in the news

pms laflame at
Fri Feb 26 22:49:36 PST 1999

At 11:27 AM 2/26/99 -0500, you wrote:
>A couple of items from today's papers suggest that all those folks looking
>to a crash to revive the fortunes of the working class may be missing the
>charms of a strong economy. First, the SEIU has succeeded in organizing
>home health care workers in California, archetypes of the low-wage side of
>the "new economy." And second, Saturn workers have voted out the old
>cooperative leadership and replaced them with old-fashioned (as corporate
>journalists like to characterize them) confrontational leaders. Cooperation
>- "jointness" - was born of fear; fear of insolvency on auto management's
>part, and fear of job loss on labor's. It's resulted in lots of overwork,
>with all the flexibility and concessions coming from labor's side. But
>several years of a sub-5% unemployment rate have calmed those fears, and
>the Saturn workers are obviously feeling bolder. And with the home health
>care workers, there can be little doubt that a low unemployment rate has
>partly dispelled their fears of signing a union card. I'll bet Alan
>Greenspan is not looking kindly on these developments

In the same vein, a nyt's article on the continuing and growing problem of people without healthe insurance. Single-payer, a unifying movement. It's not just for liberals anymore.

Dougs question, was there a question? Anyway, I was reminded of the meta-narrative that makes me expect a reaction that will cause a crash, maybe, because though there's no inflation, there is inflation in the Big Cigars minds, inflated worker security.

But then I think about that other meta-narrative that tells me the Big C's will do anything to avoid a crash until after they've "fixed" Social Security.

February 26, 1999

Americans Without Health Insurance Run the Gamut

---------------------------------------------------------------------------- ---- Related Articles Issue in Depth: Health Care ---------------------------------------------------------------------------- ----

By PETER T. KILBORN ASHINGTON -- Who are all these 43.4 million Americans, at the Census Bureau's last count, who do not have health insurance? Who runs the least risk in going without it? (Children.) Who runs the most, medical and financial? (Sick people approaching 65.) Who is most likely to have it? (People over 65.) Not to have it? (Adults who work for low wages.) Who doesn't care? (Invincible youth.)

For more than a decade, an average of a million Americans a year have either lost their health insurance or failed to obtain insurance for which they became eligible. The reasons vary: prohibitively priced premiums, reduced employer coverage, the welfare overhaul.

But whatever the causes, the unrelenting growth in the number of uninsured is taking a toll. Studies show that the uninsured, in typically forgoing care until they need a hospital emergency room, wind up far less healthy than the rest of the population. Further, emergency rooms cannot provide them follow-up care, and treatment there is much more costly than preventive services in a doctor's office, adding to the burdens on the nation's health care system.

The vast number of uninsured is a startling anomaly in an economy that has been able to subdue inflation, unemployment and budget deficits. Much to the dismay of advocates for the uninsured, the United States, despite its bounty, stands almost alone among industrial nations in not providing free basic health care for all.

"The number is going in absolutely the wrong direction," said Grace-Marie Arnett, president of the Galen Institute, a conservative health and tax policy organization. "It shows something is wrong with the system."

And with the rise in the cost of insurance and health care outrunning wage gains, said Paul Fronstin, an analyst at the nonpartisan Employee Benefit Research Institute, "this is going to get worse unless something is done about it."

The what to do about it, long primarily the concern of liberals, is now being weighed by politicians across the political spectrum. The still evolving proposals range from expansion of government insurance programs to tax breaks helping more people buy coverage.

But while there is debate on how to help the uninsured, few experts disagree on who they are. To begin with, not many are elderly or seriously disabled, groups that are mostly covered by Medicare. Another group, some five million to six million, have family incomes exceeding $75,000 a year and can usually afford the insurance that, for any number of reasons, they do without.

Almost 11 million are children, from families that range from indigent to well off. But children are a less compelling concern to many health system analysts than are large numbers of the other uninsured. First, they are generally healthier than adults and less expensive to treat. And second, alone among the uninsured, they have already been singled out for help, under a $24 billion, five-year program for non-Medicaid-eligible children approved by Congress in 1997.

That leaves the rest of the uninsured, those who need coverage most: 25 million to 30 million people who have the greatest chance of becoming ill and cannot pay for care when they do. Demographically, they run the gamut.

"Some work, and some don't," said Katherine Swartz, an associate professor at the Harvard School of Public Health. "Some don't work because they're sick. Some are very young adults not covered by their parents' health insurance. They take jobs serving latte in coffee shops that are not likely to have health insurance. They just don't think about the risks."

