Health Uninsurance Rising in America

[mrbowler]

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ONE OUT OF THREE NON-ELDERLY AMERICANS WERE UNINSURED DURING 2002-2003

82 Million People, Including Many in the Middle Class, Were Uninsured At Some Point Over The Past Two Years; Most Were Uninsured For At Least Nine Months

Washington, D.C. - Approximately 81.8 million Americans -- one out of three people under 65 years of age -- were uninsured at some point of time during 2002-2003, according to a report released today by the health consumer organization Families USA.

The report, based mainly on Census Bureau data, showed that most of these uninsured individuals lacked coverage for lengthy periods of time: Almost two-thirds (65.3 percent) were uninsured for six months or more; and over half (50.6 percent) were uninsured for at least nine months.

In 14 states, more than one out of three non-elderly people went without health insurance for all or part of 2002-2003. Texas had the highest rate with 43.4 percent of the non-elderly population uninsured. The other 13 states are: New Mexico (42.4%); California (37.1%); Nevada (36.8%); Louisiana (36.2%); Arizona (35.7%); Mississippi (35.1%); Oklahoma (35.0%); Alaska (35.0%); Florida (34.6%); Arkansas (34.4%); Idaho (33.8%); North Carolina (33.7%); and New York (33.4%).

“One out of three non-elderly Americans without health insurance constitutes an enormous epidemic that requires immediate attention,” said Ron Pollack, Executive Director of Families USA. “It is high time that this problem rises to the top of our national agenda.”

Four out of five of the uninsured were in working families, according to the report. Of those working families, the report found that significant portions of the middle class were uninsured. For example, among people with incomes between 300 and 400 percent of the federal poverty level (between $55,980 and $74,640 in annual income for a family of four in 2003), more than one out of four were uninsured over the past two years.

“The growing number of Americans without health insurance is now a phenomenon that significantly affects middle class and working families,” said Pollack. “As a result, this problem is no longer simply an altruistic issue affecting the poor, but a matter of self-interest for almost everyone.”

According to the Families USA report, the states with the largest number of uninsured people in the last two years were California (11.9 million), Texas (8.5 million), New York (5.6 million), Florida (4.8 million), Illinois (3.5 million), Pennsylvania (2.8 million), Ohio (2.8 million), Michigan (2.5 million), Georgia (2.5 million), and North Carolina (2.4 million).

Although almost half of the uninsured were non-Hispanic whites, the report found that there were huge disparities in the uninsured rate based on race. Approximately 23.5 percent of non-Hispanic whites were uninsured in the past two years, compared to 42.9 percent for non-Hispanic blacks and 59.5 percent for Hispanics.

A select group of Governors and House Members spoke at today's press conference to unveil the findings of the report. Iowa Governor Tom Vilsack, Kansas Governor Kathleen Sebelius, Maine Governor John Baldacci, and Congresswoman Hilda Solis (CA), the Chair of the Congressional Hispanic Caucus Task Force on Health, were among those at the event.

"As Families USA's prescient study states, there are considerably larger numbers of people who are without health insurance at different times than popularly believed. This means an even greater number of people are without guaranteed health care security. This is a reflection of an economy that is still not on solid ground. And it is a call to action to ensure that government programs that provide health care remain solvent and viable," said Governor Vilsack.

Governor Sebelius indicated the stakes involved in being uninsured: "Tens of millions of Americans -- and hundreds of thousands of Kansans -- are regularly risking their health and financial security because the cost of health insurance is too often out of their reach," she said.

Governor Baldacci, who pushed his State to implement a comprehensive program designed to achieve universal health coverage called the “Dirigo” Health Plan described the need for his State's unique program: "In Maine, health reform is a necessity. We brought all the stakeholders together and created Dirigo Health, our solution to fix a broken system. Our goal is universal access to affordable and quality coverage within five years," said Baldacci.

