Ter seguro
E ficar falido
A revista “Health Affairs” publica hoje (10.06.08, dia da raça, segundo CS) um estudo “How Many Are Underinsured? Trends Among U.S. Adults, 2003 And 2007” link que conclui que cerca de 25,2 milhões de cidadãos dos EUA, com idade entre os 19 e 64 anos, apesar de segurados, são obrigados a despender do seu bolso elevadas somas do orçamento familiar para terem acesso a cuidados de saúde. Este grupo de “meio/in/segurados”, registou entre 2003/07 um crescimento de cerca de 60%, devido ao aumento de custos da saúde (prémios e cuidados), integrando um elevado número de cidadãos da classe média, que quase triplicou neste período.
Por cá, os nossos liberais de pacotilha arrepiam-se todos quando ouvem falar de "opting out" e de seguros de saúde. E, não cessam de escrever disparates que fazem as delícias dos nossos investidores privados.
Sobre esta matéria acho oportuno a postagem da seguinte intervenção de Elizabeth Edwards, efectuada nas recentes eleições primárias, a desancar o "plano de saúde" do jovem Mcain, candidato republicano ás próximas eleições dos EUA.
«Despite fuzzy language and feel-good lines in the Senator's proposal, I do understand exactly how devastating it will be to people who have the health conditions with which the Senator and I are confronted (melanoma for him, breast cancer for me) but do not have the financial resources we have. In very unconfusing language: they are left outside the clinic doors.
Senator McCain likes to start speeches with a litany of questions that, presumedly, less plain-spoken politicians would refuse to answer. Well, here are some questions he does not ask but, as that plain-spoken politician, he might want to answer:
1. Under your plan, Senator McCain, would any health insurer be required to sell you or me (or those like us with pre-existing conditions) a health insurance policy?
2. You say your plan is going to increase competition to the point that it actually lowers costs. Isn't there competition today among insurance companies? Haven't costs continued to go up despite that competition?
3. You say that under your plan everyone is going to pay less for health insurance. Nice words, I admit, but they are words we have heard before. You must know when American families calculate the actual cost of health care, they have to include those deductibles and co-pays and not just the cost of the insurance. Are you talking about cheaper overall or just a cheap policy that doesn't kick in until after thousands of dollars of deductibles have been paid?
4. Isn't the type of competition you are talking about really a rush to the bottom? As long as you allow insurers to underwrite and deny access, you encourage insurers to offer plans that may be cheap, but that get that way by avoiding people with cancer or other high-cost diseases or by limiting benefits and treatments, particularly if the treatment is expensive or might be needed for a long time. We all live in the real world; those of us lucky enough to have health insurance have seen how insurers cut coverage and up co-pays or deny particular treatments. The insurance company makes money when it doesn't have to pay for our health care. (I suspect that if they could, they would write obstetrical-only policies for nuns.) Doesn't your plan really encourage insurers plans to compete to avoid people with cancer or other high-cost diseases? Don't you think that the kind of competition that starts with a decent level of required coverage, that doesn't exclude the care we actually need, would be better?
Senator McCain likes to start speeches with a litany of questions that, presumedly, less plain-spoken politicians would refuse to answer. Well, here are some questions he does not ask but, as that plain-spoken politician, he might want to answer:
1. Under your plan, Senator McCain, would any health insurer be required to sell you or me (or those like us with pre-existing conditions) a health insurance policy?
2. You say your plan is going to increase competition to the point that it actually lowers costs. Isn't there competition today among insurance companies? Haven't costs continued to go up despite that competition?
3. You say that under your plan everyone is going to pay less for health insurance. Nice words, I admit, but they are words we have heard before. You must know when American families calculate the actual cost of health care, they have to include those deductibles and co-pays and not just the cost of the insurance. Are you talking about cheaper overall or just a cheap policy that doesn't kick in until after thousands of dollars of deductibles have been paid?
4. Isn't the type of competition you are talking about really a rush to the bottom? As long as you allow insurers to underwrite and deny access, you encourage insurers to offer plans that may be cheap, but that get that way by avoiding people with cancer or other high-cost diseases or by limiting benefits and treatments, particularly if the treatment is expensive or might be needed for a long time. We all live in the real world; those of us lucky enough to have health insurance have seen how insurers cut coverage and up co-pays or deny particular treatments. The insurance company makes money when it doesn't have to pay for our health care. (I suspect that if they could, they would write obstetrical-only policies for nuns.) Doesn't your plan really encourage insurers plans to compete to avoid people with cancer or other high-cost diseases? Don't you think that the kind of competition that starts with a decent level of required coverage, that doesn't exclude the care we actually need, would be better?
Elizabeth Edwards Backs Clinton Health Plan
Etiquetas: USA health
2 Comments:
How Many Are Underinsured?
In the Literature
The number of underinsured U.S. adults—that is, people who have health coverage that does not adequately protect them from high medical expenses—has risen dramatically, a Commonwealth Fund study finds. As of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 percent from 2003.
Much of this growth comes from the ranks of the middle class. While low-income people remain vulnerable, middle-income families have been hit hardest. For adults with incomes above 200 percent of the federal poverty level (about $40,000 per year for a family), the underinsured rates nearly tripled since 2003.
