The growing problem of inadequate insurance
From: MS (mikesc_at_iname.com)
Date: 03/29/05
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Date: Tue, 29 Mar 2005 01:23:04 GMT
American Medical News
April 4, 2005
Underinsured and overlooked: The growing problem of inadequate
insurance
By Joel B. Finkelstein
Tens of millions of Americans have coverage that still leaves
medical bills they cannot afford to pay, according to estimates
by Consumers Union.
Now some physicians fear the problem is growing. They are seeing
it regularly in their practices, often in the form of unpaid bills.
The culprit is increasing deductibles and other forms of cost
sharing that employers are turning to in the face of steeply
rising health care costs.
"Underinsurance is going to become a dramatic issue in the next
two or three years," predicted Thomas Bodenheimer, MD, MPH, an
adjunct professor in the Family and Community Medicine Dept. at
the University of California, San Francisco, School of Medicine.
"More and more people are going to have plans that have huge
deductibles and very large co-pays. Even HMOs now are beginning
to have co-pays for hospital care that are quite significant, in
addition to the deductible," Dr. Bodenheimer said.
Just because someone has health insurance doesn't necessarily
mean they are covered, said Karen Pollitz, project director at
the Institute for Health Care Research and Policy at Georgetown
University, Washington, D.C. In an anecdotal study conducted in
conjunction with the American Diabetes Foundation, Georgetown
researchers found that some people with diabetes keep paying
their health insurance premiums even if that means they will not
be able to afford their routine medical costs, Pollitz said.
They couldn't simultaneously pay for test strips and their
insurance, but were too afraid of going without any coverage to
stop paying premiums. In those cases, having insurance actually
led to their diabetes worsening, she said.
"Something is not always better than nothing," Pollitz said.
In the future, politics has to play a bigger role in ensuring
that people not only have health insurance, but that it offers
appropriate coverage, Dr. (Alan) Sager said.
http://www.ama-assn.org/amednews/2005/04/04/gvsa0404.htm
Although we continue to fret about the tragic consequences of
allowing 45 million Americans to remain uninsured, we have not
really made the commitment to effect change. But there is a
prevailing issue that has provoked major policy changes. Those
who are paying for health insurance coverage are very concerned
about the dramatic increases in insurance premium prices.
Ignoring the problem of the uninsured, and ignoring the problem
of the explosion in actual health care costs, almost all policy
activity has now been narrowly limited to efforts to control the
price of premiums.
The obvious consequence of controlling premium prices in the
face of the escalating costs of health care delivery is that
out-of-pocket expenses must increase for the individuals
utilizing health care services. Thus we are facing a massive
epidemic of underinsurance due to this large coverage gap. The
irony is that this will largely spare those of us who are
healthy but threaten the financial security of those with
greater health care needs.
Our policymakers have managed to change the crisis in health
care from the single problem of covering the uninsured to the
dual problem of both covering everyone and providing financial
security for those with health care needs. We can and should
have both. But we need to fire our current policymakers and
replace them with those who really care.
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