Maybe my problem with this is the vagueness of "lower- and middle-income" and "most" ... many? some? sure. most? I seriously doubt it.
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What a strange thing to write.
Unlike say, the threat from the Romulan Star Empire or whether female orgasms make sense from a sociobio POV, the topic of non-access to health insurance -- and, therefore, consistently provided services -- is very real.
A great deal of work has been done that provides details about the hows and whys of being uninsured in the United Stares.
Is it all made up?
Consider, for example...
from -- <http://www.statecoverage.net/why.htm >
Why are people uninsured?
National health care expenditures in the United States were almost $1.3 trillion in 2000, approximately 13 percent of gross domestic product (GDP). Projections by CMS show an increase in expenditures to almost $3 trillion by 2011, or 17 percent of GDP. These projections exceed past projections due to recent higher public sector spending (more enrollees with greater benefits) and the slump in the economy.
Although the number of uninsured decreased during the economic upswing of the late 1990s, the recession and fallout from September 11th could reverse these gains. Preliminary surveys show an increase in the number of uninsured as people have lost their jobs-and thus their source of coverage-and as health care costs continue to rise.
According to the Center for Studying Health System Change, health care spending rose 9.6 percent in 2002. The Kaiser/HRET Employer Health Benefits Survey found that premiums for employer-sponsored coverage increased 13.9 percent between 2002 and 2003. As illustrated in the graph below, premiums increased in 2003 over six times the overall rate of inflation and over four times wage increases for non-supervisory workers. The Kaiser/HRET study also showed a slight decrease in the offer rate of small employers (3-199 workers) from 66 to 65 percent between 2002 and 2003.
It is not surprising, therefore that the most commonly cited reason for why individuals do not take up or buy coverage or why employers do not offer coverage, is cost. The Kaiser/HRET study finds that the average monthly premium for individual coverage is $282 and $756 for family coverage. For a family of four living on $55,000 per year (300 percent FPL), almost $9,100 a year for family coverage-over 15 percent of gross income-is a considerable burden.
The graph below-Mercer Human Resource Consulting's 2001 National Survey of Employer-Sponsored Health Plans-shows lower premium costs than the Kaiser/HRET study but similar to 12 percent price increases between 2001 and 2002.
The debate over what is causing rapidly rising health care costs is a contentious one. Several drivers of cost increase are cited: medical technology; income growth; less restrictive managed care practices; aging population; and workforce shortages. According to the Center for Studying Health System Change, since 1995, prescription drugs have been the most rapidly growing component of health care costs. By 1999, drugs were the most important contributor to overall cost growth, with the rate of growth in drug spending per person reaching more than 18 percent.
The graph below shows that several factors drove the 7.1 percent and 7.2 percent increase in health care spending in 1999 and 2000 (spending increased 7.7 percent in 2001).
Rising health care costs are a problem for employers, particularly for small employers with fewer than 50 workers. The 2003 Kaiser/HRET study found that, as health care costs continue to rise, 65 percent of large companies (200+ employees) increased employee cost-sharing; almost 30 percent of businesses with less than 200 workers said they did the same. As employers stop offering coverage or pass on these rising costs to their workers, more and more employees will make the difficult decision to decline coverage. Families USA analysis of Bureau of Labor Statistics data show an increase in the uninsured of over 2 million individuals in 2001 due to the slumping economy.
According to a November 2001 Commonwealth Fund study, titled "How The Slowing U.S. Economy Threatens Employer-Based Health Insurance," about 30 to 40 percent of workers who lose their jobs also lose their health insurance. The uninsured rate among unemployed adults is nearly three times as high as the uninsured rate in the general population (37 percent vs. 14 percent).
State Medicaid programs are adversely affected by the confluence of rising unemployment, decreasing tax revenues, and increasing health care costs. Few states have been spared from budget shortfalls. With Medicaid taking up one-fourth to one-third of state budgets, states are taking a close look at cutting or reducing public programs. The Kaiser Commission on Medicaid and the Uninsured's Medicaid Spending Growth: A 50-State Update for Fiscal Year 2003 provides a detailed analysis of these issues. In addition, the National Association of State Budget Officers (NASBO) provides updated information on how Medicaid and other public program costs are affecting states.
States are considering several cost-containment strategies from drug formularies to applying for federal waivers (see Options for Covering the Uninsured) to value-based purchasing. For an in-depth analysis of these issues, see SCI's July 2002 meeting on cost containment strategies and NASBO's analysis of shortfall strategies.
full at --
<http://www.statecoverage.net/why.htm >
...
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