August 10, 2000

YONKERS, NY - A special six-month investigation reported in the September issue of Consumer Reports finds that while the U.S. spends more money on health care than any other country, the nation's 44 million uninsured face a system of second-class health care.

This special health insurance report includes many compelling personal stories of people who are not getting the care they need. The Consumer Reports story indicates that the number of people across the country without health insurance continues to grow, despite piecemeal attempts at reform. Based on population growth alone, 47 million people will have no insurance five years from now. Currently, 20 percent of the population under age 65 lack health insurance.

To assess how people without coverage fare in the health system, Consumer Reports interviewed more than 130 doctors, hospitals, clinics, health-policy experts, and uninsured people. The key finding is that millions of people without health insurance receive second-class health care, if they receive any at all.

"People without insurance are getting second-class health care in a country that spends more of its Gross Domestic Product on health care than any other in the world," says Trudy Lieberman, Director of the Center for Consumer Health Choices at Consumers Union and author of this report. "And more people will get this type of care as the numbers of uninsured climb." Some other key conclusions and findings of the investigation include:

• If you are uninsured, care depends on chance - how old you are, what county you live in, what piecemeal programs exist, your diagnosis, how much money you can scrape together, and your perceived worthiness. For example, babies and children are more "marketable" when it comes to claims on the public purse than 20-year-olds, who don't have the same cachet with politicians. There may be money for mammograms, but not for treatment of uninsured women found to have breast cancer.
• A two-tiered system of care exists for chronically ill patients: the top tier for those who have the means to buy state-of-the-art medications and technology, and the bottom tier for those who do not. For example:
  • Uninsured patients with asthma, diabetes, or hypertension are often denied the care readily available to those who have insurance.
  • An uninsured patient in the midst of a seizure gets treatment for the seizure but no investigation to determine the cause.
  • An uninsured child in the middle of an asthma attack may be treated with medicine that opens the air passages but won't get medications to prevent future attacks.
• Waiting lists mount and rationing occurs for most specialty care. The uninsured must resort to advocates who will beg or borrow services.
• More people need care, but the system is increasingly unable to provide it. These problems are intensifying as more people leave the welfare rolls for jobs, losing government Medicaid coverage as a result. Oftentimes these jobs do not offer affordable health insurance. At the same time, most of the extra money used by hospitals to treat the uninsured is gone, a result of lower payments to providers by managed-care companies and the reduction in federal payments to hospitals for care given to Medicare beneficiaries and indigents.

The uninsured cannot rely solely on clinics for adequate care. For example:

• The number of people seeking care from clinics is up 45 percent over the past decade; hundreds of clinics receive no federal money and depend on donations as well as state, local, and private grants.
• Dental care is sparse, with some clinics rationing it. The wait for adults can be four years long.
• To supply medicine to patients, clinics most often rely on the goodwill of nearby physicians who donate unused samples left by pharmaceutical salespeople, which can result in compromised care.
• At the emergency room, uninsured diabetics receive treatment only when their blood sugar had climbed so high or sunk so low that their life is in danger.
• The uninsured who come to the emergency room get prescriptions they often cannot afford to fill.

The uninsured are also being squeezed as never before to pay for the care they do get. The bill, of course, isn't merely a deductible or co-payment - it's the entire cost of care; there is no insurance company to share the cost. Bills for care in doctors' offices and hospitals are often far higher than what an insurer would pay for the same services on behalf of someone with coverage. The uninsured have no one to broker deals for their care. So patients with very low incomes now help subsidize the lower premiums for more affluent patients who do have insurance.

This special health insurance package also examines reforms in Iowa and Tennessee, and looks at tax credits and medical savings accounts, two solutions some in Congress are promoting to help the uninsured buy their own health coverage. In a section titled "Recommendations: Health Care for All," the Consumer Reports article describes the piecemeal reforms in health care in recent years and their failure to address the needs of the growing numbers of uninsured. This analysis makes several key points:

• Basic health care is a right in every other industrialized nation, not a commodity to be bought by those lucky enough to have money.
• Consumers Union, the publisher of Consumer Reports, has supported efforts to cover all children and expand Medicare to include adults ages 55 to 64, paired with regulations that prevent discrimination by insurers against the sick.
• But overall, the piecemeal approach isn't working. Only a national system with broad pooling of risks will assure that everyone gets the health care they need.
• The sickest Americans bear an unfairly high burden of health care costs, and we can expect their share to grow.

For more information contact: Consumers Union at 914-378-2000