Health Care Crisis
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A 30 year-old healthy law clerk wouldn't expect to worry about the problems of health care in the United States. But for the past 18 months Sabrina Carey's familiar companion is the anxiety caused from being saddled with a $1,200 debt from a bout with pneumonia.
Carey is not alone. Sixty percent of personal bankruptcies in the United States stem from medical costs. Health care across the country is in crisis, and a high priority in every political campaign. As Oregon State Representative Peter Buckley notes, "I absolutely see health care as a crisis for our state." In July, Senator Gordon Smith, R-Ore, and Ron Wyden, D-Ore., recognized this fact when they unveiled their Health Care Plan Proposal, targeting catastrophic costs and the uninsured. Per capita health care costs in the United States are twice the median level of the thirty most industrialized countries.
In 1960, Americans spent about 6 percent of the Gross Domestic Product on health care. By 2005, that figured nearly tripled to 17 percent — a staggering figure of $1.8 trillion. It's estimated that over half of that amount is spent in the last two months of life. Other estimates show that by 2015, more then 20 percent of the GDP will be spent on medical expenses.
In the United States health care costs spiral upwards by 14 percent every year. At the current trend, employers' health care costs per employee will double every five years. In 2004, health insurance premiums rose 11.2 percent nationally. That was the fourth consecutive year of double digit-increases.
Beyond statistics
The problem is evident beyond statistics. Pleas for help in paying for medical treatment appear on coin jars placed beside cash registers. Benefit car washes, raffles and concerts are regular occurrences as friends and families struggle to help pay medical bills for those caught without medical insurance or those facing catastrophic medical bills and high deductibles.
Sabrina Carey is employed in a small law office in Ashland that can't afford to offer employee insurance to its two employees. Despite being just 30 years old — a "good risk" in health care parlance — Carey can't afford her own insurance.
When Carey came down with pneumonia, she simply tried to wait it out. In February, 2005, as a result of the neglected pneumonia, she suffered a severe asthma attack. The emergency room was her only option. Now, over a year and a half later, she is still struggling to pay off $1,200 in emergency room bills. She took the risk of refusing the recommended hospitalization because of the cost.
Insurance costs
The Ashland Chamber of Commerce estimates that the majority of local businesses can't afford to offer employees health insurance. According to the Office for Oregon Health Policy and Research 30 percent of those who are uninsured and employed work in office support, food preparation or construction jobs. Sixty percent of the adult uninsured are employed.
According to a U.S. Health and Human Services survey individuals with lower incomes (up to 200 percent of the Federal poverty line) are disproportionately represented among the long-term uninsured, representing almost one-fourth of the uninsured population.
Carey and her husband are employed. They don't live at the poverty level, but their inability to afford health insurance impoverishes them whenever they need medical care.
They are not alone in Oregon, where 21.6 percent of people between the ages of 18-64 were uninsured in 2004.
What can be done?
Many believe the health care industry has reached a critical mass. Ordinary citizens, local and state officials are looking for solutions. Health care plans are being proposed and enacted by several states. Some plans, such as the one enacted by Massachusetts, have a traditional insurance base. Others are more creative. Wisconsin recently passed legislation allowing for the formation of non-stock health benefit purchasing co-operatives on a geographical basis. Even smaller governmental entities are stepping up. Counties such as Lane County, Oregon, and cities such as San Francisco, Calif., are proposing some form of health care for their citizens.
A Commonwealth Fund survey, published by Newsday in August, 2006, reported that in the United States about half of middle-income families ($35,000 -$49,999) are struggling with health care, with 48 percent reporting serious or very serious problems paying medical bills in the last two years, and 50 percent having trouble affording health insurance.
Even the more affluent are affected. Twenty-three percent of the people who earn $75,000 or more per year report that they have trouble paying for health insurance, and 21 percent of that demographic have trouble paying their medical bills. Seventy-three percent of all respondents said the health care system needs fundamental change or complete rebuilding.
