Underinsurance becomes an epidemic
October 15, 2008
If you are having a difficult time paying your medical bills, you aren’t alone.
Growing numbers of working-age adults are in trouble with medical debt, according to a new report by the Commonwealth Fund. The report is based on a 2007 survey of more than 2,600 American adults less than 65 years of age.
The survey found that 41 percent of adults ages 19 to 64 were struggling with medical bills in 2007, compared with 34 percent in 2005. Problems they reported include being contacted by a collection agency about unpaid bills, negotiating to pay off bills in installments, and having to change their way of life significantly in order to settle their medical debts.
Even those covered by health insurance were feeling the pain. The survey found that 20 percent of adults with insurance owed more than $4,000 for medical care they had received.
The mounting medical-debt problem, even among those with insurance, highlights the steady erosion of America’s employer-based health-care finance system. As employers grapple with double-digit premium hikes for insuring their workers, they are increasingly faced with the unpleasant choice of reducing coverage, shifting more costs to employees or dropping insurance altogether.
The result is a dramatic rise in the number of Americans whose health insurance doesn’t protect them adequately against financial hardship in the event of illness or injury. This group, called the “underinsured,” has grown by 60 percent since 2003, according to another new study by the Commonwealth Fund.
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The study found that more than 17 percent of American adults under 65 years of age now are underinsured. This means that they spend 10 percent or more of their income on out-of-pocket medical expenses, or they have deductibles in their health policies equal to 5 percent or more of their income.
This group, which includes thousands of middle-class El Dorado County residents, is but one serious illness away from grave financial setbacks. Not surprisingly, many are dealing with inadequate coverage by skipping needed medical care whenever possible.
The study estimated that more than half of underinsured adults are going without needed care because of the cost. This means they aren’t seeing a doctor when sick, they aren’t filling prescriptions, and they aren’t following up on recommended tests or treatment because their share of the cost is too great. Only about 31 percent of adults with better insurance coverage report avoiding such care, the study found.
What can be done to stem the rising tide of underinsurance?
Both presidential candidates have proposals, as do many others in health professions, in business and in academia. Most of these ideas involve creating new efficiencies in the health-care system in order to lower costs so that coverage can be expanded.
Such approaches may have merit, but the only certain way to reduce America’s health-care bill is to prevent more of the illness that is driving up costs in the first place.
We can’t begin to relieve employers of escalating insurance costs until we eliminate preventable illnesses in their employees, illnesses that could be avoided if more people had easy access to healthy foods, more opportunities to lead active lives and stronger incentives not to smoke, drink excessively or use drugs.
No one should have to choose between getting needed medical care or paying the rent. If we all did more to prevent disease and lower health-care costs, there would be more than enough insurance for everyone.
– Jason Eberhart-Phillips, M.D., is the El Dorado County health officer. He can be reached at email@example.com.