Middle-Income Uninsured Rate Rising
The authors analyzed data from the Commonwealth Fund 2007 Biennial Health In-surance Survey, which interviewed adults ages 19 and older from June through October 2007. Respondents were identified as underinsured if they spent 10 percent of more of their income (or 5 percent if they were low-income) on out-of-pocket medical expenses, or if they had deductibles that equaled 5 percent or more of their income. An estimated 14 percent of all nonelderly adults were underinsured in 2007, and more than one of four were uninsured for all or part of the year. Adding these two groups together, 75 million adults—42 percent of the under-65 population—had either no insurance or inadequate insurance in 2007, up from 35 percent in 2003.
Lack of adequate insurance coverage, the study finds, is not a problem limited to low-income people. Adults with incomes below the poverty level were at the highest risk of being uninsured or underinsured, but "insurance erosion has spread up the income distribution well in to the middle-income range," the authors say. For those with annual incomes of $40,000 to $59,000, the underinsured percentage rate reached double digits in 2007. Barely half of those with incomes of 200 percent to 299 percent of the poverty level were insured all year with adequate coverage.
Underinsured Go Without Needed Care
In terms of access problems and financial stress, underinsured people—even though they have coverage all year—report experiences similar to the uninsured. More than half of the underinsured (53%) and two-thirds of the uninsured (68%) went without needed care—including not seeing a doctor when sick, not filling prescriptions, and not following up on recommended tests or treatment. Only 31 percent of insured adults went without such care.
About half of the underinsured (45%) and uninsured (51%) reported difficulty paying bills, being contacted by collection agencies for unpaid bills, or changing their way of life to pay medical bills. Many reported that they took on a loan, a mortgage against their home, or credit card debt to pay their bills, suggesting "that these financial difficulties had the potential to linger into the future." In contrast, only 21 percent of insured adults reported financial stress related to medical bills.
Benefit Design Matters
The sharp increase in the number of underinsured adults, say the authors, is partly due to design changes in insurance benefits that leave individuals financially vulnerable. Underinsured adults were more likely than those with adequate insurance to report benefit limits—for example, restrictions on the total amount a plan would pay for medical care or on the number of physicians' visits allowed. They were also far more likely to report high deductibles: one-quarter had annual per-person deductibles of $1,000 or more. Despite benefit limits and higher deductibles, underinsured adults often reported high annual premium costs, in line with those reported by more adequately insured people.
"Benefit design matters," the researchers conclude. Having a policy with substantial cost-sharing relative to income can undermine access to care and erode family finances. While improving insurance coverage is a worthy goal, it is important for policymakers to consider cost-sharing provisions, scope of benefits, and income when exploring coverage mandates, they say. Health care reform in Massachusetts, for example, includes graduated cost-sharing, as well as premium assistance for those with incomes up to 300 percent of the poverty level.
The goal is high-quality care and improved outcomes—not just coverage, write the authors. "[T]here is growing recognition of the need for coherent strategies that combine coverage with payment and other policies to change directions and move toward a more inclusive and higher-performing, high-value health system."
NYTimes 10.06.08
Os liberais de pacotulha defendem a Americanização do nosso sistema de saúde.
Pois aí vai mais um testemunho dos que nos poderá acontecer em breve se não nos pusermos a pau.
The Consequences of Inadequate Health Coverage
The uninsured tend to be in worse health than our nation’s privately insured population
(though better off than those who qualify for Medicaid). One in ten (11%) uninsured report being in fair or poor health compared to one in twenty (5%) of those with private insurance.
Almost half of all uninsured adults have a chronic condition. Those with health problems are likely to find private non-group coverage unavailable or unaffordable if job-based coverage is not an option. Policies sold in the non-group or individual market can be more expensive than employer-sponsored coverage because insurers can vary the premium based on age and health status. Insurers in the non-group or individual market can also deny coverage or exclude preexisting conditions and charge higher premiums for older adults, putting such policies out of reach for many of the uninsured.
Without insurance to cover health care costs, access to health care and ultimately health
suffers. Having health insurance makes a difference in whether, when, and where people get needed care and how well that coverage promotes access to preventive and primary care services and protects them from medical expenses when illness strikes. The uninsured are much more likely to postpone or forego care due to cost than those with coverage (Figure 8). More than half of uninsured adults do not have a place where they regularly go when they are sick. As a result, they are less likely than those with insurance to receive preventive care and even standard treatment for chronic conditions.
Limited access puts the uninsured at risk for worse health outcomes. Lack of access to
early and ongoing medical care leaves the uninsured more likely to be hospitalized for avoidable health problems and to risk being diagnosed at a later disease stage, leading to poorer health outcomes. When they are hospitalized, the uninsured are less likely to receive diagnostic and therapeutic services and are more likely to die in the hospital than insured patients. Being uninsured has been correlated with a 10-25% increased risk of mortality and an estimated 22,000 excess deaths in 2006 were linked to lack of health insurance coverage.
As a society, we also bear a substantial cost for leaving so many of our fellow Americans without health coverage. Children who are uninsured are more likely not to receive early and preventive care, to miss school due to illness, and not to get the healthy start in life our children deserve. Uninsured adults compromise our nation’s productivity when work is missed due to unattended health problems, and financial burdens for health care strain family resources. It is estimated that in 2006, the diminished health and shortened lifespan of the uninsured had an economic cost of between $102 and $204 billion due to the lost productivity of uninsured individuals.
DIANE ROWLAND, SC.D. link
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