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Health Care:  We’re In This Together

Yesterday I went to the doctor’s office.  I handed over my health insurance card, a $25 co-payment, and spent about twenty minutes with my doctor going over blood work, discussing a change in medication to control blood pressure, and agreeing to a referral to a dermatologist for an examination of some spots that may need attention.  Because I have good insurance provided mostly by CTS, I left knowing that I wouldn’t be receiving a big bill for the visit, that my new medicine would be affordable, and that I could go ahead and accept my optional but highly recommended referral to a specialist for care that will be mostly covered by insurance and which could avert serious medical consequences in the coming years.  In other words, my doctor and I were able to make decisions based solely on what made sense for me medically, not based on what I can afford.

Since 2008 the number of Americans over 18 who find themselves in this relatively secure situation has been shrinking – from 85% in 2008 to 82% in 2012.  The drop might even be sharper save for the provision in the Patient Protection and Affordable Health Care Act which allowed young adults from 18-25 to remain as dependents on their parents’ insurance.  If we look at only those adults aged 26 to 64, the percentage of uninsured Americans reaches almost 20%, one fifth of the working age population.  Obviously the recession has played a major role in this trend.  But perhaps even more important is the growing cost of medical care along with the declining number of employers offering health coverage fully or even at a share that makes it affordable to their employees. This, coupled with flat incomes for most low and middle income workers over the last two decades means that the number of uninsured won’t decline simply because the most devastating effects of the recession are waning.

The implications of this are profoundly disturbing.  Let’s put it in quite personal terms.  Without health insurance coverage I would have been tempted not to take my blood pressure medication which, while not exorbitant, is still costly.  In so doing I would be risking a catastrophic stroke at worst, and at best courting long term cardiovascular problems that would either shorten my life or reduce its quality.  I would probably defer the trip to the dermatologist.  The doctor doesn’t seem overly anxious and might put off the referral, knowing that getting a specialist willing to see me without proof of insurance would be difficult.  This might not be a problem, but who is to know?  I could very easily be leaving untreated a simple problem that could, over, a few years become a life-threatening and very costly crisis.

But it’s not just about me.  Research done by the Kaiser Family Foundation ten years ago found that the uninsured receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care.  The study revealed that having health insurance would reduce mortality rates for the uninsured by 10 – 15 percent, and that better health would improve annual earnings by about 10-30 percent.  Getting people insured pays big health dividends.  It also pays financial dividends as well.  While the uninsured may not get adequate health care, most do receive some health care through free clinics, emergency rooms or charity care at public or private hospitals.  While none of this may be adequate, and may mean more catastrophic illnesses and costs down the road, someone is still paying for this care.  Absent the insurance mandate of the Health Care Act, we collectively assume a mandate to provide some care at a level that meets society’s collective sense of moral decency.  Either way, we’re in this together.

So it comes as great relief that the Supreme Court this morning ruled to largely uphold the Affordable Health Care Act. This means that over the next few years more and more Americans will be able to share my experience yesterday, accessing with confidence and dignity the health care they need and which a moral society ought to provide.  Meanwhile, the fight to extend health care coverage to all American families will continue.  Opponents have made it clear they will not give up.  John Boehner and Michele Bachmann issued statements within minutes of the Supreme Court decision vowing to fight for full-scale repeal of “Obamacare” promising alternatives that heretofore have not been forthcoming.  The incrementalism proposed by opponents of health care reform offer little solace to the 50 million without coverage today and essentially asks fewer and fewer of us to pay for inadequate care for more and more of us.

This is a battle worth fighting on moral, medical, and financial grounds and makes the stakes in the November election as stark as they could be.  The angry reactions on Capitol Hill this morning suggest that some of us need a reminder that we’re in this together, morally and financially.  In the end it’s not about the race for the White House or control of the Congress.  It’s about our neighbors who want nothing more than an insurance card to take to the doctor to access the care they need and deserve.

John H. Thomas

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