Why does health insurance vary state to state

[mykidslovedogs]

Regarding life expectency. Prior to Canada going universal around 1960, their life expectancy rates were just slightly above the USA. The rates are still about the same today. A good conclusion is that the type of system, private vs. public has little to do with overall life expectancy rates.

In my studies, it appears that infant mortality is more an issue of socioeconomics vs. the type of healthcare system. Infant mortality rates: Blacks, 13.7, Puerto Ricans, 7, Whites, 6, Asians, 5 (Infant Mortality Statistics from the 1997 period: Linked Birth/Infant Death Data Set" National Vital Statistics reports 47, no 23 july 1999). Plus, the USA counts complicated births (the ones where drastic lifesaving measures are taken) in their statistics, while other countries would not necessarily count these babies (ones that would have died anyway during birth) in their statistics.

No matter how you look at it, each system has its trade offs. People have varying opinions about it, and these discussions aren't really going to change anyone's minds. I prefer quality of life over life expectency. Here are some statistics to take into consideration:

43.6 million Americans, 15.2%, lack insurance, but about 1/3 qualify for gov't coverage through low-income children or medicaid and haven't signed up for it, 1/3 in households with more than $50/k yr (people who probably could afford it, but choose not to buy it).

- Of those who become uninsured, 74.7% obtain insurance within the year, 2.5% remain insured for more than 3 yrs (Devon Herrick, 'Uninsured by Choice: Update' Brief Analysis no 460, National Center for Policy Analysis, Oct 2003)

- About one in six uninsured persons lives in a family with an income between $50,000 and $75,000, almost one in six earns $75,000. Between 1993 and 1999, the number of uninsured increased by 57% in household earning between $50,000 to $75,000 and by 114% among households earning $75,000+, while households earning less than $50,000 number of uninsured dropped 2%. Less than 25K, 24%, 25-50K, 34%, 50-75K, 16%, 75K+, 16% (Robert J Mills, 'Current Population Reports, Health Insurance Coverage: 1999' 60-211, US Census Bureau, Sep 2000

% of individuals 65+ reporting health as 'good', Aus 70.8, Can 70.2, Denmark 59.7, Ger 47.4, Neth 56.8, Nor 62.3, Swe 55.5, UK 56.5, US 72.6 (OECD Health Data, 2002)

- Ages 45-64: Aus 81.8, Can 84.9, Den 74.2, Ger 58.2, Neth 71.7, Nor 75.6, Swe 71.1, UK 71, USA 85.4

- In Britain, 20% of colon cancer considered curable at diagnosis are incurable by time of treatment (The Observer, "Cash-strapped NHS Hospitals Chase Private Patient Bonanza" Anthony Browne Dec 2001)

- Survey: Long wait to see doctor problem? 14/21/24, (US, UK, Canada) Difficulty seeing specialist due to long wait? 40/75/86, Long wait for nonemergency surgery? 5/38/27, Surgery delayed due to cancellation? 5/10/16 (Blendon, et al 'Inequities in Health Care: A Five-Country Survey' Health Affairs, vol 21, no 3, May/June 2002)

- Breast cancer mortality ratio (% of those who have it that die from it) NZ 46 UK 46 Germ 31 Can 28 US 25 France 35 Aus 28 (ibid)

- Prostate cancer mortality ratio - NZ 30 UK 57 Ger 44 Can 25 US 19 France 49 Aus 35 (bid)

- Britons are more likely to be killed by an infection caught in a hospital than by a car accident ('Watchdog Healthcheck' BBC online news Jan 2001)

[Rich_in_Tampa]

Originally Posted by ladelfina

I was recounting the story mainly to demonstrate that here there is prompt emergency care AND routine use of high-tech equipment.. it's not necessary to "do without" just because it's publicly-financed health care. My surprise was due in part to my own ignorance.. not trying to second-guess the docs... Insurers are a cartel.. they dominate the market. I have no doubt that their top 20% of employees/executives make more than doctors do. That's money that could be spent on either doctors' and nurses' salaries or on patient care. We choose to subsidize a vast insurance bureaucracy just as Italy chooses to subsidize a vast public works bureaucracy. Neither is as efficient as it could be, nor does either have much to do with "market forces".

Here's a nifty calculator..
http://www.aflcio.org/corporatewatch...u/database.cfm
I chose WellPoint:
http://www.aflcio.org/corporatewatch...m?tkr=WLP&pg=4

A lot of interesting stuff here, as well:
http://www.pnhp.org/

Yes - didn't mean to distract from your more important points. I think a cartel is a good analogy, and in this instance the product of health care is of such high stakes that letting the market do its thing to correct the problem is not appropriate, in my opinion. If you can't afford a car, you take the bus. If you can't afford or access health insurance, you may suffer, die and/or be forced to work til you die.

[Martha]

The number of uninsured is increasing. The census bureau figures MKLDs cited are from 2000. Numbers for 2004 show 45.8 million uninsured. This was an increase of 800,000 from 2003. A 2004 study from Families USA found that 81.8 million lacked health insurance at some point in 2002 and 2003 and most were uninsured for more than 9 months. Adding to these numbers, the Commonwealth Fund has found 16 million adults as under-insured in 2003. This is a problem we haven't even begun to talk about.

About 20% of the uninsured are children according to the Robert Wood Johnson Foundation. The foundation found that about 70% of those children would be eligible for SCHIP or Medicaid, but parents often are unaware of the eligibility or daunted by the paperwork. There is no one out there advertising these programs.

Medicaid is administered by the states. States divide low income people into three groups: children, parents of children, and non-parent adults. In 40 of 50 states non-parent adults are not eligible for Medicaid at all, even if they do not have a penny to their name, unless they are fully and completely disabled. The remaining 10 states provide some coverage but it is very limited. Look at the Kaiser Family Foundation website, it reports a lot of this information about Medicaid.

In 14 states, more than 1/3 of non-elderly people had no health insurance for all or part of 2002 and 2003. Texas and California were the worst.

A number of MKLD's posts seem to indicate that the uninsured get treated anyway. This is not the case. The National Academy of Sciences has found that lack of insurance causes about 18,000 unnecessary deaths a year. About 1400 is from undiagnosed high blood pressure. Chronic diseases and cancer do not get treated in the emergency room. Here is an interesting article on Houston's problem with one million uninsured and the inability for many to get treatment for cancer:

http://www.click2houston.com/investi...14/detail.html

[mykidslovedogs]

Originally Posted by Martha

A number of MKLD's posts seem to indicate that the uninsured get treated anyway. This is not the case. The National Academy of Sciences has found that lack of insurance causes about 18,000 unnecessary deaths a year. About 1400 is from undiagnosed high blood pressure. Chronic diseases and cancer do not get treated in the emergency room. Here is an interesting article on Houston's problem with one million uninsured and the inability for many to get treatment for cancer:
http://www.click2houston.com/investi...14/detail.html

Yet the USA seems to have lower numbers of deaths due to cancer (particularly cancers that are less related to lifestyle such as breast cancer and prostate cancer). Why? (Which is worse...a few people dying of cancer because of lack of affordability for care vs. a lot more people dying of cancer due to a lack of available care?)

http://www.cancer.org/docroot/NWS/co...ival_Rates.asp

Data came from the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results (SEER) program, which includes information on about 10 percent of those diagnosed with cancer in the U.S. Its European counterpart, EUROCARE, provided data from 17 European countries.

Using complex statistical methods, the researchers calculated survival rates for each type of cancer for both groups. The results show Americans have significantly better five-year relative survival rates for cancers including:

prostate (81 percent vs. 56 percent);
melanoma (86 percent vs. 76 percent);
colon (60 percent vs. 47 percent);
rectum (57 percent vs. 43 percent);
breast (82 percent vs. 73 percent), and
uterine cancer (83 percent vs. 73 percent).
However, the reverse was true for stomach cancer. U.S. survival rates trail slightly behind those of European patients (19 percent vs. 21 percent).

[Rich_in_Tampa]

Originally Posted by mykidslovedogs

Yet the USA seems to have lower numbers of deaths due to cancer (particularly cancers that are less related to lifestyle such as breast cancer and prostate cancer). Why?

This evidence shows that the US ranks average to high (that is, a poor showing) for cancer deaths. Can you please provide a link to where your contrary data come from?

Martha, thanks for collecting those numbers. Did you see anything to confirm my impression that uninsured status is steadily working its way well beyond the indigent population and deep into the middle class sector?

[mykidslovedogs]

Originally Posted by Rich_in_Tampa

This evidence shows that the US ranks average to high (that is, a poor showing) for cancer deaths. Can you please provide a link to where your contrary data come from?

Martha, thanks for collecting those numbers. Did you see anything to confirm my impression that uninsured status is steadily working its way well beyond the indigent population and deep into the middle class sector?

I did post the link on my last post, but you must have missed it:


http://www.cancer.org/docroot/NWS/co...ival_Rates.asp

[Rich_in_Tampa]

Originally Posted by mykidslovedogs

I did post the link on my last post, but you must have missed it:

http://www.cancer.org/docroot/NWS/co...ival_Rates.asp

Got it. I've seen that study and find it interesting -- it has been discussed at some length. It is a legitimate study.

Not to get technical, but 5 year survival rates are not the same as death rates, so it may be that both surveys are accurate though measuring different phenomena. One explanation is that care in the USA is better (I'd like to think so since it is close to my heart). Another is lead time bias (earlier diagnosis from, for example, excessive use of CT scans, creating a false sense of improved survival whereas in reality you just have a longer time of awareness and worry -- depends on the type of cancer) which the authors acknowledge. Finally, it may be that the survival improvements we achieve here compress death rates toward the end of the expected survival range rather than deaths distributing themselves more evenly year by year; this is generally desirable but not always since the quality of life cost of intensive treatments may not be worth it to all patients.

It is also plausible in the survey I cited that deaths from other causes will lower the apparent death rates from cancer. This situation is not a net "win" of course. Complicated stuff.

Interesting, but none of this is responsive to Martha's excellent post.

[Martha]

Originally Posted by Rich_in_Tampa

This evidence shows that the US ranks average to high (that is, a poor showing) for cancer deaths. Can you please provide a link to where your contrary data come from?

Martha, thanks for collecting those numbers. Did you see anything to confirm my impression that uninsured status is steadily working its way well beyond the indigent population and deep into the middle class sector?

From the 2004 Census, it appears that families with incomes between $50,000 and $75,000 is the fastest growing group of uninsured. Also, from the Kaiser 2005 employer health benefits survey, the percentage of employers offering insurance has decreased every year for the past six years, almost entirely in the small group market, with 40% of employers not offering any health insurance. Interestingly, 98% of employers which have 200+ employees offer health insurance. A lot of this is about bargaining power.

Many small to mid size employers I have talked to in the course of my employment would be delighted with national healthcare. The cost to employers in the small group market is becoming unaffordable for many. The employers who do buy insurance pass some of the cost on to employees in the form of higher deductibles, coinsurance and copays. This gets to the affordability issue, with increasing numbers of people forgoing important care due to cost.

[Martha]

Sorry, I missed in all my stacks of stuff that the Census Bureau recently revised its insurance figures as follows:

The revised estimates show that, in 2005, 44.8 million people, 15.3 percent of the population, were without health insurance – about 1.8 million fewer than the Census Bureau reported in August 2006. Based on the Current Population Survey, the original 2005 estimate was 46.6 million, or about 15.9 percent of the population .

[mykidslovedogs]

I wonder if there is any data available on the effects of community rating vs. rating flexibility in the small group market from state to state? Here is recent report regarding Colorado Legislation allowing rating flexibility in the small group market and how that has impacted losses of small groups in the state of Colorado. Ever since the rating flexibility legislation went into effect in 2003, we have seen a slowing or flattenting in the losses of small groups (this also coincides with a flattening of rates as well), and there has even been a slight uptick in 2006. See figure 9 of attached study:

http://www.dora.state.co.us/insurance/pb/rateflex07.pdf

[mykidslovedogs]

Originally Posted by Meadbh

Doctors in Canada must elect to (a) join the public system or (b) work exclusively privately. There is no law that prevents me, as a Canadian citizen, from using and paying for the services of a private clinic such as this one if I choose to.

Apparently, not everyone in Canada has the ability or finances to opt out of the public system for private services. If it was that easy, I'm sure this person would have:

http://www.canorth.org/en/about/waiting.asp