Recession Forcing Americans to Cut Back on Health Care
With the first wave of its new provisions set to begin in September, Americans' support for the Affordable Care Act (ACA) is gradually growing. And with good reason. A Commonwealth Fund study released last month concluded that the health care reform law will be especially beneficial to women. And now, a new analysis confirms that the economic downturn is driving Americans to dramatically cut back on routine health care, self-rationing made worse by the Bush recession.
That finding comes from the National Bureau of Economic Research, the same group which officially declares the beginning and end of U.S. recessions. The Bush recession, it turns out, has had dire consequences for the health of the American people. And as the New York Times reported, that impact is far worse than in countries where universal health care systems limit patients' out-of-pocket costs:
Among Americans responding to the survey, they said, 26.5 percent reported reducing their use of routine medical care since the start of the global economic crisis in 2007.
This proportion dwarfs the comparable numbers for other countries: 5.3 percent in Canada, 7.6 percent in Britain, 10.3 percent in Germany and 12 percent in France.
The authors concluded, "We find strong evidence that the economic crisis -- manifested in job and wealth losses -- has led to reductions in the use of routine medical care." That finding not only echoes data from the American Hospital Association, which in June reported that "About 70 percent of hospitals report fewer patient visits and elective procedures as family budgets remain tight and patients continue to delay or forgo care." The NBER study suggests that the uniquely American phenomenon of health care self-rationing is getting worse.
As McClatchy reported in October 2009, a new Consumers Union survey revealed that due to skyrocketing costs and reductions in coverage, Americans are forced to deny themselves needed medical treatment. Among the findings of CU's poll of a 1,002 respondents:
In the new poll 59 percent said that the cost of their health care had increased more than their other expenses over the past two years. Fifty-one percent said they had faced difficult health care choices in the past year. The most common responses were putting off a doctor visit because of cost (28 percent), not being unable to afford medical bills or medication (25 percent), and putting off a medical procedure because of cost (22 percent).
Twenty-eight percent said they had lost or experienced cutbacks in their health care coverage in the past year. The greatest concerns about health care expressed by respondents were a major financial loss or setback from medical cost due to an illness or accident (73 percent), not being able to afford health care in the future (73 percent), necessary care being denied or rationed by health insurance companies (73 percent), and the prospect of rising costs forcing them to choose between health care and other necessities (64 percent).
Those dismal results echoed the shocking revelations from an April 2009 Thomson Reuters survey. That poll of 12,000 people not only found that employer-provided health care coverage had plummeted to 54.9% in 2009 from 59% in early 2008, but that 20% of Americans have postponed or delayed medical care. That 1 in 5 figure is a staggering jump from 15.9% in 2006.
Other jaw-dropping numbers from the Thomson Reuters study:
In the most recent survey, 21 percent of U.S. adults expected to have difficulty paying for health insurance or healthcare services in the next three months...
More than 54 percent who skipped care said they missed a doctor visit. Eight percent said they delayed or skipped medical imaging of some sort.
What Republican orthodoxy sees as the appropriate functioning of the health care market are instead the vital signs of its failure. (And other studies show that the conservative prescription, so-called "consumer-driven health care," would only make things worse.) Costs rising at triple the rate of wages, $13,000 family premiums per year rising to $22,000 by 2019, double-digit annual increases for next year, 62% of personal bankruptcies due to medical costs, declining emergency room capacity, health insurance near-monopolies in 94% of U.S. markets are just some of the indicators of a flat-lining U.S. health care system. It's now wonder Gary Pickens of the Healthcare division of Thomson Reuters concluded:
"If this trend continues, it will ultimately have an impact on our collective well-being."
Mercifully, as the New York Times detailed, the health care reform law passed by Democrats over almost total Republican opposition will significantly ease the crisis of self-rationing. After it fully goes into effect, the ACA will not only extend insurance to 32 million more Americans, but coverage a wide range preventive care as well:
Several provisions of the new health care law, signed by President Obama in March, could counter the trend described in the report.
By 2019, the law is expected to provide coverage for more than 30 million people who are uninsured. The law would subsidize coverage for people with incomes up to four times the poverty level ($88,200 a year for a family of four), and insurers will generally be forbidden to charge deductibles or co-payments for recommended preventive services, like mammograms, colonoscopies and immunizations.
For his part, Senate Minority Leader Mitch McConnell, whose home state of Kentucky ranks near the bottom in health care performance, continues to argue, "Americans want to see changes in the health care system. But they don't want changes that deny, delay, or ration care."
Of course, that's precisely what they are doing now.