Healthcare professionals warn of "terrible consequences" as US uninsured population grows

Shannon Jones
10 October 1998

Survey figures released by the US Census Bureau show that the number of Americans without health insurance increased last year to 43.4 million, or almost one out of every six, the highest proportion of uninsured since the enactment of Medicare and Medicaid in the 1960s.

The number of uninsured increased by 1.7 million from 41.7 million in 1996, equivalent to 125,000 people losing coverage every month. California saw the largest jump in the number of uninsured, up 575,000 to 7.1 million. Michigan had the second largest increase, up 276,000 to 1.1 million, a rise of 33 percent. The state of Illinois came in third with the number of uninsured rising 169,000 to 1.5 million, an increase of 12 percent.

There are six states with more than one out of every five uninsured: Texas (24.5 percent), Arkansas (24.4 percent), Arizona (23.8 percent), California (21.5 percent), New Mexico (20.2 percent) and Mississippi (20.1 percent). Most of these states have large immigrant populations.

A press release by the Physicians for a National Health Program (PNHP) drew attention to the human cost represented by these figures. 'We see terrible consequences of patients lacking insurance in my clinic every day,' said Dr. Bob LeBow, medical director of the Terry Reilly Health Center in Nampa, Idaho and president of PNHP.

'Hispanic Americans had the highest rates of uninsurance,' noted Dr. Olveen Carrasquillo of Columbia University. 'Millions of middle and upper income families also were uninsured.'

'These may be the best of times for the economy, but they are worst of times for health care,' noted Dr. David Himmelstein of Harvard. 'Uninsurance is rising. Even people with coverage often can't get the care they need, and the costs will double in the next decade. It's time to reopen the debate over national health insurance.'

The raw statistics provided by the Census Bureau give only part of the picture. In many cases those counted as insured have minimal or inadequate coverage. In addition there are fewer and fewer resources available for the medically indigent.

Dr. Donald Lawrenchuk, medical director for the Wayne County Michigan Health Department, told the World Socialist Web Site, 'For Wayne County outside Detroit we find that close to one-half of those who contact our office don't have a personal physician. Even though they may have insurance, they call on their local health department for services because they feel they have no connection with their health care provider. There has been an increase in the number of people requesting services that far exceeds our capacity.

'Because of the significant funding cuts for state and local health departments we are asked to provide more and more services with fewer and fewer dollars.

'Sometimes the government bureaucracy can throw out figures showing large numbers have health insurance. But, if the clients are uncomfortable using that insurance it doesn't do them any good. On paper they may be medically insured, however, much of this coverage is marginal at best. When you read the fine print, many things aren't covered, such as immunizations.'

Commenting on the situation in Detroit, which has one of the lowest immunization rates in the US, he stated, 'Currently less than 1 percent of all the health care dollars the US spends are spent on prevention, even though more than 50 percent of all diseases are preventable. Every dollar we send immunizing someone saves 10 to 12 dollars. 99.9 percent of what we do in our department is focused on keeping people well. Yet every year our funding is challenged more and more.'

Among the reasons for the growth in the number of uninsured is the implementation of welfare reform, which has forced workers off Medicaid into low paying jobs that often don't provide insurance. While children of parents working at low wage jobs may still eligible for Medicaid, many parents are unaware of their rights. In addition, many employers are dropping health care coverage or adopting policies excluding spouses and children.

John Lozier, a spokesman for Health Care for the Homeless in Nashville, told the WSWS, 'The increase in the number of uninsured is the result of the free market economy.' He continued, 'Many of the low skilled jobs available don't carry health benefits. Medicaid is designed for children or the disabled. The vast majority of homeless single adults are not eligible for Medicaid. There is no political intent yet to achieve universal coverage.

'With companies downsizing we can expect more homelessness and considerably more health costs. They will be forced to use emergency rooms and the cost of treatment will be much greater at that late stage.

'There is no real effort to find the children who are eligible for Medicaid. Many are eligible, but it is tremendously difficult to enroll. There has not been an aggressive outreach program. For the poorest of kids there is no real improvement. There are significant bureaucratic and logistical barriers to enrollment.'