Sick Without A Safety Net

[Guest guest]

http://www.alternet.org/story/19609/

 

Sick Without A Safety Net

By Solana Pyne, Village Voice

 

Posted on August 20, 2004,

http://www.alternet.org/story/19609/

 

If they're not outright poor as a class, young adults

in this country are at least very, very broke. The

average collegian graduates with more than $20,000 in

debt, headed for a job market where real hourly wages

have kept pace with neither inflation nor the cost of

living. Young adults are broke in part because of

their unprecedented schooling – in the latest census

figures, 28 percent of those between 25 and 29

reported holding a bachelor's degree – which promised

to pluck them away from the constellation of problems

plaguing America's underclass, whether it was trouble

with housing or inadequate medical care.

 

Yet there they are, these latest inheritors of the

American dream, lined up in emergency rooms for

toothaches and the flu, not because they're having

emergencies, but because they don't have health

insurance, and emergency rooms, unlike private

doctors, are obliged to give them care. Since 1987,

the number of uninsured young adults has grown at

twice the rate of older adults, even though the

demographic itself is shrinking. One-quarter to

one-third of adults under 35 went without insurance

for all of 2002, the most recent year for which

statistics are available – an increase of 1.2 million

from the year before. Half were uninsured for some

part of 2002. Of the 43.6 million uninsured adults in

the U.S., 41 percent are young.

 

Of all the rationales John Kerry and George Bush will

give this year as they stump for their individual

visions of helping the nation's uninsured, one of the

most pragmatic is that those little plastic cards can

make the difference, for a crucial group of consumers,

between having a financial parachute and cratering

into debt.

 

Maria Davidson, of Meriden, Connecticut, was 26 and

working for low pay with no benefits when her

seven-year-old son tried to kill himself. The

ambulance took him to Yale-New Haven Hospital. She had

no private coverage for herself and her family. Her

children were not eligible for public plans, and she

wasn't aware of programs that could have covered the

hospital expenses. Her son amassed $3,900 in bills

that Davidson just couldn't pay. That was nine years

ago. By the time the bill was resolved as the result

of a lawsuit, she owed, with interest, over $6,000.

Collection agencies were garnishing her wages and had

put a lien on her condo.

 

Much of her story is sadly typical. A survey published

in May by the Commonwealth Fund, a nonprofit based in

New York City, found that of the uninsured between 19

and 29, half had trouble making payments, had been

contacted by a collection agency, or had modified

their lifestyles to pay off medical bills.

 

And the cost hardly stops with lost purchasing power.

The Commonwealth Fund's survey found that more than

half of those young and not covered had gone without

needed medical care in the last year, which included

not seeing a doctor, failing to fill a prescription,

or skipping a recommended medical test, treatment, or

follow-up visit.

 

Long Islander Fred Gumm, 26, now has health insurance

through his job at Starbucks, which, he said, is

" pretty much the only reason I work there. " He went

without coverage for two and a half years, during and

after school at SUNY-New Paltz. While uninsured, he

broke a few fingers and injured his shoulder and his

back. He didn't go to the doctor because he couldn't

afford the bill, and as a result, the injuries healed

badly and still trouble him.

 

The story for middle-class kids these days is that

you're covered by your family's insurance until you

graduate college, and then you're on your own. For

those not in school, the cutoff comes even sooner.

" You turn 19 and lose your parents' coverage, " said

Sara Collins, an economist for the Commonwealth Fund.

 

In theory, you quickly get a job that comes with

insurance. That's the way our system is designed to

work, with employers rather than the government

providing coverage. But as premiums have risen,

companies have begun to consider forgoing health

plans. In September, the trade journal BenefitNews.com

reported that among companies with 10 to 49 workers,

the percentage of those offering insurance dropped

from 66 percent to 62 percent. That four-point dip may

not sound like much, but the journal estimated it

could represent some 200,000 businesses. What's more,

young people tend to work for smaller firms – think

entrepreneurial start-ups – and only 55 percent of

companies with fewer than 10 workers carry health

plans. A May 2003 report by the Commonwealth Fund

found that 65 percent of working young adults are

eligible for an employer-sponsored plan, compared to

77 percent of older adults.

 

What looked like a relatively seamless transition for

your parents looks for you like a rickety bridge.