Residents of Oregon often believe that they led the way in health care plans because in 1989 the state enacted the Oregon Health Plan. It was designed to be a safety net for the state's disadvantaged citizens.
John Kitzhaber, governor of Oregon when OHP was enacted, says that even in the beginning it treated only a symptom of the problem, not the problem itself. In the years since the enactment of OHP, its provisions have been eviscerated due to economic recession, massive budget cuts and partisan wrangling.
The OHP BandAid
The story of Douglas Schmidt of Portland, as reported in the Oregonian, Nov. 19, 2003, is a cautionary tale as to how far the Oregon Health Plan has veered off course. Douglas was an epileptic who qualified for medical help under the original OHP. When the Oregon Legislature enacted cutbacks in OHP, Douglas could no longer afford the medication to control his epilepsy. Within two weeks of losing his coverage he suffered a massive seizure, suffered brain damage and had to be put on life support. Months later he died. In the Legislature's attempt to save a $13 per day expenditure on Douglas' seizure medicine, it cost the state over a million dollars in medical bills and it cost Douglas his life.
Today, officials issue conservative estimates of more than 18 percent, or 600,000 uninsured Oregonians are not covered by the OHP or any other safety net. In fact, very few Oregonians still have the OHP safety net available. Men and women between the ages of 18 and 65 do not qualify unless disabled. Additionally, after years of budget cuts, just pregnant women and children living in a household with a monthly income of less than $788 qualify for OHP services.
The Health Services Commission (HSC), which was established to create the Oregon Health Plan, faced controversy from the very beginning. It started with the question of how do we decide what to pay for? The process was made more difficult because Oregon was asking the Federal government to waiver some of its requirements for the use of Federal funds spent in Oregon.
Ultimately, the Commission came up with a list of covered health care that leaned toward the subjective, which reflected more of the public's values toward the health industry than objective medical criteria. In the end, the commission had a prioritized list of 730 "lines" of medical treatment that would be covered by OHP. The list was to be revisited every two years to reflect new medical advances and medical codes.
Politicizing health care
Although the HSC tried to foresee medical questions and problems, they could not see the political complications looming on the horizon in the form of a national tax revolt. Economic conservatives, fearful of an over-reaching budget, saw OHP as a large, slow-moving target for their agenda. Social conservatives envisioned medical decisions as a potential threat to their special concerns. Divisive issues such as birth control, elective surgery, fertility treatment, and erectile dysfunction aids soon hit the airwaves and legislators' message machines. Although the Oregon Health Plan was considered at least somewhat bullet-proof in the Oregon law books, the funding for it remained vulnerable.
In 2003, faced with the highest unemployment rate in the nation and an unprecedented budget deficit, the OHP turned to cost-sharing and benefit reduction to save the program. The result came to be known as OHP2. The benefit package was redesigned to be leaner in benefits. It had significant co-pays, tighter administrative rules and increased premiums with a six-month lock-out penalty for nonpayment of premiums.
High cost of OHP
Interestingly, the government actuary noted that if the line of covered medical procedures were drawn at 546 out of the possible 730 covered line items, the cost still was approximately 90 percent of what it would take to cover all 730 lines. The most expensive care — diagnostic services — remained high on the list.
By October of 2005 nearly two-thirds of the OHP Standard participants had left the program since the redesign. OHP2 with its increased co-pays, premiums and loss of benefits had forced them out. Up to 40 percent of these people were also likely to owe $500 or more in medical debt.
New approach
Today, former governor John Kitzhaber, an emergency room physician, is the founder of the Archimedes Movement, a private non-profit organization dedicated to searching for a new way to approach our broken health care system. His dream is to take all the public money spent on health care in Oregon each year — estimated to be over $6 billion annually — and create a whole new system that uses those dollars to the advantage of every Oregonian, a system where no one is left without health care.
In the face of such dire statistics and predictions, Kitzhaber's plan is not the only one to emerge. State Senator Alan Bates, has announced a comprehensive proposal worked out by his Commission on Health Care Access and Affordability. It is unlikely that it will be the last proposed "solution" for this deep and complex issue.
