Who Are The Uninsured In America?

The uninsured are tossed around like pawns on a chess board, but most Americans don’t have any idea about who the uninsured are and how they became part of this faceless group of people. In order to understand why it’s imperative that legislation be put in place to assist them, let’s take time to pull back the curtain of mystique on globally grouping the uninsured as the “have” and “have-nots.” Take the story of my patient, Ms. G.

Ms. G is a fifty-nine year-old African-American woman who works as a cook at a local day care in Baton Rouge, LA. Contrary to public opinion, Ms. G has been employed all of her life as a cook and has held her current job for thirteen years. She was referred to me after being evaluated in the emergency room for an elevated blood pressure, elevated blood sugar, and headaches. The emergency room doctor insisted that she seek the services of a primary care physician and get her blood pressure and blood sugar under control, or suffer the repercussions of these health conditions: a heart attack or stroke. Physically, Ms. G is in poor health, but with some lifestyle changes her health outlook could improve. She is a slightly overweight smoker with a strong family history of heart disease and diabetes. Her mother and father died from complications of heart disease, and her younger sister recently died from a massive heart attack.

Her options for treatment were limited to the local charity hospital, which has eliminated the outpatient family practice clinic due to budget cuts. Before the clinic discontinued its services, it required a typical wait of four to six months for a routine appointment. This wait was so prohibitive that she never followed up with a physician for “scheduled visits” after her initial emergency room diagnosis. In addition to simply accessing healthcare, the price tag for health maintenance has grown unreasonable. The average cost for an appointment with a primary care doctor for cash-paying patients including blood work and other tests range from 200 to 400 dollars. I have seen her in my office free of charge.

Prior to her visit at my office, the emergency room had become her primary care doctor and she was very appreciative of seeing a “regular” doctor. Because Ms. G lives just above the poverty level and, as she puts it, “robs Peter to pay Paul,” she has never been able to afford health care insurance. She placed eating, paying the bills, and helping to raise her grandchildren as a priority over her own health. She often says, ‘I gotta live Doc. Maybe I will get some insurance later, but right now, I gotta live.’ Later may just be “too late” for Ms. G. Without medical intervention and a consistent health care program maintained by a physician, her risk for heart disease and stroke are high.

Although Ms. G’s story is sad, it is a very common and frustrating problem for both physicians and patients. There are more than forty million uninsured people that live in the United States, which is twenty- percent of the U. S. population. In 2005, one in five Americans under the age of sixty-five did not have health insurance. This number has continued to increase and their validity was reinforced by a Center for Disease Control (CDC) report released on December 3, 2007 entitled Health in the United States. It showed that one-fifth of Americans could not afford one or more of the following services: medical care, mental health services, prescription medicines, eyeglasses, or dental care.

Since the release of Michael Moore’s controversial and thought provoking documentary, Sicko, which addressed the state of health care in the United States, this topic has spawned much debate. How many people are uninsured in America? Is it forty-seven million or thirty-seven million? Does that include the illegal immigrants? Is universal health care really cost effective? Who is healthier, Michael Moore or Sanjay Gupta? Who cares? One uninsured or under-insured American is one too many!

The face of the uninsured may not be what you think. Though many without health insurance do live significantly below the poverty level, nearly seventy- percent live in homes with at least one full-time worker. Health insurance is either not offered by the employer or the percentage that the worker is asked to pay towards insurance premiums is too expensive. Medicaid and the State Children’s Health Insurance Program have reduced the number of uninsured children under the age of nineteen. Nevertheless, more than eight million children, three-quarters of whom qualify for these programs are still not insured. Young adults between the ages of nineteen and twenty-nine with low income and unstable jobs