Health Populi

Monday, September 29, 2008

Must-see TV -- Critical Condition: four very personal stories on being American and uninsured

The sixth leading cause of death in the United States is the lack of health insurance, according to Critical Condition, a new documentary on the perils of being uninsured in the U.S. Being uninsured beats diabetes and HIV/AIDS on the Top Ten List of causes of death in America, according ot the Institute of Medicine.

The PBS series POV features the chilling documentary, Critical Condition, on Tuesday, 30th September 2008. You can check your local listings here for broadcast times on your local PBS station.
Critical Condition highlights the stories of four uninsured Americans with advanced stages of diabetes, cancer, liver disease, and a deteriorating back condition.

The bottom line is spoken by Dr. Patrick Dowling, the Chief of the Department of Family Medicine at UCLA, who toward the end of the film asserts: "We ration care in this country by ability to pay."

The four profiles, by sharing their very personal and challenging stories, illustrate the key statistics on uninsured Americans:
  • Insured Americans' premiums pay $992 to cover the costs of the uninsured
  • Eight in ten uninsured Americans come from working families
  • 80% of the uninsured are adults
  • The majority of uninsured adults (75%) have gone without coverage for a period of at least one year
  • The large majority of the uninsured (78%) are American citizens
  • 70% of uninsured employees work for firms that do not offer health benefits or they are not eligible for their employer's plan
  • Three-quarters of the uninsured are not eligible for public coverage
  • The uninsured are more likely to postpone and forgo care, with serious consequences that increase their chances of preventable health problems, disability, and premature death (which is the case for all four of the Americans profiled in the film)
  • About a quarter (23%) of uninsured adults report needing care in the previous year but not getting it due to cost, compared to just two percent of those with private coverage or Medicaid/SCHIP
  • The uninsured are more likely than the insured to develop a disability over time, and even after accounting for health differences, they are more likely to die early
  • Hospitals typically charge uninsured patients 2.5 times what they charge privately insured patients
  • Over half a million Americans are currently battling cancer without insurance (which is the case of one of the four Americans profiled in the film).
You can see an interview with Critical Condition's documentary filmmaker, Roger Weisberg, here.

The film was funded by the Annie E. Casey Foundation, the Charles A. Frueauff Foundation, the Josiah Macy, Jr. Foundation, the Kaiser Foundation Health Plan, Nathan Cummings Foundation, the New York Community Trust, the Park Foundation, the Public Welfare Foundation, Public Broadcasting Service, the Silverweed Foundation, Spunk Fund, and the Trull Foundation.

Health Populi's Hot Points: In addition to these four Americans and their families, another hero featured in the film is Dr. Dowling. In addition to his duties on the UCLA medical campus, Dr. Dowling participates in community health fairs which is where he randomly met Carlos, the fellow with the deforming spondylosis. Dr. Dowling negotiated on Carlos's behalf with UCLA to get him the very risky spine surgery he needed...at no cost to Carlos.

I won't spoil the endings -- or new beginnings -- of any of the four stories told in grueling, frustrating, and often gut-wrenching details.

The best summary is given by Dr. Dowling, who said that he was, "very pleased that we could help this one individual out," but, "we can't do endless surgery on uninsured patients; it begs a national solution."

4 Comments:

  • Ya, and breathing is fatal too. Did you know, everyone who has every breathed in air has either died or is going to?

    Silly correlation.

    A lot of people who are uninsured don't want to pay the high (and rising) cost of insurance. As for US healthcare prices, they're pushed up by: 1) the cost of insuring against tort lawyers; 2) the natural tendency to overcharge insurers; 3) regulation costs; 4) lack of foreign competition (not enough newcomers to force the established firms to keep on their toes) and 5) the lack of competition from low-cost alternatives to private insurance (can't the labor unions provide friendly society benefits to members like they did to millions of people in England before 1911? hey I'd join!).

    I know working people who are uninsured: they're young, they figure that $5,000 a year for a service they might not need is a bad use of their funds and the ER is a safety net. If the unused money for this year could count towards future premiums so that as one got older the natural increase in premium rates was kept in check, health insurance would be a lot more attractive. I know people who refuse to pay because they won't be able to afford coverage when they're older "better invest for long-term care."

    "Universal" i.e. federal government provided healthcare will be more expensive, if provided by private contractors (because they'll overcharge and gold plate even more) or it will be much worse (no pesky customers to be accountable to).

    In the UK, the new cancer drugs are not available for NHS patients, despite paying 9% extra income tax. If a patient DARES pay out of pocket, she is denied ANY care by the NHS. Let's be clear: the patient STILL PAYS 9% and GETS NO TREATMENT.

    Of course, articulate wealthier people can use lawyers and get what they want, but this means more cuts for those unable to hire lawyers.

    Add that to the inequality of service from one area to another, and anyone who concludes that USA needs our NHS is living in a parallel universe. Tort lawyers paradise, hell for the rest of us: I watch ER and wish UK hospitals were that uncrowded.

    By Blogger Antoine Clarke, At September 30, 2008 6:06 AM  

  • Antoine, thanks for your comment. "Universal" doesn't mean "Federal government" or "single payer" by definition. This is a common misconception, and I covered the distinction in a post about one year ago in Health Populi -- http://www.healthpopuli.com/2007/09/universal-health-care-american-style.html

    After losing $1 trillion in the market yesterday, we all have a lot to worry about. Our future fiscal stability, and that for our kids, is truly in jeopardy. See Jacob Hacker's last book, "The Great Risk Shift," for more on that.

    By Blogger Jane Sarasohn-Kahn, At September 30, 2008 7:25 AM  

  • I am a registered nurse that works for one our areas largest health care system. It is heartbreaking to see people in need of care not receive it. This country is designed for the rich to get richer and the poor to get poorer. Survival of the fittest. People in the U.S. must demand care and services for all citizens. Make health care reform and insurance for all your focus in November.

    By Anonymous upsetRN, At September 30, 2008 10:46 PM  

  • Hi Jane,
    Saw the show last night, really quite depressing. My wife had to get up and leave it was depressing her so much.

    I stuck with it to the end, which ended on a high note, if you can call it that.

    I'm not a fan of Universal Health and strongly believe that consumers need to do a better job of taking care of themselves first and foremost. Diseases/conditions that are the result of over-eating, smoking inactivity, etc. are something that the individual needs to take personal responsibility for and should not expect th public to bail them out. They made their bed.

    But what happens to those that contract some terrible disease through no fault of their own, that is where I really struggle and something needs to be done to provide a safety net in such instances.

    By Blogger Johnnysmooth, At October 1, 2008 1:10 PM  

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