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Chronic Illnesses More Often Undiscovered, Undertreated in Uninsured
Uninsured people are also more likely to have undiagnosed and undertreated medical conditions, according to a new study comparing chronic illnesses among Americans with and without health coverage. The results offer possible clues to a recently reported higher death rate among people who lack insurance.
Researchers from Cambridge Health Alliance and Boston Medical Center tracked diabetes, high blood pressure, and high cholesterol in a national survey of more than 15,000 working-age adults. Based on questionnaires, medical exams, and lab test results, they found that about half of uninsured people who had diabetes or high cholesterol were unaware of it, compared with just under one-quarter of insured people who did not know they had these conditions. High blood pressure, however, was undiagnosed in about a quarter of both uninsured and insured people.
Once diagnosed, hypertension was poorly controlled in 58 percent of uninsured people and 51 percent of those with insurance. The treatment gap was larger for high cholesterol: 77 percent of uninsured versus 60 percent of insured people had inadequately treated levels.
For diabetes control, the difference in treatment was not as clear. Insurance status did not matter in achieving good diabetes control, as defined by the national survey conducted by the US Centers for Disease Control and Prevention. But using less stringent measures that the authors say are more commonly used by physicians, 31 percent of uninsured diabetics were in poor control of their blood sugar levels, compared with 25 percent of insured diabetics.
"The diagnosis and control of chronic illness is substandard even in people with insurance," Dr. Steffie Woolhandler, co-author of the article appearing online today in Health Affairs, said in an interview. "But it's much, much worse for the uninsured."
Woolhandler said the study results fit with research published last month linking 45,000 deaths each year to the lack of insurance. The same group wrote both articles.
"We know that you can prevent deaths through good treatments for high blood pressure, for diabetes, and for high cholesterol," she said. "These common conditions are easily treated, but if you don't treat them, they can turn lethal."
Chronic conditions are diagnosed and treated through regular doctors' visits and medication regimens, both of which can be out of reach for the uninsured, Woolhandler said.
The study's conclusions are not surprising, according to Lindsey Tucker, Health Reform Policy Manager for the advocacy group Health Care For All.
"This paper demonstrates yet again the importance of having and retaining health insurance," she said in an e-mail interview. "As we know from our policy work as well as from our HelpLine callers, uninsurance is costly not only for the individual but also for the state and the health care system."- Posted in
30 Comments so far
Show All"The diagnosis and control of chronic illness is substandard even in people with insurance," Dr. Steffie Woolhandler, co-author of the article appearing online today in Health Affairs, said in an interview. "But it's much, much worse for the uninsured."
Let's parse out this statement. It begins with the clear recognition that even insurance "coverage" is not a guarantee of actually effective medical care. But since it's "much, much worse for the uninsured," the implication is that expanded coverage will at least produce "much much better" if still "substandard" health care. Unfortunately that seems the operative assumption of any likely health care "reform" bill that is passed into law. In order to expand "coverage," the bill will likely accommodate many reductions in the services for which that coverage will actually provide, with deductions and co-pays, not to mention Peter robbing from Paul with Medicaid and Medicare reductions which are going to make health conditions worse for elders and the poor. I'm reminded here of the way in which in Florida we have dealt with hurricane insurance coverage: in order to make it reasonably "affordable," the state's leaders have enabled junk home insurance that is so weak in coverage that almost no homeowner can survive the costs of an actual hurricane strike...in order words, to get "universal" coverage, you make that coverage practically useless. And this is the kind of health care "reform" in support of which we all are being asked to mobilize our efforts? Actually I never thought I'd be out beating the bushes for a "substandard" medical care system.
You can't set the bar low enough. At some point, it becomes pointless.
Something I've never understood is how is it that so many of the uninsured, underinsured, or thought-they-were-insured, can getting screwed, see loved ones die, go bankrupt and losing their homes - often all four, and NEVER come together, organize and become a powerful political force.
Instead, with the rare exceptions like Donna Smith, they just go home - or homeless - blaming only themselves all the way.
Or - in rural and small-town USA, see those sad, futile jars with a pic of their child on the counter of a nearby convienience store.
I suspect that of all the nations of the world, only in the United States are the people so cowed and disempowered. And they call this place a democracy? What pathetic nonsense!
pjd412: "Something I've never understood is how is it that so many of the uninsured, underinsured, or thought-they-were-insured, can getting screwed, see loved ones die, go bankrupt and losing their homes - often all four, and NEVER come together, organize and become a powerful political force."
