Health Care and the Uninsured Middle Class

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In the United States, 45 million people have no health care insurance — and more middle-class Americans are feeling the pinch. As "Cover The Unisured Week" launches, Ed Gordon discusses this aspect of the health care crisis with Dr. Gary Wiltz, chief executive officer of Teche Action Clinic in Franklin, La., and David Cutler, professor of economics at Harvard University and author of Your Money Or Your Life: Strong Medicine For America's Health Care System.

ED GORDON, host:

From NPR News, this is NEWS & NOTES. I'm Ed Gordon.

Today, 45 million people in this country have no health insurance. It's a staggering number that keeps growing. So pervasive is the problem that it not only affects the poor but also the working middle class. In fact, this week has been dubbed Cover the Uninsured Week as many try to bring attention to the nation's continuing problem with the health-care system. Today we take a closer look at the effect on the working class. Joining us, Dr. Gary Wiltz, chief executive officer of Teche Action Clinic in Franklin, Louisiana. He joins us by phone. Also with us, David Cutler, professor of economics at Harvard University and author of the book "Your Money Or Your Life: Strong Medicine For America's Health Care System." He joins us via phone from Greater Boston.

Gentlemen, I thank you very much for joining us.

Dr. Wiltz, let me start with you. Part of the issue here is the misnomer of uninsured and underinsured. People offtimes think that that is simply the poor, those who don't work, but, in fact, that is not the case in this country.

Dr. GARY WILTZ (Chief Executive Officer, Teche Action Clinic): No, it is not, Ed. As a matter of fact, eight out of 10 of the uninsured are in working families. We've been able to do some studies and we've calculated that 60.4 percent of those uninsured are in full-year, full-time working families. Another 22.3 percent are other workers that are not full time. And then 17.3 percent are non-workers. So that is a big myth, and it really does matter if a person has health insurance. The Institute of Medicine estimates that over 18,000 Americans die each year because they don't have health coverage.

GORDON: David Cutler, when you look at the median price of family insurance, a policy--over $9,000 a year, and that also represents, we should say, about 21 percent of the national median household income. And now you're looking at employers who once footed the bill for all of that cutting and cutting and cutting each year. What does this say to the solidly middle-class family today?

Professor DAVID CUTLER (Harvard University): Middle-class families, particularly those who are, as we're hearing, working full time and trying to do a good thing, are becoming increasingly squeezed. That's the group where health insurance costs are going up and their wages are not really increasing. It's OK if costs are going up, but you're earning more to pay for it. So the group in the population earning maybe 20,000, 30,000, $40,000 a year is really being hit very, very hard.

GORDON: Dr. Wiltz, do you like what you've been hearing and seeing from Washington? So many people have suggested for years that this has been a growing problem, a continuing problem and they are not satisfied with the attention that the nation and the government in particular has--being paid to this crisis.

Dr. WILTZ: Well, I think that underscores the necessity of highlighting this in the Covering the Uninsured Week, and we've been doing this for several years now and nothing's going to change unless we get citizens more involved in this public discussion. There have been attempts in the past at health-care reform that have not had the full effect, and unfortunately, the lack of insurance will continue to be a significant problem. So there are multiple solutions and multiple approaches that can be taken to increase the coverage and do the things that need to be done to do right by a country as great as ours to cover more people.

There are several proposals that I do like. There's one that's Cover the Kids that's being proposed, and I think that that's certainly the most moral and ethical thing to do is to first cover all the kids in the country. There are other proposals out there. I'm a CEO of a federally qualified community health center and there are proposals to expand coverage to that mechanism. It's a complex issue, Ed, and I think we're going to have to take it on a national level to get the agenda on the front burner and make people really aware that there are serious consequences to being uninsured.

GORDON: David Cutler, I'm wondering why we haven't heard a bigger groundswell, if you will, from the American public in terms of demanding that we get ahold of what is simply a runaway train.

Prof. CUTLER: The--it goes in waves. When President Clinton came to office about 15 years ago, there was a groundswell in support of wanting to cover everybody, and unfortunately what happened was a proposal that people didn't particularly like and that was defeated for a number of reasons. Things then go into hiding because of that. And we're now seeing a bit of a resurgence as the economy is doing a little bit better and people are still wondering where they're going to get their health-care coverage from.

But the difficulty is that all of the proposals sort of scare people a lot. They come with sometimes big price tags, big changes in the insurance system, and health care is very personal for people. And so when you propose something very big, people sort of naturally shy away, and I think that's partly why it's been difficult for it to be--for people to come up with something that really gets the support of the vast majority of people.

GORDON: Gary Wiltz, do you believe that we will ever in the foreseeable future see a national health-care system that works and insures and cares for everyone?

Dr. WILTZ: Well, that would be my fondest hope because I do believe--I'm one of the proponents that--I believe that that's the solution, but whether that's going to happen in my lifetime, I don't really think so. It's so complex, and there's no one magic bullet. There's no panacea. A lot of states, given the freedom that they have at the present time, have been creative and they have improved coverage to a degree, and just as the other speaker alluded to, you know, the national attempts are so complex that they can be taken apart. And I do believe that--in looking back, I think we have had some improvement since the Clinton era and what was tried at that time, but unless we get that tremendous groundswell that we talked about, I don't think that's going to happen. But we'll continue to chip away at it, and we'll have some success, but the sweeping reform, I just don't see it on the horizon just yet, but I'm hoping that it will.

GORDON: David Cutler, with about a minute to go, isn't part of the issue and part of the problem the giant lobbying muscle that health-care systems have in this country to kind of push back on politicians to change this, which, indeed, would require them to perhaps reap less benefits?

Prof. CUTLER: I think as time goes on more and more of those organizations are realizing that something has to be done. We see, for example, big businesses now that want to get out of the retiree benefits and out of expensive coverage for their employees. The physicians groups are turning increasingly to talking about this. So as the problem becomes more acute, I think what we will see is more and more people saying, `OK. It's time to put aside whatever personal views we have and think about what's good for the whole of the country.'

GORDON: All right. Dr. Gary Wiltz is CEO of the Teche Action Clinic in Franklin, Louisiana, and David Cutler is author of the book "Your Money Or Your Life: Strong Medicine For America's Health Care System."

Gentlemen, thanks very much for joining us. Greatly appreciate it.

Dr. WILTZ: You're welcome, Ed.

Prof. CUTLER: You're welcome.

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