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Monday 21st May 2018

Hope for America's uninsured?

27th November 2006

26072006_angrypatient1.jpgCurrently, if any of the 45 million people in the United States with no health insurance falls critically ill, they are seen in an emergency room and given the necessary treatment. But they still have to pay the bill, and face potential bankruptcy if they can't.

Timely primary care is obviously a more desirable option, but that isn't available to the uninsured. Only about a quarter of those without insurance could afford private cover if it were available at a reasonable price.

Around 18,000 Americans die prematurely each year for want of health insurance. Is there more hope for the uninsured with a Democratic Congress, asks Uwe E Reinhardt, James Madison professor of political economy at Princeton University.

In an editorial in the British Medical Journal, Reinhardt says it is not for want of attention that so many uninsured Americans find themselves in their predicament.

Their plight, he says, has been explored in conferences, town hall meetings, workshops, public hearings before Congress and state legislatures, television talk shows, and a nationwide campaign called "Cover the Uninsured Week".

"In August 2003 I published a paper entitled “Is there hope for the uninsured?� My answer then was “most probably not.� As economic forecasts go, this one has been accurate so far. The question now is whether the Democrats’ ascendancy to power in Congress requires a recalibration of that dire forecast...My revised answer is “probably not,� although I would love to be proved wrong by subsequent events," Reinhardt writes.

He criticises a number of proposals for health insurance reforms as being heavily influenced by the vested interests of those proposing them. One example, America’s Health Insurance Plans, calls mostly for federal subsidies of private health insurance, rather than a government-run insurance programme.

Reinhardt blames the intractability of the problem on cultural attitudes in the U.S. to poverty, which in the United States is regarded as more of a lifestyle choice than as something one is stuck with through 'lineage and bad luck'. Such attitudes mean raising taxes to fund government health insurance would be tough.

The fact that no alternative proposal has garnered the support of a political majority means the U.S. is likely to opt for the default setting: the status quo.

"It is a safe bet that any flurry of activity on uninsurance will be just another instalment in the never ending series of America’s national conversations on the topic—a conversation that resembles nothing so much as the rambling of a drunken lover at a bar—big talk, little action," he concludes.


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