Lack of Access to Health Care in America
In honor of Michael Moore's new documentary "Sicko," I have started to look into American health care. What I've discovered right off the bat is what I always discover when I look into an issue: it is far more complicated than you think.
Here's what you think (probably): it's an outrage that 50 million Americans lack health insurance. We're the richest nation on earth, but 50 million poor people have been left behind with no health care coverage whatsoever. We need to fix that problem by getting rid of the Republicans who lack the human decency to care about the poor, and then, as decent and caring Democrats, we have provide universal health care insurance so poor people can get the health care they need.
Is that what you think? If so, what evidence did you rely on to form your opinion that health care coverage and access to health care are one and the same?
A recent study published in the Annals of Family Medicine (vol. 4, pp. 359-365, 2006) looked into why some people lack regular medical care. After all, that's a big part of the problem we want to address. Health care insurance is more about who pays for health care than who receives it, which I first realized only after hearing Al Franken make this exact point on Air America some months ago. Say what you will about Franken, but he often looked into the facts of the matter instead of responding reflexively. He still always came down on the liberal side of the argument (e.g., favoring universal health care insurance), but I always appreciated his interest in the details. With his recent departure from Air America, there are no liberals like that on the radio, and that's really too bad. I always want to hear the liberal side of the argument, but only when it is based on some factual knowledge (not on reflexive, angry emotion).
Anyway, getting back to this interesting study, the methodology they used was typical and is described like this:
The 2000 MEPS-HC consists of 12,280 households, comprised of 23,839 adults who initially participated in the 1998–1999 National Health Interview Survey...After excluding those who did not respond for themselves and those less than 18 years of age, 9,011 adults were included in this analysis. The main outcome variable was respondents’ self-report of whether they had a usual source of care, defined as "a particular doctor’s office, clinic, health center, or other place one goes to if one is sick or needs advice about health."...Adults who reported they did not have a usual source of care were also asked to indicate their primary reason for not having one.
Finding out who lacked regular access to health care and why was the main purpose of this study. The people surveyed came from all walks of life. 78% were white, 12% black and 10% Hispanic. 55% had an annual income of less than $25,000. Only 16% had an annual income greater than $50,000. About 50% had a high school diploma or less, 25% had some college, and another 25% had a college degree.
They found that 20% of the sample did not have access to a usual source of health care. If your outrage detector is set on full blast, you are probably aghast that these poor people did not have the insurance coverage they need to get regular health care. Instead of jumping to that conclusion, however, you might want to consider the results of this study. Reality is always more interesting than whatever theory happens to be guiding your thinking. Here is what they found:
{Chart about why people don't have a usual soruce of heath care won't post. I can't cut and paste it or imbed it. Go to the blog post to see the chart, highlights are that 66.2% of the people who don't have a regular source of health care don't because they have not been, or have very rarely been sick or injured. Only 10.2% say its because they can't afford care, and remember that 10.2% is out of 20% of the population, so its about 2% of the total population.}
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