University Times

Along with the U.S. population recently topping the 300 million mark, comes another, less heralded, statistic: Nearly one in every six Americans has no health insurance.

According to the U.S. Census Bureau, in 2005 there were 46.6 million Americans without health insurance, including 1.64 million in Pennsylvania. That is an increase of more than 8 million since 2000.

“These are staggering numbers, even hard to comprehend,” noted Ron Pollack, founding executive director of Families USA, a public-policy advocacy group focusing on health care issues, especially on achieving universal health care coverage in this country.

“I want to give you some statistics and provide the logic of where we are, how we got there and where we should go,” Pollack said in a lecture titled “The Fight for Universal Health Coverage in America.” The Oct. 19 lecture was part of the Rubash Distinguished Lecture Series, co-sponsored by Pitt’s School of Law and School of Social Work. A panel discussion followed the lecture. (See related story.)

“First, the 46.6 million is more than the aggregate population of 24 states plus the District of Columbia,” Pollack said. “And, if anything, 46.6 million understates the problem, because it’s based on a single point-in-time calculation. Other data show that the number of people who were without health insurance at some point during 2003 and 2004 was over 85 million. And over half of the 85 million were without health care coverage for at least nine months. These are not the elderly, because almost all of them are covered by Medicare. One in three in the U.S. under 65 was at some point during those two years touched personally by this very serious problem.”

Pollack offered additional somber information:

• Health care costs are rising more than five times faster than wages, with health insurance premiums in Pennsylvania in the last five years increasing by 75.6 percent compared to 13.3 percent for personal earnings.

• Employers, especially small businesses, are being slammed by the increase in health insurance and are shifting more costs to their employees.

• Safety net programs, such as Medicaid and children’s health insurance programs, are being cut back in many states.

• Workers who earn at least $15 an hour are offered health care coverage in 93 percent of their places of employment, while those earning less than $7 an hour have only a 50 percent chance of being offered coverage by their employers.

“A recent study showed that low-wage earners actually pay more in premiums in real dollars,” Pollack said. “It’s what we call a triple-whammy: They’re offered less coverage, they pay more for coverage and they have less resources to pay for it.”

There is no single cause for the inequity and inadequacy of the current health care coverage system, he said. “But the roots actually go back to 16th-century Elizabethan poor laws,” which are the model that U.S. public health care coverage is based on, Pollack said. “Those laws said you had to be poor and fit a ‘deserving’ category, which of course is in the eye of the beholder.”

Similarly, the 1935 Social Security Act offered public assistance to those who were poor, but also who had to fall into one of four categories: had dependent children, were permanently and totally disabled, were blind or were over 65, Pollack said.

“The 1996 welfare reform law attempted to attenuate the relationship of poor and ‘deserving,’ and it added 53 million people to Medicaid,” he said.

But, Pollack said, “In 42 states a childless adult can be literally penniless but not fit a ‘deserving’ category and therefore be ineligible for assistance.”

Pollack cited five systemic problems that are barriers to achieving universal health care.

• Special interest groups. With health care constituting 16 percent of the annual U.S. gross domestic product, a lot of people are making a lot of money from the system. “You have powerful interest groups — insurance companies, hospitals, pharmaceutical companies, doctors — who spend fortunes in opposition to change,” Pollack said. In 1993-94, some $300 million was spent in a campaign against President Clinton’s proposed universal health care, he said.

• Distrust of government. Whether it’s due to a Vietnam hangover, political scandals or Ronald Reagan’s deprecation of big government, people resist government’s efforts to be involved in their lives, Pollack said.

• Public support for universal health care. Such support is “a mile wide but an inch thick,” he said. “Poll data say that the public overwhelmingly supports the idea of universal health care. This is an altruistic impulse, but self-interest trumps altruism,” Pollack said. “When people look with self-interest they see more taxes, more paperwork, less choice of doctors. So there’s high support, but low intensity of support, although I think that’s changing.”

• Partisan, divided, fractious government. “Neither conservatives, who favor a competitive market, nor liberals, who favor a single-payer system, can win this debate on their own. Due to the filibuster in the Senate, you can’t pass major legislation without broad support,” Pollack said. Since the 1930s, only Lyndon Johnson, riding the Democratic sweep of the Congress in 1964, was able to enact major health care legislation, he noted.

• Other priorities taking precedence. “In the political fray, when your top priority is not the majority’s top priority, then the likelihood of anything getting done is small,” Pollack said. “We’ve got to change that dynamic,” to make universal health care the highest priority, he said.

“I believe things will get worse in this country before they get better. But I don’t want this discussion to be all doom and gloom, because I do have some optimism,” Pollack said.

For one thing, he said, the support in the past two years for universal health coverage has spread to organizations at both ends of the political spectrum, including, on the conservative side, the Heritage Foundation, the American Medical Association and the American Hospital Association, and on the liberal side, labor unions and AARP. “I sense a sea change in attitude, when these strange bedfellows are agreeing,” Pollack said.

“Also, some states, such as Massachusetts, Vermont, Illinois, Maine, have expanded coverage to more uninsured people,” he said. “Illinois, for example, now covers every child; that’s 253,000 children. I suspect these states are acting out of frustration, since waiting for the federal government is like waiting for Godot.”

In 2007 the federal children’s health insurance program comes up for re-authorization, which could focus the debate in Congress on the need for universal health care, he said. “Of the 46.6 million uninsured, over 9 million are children,” he noted.

A final reason for optimism, Pollack said, is that the political dynamic is shifting from public support due to altruism, to support out of self-interest. “I hate to wish for the situation to get worse, but with more and more uninsured in this country, more people are directly touched — one in three under 65 who have had at least a taste of being uninsured — that we’re moving toward a tipping point,” he said. “So, as more people are feeling the pain, it’s not about what can we do for someone else, it’s for me and for my family.”

—Peter Hart