Monday, October 15, 2012

Doctor Visits Drop 20%—Life Expectancy for the Poor Drops 5%

Image from Flickr, by Metro Centric

Pretty much everyone I talk to at work or in my neighborhood has been raving about how wonderful Obamacare is going to be. Granted, most of these people are liberals (I do live in San Francisco, after all). And they are correct that Obamacare will offer some advantages over the status quo, particularly for women’s reproductive health, as I described in a recent post. It will also no doubt provide coverage for many who currently lack it.

Overall, however, it is primarily just a huge giveaway to the big insurance companies. By requiring that everyone purchase coverage, it will increase the insurers’ customer base and, therefore, their profits. It does little to reign in skyrocketing costs and profiteering. There will continue to be millions of Americans who still cannot afford coverage even with the subsidies or who refuse to purchase the mandated coverage for other reasons. Those who already receive coverage through their employers will continue to see greater and greater out of pocket expenses each year, which will further erode their take home pay and living standards. And, worst of all, we continue to see thousands of excess deaths each year because people are still not receiving adequate preventative and long term care for chronic and infectious diseases.

One of the problems with Obamacare is that it does not adequately address the skyrocketing costs, which are a product of the profit-driven basis of our healthcare system. The most expedient way to remove the profit-motive and reign in costs is to create a single payer plan in which health care costs are collectivized through progressive taxation and provided to everyone through the government free of charge whenever needed.

Since that option was never allowed onto the table in the first place, the powers that be have come up with an alternative that keeps profits high and quality of service low: Increase copayments and decrease services in exchange for lower premiums. The rationale is that lower premiums increase the chances that people will be able to afford a plan and thus have coverage for emergencies. But higher copayments discourages people from using their plans except for real emergencies, thus undermining personal, as well as public, health. For example, when copayments are high, people are less likely to go in for preventative care and physicals, and more likely to suffer through undiagnosed symptoms in hopes they’ll go away on their own, all the while infecting their colleagues and schoolmates. This also leads to more emergency room visits, when symptoms that could have been easily treated with medication, had they been promptly diagnosed, escalate into acute or life threatening conditions.

Between 2001 and 2010, the number of doctor visits for Americans between the ages of 18 and 64 declined by almost 20%, according to the U.S. Census Bureau. This was due a combination of factors, including increased copayments for those with healthcare coverage and an increasing number of people who lost coverage through unemployment or unaffordable increases in private policy premiums. A recent study in the journal Health Affairs found that life expectancy for the poorest Americans fell dramatically between 1990 and 2008. Life expectancy fell from 78 to 74 years for white women without a high school diploma, and from 70.5 to 67.5 years for men in this group. This decline in life expectancy was likely due, at least in part, to the declining access to, and quality of, healthcare.

Obamacare may result in more Americans having healthcare coverage, but it will not result in greater access or quality. Many employers will simply stop covering employees, forcing them to purchase plans on the open market which will end up being more expensive and provide poorer coverage. According to the WSWS, up to 20 million Americans could lose employer-provided coverage by 2019. Those who retain employer coverage will continue to see increased copayments and out of pocket contributions to their premiums, as overall costs continue to outpace inflation. This will translate into fewer doctor visits and increased preventable deaths.

Meanwhile, the majority of Americans will see a continued decline in their standard of living, as healthcare costs continue to eat away at their net income. This could further erode overall health and longevity as people spend less on healthy foods, fitness, preventative care and leisure to compensate for their dwindling incomes.

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