Aye and that is the Political Question of the Day, is it not? Any such political force must be a "populist" one and the silk-shirt Hollywood and "intellectual" types who tend to be the "progressives" of our time are not likely to want to get their hands dirty by actual hands-on political organization of the poor and the disenfranchised. It takes the rare Gandhi or maybe Harvey Milk or Donna Smith to pull off a populist revolution. If I ever get off my arse and head for the political hills, that's exactly where I'm going; but then I grew up on that "wrong side of the tracks" or at least that rural, small town America whose political impotence you decry.
Excellent and poignant comments.
Thank you both.
I second that.
pjd412 Not only was yours the "Political Question of the Day," in my opinion; it was as well the "quote of the day" on my daily headlines postings on The Sun State Activist, which this morning includes my summary of the article on which we have been commenting, as well as your "quote," which you'll find when you scroll down past the headlines. Thanks for your "contribution."
http://www.sunstateactivist.org/
Jerry
WE HAVE ALWAYS KNOWN THAT GREED IS BAD MORALS....WE NOW KNOW THAT IT IS ALSO BAD ECONOMICS:
FRANKLIN DELANO ROOSEVELT
This should be required by law to be engraved in letters 6 feet tall on the front of all economics and business schools and colleges.
Unfortunately AGG -- the USA has basically "outlawed" that statement by FDR - symbolically, methodically, by neglect, by suppressing anything that pertains to that concept...it's now entirely absent in the national dialogue of the USA...after all
THAT is anathema to capitalism: good morals and ethics being harmonious with good economics is the ONE single truth USA's capitalism will NOT TOLERATE to be known, be learned, be remembered.
Roosevelt today - even in this "recession" where there would be good reason for that statement, would NOT get to first round in the "election selection committees". he wouldn't be allowed to debate. or get coverage.
he'd be marginalzed quicker than you can say FDR, Nader or Kucinich. heck -- the "swiftboaters" would even have a heydey making fun of his polio and wheelchair and make it all look "christian" and "moral".
the Corporate Fascist Police State's control is practically Total now...and imo, only a revolt by americans - dropping every work on hand - will undo the damage.
the rest , otherwise - will be just a painfully slow descent to ruin and utter debasement of america...until one day -- what being 'american' means will be to be utterly anti-social, with a general citizenry that is characterised more by roughness, cold rudeness, lacking in common politeness towards one another .....and i mean this of a society stripped of any pretenses anymore of being "civilized"...and so - just behaves with unabashed animosity, impatience and even hatred towards each other and other people.
some writers have said that Capitalism is really a Destroyer of wealth, behind its facade of "wealth"....
i would add that it is really a destroyer of humanity and social cohesion that has any pretense towards being civilized.
you let it run unabated - it will eat up everything in sight...
soul, mind, heart, goods, production, abilities, morals and ethics..and spit out nothing but bones and then CRUSH them some more...before it looks for new victims to consume.
Excellent analysis Teddy. Bad times, getting worse.
We Americans don't just LACK critical thinking skills.
We have been systematically taught to defeat in ourselves even those natural critical thinking skills that would instinctively arise in humans just through normal day to day living.
Even the among uneducated impoverished peasants of other nations, there is often more common sense about the world and life, than you're likely find in the average American.
Our incessant, abnormal, force-fed, hyper propagandized, commercialized culture has actually deracinated the natural, civilizing instincts of millions of us, supplanting those drives with learned inclinations toward dependence and passivity in some behavioral areas and, alternately, with chronic arguing, complaining, and violence-seeking compensations in other behavioral areas.
Sustained, civilized critical thinking is commonly considered "bad manners" in the US. And while genuine I/Thou thinking is touted as wonderful and noble, the subtext message is: It's really only good if it's good for YOU and YOU alone.
Many of us as a result oscillate schizily between artificial helplessness and frustrated, instinctively-confused rage, finding no peace in life, except in material distractions and I'm-OK/You're-OK superficialities and denials.
By the Way: Did I mention that we are not a balanced people?
Very true. I wonder how we can even hope for a rational healthcare system when we are living in such a sick society.
I wonder if the study mentioned in the article was skewed by the fact that people without insurance coverage not only can't afford to consult a doctor about possible chronic health issues, but are also _afraid_ to go to a doctor. Afraid lest they be diagnosed with something that will then go on their record as a "pre-existing condition" and won't be covered even if they eventually get insurance.
Insurance status was self reported by participants in the biennial NHANES study, which was data mined for this report.
http://www.annals.org/cgi/content/full/149/3/170
Sioux Rose
JERRY: Funny you should mention the hurricane insurance. I am just now debating whether to renew it... just wonder if I'd be better off putting aside that sum in my own "cookie box" if a storm actually hits? So far I have got "no satisfaction" from insurance on ANYTHING thus far, from the car, to the home; and both have been hit by storms, albeit not a direct hurricane hit. I can barely understand the latest letter sent by "Citizens" but what I can decipher implies less coverage for the same amount of annual fees. The corporate capitalists without conscience know whose side the bread is buttered on these days, and they're ALL in for the proverbial kill.