The income of many is so low that they cannot afford to buy insurance, Professor Swartz said, but not so low that they qualify for Medicaid. Others may qualify but fail to apply, because of ignorance, language barriers or a general sense of intimidation.

Most of the uninsured in the greatest need of coverage "are working adults who are not quite in the middle class," said David B. Kendall, health policy analyst at the Progressive Policy Institute. "They are the folks who don't have a job that's going to be there for a lifetime."

Minority groups account for a disproportionate number of the uninsured, Kendall said. Hispanic Americans, nearly half of whom under 65 lack insurance, are only 11 percent of the population but 21 percent of all the uninsured.

Experts say there are several reasons, among them that Hispanic immigrants tend to be healthy and in addition may be intimidated by language and cultural barriers from applying for Medicaid or other assistance.

The travails of the uninsured are often dismissed because the law assures them the last-resort, safety-net care of emergency rooms, says Drew E. Altman, president of the Kaiser Family Foundation. But by the time they call the ambulance, Altman notes, many have gone without the preventive care that might have averted the crisis.

A survey of adults under 65 by Kaiser and the Commonwealth Fund found that in a single year, 24 percent of the uninsured declined to fill a prescription that had been given to them by a doctor, compared with 6 percent of those who had insurance. Fifty-one percent had encountered difficulty obtaining care, as against 10 percent of the insured. And 42 percent had not seen a doctor during the prior year, compared with 17 percent of the insured.

As a result, the uninsured are sicker than others, according to research last year by the Center for Studying Health System Change, a group supported by the Robert Wood Johnson Foundation. The study found that 16.3 percent of uninsured people under 65 were in fair to poor health, compared with 10.6 percent of all people under 65.

One explanation for the rise in the uninsured is the shift of people from welfare to work. More than six million have left the welfare rolls in the last five years, many for low-wage jobs with employers that do not offer any insurance or that charge a lot for it.

For these workers, there is help for a while from Medicaid, the Federal-state insurance program for the poor, which is automatically granted welfare recipients. In most states, families can remain on Medicaid for a year after leaving the cash-assistance rolls.

But then, said Ronald F. Pollack, executive director of Families U.S.A., a consumer advocacy group, "their reward is the loss of health insurance."

Another reason for the swelling in the number of uninsured is the rising cost of health care -- for hospital stays, visits to the doctor and prescription medicine alike. It is climbing faster than workers' wages, and on top of the general increase in the cost of care, employers are asking workers to pay a larger share of that cost.

In 1985, nearly two-thirds of all businesses with 100 or more employees paid the full cost of a worker's care, a study by the Kaiser Family Foundation found. A decade later only a third did so. Kaiser also says employers who ask workers to pay part of the cost through payroll deductions had raised the workers' share to 22 percent on average by 1996, from 13 percent in 1988.

As a result, a survey by the Federal Agency for Health Care Policy and Research found, one in four workers who were offered employer-subsidized insurance in 1997 declined to sign up. A decade ago, only one in ten declined.

These changes, analysts say, have spawned the largest segment of the uninsured, the working poor.

Young adults -- some poor, some not -- are another large group of the uninsured. Of 65 million up to 34 years old, nearly 25 percent are uninsured (compared with 13 percent of the rest of the population), and they account for nearly 40 percent of all the uninsured.

Of the youngest among them, those 19 to 24, the Center for Studying Health System Change says, 30 percent are not offered insurance through their jobs. Of those who are offered it, typically for a few hundred dollars a year, 30 percent turn it down.

Some who reject it are working poor and cannot afford it. Others, feeling invincible, simply spend the money on something else.

However much some young adults feel they can do without insurance, the nation has an incentive to help them buy it, analysts say. Like safe drivers who never have accidents and still buy car insurance, these young people, by paying health insurance premiums, will help defray the cost of care for people who are frailer and older. This process of subsidizing one group whose purchases then serve to subsidize others is called cross-subsidizing.

Among the beneficiaries of cross subsidies would be a less obviously needy group of the uninsured: the poorer and sicker, often retired and homebound, among the 23 million Americans who, age 55 to 64, are not yet eligible for Medicare.

According to the Center for Studying Health System Change, people in that age group have average family incomes of $45,800 a year, about $4,000 more than the average for all families and enough to permit nearly 90 percent of them to pay the age group's high premiums of close to $3,000 a year, even if the employer pays no share.

But the three million among them who are uninsured earn an average of only $18,000. The center reports that a third of them are in particularly perilous straits: these one million are in ill health and have average incomes of just $9,600, which puts private coverage far out of reach.

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