October 19th, 2009
Freethought San Marcos: Health insurance has saved the lives of some Americans for 45 years

Freethought San Marcos: A column
by LAMAR W. HANKINS

Back in 1970, my wife and I used to visit a friend occasionally while she received dialysis three days a week for several hours at a time. She had what is now called end stage renal disease (ESRD). The only hope for the condition is to use dialysis to cleanse the blood and wait for a kidney to become available for transplant. Our friend was fortunate. She received a kidney and lived to her normal life expectancy. But the cost of treating ESRD is quite expensive and insurance companies in the early 1970s balked at paying for the needed care.

In response to this health insurance failure (and to bail out those insurance companies that did have to pay for ESRD treatment), Congress passed and President Richard Nixon signed a bipartisan bill in 1972 to allow ESRD patients to buy into Medicare. It is the only disease-specific Medicare program that people of all ages can participate in if they have a sufficient work history that includes payments into the Social Security system. The program covers 90% of all people who have ESRD, which includes around 350,000 people nationwide. I had never heard before of this program because my friend’s ESRD was successfully treated before the program went into effect and I haven’t known anyone else with the condition until recently.

If it were not for the current health insurance debate, I would probably not have heard of the program. It took me a while to digest the information. Some 350,000 people in the US have an option to receive health insurance for ESRD through Medicare. These people are helped by their government to receive lifesaving treatment. Without it, they would die quickly. This public option is, for them, a matter of life and death.

The same thing is true of the 45,000 people who die each year because they do not have medical insurance. Each day, 122 people die from the condition known as uninsured. But this isn’t true in Hawaii, where, since 1974, state law has mandated high-value employer health insurance coverage for all people working at least 20 hours per week. Even a part-time employee at an ice cream parlor receives health insurance. Ninety percent of Hawaii’s residents are covered by very good health insurance.

In Hawaii, one of the most expensive states in which to live, with median home prices over $600,000 and milk costing $8 a gallon, health insurance costs are the second lowest in the US, and Medicare costs are the lowest. The Hawaii system has led to innovations that put them ahead of most of the mainland. The three top health insurance providers have instituted electronic record-keeping, which permits rapid sharing of vital medical records.

Gardiner Harris reported recently in the New York Times, “The Hawaii Medical Service Association, the state’s largest insurer and a Blue Cross Blue Shield member, recently offered the nation’s only statewide system whereby anyone for a nominal fee can talk by phone or e-mail, day or night, to doctors of their choosing.

Kaiser Permanente Hawaii, which covers about 20 percent of the state’s population, screens 85 percent of its female members ages 42 to 69 for breast cancer, among the highest screening rates in the country.”

Because of the quality of the health care mandated by law, emergency rooms are not swamped with the uninsured. According to Harris, “Hawaii law requires employers to offer standardized health plans with low co-pays, no deductibles and few out-of-pocket costs. Cliff Cisco, a senior vice president at the Hawaii Medical Service Association, said that having a standardized and popular benefit has helped keep administrative costs to just 7 percent of revenue, among the lowest in the nation.” Contrast this with the 30% or higher administrative costs incurred by most health insurance companies in the US.

Harris reports, also, that in “Hawaii residents live longer than people in the rest of the country, recent surveys have shown, and the state’s health care system may be one reason. In one example, Hawaii has the nation’s highest incidence of breast cancer but the lowest death rate from the disease.” This low death rate from breast cancer may be a result of widespread screening, made possible by the near-universal coverage, which catches the cancer at an early stage.

But the economic problems of the last year have begun to distort Hawaii’s health insurance system. As people have lost jobs, they have lost their insurance, which has made some residents more dependent on the emergency rooms. Some employers are intentionally hiring employees to work at fewer than the minimum twenty hours per week so that they don’t have to provide health insurance.

Hawaii’s recent experience may indicate that having health insurance tied to employment is not the best system. But employment-related insurance is the main reason President Obama gave for not favoring a single-payer system. This is one reason why having, at the very least, a viable, people-oriented public option that is available when employees lose their health insurance or can no longer afford the costs of the insurance could assure affordable health care for all Americans, if it is enacted by Congress.

During this long debate about health insurance, we have learned that the insurance companies will do anything to increase their profits. Insurance companies don’t provide health care. They pay the health care providers and the less they pay, the more profits they make, which is why they deny medical procedures needed to keep people alive, they refuse to pay for doctor-prescribed drugs, they cancel insurance for people who they determine have pre-existing conditions, and they raise premiums and deductibles to the point that people and employers can’t afford them.

I have known about Medicare for seniors for years, and in two weeks I will join their ranks. I have known about the well-functioning VA health care system for a long time, which includes a mixture of direct health services and health insurance. But only recently have I learned about the ESRD Medicare program that covers about 90% of people of all ages with this disease. Only recently have I learned about Hawaii’s excellent health insurance system that covers 90% of their residents. But I have known for a very long time that the health insurance system available for most other Americans is a failure for about 47 million of my fellow citizens.

Health insurance is a matter of life and death for the 45,000 Americans who will die in the next twelve months because they can’t afford adequate health insurance. If 45,000 Americans were killed during this next year by terrorists, I have no doubt that all Americans would want the government to do something to prevent such loss of life in the future, no matter what the cost.

According to a recent poll by the Employee Benefit Research Institute (EBRI), 83% of Americans favor a public option that all people can buy into. EBRI is no left-wing, socialist polling company. It is funded by many of the largest corporations in America. The only reason we don’t have a public option now is political ideology. When ideology keeps us from meeting human need, we reveal a disturbing character flaw. Political ideas are never an excuse for allowing human suffering. If we cannot overcome this trait, we are not the America that we claim to be.

© Freethought San Marcos, Lamar W. Hankins