Hurricane insurance is one of those expenses that is expected to naturally increase as climate change progresses. Wait until your flood insurance goes crazy down there in Florida!
This is why I rail for nationalization of the whole insurance industry. It has become nothing more than legalized robbery. They take in premiums, write a few checks and pocket the rest. Should disaster strike at either the personal or community level, it's good luck and see ya never.
Only a single payer system can deliver optimal health care for all. That's because single payer elimiates the insurance company's upwards of 30% overhead/profit ripoff, more than enough savings to cover the 45 million now uninsured, not to mention improving coverage for the underinsured. None of this matters to the Republicans, because they put laissez faire ideology uber human life, which explains why they so doggedly hold out against single payer. What they fear is that a single payer system such as Medicare for all would be so successful & popular that it would shatter the myth about government being the problem, not the solution, and whither then capitalism and won't that be nice.
This talk about the "uninsured" is troubling - as though the over riding problem with those suffering from chronic illness is lack of "insurance". The problem is lack of access to affordable, quality preventative care and treatment. Health insurers and other profiteering mercenaries create the injustices and inequities in our health care system in the U.S. Their contributions are death and misery. They provide no comfort and inhibit the healing efforts of those who do by denying necessary care and treatment.
A single payer system (HR676) is the best approach for making universal access to quality healthcare a reality.
Newt "the flute" Gingrich publicly said, when the Clinton Admn. tried health care reform, (and I paraphrase) "We can't let this pass --- the democrats would own government for forty years, like they did after the New Deal"
"single payer system such as Medicare for all ..."
Alas, Medicare is not a single-payer system. People on Medicare need extra private insurance in order to get good health care. See:
Mary Lynn Cramer, "Don't Confuse Medicare with Single-Payer: Progressives Abet Obama-Fraud", CounterPunch, August 18, 2009
http://www.counterpunch.com/cramer08182009.html
I'm poor. And screwed for it too;
I broke my 5th metatarsul 8 wks ago.
Today I was told I could lose my foot.
Substandard care? I just fell? that is all; now that Doc's are helping me it hurts always and I "might lose your foot."
this is so horrible! I wish for you with all my heart that it doesn't get to that, Joe!! how i wish i was rich ! and just give money to anyone that needs it, even if it makes me as poor as I am again!!
Solution for the sick uninsured:
Buy a kilo of pot and have a smoke-in at your local fuzz, get put in jail and get free food, free rent and free medical treatment.
ezeflyer; These days you get a bill for everything in some places, and medical in just about all.
Some states require you to pay back the money it cost to incarcerate your sorry butt. So check into that before executing that plan.
Are you kidding? Please tell me that's a sick sort of joke. Lie if you have to...
Even if you're guilty of breaking the law, isn't the loss of liberty enough of a cost for the individual? Can you buy a better prison cell if you have to pay?
"What they fear is that a single payer system such as Medicare for all would be so successful & popular that it would shatter the myth about government being the problem....and whither then capitalism...."
Right on target, Sioux Rose.
But the question remains: Why don't more people see this truth and fight back?
In rereading my own above explanation of Why, it sounds like the same kind of disempowered whining I lament in others; just a description of what's wrong, not a real explanation.
For what it's worth, my intent is not to whine or to mock the duped victims of an elitist system; but to probe the Why of Americans' mass credulity/passivity and then offer thoughts about how to create belief in a more humane system.
No one here exceeds your ability, Sioux Rose, to do two crucial things, credibly for a wide range of psyches:
<>symbolically model and factually pick apart the wrong ideas and values we uphold and are dying-by (e.g. the values of Mammon, Mars, etc.)
<>symbolically model and explicate those deeper, unifying ideas and values that we could, instead, uphold and sustainably live-by.
Especially when my posts fail to do the latter on any given issue or metaview ( which is all too often), I always hope that yours will.
Keep tight in you approach, SR.
Self-understanding is the only force that can change us humans for the better, as you well know.
We should also be talking about the people who have BAD insurance. Many people die because of their insurance companies - canceling coverage, kicking people off when they get sick, turning down legitimate claims. Just getting everybody signed up with these corrupt insurance agencies who are raking in huge profits by cutting people off when their lives are at stake - is NOT the way to solve the health care crisis. It's not an insurance crisis - it's a health crisis - our health. If we had Medicare for all we wouldn't even need insurance companies. We could train all those out of work people from the insurance companies to be the nurses and doctors we DO need. Imagine that!