Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group What to do about healthcare? Can it be fixed?

Sorry, Jay. As I am not a citizen of the United States, my knowledge is limited. However, the following quotes come from an article in Wikipedia:

Poverty alone does not necessarily qualify an individual for Medicaid. It is estimated that approximately 60 percent of poor Americans are not covered by Medicaid.

According to the CMS website, "Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups."


This quote is by the Reverend Gregory Seal Livingston who does a lot of anti-poverty work in the US:

The more than 10 million adolescents who currently live in low-income families are not just denied life's little luxuries. They also are denied basic human rights, such as healthcare and nutritious food. Many of these children are unable to see a dentist because their families don't have insurance, and their parents can't take time off from work to spend the whole day waiting at the public health facility. Many of them have poor vision but do not get glasses since their families don't have insurance for vision care.

Finally - this is from CNN Health.com (June 5, 2009):

This year, an estimated 1.5 million Americans will declare bankruptcy. Many people may chalk up that misfortune to overspending or a lavish lifestyle, but a new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills.

Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.

Wendy, nicely researched.

Jay, I'm glad that you can afford to pay for all of your healthcare needs out of pocket. I don't know what kind of dent that makes in your monthly budget, but at least you can do it. Too many of those less fortunate than you cannot afford to pay out of pocket. I've read some of the same or similar articles that Wendy quoted here. The numbers of people whose lives are being destroyed because of medical bills they cannot afford, yet had to due to circumstances accrue, is tragic.

Healthcare is a basic human right. Nothing, I repeat, nothing, else matters if you don't have your health.

Like John, I have seen abject poverty close up and personal in my travels. I have seen too thin children wearing clothes that we in the northern-two most countries of North America wouldn't donate to charity because they are so awful. Our poor, in comparison to theirs, are rich, yet they cannot get healthcare in the United States, arguably the richest country on the planet, because they have a job with no coverage, or aren't eligible for medicare. And that doesn't come close to those living on the streets, or in cars, or cardboard boxes with their families because they lost their homes to medical bills. What are those people supposed to do? With no address, can they even apply for Medicare?

It breaks my heart when I hear stories here from people who cannot see the doctor/specialist they want because he/she isn't covered under their HMO, or they have to drive 500 miles to the nearest specialist that is covered. It breaks my heart when I hear that good people like you, Jay, who live with something like AS have to pay out of pocket for the essential medical care required just to keep you going every day. It should not be this way. It is just plain wrong.

Or maybe I'm just a dumb Canuck with too many opinions.

Warm hugs,

i agree with you kat. i've read too much, seen too much of people being denied procedures, drugs, surgeries and then suffering or even worse dying due to those denials. and usually those things are denied due to cost. it may just be my opinion, but when it comes to people's lives and quality of life, i don't think cost should be the deciding factor, as it often is. and i think reading the books or watching the documentaries mentioned here would be a good place to start as a reminder that this isn't just an intellectual argument about money but a discussion about people's lives.

You are kidding ... right????

CNN/Opinion Research Corporation
March 2009 http://www.cnn.com/2009/POLITICS/03/19/health.care.poll/index.html
Most Americans like their health care coverage but are not happy with the overall cost of health care, a national poll shows.

CNN/Opinion Research Corporation
December 10,2009
http://spectator.org/blog/2009/12/10/cnn-poll-61-of-americans-oppos
CNN Poll: 61% of Americans Oppose Health Care Bill

NBC News / Wall Street Journal
Posted on MSNBC
December 16. 2009
http://firstread.msnbc.msn.com/archive/2009/12/16/2153563.aspx
The latest NBC News/Wall Street Journal poll finds that those believing President Obama's health-reform plan is a good idea has sunk to its lowest level. Just 32 percent say it's a good idea, versus 47 percent who say it's a bad idea.

NBC poll
Agust 18, 2009
http://www.msnbc.msn.com/id/32464936/ns/politics-white_house/
A plurality believes Obama’s health plan would worsen the quality of health care, a result that is virtually unchanged from last month’s NBC/Wall Street Journal poll. What’s more, only four in 10 approve of the president’s handling of the issue, which also is unchanged from July.

Zogby International
July 16, 2009
http://newsmax.com/InsideCover/healthcare-poll/2009/07/16/id/331634
The year's biggest survey on healthcare reveals most Americans oppose the very reforms that President Obama is trying to push through Congress.

Zogby International
September 15, 2009
http://freshleadership.blogspot.com/2009/09/zogby-poll-americans-overwhelmingly.html
Americans overwhelmingly oppose Obamacare on key points
“A resounding 75 percent of respondents said that taxes should not be raised to fund a government-run health insurance program for Americans who do not have health insurance.”

Rasmussen Reports
December 14, 2009
http://www.rasmussenreports.com/public_c...lth_care_reform
40% Support Health Care Plan, 56% Oppose It

Rasmussen Reports
December 18, 2009
http://www.rasmussenreports.com/public_c...passing_nothing
Fifty-seven percent (57%) of voters nationwide say that it would be better to pass no health care reform bill this year instead of passing the plan currently being considered by Congress.

Wendy - It is much more complex then the Wiki article and subsequent quotes would lead you to believe. To make a valid assessment, we need to start with a basic agreement of what exactly constitutes poverty. People in this country have very different standards that they try to force into the poverty definition. (I can afford week long family trip to Disney, but I am too poor to pay for health insurance.) In almost any other country, our poor would be considered well off. At what point are you living in poverty? What responsibility do individuals have to try to seek solutions to their difficult financial circumstances? And what exactly defines difficult financial circumstances anyway? The US government, state agencies, and many charitable organizations (among others) use the poverty threshold or poverty guidelines (aka the poverty line) calculated annually by the US Department of Health and Human Services - see link.
http://aspe.hhs.gov/poverty/09poverty.shtml

In the US, qualifying individuals and families earning less then 133% of the poverty line qualify for Medicaid. (That would be $22,050 X 1.33 = $29,326 for a family of four.) Individuals who do not meet the income guidelines, but are medically needy qualify for Medicaid in 32 states and two territories in the US. Many states sponsor low cost health plans available for purchase. Here is a link to one state's website: http://www.coverfloridahealthcare.com/ - Other states offer similar programs. Families earning up to 300% of the poverty line are eligible to enroll their children in SCHIP ($66,150 for a family of four).