The Families USA report was based on data from the Census Bureau. Last year the Census Bureau, when it released its Current Population Survey (CPS), estimated that there were 43.6 million uninsured people. That number reflects responses to the CPS survey asking respondents if they did not have health insurance for the previous entire calendar year. The Families USA report data are drawn from the Census Bureau's most recent Survey of Income and Program Participation as well as the CPS, and it reflects how many people were uninsured at some point over the past two years. The 81.8 million uninsured number does not double count people who were uninsured in 2002 and 2003.

Source: Families USA The Voice of Healthcare Consumers, press release June 16, 2004 ([Only registered and activated users can see links. Either login above or Register Now])

[mayor]

As much as I hate rising costs of insurance, health insurance is NOT a right! We have the right to:

Life
Liberty
The PURSUIT of happiness

There is NO guarantee of happiness! It is not a right!

However, is there really a lack of healthcare in this country? Even the uninsured have places to go to see a doctor. They just don't necessarily get their CHOICE of who that doctor is. The whole health insurance "crisis" is a big sham designed to turn over the health care industry to the government so they can have more control and make things even worse.

For the record, MY employer does NOT provide health insurance. I must PAY FOR IT out of my own pocket.

Mayor

[mrbowler]

Originally Posted by mayor

As much as I hate rising costs of insurance, health insurance is NOT a right! We have the right to:

Life
Liberty
The PURSUIT of happiness

There is NO guarantee of happiness! It is not a right!

However, is there really a lack of healthcare in this country? Even the uninsured have places to go to see a doctor. They just don't necessarily get their CHOICE of who that doctor is. The whole health insurance "crisis" is a big sham designed to turn over the health care industry to the government so they can have more control and make things even worse.

For the record, MY employer does NOT provide health insurance. I must PAY FOR IT out of my own pocket.

Mayor

That's fine mayor..but it doesn't solve the problem. By companies eliminating or passing the cost of Healthcare Insurance to employees they are indirectly going to cause more people to become unhappy, and they will demand a solution.

[chippers21]

There are so many factors in this issue. Employers often cannot afford the cost of healthcare insurance, especially if they are small companies.
My own son, fresh out of college, is working for less than $30,000 a year and his benefits package (with a large company) are almost as great as his salary. These benefits include generous dental and medical coverage. He is fortunate to have such benefits early in his employed-life. Many people work for themselves or for small companies which cannot afford the cost of providing benefits. Many companies, such as my own employer (the YMCA) employ most of their people part-time, so they do not have to provide benefits.
I agree with Mayor about the availability of medical care for the poor. It is available. Just a little more difficult, as is most everything for the poor.
My philosophy for the elderly is to save every penny you can toward your later years. Even small amounts add up. Hubby and I will be free of our huge mortgage in just 5 years so that income will be available for the additional health concerns we expect as we age. You have to plan your own future, not expect the government to redistribute everyone elses money to support you.

[mayor]

Two words.

Tort reform.

Rising healthcare costs are due to frivolous litigation, which are encouraged by the trial attornies (paging John Edward, ambulance chaser...).

Two more words.

Personal responsibility.

Mayor

[mrbowler]

Really

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President Bush said in his State of the Union address this year that the threat of lawsuits against doctors and hospitals was one of the "prime causes" of rising health-care costs. Bush's words suggest a correlation between health-care costs and the premiums physicians and hospitals pay to protect themselves in lawsuits.

Yet between 1988 and 1998, U.S. health-care costs increased 74.4 percent while malpractice premiums increased 5.7 percent. The total premiums paid in 2000 added up to 0.56 of the nation's total health-care bill.

Bush asked Congress to "pass medical-liability reform" that would limit malpractice awards. The House passed it. Senate Democrats thwarted the bill this week. Bush wants Americans to believe that if insurance companies have to pay smaller damages to injured patients, physicians will have lower premiums and health-care costs could actually be held down.

Wrong again.

New information in a national database that collects reports of every judgment and settlement paid in malpractice demonstrates just the opposite. An analysis of that data by a consumer-advocacy group reveals malpractice payouts decreased by 8.2 percent between 2001 and 2002. Meanwhile, doctors" premiums didn't go down.

