Despite national legislative health reform, health care in the US will remain dismal for many Americans, resulting in continuing deaths and personal tragedies. A recent Harvard research team estimates that 2,266 US military veterans died in 2008 due to lack of health insurance. The figure is more than fourteen times the number of deaths suffered by US troops in Afghanistan in 2008, and more than twice as many as have died since the war began in 2001. Harvard researchers concluded that 1.46 million working-age vets lacked health coverage, increasing their death rate. The American Journal of Public Health published findings demonstrating that being uninsured raises an individual’s odds of dying by 40 percent.
Dr. David Himmelstein, coauthor of the analysis and associate professor of medicine at Harvard, commented, “These unnecessary deaths will continue under the new health care reform legislation. The bill would do virtually nothing for the uninsured until 2013, and leave at least 17 million uninsured over the long run.”
In a related story on health care inequalities, Stacie Ritter’s twin daughters were diagnosed with cancer at the age of four. They both needed stem cell transplants and other cancer treatments. The twins survived, but the glands controlling their growth were damaged beyond repair from the treatment. To continue growing, they needed doctor-recommended growth hormone injections regularly. Stacie’s husband’s company switched to CIGNA health insurance, and CIGNA refused to cover the hormone shots. Each time Stacie takes her daughters to the doctor for the shots, it costs her $440. The incident marked just the latest chapter in the family’s ongoing troubles with the health insurance industry. Between the cancer treatment and the denied care, Stacie and her husband had to file for bankruptcy due to their high medical expenses. Ed Hanway, CEO of CIGNA, made $12.2 million last year—$5,883 an hour.
Health insurance laws are often complicated by individual states, where health insurance is legally controlled. There are eight states, plus the District of Columbia, where insurance companies can claim that getting beaten up by your spouse is a preexisting condition for which you can be denied health insurance coverage. Victims of domestic violence are legally denied health insurance by companies that say this condition is preexisting and cannot be covered. The companies involved—Nationwide, Allstate, State Farm, Aetna, Metropolitan Life, Equitable Companies, First Colony Life, Prudential, and Principal Financial Group—were all found in 1995 to have denied or canceled coverage to women who were beaten. The states that still allow this practice are Idaho, North Dakota, South Dakota, Mississippi, North Carolina, South Carolina, Oklahoma, and Wyoming.
While the new national health care plan will remediate some of the above problems, thousands of people will continue to suffer in the US for many years to come.
Update by Steffie Woolhandler, MD
In fall 2009, as the health reform debate was roiling, we reported that 1.54 million US veterans were uninsured in 2008, and that 2,226 would be expected to die due to lack of coverage.
We based our analysis on our recently published finding (in the American Journal of Public Health) that being uninsured raises the odds of dying by 40 percent. Hence, lack of health insurance causes 44,798 deaths each year among the 46 million uninsured Americans. We combined this data with tabulations of the number of uninsured veterans from the Census Bureau’s March 2009 Current Population Survey, which surveyed Americans about their insurance coverage and veteran status. We only classified veterans as uninsured if they neither had health insurance nor received ongoing care at Veterans Health Administration (VHA) hospitals or clinics.
We estimated that among nonelderly veterans, 2,266 deaths were associated with lack of health insurance last year. That figure is more than fourteen times the number of deaths (155) suffered by US troops in Afghanistan that year, and more than twice as many as have died since the beginning of the war.
While many Americans believe that all veterans can get care from the VHA, even combat veterans may not be able to obtain VHA care. As a rule, VHA facilities provide care for any veteran who is disabled by a condition connected to military service, and treatments for specific medical conditions acquired during military service. Low-income veterans who pass a means test are eligible for care in VHA facilities but have lower priority status (Priority 5 or Priority 7, depending upon income level). Veterans with higher incomes are classified in the lowest priority group, and are not eligible for VHA enrollment.
Like other uninsured Americans, most uninsured vets are working people—too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VHA care. Unfortunately, lack of insurance will continue to cause deaths, despite the new health reform law. According to the Congressional Budget Office, 23 million Americans will remain uninsured in 2019, when the law is fully implemented. This will translate into about 23,000 unnecessary deaths annually. Unfortunately, Congress bowed to pressures from the insurance and drug industry, and refused to consider the reform that would have comprehensively covered all Americans—single-payer national health insurance.
For more information, visit Physicians for a National Health Program (www.pnhp.org), a research and educational organization of 17,000 doctors who support single-payer national health insurance.
Update by the Johns Hopkins Children’s Center
Lack of health insurance might have led or contributed to nearly 17,000 deaths among hospitalized children in the United States in the span of less than two decades, according to research led by the Johns Hopkins Children’s Center.
According to the Hopkins researchers, a study published on October 29, 2009, in the Journal of Public Health is one of the largest ever to look at the impact of insurance on the number of preventable deaths and the potential for saved lives among sick children in the United States.
