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Second Opinion: Is Health Insurance a Civil Right?
Vickie Henderson of Dale City has no health insurance. She is undergoing lab tests for a suspected cyst on her ovary. If she requires surgery, she doesn't know how she will pay for it. Shawn Hegdal of Bozeman, Mont., also has no coverage. Several years ago, she had back surgery and still owes the hospital more than $5,000. Two weeks ago, her husband, a logger, got blindsided by a logging truck barreling down a mountain road. He survived, though his pickup was totaled. "He did not go to the doctor, though he was very sore," says Hegdal. They couldn't pay for it. Nancy Potter of New Glarus, Wis., ran a profitable mail-order bakery with 20 employees. One was in the hospital receiving chemotherapy when the company's health plan announced that it was pulling out of the area and canceling all policies in 90 days. "We couldn't find other insurers" that were affordable, says Potter. Last week the leaders of health care held a summit conference at the National Press Club where Henderson, Hegdal and Potter were on parade as examples of the plague of "uninsurance." Their stories are hardly unique. Roughly 39 million Americans lacked health coverage in 2000, according to the latest census data. Since then, another 2 million have lost insurance because they lost their jobs. With pomp and circumstance and the glare of TV lights, representatives from 12 leading health, business and labor organizations signed a proclamation to "come together from diverse perspectives to seek solutions to one of America's greatest problems." The Catholic Health Association called the campaign "morally and medically imperative." Because people without insurance have more untreated health problems and die younger than those with coverage, the American Medical Association said that ignoring this problem is "bad fiscal policy . . . bad public policy [and] bad medicine." The day before, President Bush unveiled his health care agenda, highlighting the need to expand insurance. Meanwhile, the Association of Academic Health Centers launched its own campaign to help the uninsured. So far, so good. Everyone agrees on the problem. But the marching spirit of the summit conference started to sputter as soon as the health care moguls were asked about solutions. Out came the old buzzwords of stall, stall and stall: "Incremental," said one chieftain. There would be no one solution but a number of possible steps to chip away at the problem. "Public, private, incremental, long haul," agreed another. "Progress will be slow," said the consumer representative. "We have to keep the best we have and allocate resources," added another leader. "Incremental," echoed another. The fight is about money – who wins, who loses, who pays and who decides. To make progress, all factions, from the U.S. Chamber of Commerce and the AFL-CIO to the Health Insurance Association of America and the Federation of American Hospitals, will have to go against their individual interest. Or try to shove more of the burden on taxpayers and state and federal programs. To find solutions, each leader at the summit has to be willing to lose a little for the country to gain a lot. "Incremental" is not a word that helps Potter, Hegdal or Henderson. They're not interested in "slow progress." They need coverage now. The uninsured have been waiting for decades for some relief. They got their hopes up with the failed Clinton health care initiative. Since then their ranks have swelled as more than 5 million Americans lost health insurance and millions more have seen their coverage reduced. Has the moment finally come to address this problem? "I'm lukewarm," said Rep. Elijah E. Cummings (D-Md.), who makes an analogy with the civil rights movement. "You need to pull together a critical mass of people who get it and give them a vision to follow. Hopefully this campaign will serve as the glue." One hurdle is the public's perception of the uninsured as a problem for the health care system rather than the other way around. The moguls at the summit reinforced this skewed view by underscoring the dangers of integrating the minority of Americans who lack insurance with the majority who have it. "If you shift [to a system] that covered everyone else, my great fear is that you would see a significant drop in quality of care and it would drive up taxes," said one business leader. But this is a blame-the-victim game. Hegdal, Henderson and Potter are not so different from people with insurance. They are working and raising families. Eight out of 10 people without insurance hold jobs. How absurd to blame them for eroding medical quality and increasing costs. Surely the greater responsibility for costs and quality rests with the chieftains. As it stands now, the uninsured are mainly shouldering the financial burden of the nation's failure to provide affordable insurance to all of its citizens. After Henderson's father had a heart attack several years ago at age 53, he lost his job as a truck driver – and with it his health coverage. He came to live with Henderson and her family. Between surgeries and medications, he now faces more than $50,000 in medical bills and is considering bankruptcy. The chieftains have signed a proclamation to find solutions so that what happened to the Henderson family won't happen anymore. "What's different is that we're not going to walk away from the problem," said Steven A. Schroeder, president of the Robert Wood Johnson Foundation, which helped sponsor the current media campaign to cover the uninsured. Let's hold them to that promise. When Potter complained to the state insurance commissioner that the nonprofit health maintenance organization that covered her employees was canceling her company policy, she was told to be grateful that the insurer gave her 90 days' warning instead of the usual 60 days. So let's give the chieftains 90 days to come up with a unified plan. After that, to return to the civil rights mode, it may be time for a march on Washington.
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