America has been in need of healthcare reform for some time now with government health services slated to become an ever larger part of the budget in the future, while the increasing cost of private health insurance has outstripped growth in income by about 3 to 1 over the previous years. While the government debates reform, the recession is having an increasing impact on people and may be a driving force in the widest ranging healthcare reforms in the United States in years.
One fact about the American healthcare system that is fast becoming apparent is that it doesn’t function very smoothly. America has the highest medical costs in the world and the price tag does not always guarantee the highest quality care. Private insurance is prohibitively expensive unless purchased through an employer-based plan, while government run insurance manages to be under funded with an enormous budget at the same time. One thing is for certain, the current mix of public and private insurance have not excelled over time.
A recent survey carried out by David Cutler of Harvard University and Alexander Gelber of the Wharton School show that over the last two decades, a larger number of Americans are losing health insurance coverage at some point during the year. Using data from the US Census Bureau, the authors compared statistics from 1983-1986 and 2001-2004, finding that the percentage of the population that lost their insurance coverage during a 12 month period increased from 19.8% to 21.8% during the two decades or so in between the data sets. The percentage of people losing insurance as you look at the poor and those not in perfect health increases alarmingly.
There is good news though, in that for most of those losing their private insurance, many of them seek coverage under various government healthcare programs. The most recent Census Bureau figures for 2006-2007 show a minor dip in private insurance from 67.9% to 67.5% of the population, but the number of uninsured people in the country went down from 47 million to 45.7 million people. Government health insurance seems to have absorbed most of these people, growing from 80.3 million people covered to 83 million in the 2006-2007 period.
While it’s nice to see that government programs are stepping in to fill the gap, the problem is that its old news. It does not even begin to take into account the massive shifts brought on by the recent recession. The consequences are beginning to take a heavy toll on the health of the country in a myriad of ways. Since the start of the downturn in December 2007, employers have cut 5.1 million jobs. The number of people currently on continuing unemployment benefits is at 6.13 million, bringing the national unemployment rate to 8.5%. Because many people in the US receive their medical insurance through their employers, lost jobs means lost insurance. The Kaiser Family Foundation says that a 1% increase in the unemployment rate means an increase of 1 million enrollments in Medicaid and the Child Health Insurance Program (CHIP), and also a 1.1 million increase in uninsured people.
This high rate of lost jobs, estimated to be as high as 14,000 jobs per day, is pushing people out of their employer-based insurance and either into a government health insurance program or, if they are too young for Medicare or simply not poor enough to qualify for Medicaid, are forced to purchase private individual health insurance plans if they would like to have health insurance at all. An investigation by Consumer Reports has found this trend to carry problems of its own.
The investigation showed that personal health insurance is regularly more expensive than the equivalent cover would be through an employer-based plan. It is often extremely expensive or completely out of reach for people of meager income and less than stellar health. Consumer protection in this area is also an issue where, once again, America demonstrates the importance of appropriate regulation by not having it. Consumer Reports found that most state insurance regulators are not charged with evaluating the coverage these products offer and most disclosure requirements are decidedly limp-wristed at best. So, trying to compare plans, figure out prior to purchase what is and is not covered, or approximately calculating the out-of-pocket liability for any serious medical procedure is nigh impossible. While affordable, these low-end personal plans often come with extensive exclusions and loopholes which often leave people in serious medical debt if they suffer a medical catastrophe.
As everyday American consumers are continuing to feel financial pressure, recent polls have shown an increasing trend to put off medical care. A poll released by Thomson Reuters this month showed that over the past year, 20% of American households have either delayed or cancelled receiving medical care. Out of those who did cancel or delay care, 24.1 attributed it to the cost. The last time this poll was administered in 2006, the number of people delaying or canceling care was at 15.9% and the main reason for delays and cancellations was lack of time. Another chilling figure from the poll was that 21% of American adults were anticipating they would have difficulties paying for either health insurance or healthcare services within the next three months.
As the financial implications on healthcare snowball for the consumers, so too does it snowball for medical practitioners. One instance of this is in North Carolina, which has the fourth highest unemployment rate in the country at 10.7%. The increasing numbers of unemployed and uninsured people have led to a remarkable increase in traffic in free or discounted clinics and also emergency rooms, where hospitals are obliged to administer treatment to everyone, insurance or no. This often means hospitals are performing millions of dollars worth of healthcare services and not seeing any money from it. On top of this, people who do have insurance and actually pay the hospitals for their services are shying away from optional procedures and surgeries which would usually help generate income to keep the hospital running. At the moment, hospitals under financial pressure from both the shrinkage of revenue generating procedures and the amount of “uncompensated care” hospitals are offering to those in need, in some cases only staying functional through infusions of federal monies from the stimulus package.
The picture of American healthcare is looking increasingly bleak. Record numbers of Americans are losing their livelihoods and insurance, forcing the federal government to widen enrollment to more people and ratchet up spending on government programs which receive regular sniping from conservatives for being too expensive already. Not only that, but the health and finances of the people may suffer in the long run as they either cannot get the healthcare they need, or go into medical debt receiving it. One thing is for certain, the current hodge-podge of public and private in the healthcare system is a mess that is only getting worse with the limping economy. It can no longer be fixed by piecemeal measures and requires an alteration at the fundamental level of which the system operates.