You're not making much money, you've got student debt,

the job market stinks, and what jobs exist aren't

promising much. " The kinds of jobs you're eligible for

are the kinds that often don't come with health

insurance, " Collins said.

 

America's approach to paying for medical care

stretches back to World War II, when regulations made

accident and health insurance for employees

tax-exempt. Meanwhile, a simultaneous wage freeze and

worker shortage encouraged employers to offer

insurance as a perk to attract labor, explained Ken

McDonnell, a research analyst with the Employee

Benefit Research Institute.

 

During the same period, England instituted universal

coverage. The reasons we didn't are a complex knot of

social and political influences now nearly impossible

to untangle. " I think part of it is who's being served

here. In more homogeneous societies, like in

Scandinavian countries, [universal health care] came

as a no-brainer, " said David Jones, the president of

the Community Services Society, a New York nonprofit.

" But we're not homogeneous. There's a sense that

'We've got ours, I'm not sure I want to give it to

those guys.' "

 

As employer-sponsored insurance took hold, the number

of uninsured dropped steadily, reaching an all-time

low of 23 million in 1976. But the very availability

of good care quickly drove premiums up. In the 1980s,

health care costs exploded, with annual increases

peaking at 18 percent in 1989, before slowing briefly

in the 1990s. Increases hit the double digits again in

2001, and reached 13.9 percent last year.

 

Perhaps not surprising, companies began to balk at

providing benefits, leading individuals – the

self-employed, the unemployed, the employed but not

covered – to go it alone. Reforms designed to help the

older and sicker buy private insurance served to

further squeeze the able-bodied but vulnerable. Prices

today are all over the map. A young, healthy adult in

California can find basic catastrophic coverage for

under $100 a month, but the same person would have to

pay $280 for a similar plan in New York, largely due

to differing state regulations.

 

For Lars Russell, in his early twenties, the cost of

health insurance came as a shock. He graduated last

year from the University of Michigan and moved to New

York. " It's not really anything I can afford, " he said

in November. " I don't even have car insurance right

now. "

 

Russell would get little sympathy from McDonnell, the

benefits research analyst. " That's life, " he said,

when asked about the huge number of uninsured young

adults. " If you're young and healthy, you're going to

take risks. It's life everywhere. "

 

McDonnell cited an unwillingness to pay for insurance

as a big reason young adults go without coverage.

 

It's a fine line, however, between being unwilling to

pay even $100 a month and being unable to. And it's

significant that when offered health insurance by an

employer in exchange for a deduction from each

paycheck, 74 percent of young adults take it, just a

hair less than the 79 percent of older adults who do

the same. " The argument is that if it's that important

to you, then get a job that offers health insurance, "

said McDonnell, who, like so many experts on health

care issues, is over 35 and has long had jobs with

good benefits.

 

Janet Murray – who asked that her name be changed

because of pending litigation – followed McDonnell's

advice. Now in her late twenties, she was born with

hypothyroidism and takes daily medication. During her

first year of college in upstate New York, she

contracted Lyme disease. Because she caught it early,

she doesn't need constant treatment, though she is

prone to exhaustion and respiratory infections like

pneumonia. Her health problems don't prevent her from

working, but they make it impossible for her to do

without good insurance. Murray studied film in college

but gave up on her dream of working in movie

production. Instead, she took an office job with a

media company because it came with benefits.

 

" I think the biggest thing for me was, if I had the

stamina and I didn't have the general expenses of

being on a bunch of medication, I would have taken

more risks, " Murray said. " I feel like I don't really

have that luxury. "

 

Maybe her dreams wouldn't have panned out, but the

American health care system has made it nearly

impossible for her even to try.

 

Or maybe Murray is lucky. At 21, Pedro Jimenez of

South Williamsburg said he has never had health

insurance at all. " I don't really know anything about

it, to be honest, " he said. When necessary, he has

gone to the emergency room and tried to pay off the

bills in installments. Otherwise, he has avoided going

to the doctor. But basically, he has avoided thinking

about the dangers, focusing instead on looking for

work, getting his GED, and going to college.

 

It's important to note that degrees of coverage vary

greatly by race: African Americans were nearly twice

as likely as non-Hispanic white people to be uninsured

in 2002, and Latinos three times as likely.