There is absolutely no reason for a child in the US to be uninsured. If their family makes up tp 300% of the poverty line, they qualify for assistance. If they make more then that, they do not need assistance. There is certainly no reason for a child in need of medical, dental or vision care to go without. (My children attend public school in one of the wealthiest school districts in the nation. Very few children in the district need or qualify for any type of financial assistance. Yet, I can not sign my kids up for school, camp or sports without being bombarded by information about SCHIP, the free School Lunch Program, subsidized school uniforms, free vision screenings, low cost eyeglasses, low cost or free school physicals, etc, etc. It is not because it is a wealthy county with excess money to burn. When we lived in a rural county that was classified as "disadvantaged" we were bombarded by the same amount of information. )

There is little reason for the average adult in America to be uninsured. One exception would be an individual who does not (yet) meet the definition of disabled, but has a chronic medical condition; who is earning above the poverty line; is ineligible for group health insurance (which by law faces severe limitations on pre-existing condition clauses - see the HIPAA Act); was unable for a variety of reasons to transition a previous group health insurance policy to a private policy; and cannot afford to pay the premiums for private health insurance. These are the people that we need to help. These are the people that the politicians should be focused on. These are the people who are largely being ignored in this fracas. Not all uninsured adults fall into this category. Their numbers are actually very few. Unfortunately, because of the nature of this disease, I am sure that a disproportionate number of Spondys do fall into this category. Again, these are the people we should be helping.

Things are not as dire as some in the media and politicians with agendas would have you believe. Most Americans do in fact have health insurance - and the majority of them are satisfied with their plans. We DO need to do something to help the people who are legitimately uninsured. I believe that forcing the majority of Americans to change their way of life for the benefit of the few is the wrong way to "fix" the problem. Polling data seems to agree with me.

on the internet, looking for some good books on the topic, this is a little old (feb 2006) but i found it useful:

the healthcare crisis and what to do about it

off to see what else i can find....going back to the original premise: what to do about healthcare? can it be fixed?

i just bought this book:

Howard Deans "Prescription for Real Healthcare Reform"

after reading the reviews, which i encourage you to read too, a lot of information there, i think this may be an even handed discussion of health care reform by someone with both degrees and experience in both politics and medicine. i'll know more once i read the book.

interestingly, both the older essay i posted and the reviews for this book talk about looking toward other countries for ideas and then tailoring to our needs.

the other thing i found very interesting is that the private insurers spend a lot more money (one of the reviews said 20% of their revenue, double what medicare spends) on administration. the essay i posted separately said much of that administrative cost goes toward: "fighting adverse selection, trying to identify and screen out high-cost customers".

there are additional books on healthcare suggested on the amazon page as well.

does anyone else have any other good books on the topic to recommend?

Stormy - your statements that there is no reason for children and average adults to be uninsured in America don't seem to jive with the statistics.

I don’t know whether you could manage to clothe, feed and shelter a family of four for $22,050, but I would find that a struggle. It certainly wouldn’t be possible to go to Disney at this income level. Your choices are between food and heat, not Disney or health insurance. In fact, elderly people living at the poverty level are sometimes found dead from hypothermia because they can’t afford heat or dead from malnutrition because they’ve chosen heat instead of food.

USA Today quotes average annual healthcare premiums at slightly over $13,000 per annum - that's a big chunk of change for a low-income family, even if they are above the poverty line.

The following statistics sound quite dire to me:

• The United States is the only wealthy, industrialized nation that does not have a universal health care system. Source: Institute of Medicine of the National Academy of Sciences

• In 2006, the percentage of Americans without health insurance was 15.8%, or approximately 47 million uninsured people. Source: US Census Bureau

• The primary reason given for lack of health insurance coverage in 2005 was cost (more than 50%), lost job or a change in employment (24%), Medicaid benefits stopped (10%), ineligibility for family insurance coverage due to age or leaving school (8%). Source: National Center for Health Statistics

• The United States ranks 43rd in lowest infant mortality rate, down from 12th in 1960 and 21st in 1990. Singapore has the lowest rate with 2.3 deaths per 1000 live births, while the United States has a rate of 6.3 deaths per 1000 live births. Some of the other 42 nations that have a lower infant mortality rate than the US include Hong Kong, Slovenia, and Cuba. Source: CIA Factbook (2008)

• Approximately 30,000 infants die in the United States each year. The infant mortality rate, which is the risk of death during the first year of life, is related to the underlying health of the mother, public health practices, socioeconomic conditions, and availability and use of appropriate health care for infants and pregnant women. Sources: CDC and National Center for Health Statistics.

• Two-thirds of non-elderly people without health insurance have jobs, and the number of uninsured people is steadily growing — 46.6 million according to a 2006 Census Bureau Report.

• Three-quarters of Americans who declare medical bankruptcy had medical insurance when they became ill.

• People with incomes that are more than 200 percent of the federal poverty level accounted for one-third of the recent increase in the number of uninsured adults, and half that growth was among young adults aged 19 to 34.

another statistic (from that 2006 essay) (and i can't imagine things have improved since then):

"To take just one example, one study found that among Americans diagnosed with colorectal cancer, those without insurance were 70 percent more likely than those with insurance to die over the next three years."