Weekly Briefing

New analysis shows how many North Carolinians are dying (literally) for lack of health insurance

One of the major ideological bones of contention between progressives and market fundamentalists these days relates to the impact of societal inequality. Does it really matter and, if so, how? Does inequality just bruise people's egos or is there something more to it?

Here in North Carolina, advocates at the North Carolina Justice Center have released a series of reports over the last few years that have documented just how many people fail to earn a "living income." The most recent, which was released just last month, demonstrated that 37% of the families in the state had incomes below the living income standard. This means that these families did not bring in enough income each year in order to afford the actual costs of seven essential expenses: housing, food, childcare, health care, transportation, other necessities and taxes.

According to the market fundamentalists, however, income inequality and inadequacy are overblown. They note that many of the poor have phones and televisions and are living better than people in the Third World. So what's the big deal? As one right wing commentator noted a few years back in critiquing one of the Justice Center's earlier reports, "Does this mean that those below the living income standard are earning a ‘dying income'"? In other words, "ha ha, lighten up all you bleeding hearts with all this talk about ‘living incomes,' people will find a way to survive and certainly aren't dying in the streets."

Or maybe they are

Now comes confirmation from a reputable national source that people are dying in North Carolina - in the streets, in their apartments, in our emergency rooms - as a result of inequality. The report was released last week by the respected national health care advocacy group, Families USA. It looked at health outcomes in all 50 states and the District of Columbia for people without health insurance. Here are some of the key findings for North Carolina:

"In 2006, there were more than 4,811,000 people between the ages of 25 and 64 living in North Carolina. Of those, 21.1 percent were uninsured. Uninsured North Carolinians are sicker and die sooner than their insured counterparts."

The report goes on:

"Working-Age People without Health Insurance Die Sooner

• Families USA estimates that nearly three working-age North Carolinians die each day due to lack of health insurance (approximately 1,000 people in 2006).
• Between 2000 and 2006, the estimated number of adults between the ages of 25 and 64 in North Carolina who died because they did not have health insurance was nearly 5,600.
• Across the United States, in 2006, twice as many people died from lack of health insurance as died from homicide."

How could this be so? As the market fundamentalists regularly note, America is home to some of the finest health care in the world. North Carolina's system for serving the poor, Medicaid, costs billion of dollars and is often excoriated by the right as a "Cadillac program" (though, truth be told, it works more like underpowered but efficient Honda).

Well, as Families USA explains, here's how:

"The uninsured are less likely to have a usual source of care outside of the emergency room.

• Uninsured Americans are up to four times less likely to have a regular source of care than the insured.

The uninsured often go without screenings and preventive care.

• Uninsured adults are more than 30 percent less likely than insured adults to have had a checkup in the past year.
• Uninsured adults are more likely to be diagnosed with a disease in an advanced stage. For example, uninsured women are substantially more likely to be diagnosed with advanced stage breast cancer than women with private insurance.

The uninsured often delay or forgo needed medical care.

• Uninsured Americans are up to three times more likely to report having problems getting needed medical care.
• Uninsured adults are more than three times as likely as insured adults to delay seeking medical care (47 percent versus 15 percent).

Uninsured Americans are sicker and die earlier than those who have insurance.

• Uninsured adults are 25 percent more likely to die prematurely than adults with private health insurance.
• Uninsured Americans between 55 and 64 years of age are at much greater risk of premature death than their insured counterparts. This makes uninsurance the third leading cause of death for the near-elderly, following heart disease and cancer.

The uninsured pay more for medical care.

• Uninsured patients are unable to negotiate the discounts on hospital and doctor charges that insurance companies do. As a result, uninsured patients are often charged more than 2.5 times what insured patients are charged for hospital services.
• Three out of five uninsured adults (60 percent) under the age of 65 reported having problems with medical bills."

 A matter of choice?

The market fundamentalist response to such damning numbers, of course, is to blame the dying. "If only these people would make better choices with their resources and lifestyles," goes the argument, "they could find affordable health insurance and lead healthier lives."

Well, maybe. It's true that there are a lot of things that at least some individuals could do in order to do a better job of coping with the challenges of life in modern society. Life is complicated and some people do make poor choices. People should eat better and exercise and better prioritize their spending habits.

But should the penalty for choosing incorrectly be death? Is that what we really believe? By such reasoning, society might also forego any public guarantees of safe drinking water or meat inspectors or airplane safety. With enough research and hard work and good old capitalist competition, of course, most people of means would figure out how to get the water and food and safe travel that they need. And while it's true that some people who made poor choices (and/or their family members) would die (maybe even a thousand per year in North Carolina) think of all the tax dollars we'd save.

Or a matter of common sense?

Of course, if 1,000 North Carolinians actually were dying each year as the result of tainted water or meat, the vast majority of us would not blame the victims for their poor purchasing choices just because they didn't buy Evian water or Fresh Market filet mignon. We would demand that public institutions act immediately to end such senseless and preventable carnage. We would demand that our elected officials and professional policymakers assure that all members of the public be provided with a baseline safety net of protection - even those individuals who were shiftless/careless enough to drink tap water or consume Food Lion hamburger.    

Could it be that a better response to the new Families USA numbers should be this: a long, serious collective look in the societal mirror? If we take such an opportunity, we might just come to the realization that for a comparative pittance (say a modest bump in the income taxes on the wealthiest individuals and corporations) we can save the lives of thousands of our friends and neighbors, and in so doing, rescue millions more from the nagging and often debilitating fear that comes with having no ready access to health care.

We won't end inequality. Lord knows, there will still plenty of opportunity for individuals to screw up, to make bad choices, and to suffer. But at least 1,000 more North Carolinians each year will be free to do so. If we take such a look, we might also realize that there's more to freedom and liberty and, indeed, to life on earth, than having the lowest possible tax rates.  

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This entry was posted on Tuesday, April 8th, 2008 at 9:21 am and is filed under Weekly Briefing. You can follow any responses to this entry through the RSS 2.0 feed.