Our News column this month includes two pieces on the impact of insurance (or lack thereof) on child mortality. Children without insurance are 60% more likely to die from a serious illness than insured children. Uninsured children who have trauma injuries are three times more likely to die than insured children with trauma injuries.
Stop. Read it again. Children without insurance are 60% more likely to die than children with insurance. Some number of insured kids check into the hospital and five die. The same number of uninsured kids get into a hospital and eight die. Three children died because they were not insured.
Some number of insured kids get injured and five die. The same number of uninsured kids get injured and odds are that 15 will die. Ten children will die because they don’t have insurance. In this case, the study took into account those covered by public insurance; they are still more likely to die of trauma than those who are commercially insured.
How is universal coverage a debatable issue? I’m not talking about the HOW – employer mandate, individual mandate, government option, penalties, and subsidies…. How can there be a debate about universal coverage? Who, specifically, is OK with three more children dying or 10 more dying? I’d like to understand them. No, I probably don’t want to understand them.
I know this is a simplistic argument, but it is the essential argument. If we are not sanguine about this disparity then there isn’t a question about whether we solve it, only how. Yes, there are public programs for children – an easy answer is to make sure they get enrolled. But if these are the statistics for children, what are the statistics for adults? Are we OK if three adults die because they are uninsured? Would we be OK if that adult were our wife, husband, mother, or father?
Let’s look to the future. What kinds of decisions are on our horizon if we don’t deal with this now? Recent medical studies are questioning the necessity for mammograms for women between 40 and 49. It seems that it takes 1,900 women doing annual mammograms between age 40 and 49 to find one with breast cancer whose life is saved by the diagnosis. Over age 50, it only takes 1,300 women to find that life saving picture. This becomes cause for suggesting that women between 40 and 49 don’t really need mammograms.
Why not have them anyway? Because of the “false positives,” some numbers of those 1,900 women are finding something on their mammogram that sends them to have a biopsy or an ultrasound and there is nothing there. Somehow, the medical community has decided that those false positives are not worth the life saved. Whereas, we are willing to send 1,300 women through the same ordeal to save the life their tests will find – false positives included.
These are all medical studies; in no article or discussion, so far, have I heard the words “covered benefit.” Old cynical me is hearing it clear as a bell in every discussion. Why is the discussion even taking place if the essential issue isn’t cost? Ask ANY 40-year old woman the question: If we give you a mammogram there is one chance in 1,900 that we will find something and save your life; there is a greater chance that we will think we find something and send you for a useless biopsy for no reason. What would you like to do?
The problem is that, if the medical theory becomes the justification for not covering mammograms for women over 40, that choice changes radically. Those women who can afford to pay out-of-pocket have a choice. The others don’t. Look for new stats on the impact of insurance on women between 40 and 49.
The point really is whether we want to live in a society where money determines whether someone lives or dies. And before we answer the question we should all assume that someone we love, or at least really care about, doesn’t have money or insurance. Picture our daughter’s best friend at school, or our father’s chess partner. Picture the plumber we have come to know over the years. Picture our next-door neighbor who has been out of a job; picture his family. If they died because they didn’t have insurance, or didn’t have money, is that OK?
As this is being written, the argument in Congress is not about working through provisions of the House and Senate health care bills. The argument is whether the Senate bill will even come to a vote so the process of getting to compromise can start. We know our representatives don’t have to worry about their own health insurance. Too bad they don’t know any of these uninsured kids.
