

American Medical Association Supports House Bill

The American Medical Association has, today, announced its qualified support for the current health reform bill pending before Congress.  

J. James Rohack, M.D., AMA president said:

"By extending health coverage to the vast majority of the uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and their physicians."

The Surge of the Underinsured

Much of the tragedy of our unreformed health care financing system is hidden. We don't find out how poorly we are covered by our health policy until we have a serious illness. An interesting report from the Commonwealth Fund shows the fastest growing population segment is those who are underinsured, not those who are uninsured.

The uninsured population has grown about 54 percent between 1993 and 2008, rising from about 30 million to 46.3 million in 2008. Since the full impact of the Great Recession was felt in 2009, and since those who can afford to keep employer-based health insurance as a result of COBRA for up to 18 months would only now be losing coverage, even at this point in 2010, the number of uninsured is probably less than 55 million, and this would represent an increase of 83 percent over 15 years.

The following charts show that the number of underinsured has grown by 62 percent in only the four years from 2003 to 2007. Conversely, those who are adequately insured in the population under age 65 (Medicare provides universal coverage for those 65 and older), dropped from 65 percent to 58 percent in the four year period. The cause? An 8.8 percent increase in the uninsured, and a 62 percent increase in the underinsured.

What Health Reform Does in 2010

The President's weekly address today is devoted to the health care reform debate.  He lays out the immediate benefits to small business, individuals, those covered by Medicare, and those uninsured because of pre-existing conditions. If the bill is passed, these are benefits that will take effect this year.  Federal subsidies to help with the cost of insurance premiums for low and middle income taxpayers and the development of the insurance exchanges, where we'll be able to choose from a range of qualified benefit plans from many health insurers will come later.  The full text of the address is provided after the jump. 

The King Has No Clothes

The way we finance healthcare does not work well for all American's because it's not a system that was designed to work for all Americans. This is evident in the plethora of health plans, some large, some small, most group plans, but with a few individual plans, most private, several government-sponsored, with different eligibility requirements, different benefits, different waiting periods and exclusions, widely different administrative expenses, ranging from less than the four percent spent to administer Medicare, to the 30 percent of premium spent to administer an individual health plan. Despite decades of lip-service to the concept that healthcare in America is a right, we still have no universal plan to guarantee the financial protection needed to make that right a reality.

The public/private system that has evolved to finance health care is not the result of the best minds in America planning thoughtfully for the needs of all of the American people. It is largely an accident of history, where each step has been taken to address some subset of the population: The poor and the elderly in the mid-60's; those who are between jobs in the mid 80's; uninsured children in the mid-90s, prescription drugs for the elderly in 2003.

Why Care About the Uninsured?

Most of us have health insurance coverage, so why care about those who don't? There are several reasons why Americans who have health insurance should worry about the very real costs and dangers we face as a result of living with 46.3 million Americans who don't have health insurance coverage.

A January 2004 report by the Institute of Medicine of the National Academies entitled, Insuring American's Health: Principles and Recommendations illustrates some of the problems and costs resulting from this societal problem. I have provided comments from this report, which appear in italics, interspersed with my own thinking in ordinary type.

On average, people who are uninsured for a full year pay 35 percent of the overall cost of their medical care.

The roughly $35 billion for uncompensated care provided to uninsured individuals is comprised of $23.6 billion in patients' unpaid hospital bills, $7.1 billion in public expenditures for government grant and direct service programs (e.g. Veterans Affairs, Indian Health Services, Health Resources and Services Administration programs, local health departments) and $5.1 billion in free or reduced cost care provided by office-based physicians and through volunteer service in clinics.

Maybe We Can All Just Get Along

The Kaiser Family Foundation Health Tracking Poll for February shows the country divided equally with 43% in favor and 43% opposed to health reform.  But large majorities of Democrats, Independents and Republicans support key elements included in health reform legislation, arguing strongly that passing health reform will ultimately win broad support from Americans.  Fortunately, these areas represent the core elements of any of the health reform proposals being considered.  Here's a table summarizing areas where large majorities agree: