A determined young lady, Elisa was going to be the first in her family to finish college. Her parents had made significant sacrifices to help her achieve this dream. In fact, they stopped paying for health insurance to save for tuition. I offered our social work services to assist with coverage issues. Elisa declined, saying she could not put her family further into debt.
Elisa didn’t come back for her follow-up appointment. A few weeks later, a doctor from a hospital near her school, called asking for medical records, stating that Elisa was in critical condition. The cancer had spread. She received emergency surgery, but she rapidly deteriorated despite heroic efforts. Like many others who get care too late, her final days were spent in the ICU.
Elisa is a poignant reminder that our health care system continues to fail people who deserve better. I can’t say for sure if Elisa would have survived if she had health insurance from the start, but her care wouldn’t have been delayed. Most Americans believe that health care is a right. Yet, the United States remains the only developed nation that doesn’t ensure basic coverage for all its citizens. Over 16% of American adults are uninsured and we have the poor health outcomes to show for it. Of all the reforms needed to fix our broken system, universal coverage is actually one of the more clearly defined problems with an identifiable solution. The Affordable Health Care Act of 2010 was designed to put this issue to rest. However, certain factions are trying to dismantle it before it fully takes effect, and public support is declining due to the contentious election year climate. I think if more people grasped who the uninsured are and how insurance works, we would be less distracted by the politics and be able to solidify our support for the issue.
First, the uninsured population is multidimensional, diverse, and looks a lot like you and me. It includes the growing number of people who are unemployed, because our society links health insurance to jobs. There are people who are self-employed or work in small businesses, who can’t afford insurance. There are people who work in large companies who still find the reduced premiums prohibitively expensive. There are people who lose coverage due to pre-existing conditions. There are young people, especially men, who forego insurance by choice. And there are a lot of children without coverage because their parents belong to one of the above groups. A much smaller number are undocumented immigrants and freeloaders. In brief, the uninsured population isn’t marginalized or hidden. For the most part, it is our well-meaning, hard-working neighbors.
Second, insurance works by pooling risk. Everyone has some risk of getting sick. Most people will want to prepare for the uncertainty by saving up while they’re healthy. Instead of having people hoard large sums of money, it benefits society for people to spend most of that money to improve their current quality of life and circulate it back into the economy. Besides, as a reality check, most people could never put away enough, even with generous tax credits, to pay for a typical diagnostic work-up, not to mention a full course of treatment. So, it makes sense for a group to organize collecting a relatively minor contribution from each individual and then portion it out as needed. Individuals are generally willing to pay a small amount for this sense of security. Insurance harnesses the power of collective resources to mitigate the financially disabling effects of illness. It is economically efficient, and reduces the cost of lost workdays by getting people the care they need in a timely manner. It is most effective when everyone participates.
Elisa’s situation infuriated me. The most prosperous nation in the world should not tolerate having an uninsured population. Universal coverage makes moral sense, human sense, and fiscal sense. It not only improves the health outlook of the individual, but also benefits families, communities, and domestic productivity. Instead of weakening the Affordable Health Care Act, we should get it up and running as soon as possible.