Using more than 23 million hospital records from thirty-seven states between 1988 and 2005, the Johns Hopkins investigators compared the risk of death in children with insurance to those without. Other factors being equal, researchers found that uninsured children in the study were 60 percent more likely to die in the hospital than those with insurance. When comparing death rates by underlying disease, the uninsured appeared to have increased risk of dying regardless of their medical condition. The findings only capture deaths during hospitalization and do not reflect deaths after discharge from the hospital, nor do they count children who died without ever being hospitalized, the researchers say, which means the real death toll of uninsured children could be even higher.
“If you are a child without insurance, if you’re seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance,” says lead investigator Fizan Abdullah, MD, PhD, pediatric surgeon at Johns Hopkins Children’s Center.
The researchers caution that the study looked at hospital records after the fact of death so they cannot directly establish cause and effect between health insurance and risk of dying. However, because of the volume of records analyzed and because of the researchers’ ability to identify and eliminate most factors that typically cloud such research, the analysis shows a powerful link between health insurance and risk of dying, they say.
“Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not,” says co-investigator David Chang, PhD, MPH, MBA. “The point here is that a substantial number of children may be saved by health coverage.”
“From a scientific perspective, we are confident in our finding that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance,” he adds.
Given that more than 7 million American children in the United States remain uninsured amidst this nation’s struggle with health care reform, researchers say policy makers and, indeed, society as a whole should pay heed to such findings.
“Thousands of children die needlessly each year because we lack a health system that provides them health insurance. This should not be,” says co-investigator Peter Pronovost, MD, PhD, director of Critical Care Medicine at Johns Hopkins and medical director of the Center for Innovations in Quality Patient Care. “In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue,” he adds.
In the study, 104,520 patients died (0.47 percent) out of 22.2 million insured hospitalized children, compared to 9,468 (0.75 percent) who died among the 1.2 million uninsured ones. To find out what portion of these deaths would have been prevented by health insurance, researchers performed a statistical simulation by projecting the expected number of deaths for insured patients based on the severity of their medical conditions among other factors, and then applied this expected number of deaths to the uninsured group. In the uninsured group, there were 3,535 more deaths than expected, not explained by disease severity or other factors. Going a step further and applying the excess number of deaths to the total number of pediatric hospitalizations in the United States (117 million) for the study period, the researchers found an excess of 16,787 deaths among the nearly six million uninsured children who ended up in the hospital during that time.
Steffie Woolhandler, MD, David Himmelstein, MPH, and Mark Almberg, MD, “Over 2,200 Veterans Died in 2008 Due to Lack of Health Insurance,” Physicians for a National Health Program, November 10, 2009, http://www.pnhp.org/news/2009/november/over_2200_veterans_.php.
Amy Goodman, “Mother Speaks Out on Insurance Giant CIGNA’s Denial of Healthcare to Cancer-Stricken Twin Daughters,” Democracy Now!, October 1, 2009, http://www.democracynow.org/2009/10/1/mother_speaks_out_on_insurance_giant.
Jason Rosenbaum, “Stacie Ritter Lost Everything. CIGNA CEO Ed Hanway Bought Another House,” Health Care for America Now blog, October 1, 2009, http://blog.healthcareforamericanow.org/2009/10/01/stacie-ritter-lost-everything-cigna-ceo-ed-hanway-bought-another-house.
Ryan Grim, “When Getting Beaten By Your Husband Is A Pre-Existing Condition,” Huffington Post, September 14, 2009, http://www.huffingtonpost.com/2009/09/14/ when-getting -beaten-by-yo_n_286029.html.
Fizan Abdullah, MD, PhD, “Lack of Insurance May Have Figured in Nearly 17,000 Childhood Deaths, Study Shows,” Johns Hopkins Children’s Center news release, November 7, 2009, http://www.hopkinschildrens.org/Lack-of-Insurance-May-Have-Figured-In-Nearly-17000-Childhood-Deaths.aspx.
Other findings from the study:
More uninsured children were seen in hospitals in the Northeast and Midwest than in the South and West. However, hospitals from the Northeast had lower mortality rates than hospitals from the South, Midwest, and West.
Insured children on average incurred higher hospital charges than uninsured children, most likely explained by the fact that uninsured children tend to present to the hospital at more advanced stages of their disease, which in turn gives doctors less chance for intervention and treatment, especially in terminal cases, investigators say.
Uninsured patients were more likely to seek treatment through the emergency room, rather than through a referral by a doctor, likely markers of more advanced disease stage and/or delays in seeking medical attention.
Insurance status did not affect how long a child spent overall in the hospital.
The research was funded by the Robert Garrett Fund for the Treatment of Children, and co-investigators in the study include Yiyi Zhang, MHS; Thomas Lardaro, BS; Marissa Black; and Paul Colombani, MD.