America's uninsured
haven't shown collective power
By RICARDO ALONSO-ZALDIVAR
The Associated Press
Sunday,
April 12, 2009; 4:49 AM
WASHINGTON -- If the uninsured were a political lobbying group, they'd have
more members than AARP. The National Mall couldn't hold them if they decided to
march on Washington.
But going without health insurance is still seen as a personal issue, a
misfortune for many and a choice for some. People who lose coverage often
struggle alone instead of turning their frustration into political action.
Illegal immigrants rallied in Washington during past immigration debates, but
the uninsured linger in the background as Congress struggles with a health care
overhaul that seems to have the best odds in years of passing.
That isolation could have profound repercussions.
Lawmakers already face tough choices to come up with the hundreds of billions
it would cost to guarantee coverage for all. The lack of a vocal constituency
won't help. Congress might decide to cover the uninsured slowly, in stages.
The uninsured "do not provide political benefit for the aid you give them,"
said Robert Blendon, a professor of health policy and political analysis at the
Harvard School of Public Health. "That's one of the dilemmas in getting all this
money. If I'm in Congress, and I help out farmers, they'll help me out
politically. But if I help out the uninsured, they are not likely to help
members of Congress get re-elected."
The number of uninsured has grown to an estimated 50 million people because
of the recession. Even so, advocates in the halls of Congress are rarely the
uninsured themselves. The most visible are groups that represent people who have
insurance, usually union members and older people. In the last election, only 10
percent of registered voters said they were uninsured.
The grass-roots group Health Care for America Now plans to bring as many as
15,000 people to Washington this year to lobby Congress for guaranteed coverage.
Campaign director Richard Kirsch expects most to have health insurance.
"We would never want to organize the uninsured by themselves because
Americans see the problem as affordability, and that is the key thing," he said.
Besides, added Kirsch, the uninsured are too busy scrambling to make ends
meet. Many are self-employed; others are holding two or three part-time jobs.
"They may not have a lot of time to be activists," he said.
Vicki and Lyle White of Summerfield, Fla., know about such predicaments. They
lost their health insurance because Lyle had to retire early after a heart
attack left him unable to do his job as a custodian at Disney World. Vicki, 60,
sells real estate. Her income has plunged due to the housing collapse.
"We didn't realize that after he had the heart attack no one would want to
insure him," said Vicki. The one bright spot is that Lyle, 64, has qualified for
Medicare disability benefits and expects to be getting his card in July.
But for now, the Whites have to pay out of pocket for Lyle's visits to the
cardiologist and his medications. The bills came to about $5,000 last year. That
put a strain on their limited budget because they are still making payments on
their house and car.
"I never thought when we got to this age that we would be in such a mess,"
said Vicki, who has been married to Lyle for 43 years. "We didn't think we would
have a heart attack and it would change our life forever."
While her own health is "pretty good," Vicki said she suffers chronic sinus
infections and hasn't had a checkup since 2007. "I have just learned to live
with it," she said.
The Whites' example shows how the lack of guaranteed health care access
undermines middle-class families and puts them at risk, but that many of the
uninsured eventually do find coverage. Lyle White has qualified for Medicare,
even if the couple must still find a plan for Vicki.
Research shows that nearly half of those who lose coverage find other health
insurance in four months or less. That may be another reason the uninsured have
not organized an advocacy group. At least until this recession, many have been
able to fix the situation themselves.
"The uninsured are a moving target," said Cathy Schoen, a vice president of
the Commonwealth Fund, a research group that studies the problems of health care
costs and coverage.
But even if gaps in coverage are only temporary, they can be dangerous.
"Whenever you are uninsured, you are at risk," said Schoen. "People don't plan
very well when they are going to get sick or injured."
Indeed, the Institute of Medicine, which provides scientific advice to the
government, has found that a lack of health insurance increases the chances of
bad outcomes for people with a range of common ailments, from diabetes and high
blood pressure to cancer and stroke. Uninsured patients don't get needed
follow-up care, skip taking prescription medicines and put off seeking help when
they develop new symptoms.
Such evidence strengthens the case for getting everybody covered right away,
Schoen said. But she acknowledges the politics may get tough. "It certainly has
been a concern out of our history that unorganized voices aren't heard," she
said.
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On the Net:
White House:http://www.whitehouse.gov/agenda/health_care/
Health Care for America Now:http://www.healthcareforamericanow.org/
Commonwealth Fund:http://www.commonwealthfund.org/
Institute of Medicine:http://tinyurl.com/dm8gnn
© 2009 The
Associated Press