Once again a spike in the number of uninsured Americans is front-page news. Even the normally vacuous TV news shows picked it up. It's already a central theme of the presidential campaign.
It's also likely that little will be done about it.
The factors behind the biggest single-year rise in the past decade in the number of people who lack coverage are little known or understood by members of Congress, let alone average folk. These causes are complicated enough not to be easily digested in the sound bites that now seem to dictate public policy in this country. There is no single culprit to take to the woodshed, though everyone in the healthcare community is pointing fingers at everyone else. The solutions to the problem involve effort, money and a restructuring of the way medical care is paid for and delivered. And, perhaps most significantly, they involve some behavioral changes by Americans used to getting what they want.
On the surface, the 2.4 million-person increase in the number of uninsured Americans was fed by rising unemployment (offset by an increase in government-sponsored coverage) and cutbacks in employer-sponsored coverage.
Peel back a layer and you find rising healthcare costs. Say what you will about employers these days, but the truth is most want to continue to provide coverage to their workers, but the costs are eating up too much of their meager profits. The most recent data came just last week from benefits consultancy Towers Perrin, whose survey found employers' healthcare costs are expected to rise 12% next year, the fifth year in a row of double-digit percentage increases and a doubling in costs since 1999.
Which brings us down another layer to patients. After they ranted and raved about managed care, employers and health plans caved, opening the floodgates on utilization. Inpatient admissions and lengths of stay have been on an upward trend for years. Emergency room use has risen dramatically as patients won't wait for an appointment with their busy doctors. Hospitals are in the midst of a huge building boom to take advantage of the frenzy.
You want drugs? Take 'em, the payers say. Express Scripts, the huge pharmacy benefit manager, says the 18.5% rise in prescription drug spending in 2002 was the largest since it began tracking the trend.
And what are patients doing about their health? Well, many are eating a lot. Some 65% of Americans are overweight or obese, up from 45% in 1962, and the trend line is accelerating. Some 300,000 people die each year from weight-related illnesses such as Type II diabetes and cardiovascular disease.
Here's a cheery statistic: 12% of pregnant women still smoke, the federal Centers for Disease Control and Prevention says. Tobacco-related diseases are still the leading cause of preventable death in women.
We talk and talk about preventive care and disease management, but most employers, health plans and providers aren't doing much to implement such programs. We have a wealth of data showing that managing the highest-cost conditions such as diabetes and cardiovascular disease have huge payoffs in reducing overall health cost inflation through fewer ER visits and hospital admissions. When an employer actually does something about it, it's news.
Paying for quality, such as rewarding providers that follow clinical protocols, is still in its infancy, for no reason other than complacency.
Until payers, providers, employers, and, yes, patients wake up to the need to control costs we will continue to see the kind of overutilization we have today and the parallel rise in the numbers of the uninsured.
What do you think?
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