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The Medical Journal

Lack of insurance contributes to many deaths in U.S.
Scripps Howard News Service


April 09, 2008

Being without health insurance can kill.

By one recent estimate from the Urban Institute, lack of coverage contributed to the deaths of at least 22,000 Americans between ages 25 and 64 in 2006.

To be sure, there is still free medical care offered in many places in the United States. Hospitals continue to write off some bills and discount others, as do a lot of doctors. But when nearly one out of every six Americans lacks health coverage for at least part of the year, and when the nation is spending $2.2 trillion on health care, that's a lot to absorb.

It's easy to say that nothing's more important than your health, unless "nothing" comes down to food on the table or gas in the car. The hard fact is that people without health insurance are more likely to skip checkups, screenings and other preventive care -- and they're 25 percent more likely to die as a result than people with insurance.

"Our inadequate system of health coverage condemns a great number of Americans to an early death simply because they don't have the same access to health care as their insured neighbors," said Ron Pollack, executive director of Families USA, a health-care consumer group.

The study from the Urban Institute, and updated by Families USA this week, looks at people in the working years of life because they're most affected by not having insurance -- children and college students either stay on a family plan or are more likely to get public coverage, while those 64 and older transition to Medicare. The Urban Institute is a Washington-based think tank.

Pollack tells of one uninsured woman who went to a hospital with chest pains and was diagnosed as having had a heart attack. Her ensuing medical bills were so big she was forced to declare bankruptcy. And when, months later, she again experienced heart-attack symptoms, she balked at a trip to the emergency room and died from a second heart attack.

In fact, trips to the ER, once considered the last resort of the uninsured, have become more a refuge for the affluent insured, according to another study, this one published online Tuesday by the Annals of Emergency Medicine.

This study, based on an ongoing federal survey of households, found that most of the nearly114 million emergency-room visits recorded in 2004 were among people earning four times the federal poverty level -- 29 percent, up from 22 percent in 1996.

Uninsured people accounted for 15.5 percent of ER visits in 1996, but only 14.5 percent in 2004. Fifty-nine percent of all those who went to the ER in 2007 had a physician or group practice as a regular source of care.

University of California-San Francisco researchers on the project don't know exactly why the growth trend is among those who do have someplace else to go. However, they suggest that difficulty in getting appointments and a failure of many doctors' offices to arrange staffing for emergencies is largely to blame.

"Emergency departments act as the safety net for all patients, not just those without insurance," said Dr. Ellen Weber, lead author of the study.

Another reason for the increased use among the insured may be that with more people covered by high-deductible plans, even a relatively high-co-pay trip to the ER doesn't cost a great deal more -- and is at least as convenient -- than setting up a visit to the doctor's office or an urgent-care clinic.


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Contact Lee Bowman at bowmanl(at)
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