The uninsured: from dilemma to crisis

Article Abstract:

In 1987 almost 48 million Americans had no health insurance for part or all of the year. At any given time in this country about 35 million people lack insurance, about 20 percent of all children and adults. One out of eight people between 55 to 64 years old lacks coverage for at least part of the year, and those over 65 qualify for Medicare. Lack of insurance affects minorities disproportionately, with 30 percent of blacks and over 40 percent of Hispanics uninsured. Men are more likely to be uninsured than women, partly because of the structure of Medicaid, which excludes almost all men. In addition to the numbers of uninsured, there are many more who are underinsured, and others who are covered by Medicaid but cannot find a physician who will treat Medicaid clients. Medicaid itself faces many problems and only covers about 40 percent of those it is meant to serve; even so, it is a form of reinsurance for elderly patients whose Medicare benefits do not cover long-term care. More than three out of four of the uninsured are working adults or their dependents. The uninsured receive less health care, and when they do seek health care, they are likely to be sicker and have poorer outcomes. Conditions that could have been treated cost-effectively become chronic and expensive. The health care system, when it finally treats these patients, often cannot collect, leading to a $6.3 billion in physicians' uncollected revenues in 1988. Workers, who once assumed good health coverage as part of the employment contract, now find that whether coverage is adequate depends on the company they work for, and the laws of the state. The inequalities of health care justified in the United States would be considered intolerable in the rest of the industrialized world, and indeed in much of the developing world. The current medical care crisis is the result of a series of events over a long period, and a lack of response to them. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Statistics, Health insurance, Medicaid, Medicare, National health insurance

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Welcome to year 83

Article Abstract:

The arduous health care reform debate of 1994 may have been a learning experience that will help illuminate the future direction of reform efforts. In 1995, efforts to achieve health care reform will be shifted to the states. Barriers to medical care and ever-increasing health care costs will force the states to take action. The realities of health care reform must be acknowledged. Universal coverage requires stable funding mechanisms that are likely to include tax increases. Promoters of different reform models must be flexible and willing to compromise. As cost-shifting wanes, protections must be extended to the uninsured and their medical providers. Legislators must refrain from divisive partisanship in discussions of health care reform. The debate should not be swayed by the financial lures of lobbyists. Issues should be presented in simple language rather than technical terms. Health care reform advocates should keep the issues uppermost in the public's consciousness until reform is adopted.

Care and treatment, Political aspects, Health care reform

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California public hospitals: the buck has stopped

Article Abstract:

The crisis facing the public hospital system in California may serve as a lesson for other states. California has been hit hard by a recession and a law that caps property taxes. Many public hospitals have closed and many others are restructuring. The Los Angeles public hospital system almost closed until Pres Clinton authorized a federal bailout. In Fresno, a private hospital will take over the county hospital. Several solutions are being tried in the San Francisco Bay Area. The solutions attempted in California could be adapted by other states.

Management, Economic aspects, California, Hospitals, Public, Public hospitals, Hospital closures

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