The truth is that according to the World Health Organization, the United States spends more on healthcare per person than any other nation in the world,10 yet still was only tied for the twentyeighth highest life expectancy,11 and ranked in at a low thirtyseventh for our mortality rate of children under five years old.12 We aren’t getting much for the money we spend.
Some states are trying to do something about this. For example, there’s been a movement in California to get universal health coverage for kids, Maine is working on getting costs to businesses down while covering more people, and Vermont passed a bill that called for a publicly financed comprehensive healthcare system through the State House and State Senate in 2004 that was eventually vetoed by the Governor.
Dr. Deborah Richter, current Chair of Vermont healthcare For All, got tired of seeing her patients die from treatable diseases because they were uninsured and unable to pay for proper medical care. A few of her patients pushed her to activism: One situation involved a brother and sister who both had juvenile diabetes and didn’t have insurance. They came from a hardworking family that made just enough money so they weren’t eligible for Medicaid, but their jobs didn’t come linked with health insurance. When their health worsened, they weren’t able to take care of their health needs, leading to tragic consequences.
Like the siblings, many in our healthcare system are lost in the huge gaps in coverage, “Right now we have private insurance for most middle and upper income kids, and several low income coverage possibilities including Medicaid and SCHIP (State Children’s Health Insurance Program), but we still have nine million kids falling through the cracks,” notes Dr. Alison Buist, Health Policy Director for the Children’s Defense Fund.
Some coverage is available to low-income families, Buist explains how it works. Medicaid, a federal entitlement program, requires the federal government to provide support if a person meets their eligibility criteria. It currently covers more than forty million people, half of whom are children.13 SCHIP, a federal block grant program that provides funding to states, is essentially a state health insurance program that covers children from families with slightly higher incomes than Medicaid covers. Yet there are too many children and families who do not qualify for either program and are left without healthcare options.
Many of those are Americans who hold jobs without health insurance coverage. These workers make too much money to qualify for any state or federal medical assistance, yet the high cost of private insurance makes it out of reach, particularly for those holding low-income jobs (which are the jobs least likely to have job-linked health coverage). In fact, working families make up 81 percent of uninsured people.14
Patricia Schoeni, Executive Director of National Coalition on healthcare, notes, “Lots of people think that when you’re talking about the uninsured, you’re talking about poor people. But the majority of uninsured work; and a large number of them are middle class Americans. They are uninsured either because they work for an employer who doesn’t provide health insurance and going out onto the open market to buy an individual insurance policy is prohibitively expensive; or they are uninsured because they are unemployed, or because employers are passing along the cost increases to them and they drop the coverage.”
Not to give the wrong impression: People in poverty are also doing without healthcare in our nation. Right now, the Kaiser Family Foundation reports, “Low-income Americans with family incomes below 200 percent of the poverty level run the highest risk of being uninsured. Over a third of the poor and nearly 30 percent of the near-poor lack health insurance.”15 And again, these statistics are only those without health insurance, and don’t include the significant number of Americans whose healthcare coverage would not carry them through a serious or long-term illness. Essentially, as Dr. Himmelstein, associate professor at Harvard, noted, unless you are Bill Gates and can pay unlimited sums out-of-pocket, you can’t count on coverage in this country when the chips are down.
This crisis is only deepening, with the number of uninsured Americans rising quickly. Between 2000 and 2004 alone, the number of uninsured people under sixty-five years old increased by six million.16 In that same time period, job-linked coverage dropped by 5 percent.17
The 5 percent drop in job-linked coverage is nothing to be glossed over. Frankly, the cost of employer-sponsored health insurance is going through the roof. Businesses are also struggling with the rising costs of healthcare. Many businesses are stretched to the limits of profitability just because of the escalating premiums for employees. There was an 11 percent increase in premium costs in the one year between 2003 and 2004. By 2004 the average cost of a premium for family coverage was $9,950.18 The Kaiser Family Foundation finds, “Premiums for employersponsored health insurance rose at about five times the rate of inflation and workers earnings.”19 And it further notes, “Since 2000, premiums for family coverage have risen 59 percent.”20
In this current situation of increasingly expensive healthcare coverage, the impacts are also seen in the way we work. Joan Williams, Professor of Law at the University of California, Hastings, and Director of the Center for WorkLife Law, comments, “Healthcare is a huge reason why people overwork in the United States. One of the reasons people strive so hard to get ‘good jobs’ is because otherwise they wouldn’t have health insurance. In the U.S. we tend to have bad twenty to twentyfive hour per week jobs without benefits, and good forty to sixty hour per week jobs with benefits. A lot of the reason people are willing to work such long hours is not that they prefer to do so, but because they have no other choice since we deliver healthcare through a job link.
“This has direct implications for moms,” explains Williams, “because it pushes families into a format where one person has an all consuming job with healthcare, which means mothers get pushed into marginalized jobs or out of the labor force. Also, the lack of socially provided healthcare makes it very difficult for proportional pay and equity for part-time work because it’s so expensive for an employer.” She concludes, “Europe has a guarantee of part-time equity in their laws, and one of the reasons is healthcare. The lack of socially provided healthcare in the United States plays a major role in the fact that we work longer hours than virtually any industrialized country.” These long hours, in turn, allow little time for raising a family.
The astronomical cost of healthcare coverage is not only changing the way we work, but has also caused a drop in job-linked healthcare coverage altogether. Many employers are simply unable to afford the sky-rocketing costs of health coverage Healthcare for All Kids 131 for their employees, leading to an increasing number of uninsured Americans.