Damage awards greater than $1 million decreased more than 10 percent between those years. Doctors" premiums weren't affected.

There's simply no correlation between lawsuits and insurance rates. Rather, insurance rates are tied to the climate of the stock and bond market, where insurance companies invest much of their money.

Granted, the way doctors practice medicine could be affected by the threat of lawsuits. They order tests as "defensive medicine" for fear that not doing so could land them in a heap of trouble. Limiting damage awards wouldn't assuage that fear. It would, however, unfairly hurt patients who deserve compensation.

Limiting damages to wronged Americans would have no impact on health-care costs. The president should stop perpetuating the myth that it would.

[chippers21]

MrBowler I do not know where you get your statistics but I do not believe they could be true, as my discussions with physicians have taught me at least one example of why health-care is so high- ob-gyns are becoming only gyns because they cannot afford to deliver babies anymore with the high cost of malpractice. Fewer obs with exhorbitant insurance rates = higher costs to the consumer. I think that torte reform would eventually reverse this trend.
Incidentally, what is your proposed solution to the high cost of health-care?

[mrbowler]

This article explains both sides:

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The rhetoric has been escalating in the battle between doctors and lawyers over the problem of soaring medical malpractice insurance premiums. "What's behind this?" asked a former American Medical Association president last year. "Excessive awards in liability suits. More and more, America's courtrooms are becoming casinos for jackpot justice... In short, a few lawyers may get rich, while a lot of us may get sick."

March 12, 2003

B U R T M A N


"Corporate America and its lobbyists are working hard to reduce wrongdoers' liability when their actions cause injury and death to innocent American children and families," fires back the Association of Trial Lawyers of America.

In North Carolina, doctors and their insurance companies are urging the legislature to pass a $250,000 cap on "non-economic" damages in malpractice cases as a fix for spiking premiums; currently, juries can determine how much victims should receive for such damages, which include the proverbial "pain and suffering" and "emotional distress." The Bush administration is backing similar federal legislation, which passed the House last year.
The primary arguments for caps in North Carolina and elsewhere have been almost entirely anecdotal: A Raleigh ob/gyn, John Schmitt, whose premiums increased from $17,000 to $46,000 in one year, prompting him to give up his practice and take a faculty position at the University of Virginia; nine judgments in excess of $3 million last year, a record number, with one case going for $15 million; a physician in Allegheny County who stopped delivering babies to reduce her insurance, leaving only one delivery-qualified obstetrician in the entire county.

Seizing the moment in a way that tends to reinforce their image as opportunistic sharks, trial attorneys have countered with a high-profile anecdote of their own. Caps, they say, would be an injustice to the family of Jésica Santillán, whose botched heart-lung transplant made national headlines.

Sensational examples are a time-honored tool for tort reform efforts, made famous by the McDonald's spilled-coffee lawsuit, which yielded a multi-million dollar verdict and became Exhibit A in the case against a legal system spiraling out of control. Such stories make great soundbites, but they obscure the truth. Santillán makes a weak case for unlimited non-economic damages, heart-tugging as her story may have been; in particular, her life expectancy was very short even under the best of circumstances.

And the examples cited by the proponents of a cap hold little water under the microscope: The argument that physicians are being driven out of the state by outrageous premiums, for instance, conflicts with information provided by the Sheps Center for Health Services Research at UNC, which shows a steady increase in the number of physicians serving the citizens for the past two decades -- and at a slightly faster growth rate than the general population. The same is true for ob/gyns, who along with neurosurgeons pay the highest premiums. Medical Mutual Insurance Company of North Carolina, the largest malpractice carrier in the state, says on its own telephone hold message that "Premium rates in North Carolina are among the lowest in the country."

Hardly the stuff of a crisis, as the AMA and cap advocates contend.

At the same time, no one disputes that malpractice premiums have been increasing at an alarming rate the past couple of years, here and everywhere else. The tales of huge rate hikes are not confined to the cap debate. "We've been hearing the same things," says Chrissy Pearson, spokeswoman for the state Department of Insurance.

The why of rate hikes, however, is a fuzzier question. Arguing cause and effect has been largely a matter of faith for both sides. The doctors point to huge jury verdicts, but the figures don't support the conclusion. Most of the large awards for non-economic damages have been settlements, not jury awards--only two of the last 16 awards exceeding $1 million came from juries. And while historical jury decisions do drive settlement terms, they're only part of the equation. Moreover, according to Medical Mutual senior vice-president and general counsel David Sousa, his company's average claims payout in 2002 actually decreased from the previous year by almost $100,000.

Focusing on jury awards also ignores the many complex factors that go into rate hikes. The single most dramatic development in recent years affecting rates in North Carolina, for example, was the pullout of one of the major players, St. Paul Companies, from the malpractice market in 2001. Doctors covered by St. Paul (which had a high percentage of the state's ob/gyns on its roster) had to find new carriers. None of the remaining companies in North Carolina would provide "tail coverage," an expensive provision that protects doctors from past malpractice. So the doctors had to get tail coverage from St. Paul on top of their new malpractice insurance, which in many cases blew the lid off their premiums.

Former Raleigh ob/gyn John Schmitt, whose case was invoked by President Bush as an example of why caps are needed, was one of the St. Paul casualties.

For their part, the lawyers blame malpractice premium hikes on the insurance companies, saying that the underwriters are jacking rates to cover investment and other corporate losses. They also say that doctors should be charged according to their experience--the more claims they have against them, the more they should pay. "By failing to adjust premiums based on performance, the current system does not allow the market to promote good medicine," states a fact sheet produced by the North Carolina Academy of Trial Lawyers.

Sousa calls those charges bunk. The company has performed well the past several years even in a tough economy, he says. And the company does charge doctors and healthcare facilities according to their claims history. "I don't know where they're getting their information that we do not experience-rate," Sousa says. "The only way that [we have] ever charged a doctor is through experience rating."

That may be, but that still doesn't help explain the anecdote--offered by both sides--about the doctor with no claims experience whose rate jumps by 50 percent or more in a single year. In fact, it's impossible to know how individual premium rates are calculated by looking at the public records at the state Department of Insurance. Companies set a base rate for various specialties, then apply a host of variables that may or may not include a doctor's claim history. "There is no way to track those numbers," confirms DOI spokeswoman Chrissy Pearson.

And those numbers may be at the heart of the answers. Medical Mutual's base rate increase this year ranged from 12 to 14 percent after several years of only single-digit increases that kept pace with the inflation of healthcare costs, a far cry from the screaming hikes cited by doctors as the reason for lawsuit reform.

The question of whether the suggested fix would solve the problem is also open to debate. California, which supporters tout as an example of how the reform worked, passed the first cap in 1975 that became the model for legislation in other states. But after an initial drop, malpractice insurance premiums in that state increased by 190 percent between 1976 and 1988, and only flattened when voters passed an insurance reform. Data on states that have caps, versus states that don't, show no clear correlation between caps and lower malpractice rates.

Getting a handle on the numbers and other nebulous facts--a step that some legislators say will have to happen before any dramatic changes are made--seems to be in order. At this point, there's little evidence of a crisis in North Carolina, no indication that juries here are out of control, no clear rationale for a $250,000 figure, and conflicting data on the effect of caps elsewhere. The case for a cap has simply not been made.

The focus on runaway juries and greedy lawyers is remarkably similar to the tenor of similar debates in 1986 and 1995, which resulted in tort reforms that were supposed to fix some of the same problems. Today, attorneys filing malpractice cases against physicians have to get another doctor in the same specialty to certify negligence and agree to testify. Frivolous suits can be punished. Punitive damages are already capped. Barriers to unreasonable lawsuits already exist.

And the one group lost in the latest permutation have been the injured patients, whose stories are the most compelling of all. Measuring the pain and suffering of a patient who, as a result of malpractice, has died or been permanently maimed or is unable to speak or function without assistance is indeed a subjective task. Does $250,000 cover that loss? Sometimes yes, sometimes no. That's what juries are for

[mrbowler]

Originally Posted by chippers21

MrBowler I do not know where you get your statistics but I do not believe they could be true, as my discussions with physicians have taught me at least one example of why health-care is so high- ob-gyns are becoming only gyns because they cannot afford to deliver babies anymore with the high cost of malpractice. Fewer obs with exhorbitant insurance rates = higher costs to the consumer. I think that torte reform would eventually reverse this trend.
Incidentally, what is your proposed solution to the high cost of health-care?

Maybe the Two-Words should be Insurance Reform

[mrbowler]

Originally Posted by chippers21

Incidentally, what is your proposed solution to the high cost of health-care?

Such a complicated issue-I don't feel that i'm qualified enough to offer a cure-all for the health care system. I do feel that our current drug system is flawed in that the United States consumer is indirectly supporting other governments drug system.

[mrbowler]

Originally Posted by mayor

Two more words.

Personal responsibility.

Mayor

I agree Mayor!

Dr. SIDNEY WOLFE (Public Citizen's Health Research Group): When 5.1 percent of the doctors in this country over a 12-year period account for more than 54 percent of the malpractice payouts, you know that there is a small core--most doctors are practicing good medicine--but there's a small core of doctors who are repeatedly injuring and killing patients, and very few of them are disciplined.

[Twinplets]

Originally Posted by mrbowler

This article explains both sides:
(article trimmed for space)
And the examples cited by the proponents of a cap hold little water under the microscope: The argument that physicians are being driven out of the state by outrageous premiums, for instance, conflicts with information provided by the Sheps Center for Health Services Research at UNC, which shows a steady increase in the number of physicians serving the citizens for the past two decades -- and at a slightly faster growth rate than the general population. The same is true for ob/gyns, who along with neurosurgeons pay the highest premiums. Medical Mutual Insurance Company of North Carolina, the largest malpractice carrier in the state, says on its own telephone hold message that "Premium rates in North Carolina are among the lowest in the country."

Great for North Carolina, but there have been articles in the Boston newspaper about doctors leaving the state because we don't have malpractice insurance rates among the lowest in the country.

Originally Posted by mrbowler

This article explains both sides:
(article trimmed for space)
The why of rate hikes, however, is a fuzzier question. Arguing cause and effect has been largely a matter of faith for both sides. The doctors point to huge jury verdicts, but the figures don't support the conclusion. Most of the large awards for non-economic damages have been settlements, not jury awards--only two of the last 16 awards exceeding $1 million came from juries. And while historical jury decisions do drive settlement terms, they're only part of the equation. Moreover, according to Medical Mutual senior vice-president and general counsel David Sousa, his company's average claims payout in 2002 actually decreased from the previous year by almost $100,000.

Settlements instead of jury awards is a minor distinction, since in both cases it means that someone sued the doctor (or hospital, etc) and the insurance company had to pay out. Maybe if there was a cap on legal fees (instead of the "usual" 1/3 of the payout), lawyers wouldn't press for such high payments.

[luvmetender]

Average cost for a family on an employer-sponsored plan here in PA: $125 per week deducted from your paycheck. This is for a company which pays for the employee's coverage ($300 a month). Go to NJ and you will be paying up to $1500 a month for a family plan.

[mrbowler]

Originally Posted by Twinplets

Maybe if there was a cap on legal fees (instead of the "usual" 1/3 of the payout), lawyers wouldn't press for such high payments.

Well I don't think people like the idea of having a salary cap. Maybe stricter fines for lawyers/firms that try frivolous lawsuits.

[mayor]

Actually, the trial attornies will milk it until they can build it to crisis level, which the liberals are screaming, but in truth we are nowhere near. At that point, the mind-numbed masses will look to Daddy Government to come in and solve their problems, aka: Hilary-care.. socialized medicine.

Hey, guess who you'll get to sue if something goes wrong then? That's right. No one. Tough beans.

Mayor