Guest Author - A. Maria Hester, M.D.
As we are all painfully aware, the state of health care in the United States is in a crisis mode. There are close to 47 million uninsured Americans, and the rising cost of health insurance is forcing more and more businesses to drop health care benefits completely, limit eligibility, or pass an increasing proportion of the costs along to workers.
Businesses must remain profitable if they are to survive in our competitive global economy. As a result, there is a strong correlation between rises in health insurance premiums and the rates at which U.S. companies offer their employees health benefits. According to a report published by the Kaiser Family Foundation in December of 2006, between the years of 2001 and 2005, health insurance premiums grew between 9.2 and 13.9 percent annually for a family of four. Not surprisingly, between 2000 and 2005 the share of all U.S. businesses offering health benefits to their employees declined from 69 percent to 60 percent. In a similar report, the Foundation reported that in 2005, 17% of employed Americans lacked health insurance.
Many may be surprised to know that 8 in 10 uninsured Americans come from working families. In 2005, 37 million people from working families were uninsured because their employer did not offer health benefits, they did not qualify for coverage, or they simply couldn’t afford their share of the premium.
High medical bills have destroyed the American dream for many. A Harvard study found that half of the personal bankruptcies in 2001 were the result of illness and medical bills. The study went on to estimate that medical bankruptcies affect close to 2 million Americans each year.
The Institute of Medicine estimates that each year, close to 18,000 people die because they lack health insurance. When patients don’t have health insurance they frequently forgo not only life-saving preventive services, they also forgo basic medical care as well. Many ED are overwhelmed by uninsured citizens who cannot afford to see a private doctor and by the time they get to the ED that once minor problem may be life-threatening! ED physicians frequently see patients in septic shock from a minor cut that went untreated, or patients who have suffered a hemorrhagic stroke due to uncontrolled hypertension.
Emergency rooms are packed with decent, hard-working citizens who, when faced with the choice of paying a high health insurance premium or paying the rent, opted to keep a roof over their heads. While the lion’s share of uncompensated care is paid for by federal and state governments, it comes far short of what is needed for patients, physicians, and health care facilities alike.
America’s EDs are in a crisis. The Institute of Medicine reports that while the demand for emergency care has been growing rapidly, the number of EDs has declined significantly. Between 1993 and 2003 ED visits grew by 26%, but the number of EDs declined by 425, and the number of hospital beds declined by almost 200,000. Patients are frequently boarded in the ED for 48 hours or longer because there are no inpatient beds available. The Institute further reports that half a million times each year—that’s an average of once each minute—an ambulance carrying an emergency patient is diverted
from a full ED to one that is farther away, thus prolonging the time for the patient to be seen and evaluated AND potentially prolonging the time before the ambulance can respond to the next emergency.
Even when patients reach the ED there is no guarantee that the appropriate specialists will be available to help them. In their report, Hospital-Based Emergency Care: At the Breaking Point, the Institute reported that three quarters of hospitals report difficulty finding specialists to take emergency and trauma calls and on-call specialists often go uncompensated due to high levels of uninsured patients. Nevertheless, they still face higher medical liability exposure than those who do not provide on-call coverage.
America is facing a significant challenge and every last citizen should do all she can do to avoid optimize her health and minimize medical waste. Just as our former Vice-President Al Gore has issued a warning about global warning, I am issuing one about the state of health care in America.