Uninsured carry a heavy burden

The costs of being without health insurance go beyond dollars and individual families.
When the uninsured seek medical care, they arrive with more serious health problems and more advanced disease, said Dr. Mike O’Dell, chief quality officer for North Mississippi Health Services and president of the Mississippi Academy of Family Physicians.
“The care they need is more expensive and they are less likely to be able to afford it,” O’Dell said.
Expanding coverage for the uninsured is among the primary goals of the current health care reform efforts. Different versions of the legislation seek to extend coverage to more than 90 percent of the uninsured.
Until they uninsured get coverage, the emergency room – where everyone is guaranteed access – becomes their primary care source.
“The ER is the most expensive care you can have,” O’Dell said.
Because there’s no ongoing relationship, emergency physicians usually have to order more tests, O’Dell said. The costs of providing trauma care is built into ER charges; primary care doctors don’t have to maintain that kind of equipment.
Beyond the cost of seeing a physician, it is the lack of access to medicine, especially maintenance medicines that do so much damage to the health of the uninsured.
“In many ways I was more effective my first year out of internship” said O’Dell, who served as a physician in the Navy. “All my patients could get their medications and all the tests they needed. I was able to get much more positive results.”
It’s very frustrating as a physician to see patients spend their time, money and effort to see a doctor and then not be able to follow through on the medical advice because they can’t afford the medications, O’Dell said.
“That much more likely to happen to uninsured than the insured,” O’Dell said.

By the numbers
The uninsured have a lot of company in Mississippi.
More than 500,000 Mississippi children and adults under 65 – about 20 percent – are estimated to be without insurance according to U.S. Census figures gathered in March 2009.
Using U.S. Census data and unemployment statistics, Families USA estimates the number of uninsured Mississippi adults has grown to 436,400 people, 25.7 percent for that group.
In 2007, Families USA analyzed National Institutes of Medicine and Urban Institute reports to estimate 2,600 Mississippians died because of lack of health insurance between 2000 and 2006.
“When we look at the economy, we see the reflection in our growth,” said Cindy Sparks, executive director of the Antone Tannehill Good Samaritan Free Clinic in Tupelo.
The clinic, which cares for working Lee County residents who can’t afford health insurance but don’t qualify for public programs, compared the prescriptions it dispensed at one October 2007 clinic with the same date in Oct. 2009.
“We filled 63 percent more prescriptions,” Sparks said.
The number of Mississippians covered by employer-based insurance – which generally offers broader, better coverage than direct purchase insurance – has dropped 12 percentage points in the last 10 years, covering more than 200,000 fewer Mississippians between 1999 and 2008.
“Private coverage is just eroding under the current system,” said Roy Mitchell, executive director of the Mississippi Health Advocacy Program.
The real costs start adding up with chronic health conditions like diabetes, high blood pressure and obesity.
“They need preventive treatment, but both of those things can be used as pre-existing conditions that can be denied coverage,” Mitchell said.
For example, high blood pressure, which affects about a third of Mississippians, can be controlled with medication, diet and exercise. Those people need to see a doctor two to three times a year to monitor their progress and manage the medications. Most of the medications are available in generic.
The insured patient will probably have the condition – which usually has no symptoms – during a regular office visit with their doctor.
It costs several hundred dollars annually for the doctor’s visits, tests and medicine. But the gains are huge.
“You’re maintaining productivity for someone,” O’Dell said.
The uninsured patients are more likely to come in with advanced disease, where the untreated high blood pressure has destroyed their kidneys or caused a stroke or a heart attack.
Instead of costing several hundred dollars for medicine and doctor’s visits over the course of year, they are facing bills $15,000 to $50,000 for just the acute care.
“The uninsured actually consume an enormous amount of health care,” O’Dell said.
There’s a hidden cost for not having health care, Mitchell said. Lack of health insurance also can cost people their livelihood when they become disabled as a result of treatable, controllable conditions. It costs employers in terms of productivity. It costs health care providers in terms of bad debt.
It costs tax payers, because we pay for the health care of people who become disabled.
Those costs ultimately get passed on to the people who have health insurance and taxpayers who cover costs for government insurance programs.
North Mississippi Health Services is on track to have $68 to $70 million in charity care for the 2009 fiscal year, O’Dell said.
Money spent on health care helps the person, but those dollars also turn over several times in the local economy.
“There’s no better way to spend money in our economy,” Mitchell said.

Michael Gibson Morris/NEMS Daily Journal