Sunday, January 1, 2006; B08
What does it mean to be uninsured in the United States?
A recent study revealed that if you don't have health insurance, you might as well have a scarlet letter sewn on your shirt because you will be identified as someone who can be ignored, discarded and shamed with impunity.
A group of Georgetown medical students recently posed as either low-income, uninsured adults or as the parents of low-income uninsured children who needed a wellness exam. The students visited 311 clinics, doctors' offices and community health centers in the District.
Nearly half of these pretend patients were unable to get an appointment; those who were able to get one usually had to wait 2 1/2 weeks to see a doctor.
Providers also asked the students for a pre-visit deposit averaging $190 -- a quarter of the gross monthly income of a minimum-wage worker. Only one in 40 sites was willing to see an uninsured patient without payment at time of service, and four out of five required payment in full at the time of the visit. The students further reported that more than one in five of the personnel with whom they interacted were rude or very rude.
What does this snapshot of the uninsured life tell us?
Tom O'Toole, a faculty adviser on the project and a dean at Georgetown University School of Medicine, said, "Our current health care system is not prepared or equipped to respond to the growing segment of our community that has fallen through the cracks, making too much money for Medicaid coverage but not enough to afford health insurance on their own. We need a better approach to connecting people to affordable health care and safeguards to keep them from becoming bankrupt trying to stay healthy."
I agree.
Americans must take a moral stand on changing the health care system. They should resist efforts -- such as the changes to Medicaid recently passed in the House -- that will result in even more Americans going without health insurance.
Care must be accessible and affordable for everyone. High up-front costs and significant out-of-pocket expenses, as seen in the sampling, put health care out of reach for too many people.
In addition, coverage must make sense. Many of the phantom patients were left without preventive care. For real patients this means that somewhere down the line, they might develop a difficult and costly condition that could have been identified and addressed during a preventive visit. As a physician who has spent many years working with low-income and impoverished families, I know that emphasizing disease prevention and health promotion makes sense.
Finally, we have to be willing to make the necessary financial investments to bring about change.
No one in our country should have to suffer the indignity and the physical harm that comes with having no health insurance. Let's remove the scarlet letters from the chests of the uninsured by improving our health care system now.
-- George Askew
is an assistant clinical professor of pediatrics at George Washington University and a senior fellow at the Center for American Progress.
gaskew@
americanprogress.org