Sunday, September 21, 2008

The Moral Hazard Myth - Malcolm Gladwell, New Yorker

The U.  S.  health-care system, according to "Uninsured in America," has created a group of people who increasingly look different from others and suffer in ways that others do not.  The leading cause of personal bankruptcy in the United States is unpaid medical bills.  

Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies.  Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma.  Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment.  Heart-attack victims without health insurance are less likely to receive angioplasty.  People with pneumonia who don't have health insurance are less likely to receive X rays or consultations.  The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance.  

Because the uninsured are sicker than the rest of us, they can't get better jobs, and because they can't get better jobs they can't afford health insurance, and because they can't afford health insurance they get even sicker.  John, the manager of a bar in Idaho, tells Sered and Fernandopulle that as a result of various workplace injuries over the years he takes eight ibuprofen, waits two hours, then takes eight more—and tries to cadge as much prescription pain medication as he can from friends.  "There are times when I should've gone to the doctor, but I couldn't afford to go because I don't have insurance," he says.  "Like when my back messed up, I should've gone.  If I had insurance, I would've went, because I know I could get treatment, but when you can't afford it you don't go.  Because the harder the hole you get into in terms of bills, then you'll never get out.  So you just say, 'I can deal with the pain.' "

More ...

http://www.gladwell.com/2005/2005_08_29_a_hazard.html

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