 

Not having a job with benefits can mean being forced

to choose between health insurance and other expenses,

some of them critical to building a so-called life.

Young adults " are in a stage where people have debts

from school, they are trying to buy a house, and that

seems more important than paying for health insurance,

which might cost multiple thousands each year, " said

Robert Blendon, a professor of health policy and

political analysis at Harvard University.

 

The types and prices of plans for sale vary

dramatically by state, largely according to

regulations. Premiums nationwide for those under 35

average about $136 per month, according to

eHealthInsurance, a website that sells individual and

family insurance. Many states have plans with premiums

below $100 for young, healthy adults without any

pre-existing conditions. Cheaper plans are usually for

emergencies only, don't cover routine doctor visits,

and carry four-digit deductibles.

 

At age 22, Kristen Gass had minor outpatient surgery

to remove pre-cancerous cells from her cervix. At the

time, she was working as an actress and had health

insurance through the Actors' Equity Association, a

union that represents actors and stage managers

working in theater. Soon after, she moved back home to

Los Angeles, took a break from acting, and lost

hercoverage. When she looked into buying a policy,

insurers quoted monthly premiums hundreds of dollars

higher than she was able to afford, citing her recent

surgery and a family history of cancer. They told her

she would have to be without symptoms or treatment for

at least two years before premiums would drop. So she

went without.

 

" I just didn't go to the doctor, " Gass said. " I went

once for a checkup and that was it. I realized how

much it would cost. "

 

Had she been in New York, the cost of individual

insurance would have been the same regardless of her

history. But she still couldn't have afforded it.

 

Only one New York insurer has posted a plan on

eHealthInsurance, at a monthly premium of $280. The

plan covers hospitalization but not doctor visits.

According to the New York State Insurance Department,

basic HMO plans start at $320 a month. The

self-employed may be able to get insurance at group

rates through organizations in their field. One of the

more popular comes from the Freelancers Union – part

of Working Today – which offers HMO coverage,

including vision and dental, for $286 through Health

Insurance Plan of Greater New York.

 

Just as race plays a factor, so does gender. By the

time he reaches age 34, the average Joe earns $30,677,

and could expect to pay 11 percent of that gross for

the cheapest plan in New York. The average Jane,

earning $21,649, would fork over 4 percent more.

 

If the cost of insurance is unbearable, so is the cost

of not having it. Even common injuries can be

financially debilitating for people still trying to

get on their feet. Manhattan resident Drew Brown,

uninsured and unemployed, went to the emergency room

at Beth Israel for a toothache and left with a

prescription and a $500 bill. Brooklynite Andrea Craig

had to pay $2,000 for surgery to treat a mouth

infection before she got insurance through her current

job.

 

Some people have almost gotten used to it. " If I get

sick, I go to the emergency room. I usually give them

my real name. I get bills. If they are reasonable I

pay them. If not – if they're, like, four or five

grand – I ignore them, " said a 35-year-old Manhattan

photographer who refused to give his name. " The

emergency room is the only place I go. It's the only

place that's free. "

 

High numbers of uninsured strain hospital budgets

because emergency rooms can't deny care to those who

can't pay, Harvard professor Blendon said. Disease

outbreaks are worsened when a significant fraction of

the population doesn't have insurance. " We've lucked

out because we haven't had any big epidemics, but with

SARS and anthrax it really struck experts that you are

going to have people getting sick and not going to the

doctor, " Blendon said. " Canada didn't have that

problem. "

 

The only real fix is universal health care, said Ken

McDonnell, and with the current political climate, he

says, such a policy has " a snowball's chance in hell. "

Estimates of the cost range from a net savings to a

new burden of trillions. A study published by the

journal Health Affairs estimated that extending

coverage to the uninsured would lead to extra spending

on the order of $33.9 billion to $68.7 billion each

year as the newly insured sought additional medical

care.

 

Short of universal health care, most reforms still

leave young adults at risk. For now, many go it alone,

scrounging up care where possible and resigning

themselves to the hope that lighting won't strike.

After all, millions of people do it.

© 2004 Independent Media Institute. All rights

reserved.

View this story online at: http://www.alternet.org/story/19609/