World Tuberculosis Day was marked on March 24th with a forum in Rio de Janeiro this year and despite this disease having a history dating back to antiquity may be becoming more of a problem today than ever.
Tuberculosis is caused by the bacteria Mycobacterium tuberculosis and is the most deadly bacterial disease in the world. The World Health Organization alongside other partners is on a drive to bring mortality and prevalence rates of tuberculosis down to half the levels they were in 1990 by 2015.
The WHO currently estimates that one third of the world’s population is infected with the tuberculosis bacteria. Out of everyone infected with the Mycobacterium tuberculosis bacteria only 5-10% of those people will develop active tuberculosis of the lungs, which is the only way to become infectious and transmit the disease. While this may seem like a statistically low number, it is estimated that every second someone new is infected with tuberculosis bacteria.
In spite of the fact that tuberculosis is not only millennia old but also treatable, the goals that the World Health Organization set out to achieve are becoming increasingly hard to attain. While the agency has said that the percentage of the global population becoming ill with tuberculosis has continued the decline first noticed in 2004, they have also said that both Europe and Africa will not meet the intended reductions in either mortality or prevalence rates. So if the percentage of people suffering from tuberculosis is, as a percentage of the world’s population, going down, why is there increased concern over the issue?
There are two major reasons that are making tuberculosis an even larger health issue than it has ever been before. The first is that there is an incredible increase in the number of people with active tuberculosis that are also HIV positive, leading to increased complications in treatment and prevention. The second reason is that the disease has evolved into both multidrug-resistant tuberculosis (MRD-TB) and extensively drug-resistant tuberculosis (XDR-TB), which has made some standard treatments ineffective in combating the disease.
Because HIV attacks the body’s immune system, it is leading not only to increased rates of infection but also increased mortality rates in people infected with both HIV and tuberculosis. The co-infection of HIV/TB is a seriously threat as the diseases piggy back on each other, each speeding the progress of the other. The WHO’s 2009 global TB control report indicates that about one out of four TB deaths are HIV related, which is more than twice as many as was previously indicated. Regions with high levels of HIV infections like Africa are being hit the hardest, with some places like South Africa where numbers of tuberculosis infections almost tripled. In 2007 alone it is estimated that there were 1.37 million new cases of tuberculosis in people infected with HIV as well as 456,000 deaths.
There is, however, somewhat good news arising from the intense scrutiny of data over the years. Having realized the increased threat that HIV/TB co-infection poses, there has been a raised effort to test for HIV in people who are receiving treatment for TB. The WHO report shows that in Africa in 2004, only 4% of patients being treated for tuberculosis were tested for HIV. By 2007 the number of TB patients in the African region getting HIV tests has risen to 37%, with some individual countries testing as many as 75% of their TB patients for the immunodeficiency disease.
The other issue of drug-resistant tuberculosis is beginning to attract increased attention because of concerns about the possibility of a virtually untreatable tuberculosis epidemic. The driving force behind the rise in drug-resistant strains of tuberculosis is that in the places with the highest rates of TB infections, such as Africa, Eastern Europe and Asia often have poor healthcare systems.
One of the gravest problems is that the systems will lose track of tuberculosis patients who do not finish their course of treatment for TB, allowing the disease to morph into a drug-resistant form of the disease. Some places such as India or Russia have poor healthcare where there is either a shortage of doctors and appropriate medication, or little control over the sale and usage of TB drugs.
As health ministers from some of the most direly affected countries, along with the leader of the WHO and Bill Gates gathered in Beijing on April 1st to formulate plans to prevent the spread of drug-resistant tuberculosis, one story has illustrated the need for quality medical insurance networks. A migrant worker named Wang Chong was in the Beijing Chest Hospital for his tuberculosis treatment which has been continuing for over five months. But because he has no insurance of his own and no national healthcare safety net to support him, he must decide whether to continue the treatment which has already cost him more than $5000 dollars, no small amount of money for a migrant worker in China, or to stop treatment and risk his disease evolving into a drug-resistant variety which could kill him.
There are estimated to be more than half a million people in the world with drug-resistant tuberculosis across the globe, with more than a quarter of them in China. Some health advocacy groups say that less than five percent of the people carrying drug-resistant strains of the disease are being treated properly, meaning that they are often out and about spreading the increasingly resilient disease to others.
At the moment, treatment of regular tuberculosis requires taking four different antibiotics and lasts for up to six months. Treatment for extensively drug-resistant tuberculosis is toxic to the patient and may last up to two years, often leading to the confinement of the patient. There are ongoing efforts to find a two drug combination that will work in combating both regular tuberculosis and extensively drug-resistant tuberculosis, with one phase of clinical trials scheduled to be completed by the end of 2009 in South Korea. The recent forums and meetings of the worlds’ healthcare leaders in highlights the need for awareness on the topic and the need to make sure you are protected, so that you can be assured a full treatment without having to make the same decisions that Wang Chong is having to make this very moment.