Left Behind: Texas’s Uninsured Children

One in five children living in Texas is without health insurance — the highest in the nation, according to a report released by Families USA.

The study, “Left Behind: Texas’s Uninsured Children,” found that 1.4 million children, or 20.5 percent of the population aged 18 and under were without health insurance in the three years from 2005 to 2007.

The number of uninsured children in the state grew by more than 33,000 between 2003 and 2007, according to the study.

Of the children without health insurance, 89.5 percent lived in a household where at least one parent worked, and 73.9 percent lived in a household where at least one family member worked at a year-round, full-time job.

Sixty-five percent of the children lived in low-income families — $35,200 for a family of three in 2008.

Washington D.C.-based Families USA is a national organization for health care consumers.

Wow, what a concept: Healthcare should Focus on Prevention & Preparedness

I received the Foundation Center's e-newsletter "Philanthropy News Digest" today. As I scanned the headlines, I was drawn to the headline Report Lays Out Blueprint for Modernizing U.S. Healthcare System. The summary information is noted below, click the links for the whole report.

(The first link, Trust for America's Health, has key health statistics by state. The Texas information was disheartening, but not surprising.)

In order to make up for a $20 billion annual shortfall in funding for public health programs, the U.S. needs to establish a stable, reliable funding stream and increase state, local, and federal spending by billions of dollars, a new report from the Trust for America's Health argues.

Funded by the Robert Wood Johnson Foundation, the report, Blueprint for a Healthier America: Modernizing the Federal Public Health System to Focus on Prevention and Preparedness (134 pages, PDF), found that despite the $2 trillion spent annually on health care in the United States, tens of millions of Americans suffer from preventable diseases, while major vulnerabilities exist in the nation's preparedness to respond to health emergencies. To help address these issues, the report recommends increasing federal spending by $12 billion and state and local spending by $8 billion annually over the next four to five years.

Other recommendations in the report include setting realistic short- and long-term health goals for the country; investing in disease prevention as a cornerstone of healthcare reform; implementing a National Health and Prevention Strategy focused on lowering disease rates and combating obesity; and clearly defining public health emergency preparedness and response roles and responsibilities.

"America's public health system is broken. Serious gaps exist in the nation's ability to safeguard health, putting our families, communities, states, and the country at risk," said TFAH executive director Jeff Levi. "This blueprint reflects ideas from the best and the brightest minds in public health for ways to prevent disease, prepare for disasters, and bring down healthcare costs."

“Trust for America's Health Releases Blueprint for Modernizing Public Health for the Presidential Transition and Next Congress.”

Robert Wood Johnson Foundation
Press Release 10/21/08.

Rhetoric Rising

Wow, can't believe it's been three weeks since I posted. Over these weeks, Keith and I have been immersed in the political rhetoric keeping our attenae up for the golden moments when a real discussion of the healthcare issues we live with daily bubble up to the top of the candidates' messaging. As you all know, those are rare moments indeed.

Without a doubt, the economic crisis is deservedly the overarching message delivered in multiple forms as the 2008 presidential election builds to its (vain)glorious finish. Like all Americans we are acutely aware of the rippling impact of the economic meltdown. What has me scratching my head in confusion, is why the candidates seemingly separate the country's fiscal health from its physical health in their campaign stops.

I got the following facts from the National Coalition on Health Care website. There is much more information there, these are the points with which I found myself nodding my head in agreement:

• In a Wall Street Journal-NBC Survey almost 50 percent of the American public say the cost of health care is their number one economic concern.
• Rising health care costs is the top personal pocketbook concern for Democratic voters (45%) and Republicans (35%), well ahead of higher taxes or retirement security
• One in four Americans say their family has had a problem paying for medical care during the past year, up 7 percentage points over the past nine years. Nearly 30 percent say someone in their family has delayed medical care in the past year, a new high based on recent polling. Most say the medical condition was at least somewhat serious.
• Nearly one-quarter (23 percent) of the uninsured reported changing their way of life significantly in order to pay medical bills
• A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses. Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
• One half of workers in the lowest-compensation jobs and one-half of workers in mid range-compensation jobs either had problems with medical bills in a 12-month period or were paying off accrued debt. One-quarter of workers in higher-compensated positions also reported problems with medical bills or were paying off accrued debt.
• If one member of a family is uninsured and has an accident, a hospital stay, or a costly medical treatment, the resulting medical bills can affect the economic stability of the whole family.
• A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings.
• A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses.
• Retiring elderly couples will need $200,000 in savings just to pay for the most basic medical coverage; many experts believe that this figure is conservative and that $300,000 may be a more realistic number

What is not on this list is the immeasurable cost in time and energy of managing post-crisis aftercare. As you know from this blog, Keith and I have experienced this first hand as we negotiated the paperwork, funding concerns, insurance requirements and, oh yeah, actual health issues over the 5 months since Keith returned home to recover. We are fortunate to have the support of family and friends, excellent personal caregivers, good insurance, interested health providers, and, most importantly, the ability & confidence to create our own best path to recovery.

