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Living Without Health Insurance

Eighteen thousand people die every year because they lack health insurance.

Betsy Rotzler was one of those 18,000 people in 1996. Although both Betsy and her husband Gary had full-time jobs, their employers didn’t offer health insurance and they couldn’t afford it on their own. Betsy began experiencing fatigue and pain in her back in the summer of 1996, but decided not to go to her doctor. She wanted to save money in case one of her three children had a medical emergency. But by fall, the pain was too great for her to cope with any longer. The Rotzlers went to a free clinic, where a doctor told Betsy she likely had breast cancer. Betsy died within a week of an MRI scan’s confirmation of the diagnosis.

For Americans without health coverage, health care reform isn’t just another item on the political agenda. It’s a matter affecting their lives and—in thousands of tragic cases every year—their deaths, as well.

Gary Rotzler told his family’s story at a House Energy and Commerce Subcommittee on Health hearing recognizing “Cover the Uninsured Week,” a national week sponsored by the Robert Wood Johnson Foundation to promote awareness about the 45 million Americans living without health insurance. Center for American Progress Distinguished Senior Fellow Sen. Tom Daschle and George Washington University Associate Professor Jeanne Lambrew, also a Senior Fellow at CAP, testified at the hearing on the need to ensure that all Americans have affordable, quality health care.

Committee members and panel witnesses agreed that that the U.S. health care system is in need of serious repair. “Health care is “the most important issue on the minds of the American people,” Rep. Jan Schakowsky (D-IL) said, but the system is “completely disintegrating… simply broken.”

Opinions varied on the best way to go about fixing it.

Daschle argued that reauthorizing the State Children’s Health Insurance program, extending insurance parity for mental illness, and protecting Americans from genetic non-discrimination are incremental steps that would improve the health care system, but they aren’t sufficient. “There is no pathway of incremental steps that will improve and expand health coverage for all,” he said. “The only solution is comprehensive reform.”

Lambrew argued that that “we would achieve universal coverage by building on what works in the system.” Medicaid, SCHIP, and possibly Medicare could be extended to become safety nets; employer-sponsored coverage could be supplemented with a new “purchasing pool” for group insurance; and assistance would be provided to ensure that everyone could afford coverage.

Gerald W. McEntee, international president of the American Federation of State, County, and Municipal Employees, said that “government must play a central role in regulating, financing, and providing health coverage,” but we must first “do no harm.” Until we have a plan for comprehensive reform, we must not undermine existing coverage, McEntee argued.

The path to reform, Daschle and Lambrew both stressed, must include leadership from the political, business, and health care industry spheres. “Businesses are a major payer of health care and player in the political system,” Daschle said. More than half of Americans have employee-sponsored health insurance, and rising health care costs are putting a strain on businesses. “We are making headway with business and labor leaders in a collaboration with the Better Health Care Together coalition, cementing support for legislation to provide coverage for all, greater value, and shared responsibility for managing and financing a new American health care system by 2012,” said Lambrew.

Daschle emphasized that “we need to think outside the box.” He proposed that we run our health care system by means similar to the nation’s monetary system. The Federal Reserve System largely operates through the private sector, but decisions governing it are made within a federal governmental infrastructure. “Just as the Federal Reserve protects difficult decisions on monetary policy from political pressure, I would like to see a framework that insulates health care decision-making about cost and financing,” Daschle said. “If we could fix our financing system, I think we could fix a lot of the other problems involved with our health care system today.”

Lambrew argued that health system reform would lower health care costs. “Lower costs would result from insuring all Americans in a simpler, seamless system,” said Lambrew. Health care costs could also be cut by installing information technology systems to increase efficiency.

Several witnesses emphasized prevention as a strategy for cutting costs and reducing the strains put on our health care system, in particular, putting a new focus on preventive care and the responsibility individuals have to look after their own health. Lambrew argued that an emphasis on wellness scould lower costs: “Today, nearly 80 percent of our health costs result from chronic disease, much of which is preventable,” she said. Michael K. Smith, secretary of Vermont’s agency of administration, said that we need to craft “public policy that promotes healthy lifestyles.”

In a hearing that aired many voices and opinions, there were three unifying refrains: the current health care system is broken; the economic and human costs of 45 million Americans coping without health insurance take a toll on our families, our communities, and our nation; and government and businesses must work together to ensure that all Americans have affordable health care coverage. As Americans’ support for universal health care grows, policymakers and health care stakeholders will need to seek bold solutions that address the health care needs of an increasingly frustrated public.

Read the full testimony: