The Times, Trenton

An Unhealthy Crisis

The Times of Trenton — Tuesday, April 7, 2009

BY DAVID L. KNOWLTON

The numbers splashed across our newspaper front pages and on our television screens when we catch up on the news are staggering: More than 1.2 million Americans lost their jobs in the first two months of this year alone. Wall Street appeared to be in free fall. Our financial system looked to be on the brink of collapse.

The statistics by themselves would be distressing enough, but behind many of them are the very real and tragic health consequences of the newly unemployed who no longer have health-care coverage. Occasionally, we will hear the story of the child whose family can no longer afford her cancer treatments, or the expectant mom who can't get the prenatal care she needs to assure a healthy baby, or the father who stops taking his blood pressure medication and puts his life at risk. Multiply those "occasional" stories by thousands and we begin to grasp what is playing out behind the closed doors of American homes every single day during this most unhealthy of all national economic crises.

Today, it is fair to say that more Americans are concerned about their health than at any time in our nation's history, and for good reason. The economic tsunami that has reached our shores has left tens of millions of working families without the means to provide for their own health. They are victims of an employer-based health system that, though fragile, has held up for decades — until now.

A report last month by Families USA (familiesusa.org) found that an astounding 86.7 million Americans went without health-care coverage for at least some portion of the past two years. Something that many of us take for granted — access to medical care — was unavailable to one in three Americans. Unfortunately, the problem is getting worse.

The newly unemployed in the United States (598,000 in January and another 651,000 in February) threaten to collapse our already fragile and woefully imperfect health-care system for the poor. On top of the struggles these workers have in finding the means to afford their monthly food, utility and mortgage bills, they worry about the health coverage that is no longer available to them.

Recognizing this looming crisis, the president has taken some steps to help the newly uninsured, but I fear that they are not enough. A provision in the federal stimulus package to provide temporary COBRA assistance to the unemployed may help, but it is not enough and will still leave health coverage economically untenable for millions of families who have lost jobs. In addition, COBRA and generous severance packages mask the real problem of the uninsured and apply a Band Aid to what has become a festering wound. A year from now, as severance funds begin to run out and COBRA coverage runs its course, a new wave of families without coverage will be upon us.

It is important that we recognize the long-term consequences of ignoring the health needs of millions of Americans who are unable to get the preventative care they require, which further exacerbates chronic ailments and drives up costs. Investments we make collectively today to prevent this catastrophe will pay dividends down the road. The simple fact of the matter is that when people are sicker, they are more expensive to treat.

It is time we realize that the uninsured in our state and nation are an economic drain. When they walk into our emergency rooms, because they do not have the coverage that will permit them to walk into a primary care physician's office, we all pay. Businesses pay through the higher premiums that insurers are forced to collect to subsidize these patients. Hospitals pay because of a reimbursement system that forces them to accept pennies on the dollar for the care they provide these patients. And taxpayers pay because the government must become the "payer of last resort."

We all know there is a better way.

We have taken enormous steps and invested hundreds of billions of dollars in our financial system, our automakers and our housing system to forestall and prevent their impending collapse. We need to do the same for our health-care system before it, too, crumbles under the weight of the newly uninsured.

A broad-based solution that provides the funding necessary to make affordable and accessible health care available to all Americans — starting immediately with the newly uninsured — is the only answer to our complete reliance on the employer-based system that has served us so well for the past half-century or more, but now collapses of its own weight. I invite all Americans to get involved in the health-care reform debate, which is shaping up in Washington, D.C., and in the State House in Trenton.

Here in New Jersey, we have already taken an important first step through the first phase of Sen. Joseph Vitale and Assemblyman Lou Greenwald's plan to provide coverage for all children in the state. It was a proud day for all of us when Gov. Jon Corzine signed that legislation into law last July. Now, we must take the next step and start with the newly uninsured.

Finding the money to pay for it in these tough budgetary times will not be easy; however, it would be penny-wise but pound-foolish not to act decisively in the weeks and months ahead to protect the newly uninsured. We will regret such a failure to act for a long time to come.

David L. Knowlton is president and CEO of the New Jersey Health Care Quality Institute.

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