Argument: It is a myth that the uninsured receive sufficient care now

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Kao-Ping Chua, “Arguments and counterarguments about universal health care”. AMSA. Retrieved May 30th, 2008 – “Arguments that the uninsured are already taken care of in this country
The uninsured already get free healthcare.
• This is a common myth. In fact, among families with at least one uninsured member, less than a quarter report getting free or discounted care in any given year (Kasper J, Giovannini T, and Hoffman C. “Gaining and Losing Health Insurance: Strengthening the evidence for efforts on access to care and health outcomes.” MCRR. 57(3): 298-318, 2000).
• There is indeed a safety net for a minority of the uninsured, including government-sponsored clinics and hospitals, as well as care provided by private physicians. However, financial pressures due to managed care are reducing the ability of private physicians to provide charity care (Cunningham P et al. “Managed care and physicians’ provision of charity care. JAMA 1999; 281:1087-92).
• The uninsured are much less likely than the insured to have a usual source of care (Kaiser Commission on Medicaid and the Uninsured. 2003. “Access to Care for the Uninsured: An Update. ($4142; September).”

“The Case for Universal Health Care”. American Medical Student Association (AMSA). 2005-2006 – “The problems of accessing health care for the uninsured have been detailed extensively.4,5

• The uninsured are less likely to be able to fill prescriptions and more likely to pay much more of their money out-of-pocket for prescriptions. In a recent survey, one third of uninsured Americans reported that they were unable to fill a prescription drug in the last year because of the cost.
• The uninsured are 3-4 times more likely than those with insurance to report problems getting needed medical care, even for serious conditions. In one study, more than half of the uninsured postponed needed medical care due to financial concerns, while over one third went without a physician-recommended medical test or treatment due to financial concerns.
• The uninsured are less likely to have a regular source of health care. 40% of the uninsured do not have a regular place to go when they are sick or need medical advice, compared to less than 10% of the insured. As a result, 20% of the uninsured say their usual source of care is the emergency room, compared to just 3% of the insured.
• The uninsured are less likely to get needed preventive care. When compared to the insured, uninsured, non-elderly adults are 50% less likely to receive preventive care such as pap smears, mammograms, blood pressure checks, sigmoidoscopies, cholesterol screening, and prostate exams.
• The uninsured are more likely to be forced to delay medical services, affecting the timeline of diagnosis and thus the prognosis of the disease process. In one study, the time to diagnosis of late-stage cancer was compared between uninsured and privately insured patients. The uninsured patients were 1.7, 2.6, 1.4, and 1.5 times more likely to be diagnosed late for colorectal cancer, melanoma, breast cancer, and prostate cancer, respectively.
• The uninsured are more likely to receive poor care for chronic diseases. Among non-elderly adult diabetics, a lack of insurance is associated with less glucose monitoring and fewer foot and eye exams, leading to an increased risk of hospitalization and disability. Uninsured individuals with end-stage renal disease are more likely to have progressed to a more advanced stage before beginning dialysis.

As a result of these difficulties accessing health care, the non-partisan Institute of Medicine estimates that the uninsured have an excess annual mortality rate of 25%. This increased mortality translates into 18,000 excess deaths for people between age 25-64 per year, which is of comparable magnitude to the number of people in this age group who die each year from diabetes, stroke, HIV, and homicide.”

“The Case for Universal Health Care”. American Medical Student Association (AMSA). 2005-2006 – “Lack of preventive care and adequate care of chronic diseases: Because the uninsured do not get the preventive and chronic disease care they need, they are more likely to develop complications and advanced stage disease, both of which are expensive to treat. The magnitude of this cost is difficult to estimate, but it is significant.”