Our 'Kindness Deficit' of Care; We Ration Health Care, Harshly, by Income and Price. People with Money Get Topnotch Treatment. Those without Scramble for What They Can Get

By Quinn, Jane Bryant | Newsweek, November 8, 2004 | Go to article overview

Our 'Kindness Deficit' of Care; We Ration Health Care, Harshly, by Income and Price. People with Money Get Topnotch Treatment. Those without Scramble for What They Can Get


Quinn, Jane Bryant, Newsweek


Byline: Jane Bryant Quinn (Reporter Associate: Temma Ehrenfeld)

After the third presidential debate, the plight of those without health insurance vanished from political sight. No surprise there. Lack of medical care represents a moral lapse that voters love to tut-tut about but aren't moved to fix. Fixing it might cost money, at which point the moralists usually change the subject to the weather. Besides, the uninsured tend to be powerless people whom America's comfortable middle can ignore.

A cynical judgment? Sure, but true. If we cared, public policy would have changed long ago. When the elderly scream about the cost of prescription drugs, ears prick up. But 80 percent of the 45 million uninsured are what Princeton health-care analyst Uwe Reinhardt calls "low-income, hardworking stiffs"--waitresses, taxi drivers, clerks, nursing-home aides, gas-station attendants. They swing no weight among policymakers; no lobby represents them; their pockets aren't deep enough to buy congressional attention. Working stiffs have to depend on the kindness of strangers and we're running a kindness deficit.

What's more, failing to cover 45 million people is, indisputably, a bargain. The uninsured received $48 billion in free or government-paid care last year (less than they needed, but so what?). Insuring them could cost about $96 billion more. Ooooh, that would raise taxes, so we look away.

But does it have to raise taxes? Imagine, for a blessed moment, that we ditched our costly, inefficient, bureaucratic, paper-pushing, interfering private health insurers in favor of a single government-run system--for example, Medicare for everyone. The savings in administrative costs alone could reach $325 billion, says Dr. David Himmelstein of the Harvard Medical School. Taxpayers already cover 61 percent of American health-care spending (counting both subsidies and direct payments). If that money didn't have to be funneled through private insurers, who take 20 percent or more off the top, we could have universal care at no increase in cost.

Any rant against our carelessness toward the uninsured requires statistics, so here they are: among all working people, 61 percent receive employer coverage, down from 65 percent in 2001 (Kaiser Family Foundation). One out of three people under 65--that's 85.2 million--went uninsured at some point during 2002-03 (Families USA). The proportion of doctors giving charity care dropped to 71.5 percent in 2001, from 76.3 percent in 1997 (Center for Studying Health System Change). Among people 51 to 61, the uninsured are 63 percent more likely to suffer declining health, over a four-year period, than the insured (Center on an Aging Society). …

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