Research Professor Joseph Feinglass of Northwestern University’s medical school finds that living without insurance can be lethal. In the US the uninsured have fewer doctor visits, receive less preventive care and have worse, often far worse health outcomes.
A personal experience is illuminating. Last week, as a result of a doctor’s appointment (no copay or charges) I picked up a prescription of 14 tablets of antibiotics for a cost of $4.00. Without insurance the antibiotics would have cost $380.00 and the doctor’s appointment $243.00. As a senior my monthly total insurance outlay is $150.90. An uninsured, if they could afford it, would have paid a total of $623.90.
Big picture
My picture of what it’s like to be uninsured, though illuminating, is barely indicative of the problem...
It’s no surprise that 24 Republican-led states have declined federally financed Medicaid expansion for low-income uninsured residents. The critics have repeatedly argued that Medicaid coverage actually “harms the poor.” Systematic research shows this is baloney. In fact, Feinglass argues that coverage from the Affordable Care Act (ACA) is “likely to have a dramatic effect on the health of the uninsured.” Here’s why.
Living without insurance
Feinglass writes that more than 40 years of studies reveal that uninsured adults receive little preventive care such as “blood pressure screening, Pap tests, cholesterol testing or vaccinations.” He provides an example of a 53 year-old woman with undiagnosed diabetes who went into a diabetic coma, was hospitalized, requiring an amputation of her infected toes. With regular checkups and diabetes medications, the amputation could have been avoided. That is. . .if she could afford doctors’ care, tests and drugs. Similar issues such as colonoscopies for cancer detection and mammograms for breast cancer require an outlay of hundreds of dollars. They are often unavailable or require long waiting lists at public hospitals or clinics.
The consequence is that the uninsured are diagnosed at more advanced stages of cancer, have higher rates of blood pressure and cholesterol, making them at high risk for severe strokes and poor diabetes control.
Early death
Inevitably, the uninsured die earlier. Older adults lacking health insurance have mortality rates comparable to long time smokers. A study from 2009, with a representative sampling of the U.S. adjusted for “detailed health information,” estimated that between 35,000 and 45,000 American between the ages of 18—64 die annually because of their lack of health insurance.
States that expanded Medicaid decreased lack of insurance by 15 percent. In five years, they saw a 6 percent decline in death of adults ages 20—64.
Feinglass summarizes the current policy debates as following: The political debate over the Affordable Care Act has reached ludicrous proportions, as Republican politicians attempt to block national surveys that collect data about insurance coverage rates, presumably to prevent President Barack Obama’s administration from taking credit for what will be major declines in lack of insurance.
But whether to provide coverage for the low-income uninsured is not simply a matter of politics—it is about saving lives and needless suffering.
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Joseph Feinglass, PhD, is a Research Professor of Medicine in the Division of General Internal Medicine and the Institute for Healthcare Studies at Northwestern University. Dr. Feinglass is a health services researcher with a degree in Public Policy Analysis. He has over 20 years of experience in health policy, quality improvement, health disparities, medical informatics, patient safety, and social epidemiology.
As of 2/8/2013, Feinglass reported no external professional relationships for calendar year 2012. That means that there was no possible financial bias in the report.