HCR -- Over Fifty Million Uninsured Americans

By John Ballard

PPACA is on the books but the results will not be seen for several years. Many of the most important changes to both insurance and health care will not be in place for another four years, and even then positive results will not be apparent at once.

Recent court cases suggesting defeat of the individual mandate is a symbolic gesture encouraging opponents to keep up efforts to weaken, unfund or repeal the new law. Meantime, the population of uninsured Americans, already massive, continues to swell as a turgid economy and unemployment numbers drag on. This snapshot by a Missouri family doctor who voluntered to participate in a free clinic is a reminder that we face a serious public health challenge.

I get overwhelmed when I try to think about the facts that there are over 50 million Americans without healthcare insurance and millions more with grossly inadequate insurance. I�m just as devastated to know that this kills 46,000 of us every year. I personally find it almost impossible to fully grasp the scale of these numbers, to fully understand the human impact of this ongoing disaster. Even welcoming uninsured patients into my medical practice and seeing them on a daily basis still masks the enormity of the problem to me.

I recently had the opportunity to get more of a sense of the human scale by volunteering at one-day massive mobile clinics sponsored by the National Association of Free Clinics (NAFC), the non-profit organization that supports the 1,200 brick and mortar free clinics across the country. This is the safety net that catches people who can�t afford even the modest fees charged in the network of community clinics (FQHCs). About two years ago, NAFC began a campaign to bring greater public awareness to the plight of uninsured Americans by sponsoring these free clinics across the nation. There have now been nine of these events in cities ranging from New Orleans to Washington DC, serving over 11,000 uninsured patients (well over 1,000 each day!) and connecting them up with local resources. If you are fortunate enough to have one come to your community, please volunteer your time at www.freeclinics.us.

I�ve had the opportunity to volunteer at five of these now and am overwhelmed by seeing the pride and dignity people have despite needless pain and suffering. I�ve seen countless people with the same story: their employer doesn�t offer an affordable benefit, or they lost their job and COBRA ran out, and now they can�t afford the $130+ their physician must charge them for care, so they�ve run out of their hypertension/diabetes/lipid/migraine/asthma/whatever meds and just desperately want someone to write some refills. �Please, can you help me stay alive?� Unbelievable to see people choosing between their rent and their insulin, but it�s happening every day in our modern society.

Last week I saw a mother with her uninsured 25 year-old son. He�d told her a few days earlier that he had been hearing voices telling him to hurt someone. She�d tried calling local psychiatrists but couldn�t get an appointment given his lack of insurance. She was terrified but didn�t know what to do for him. She saw a notice about our upcoming free clinic, brought him in, and we were able to get him in immediately to see a psychiatrist who was also donating his day�s work. I�m still trying not to imagine what would have happened if NAFC�s clinic weren�t there that day. Universal healthcare would protect all of us, even those who are �insured� today.

I saw a diabetic terrified about a two centimeter abscess on her foot. We were able to drain it, put her on antibiotics, and get her in for aftercare in 48 hours. She�d had the abscess for several weeks, knew it was a potential disaster, but couldn�t afford to go anywhere for care. Another few days and the outcome could have been much more grave.

This is simply not the America I grew up believing in. Over 80% of the people we see at these clinics are employed, but at jobs that don�t provide affordable healthcare benefits. I saw a woman who works full time at the US Dept of Agriculture as a chef, but has no benefits as they consider her a contract worker. She �works� for the government, but not really. Congress may mandate that federal employees have benefits, but then they permit this sort of out-sourcing travesty to go on under the radar. She really works for our government, but has no healthcare benefits.

I have one word for this situation: unacceptable.

There�s just no justification to continue our current deplorable linkage between employment and healthcare. This disconnect greatly reduces quality, skyrockets costs, and puts us in a compromised global status. But if ever we needed a clear statement of the dangers of this linkage, the 9.8% rate of unemployment makes this argument far more clearly than ever.

My stomach turns at the political games going on in DC when I realize that each and every day of delay towards universal care, my neighbors are suffering and dying. And frankly, it�s only a matter of time before it�s me and my own family. Or yours.

Every day that we don�t succeed at getting improved Medicare for all, we�re all at risk. Even those of us with �insurance.�

FQHC, mentioned in the second paragraph, refers to Federally Qualified Health Centers.

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I find it harder to resist becoming cynical as I follow this debate. My hope for improvement remains only that -- hope. Unfortunately the political signs point in the wrong direction. A widening gap between rich and poor, stagnant unemployment numbers devoid of meaningful measures of underemployment or those who have given up looking for work, and reports of doctors and clinics no longer accepting Medicare... all these appear to be moving in the wrong direction.

I am slowly coming to the conclusion that Medicare will eventually become something like a federalized version of Medicaid as state public assistance programs, never really equal to the mission, cut back even more or pull out of Medicaid rather than comply with compliance requirements of federal disbursements.  And who can blame them?

Preliminary census reports indicate a geographic stratification of wealth with some parts of the country becoming concentrations of wealth as other places lose. Counties, regions and states on the poor end of the curve will not have enough resources to deliver a meaningful degree of public asisstance to those in need as their tax base contracts.

FWIW, the recent flap about the Virginia federal court's ruling the individual mandate unconstitutional is stirring a wave of breathless commentary by talking heads, but the larger picture is less interesting.

Lest we get all excited about the Virginia case, note that there have been about twenty suits filed so far re the ACA, 12 have been dismissed and in two other cases both judges ruled the mandate is Constitutional

Joe Paduda's expertise is managed care and he has been monitoring health care reform for longer than it has been in the news.