However, all those pluses don't prevent me from falling asleep with an eye on the oxygenation/heart rate monitor to be sure that there are no indications of a restless night. Or making sure that the oxygen tube has not silently slipped off the ventilator because there is no alarm built in to alert you of that situation. (I emailed the company about this the first time it happened in the hosptial. Their reply? "Yes, that's a problem. No, we have no plans to do anything about it."). Or knowing that every piece of paper that comes through the door takes about 20 minutes of your life that you'll never get back. Or any number of other things that can happen to slow the recovery process as we, like far too many American citizens, practice unlicensed medicine managing machines and medications.

Yet, with all that said, we are still firmly in the category of the lucky ones. Keith is healing faster than anyone anticipated (except for him, of course, lol). We have weathered the economic storms and are fortunate to be in Austin which was recently named the best place to ride out the recession. I can do my work from home so I'm not away from the house for long periods of time and Keith has been able to continue his business life from the comfort of bed (much like the European royalty in the Middle Ages).

Without a doubt, we are the exception to many, many rules. Of course we have adapted our life to meet the new responsibilities, but haven't been forced completely off track. The reality is that most folks have been or are being beaten by the healthcare system. They have been forced to compromise their financial resources to maintain their physical health. Every day brings a new short-term choice that sacrifices long-term sustainability. While the dollar cost of those decisions is painfully measurable, the emotional strain is exponential and has a dangerous ripple effect. Once the fundamentals of your world are eroded, the rest falls rapidly.

The United States is the most powerful country in the world and, as noted on the National Coalition on Health Care website, experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of families. As the 2008 Presidential election winds down, it's time to ask ourselves and our candidates if we are being served. There is an old saying, "when you have your health, you have everything". So, by extension, is it also true that if you don't have your health, you have nothing? We have all worked too hard to have nothing and deserve leadership that understands and acts on the knowledge of the importance of a healthy citizenry to the sustainability of America.

Sobering, indeed.

I was perusing the news on Yahoo tonight and a headline caught my eye "6 die in family murder-suicide in upscale LA home". I lived in Santa Monica for about 13 years and knew quite a few folks in upscale homes so I clicked on the link and read the article. As I read the article, I scanned for the name of the people involved. There was no name but as I read the work details naming Price Waterhouse and Sony Pictures, I turned to Keith and said there was a good chance that I had been acquainted with the gunman. (Like many places, LA is big at first glance, but once you get into certain circles, it's a pretty small town.) About 30 minutes passed and the story was updated. My eyes were drawn to the name, Karthik Rajaram. It was one of those surreal moments when the news moves from there to here at supersonic speed. All of a sudden I got a clear mental picture of Karthik in the PW offices (no C at that time) excited about his second son's birth and explaining to us the significance of his son's name. Ganesha, in honor of Lord Ganesh, the Remover of Obstacles and Lord of Beginnings. When he died on Saturday, Karthik's son Ganesha was only 12. To add more significance, in numerology 12 is the number of what is completed.

I cannot pretend to know why this tragedy occurred, or why Karthik felt he had no other options. I do know that Karthik was proud of his family and was committed to successfully providing for them. I also know that I saw moments of fear in his eyes that were covered up with intellectual bravado. Even on that day he was overjoyed at his son's birth, the fear was still there. He felt validated for having another son, yet knew that the proving had just begun. Apparently, it all became too much and it ended Saturday night in an upscale home just north of LA.

I think this story struck me for another reason as well. With what Keith and I have experienced this year, I have been made acutely aware of how thin the thread can be that binds us to this world. We create constructs such as friends, family and other emotional or physical commitments in the hope that they will keep us grounded and engaged in our own life. Keith has said that one of the reasons he didn't succomb to those near-death moments is because he knew he had to live now that he had a wife. That was an emotional commitment that overrode any other fears he may have had. Keith chose to live despite institutional care that put him at serious risk and, seemingly, would have been just fine if he had slipped away. The institution is not moved by individual desires and once you know that, you know what you must do to survive.