A quarter of all Americans faced health coverage gaps last year

Take a look around you and pick out four adults. One of them did not have health insurance coverage for all or part of 2011, according to a new report by The Commonwealth Fund. Twenty six percent of adults age 19-64 experienced some type of coverage gap last year, usually due to job change or loss, and the gap often lasted a year or more.

That means they were less likely to get preventive care, have a regular doctor or stay up to date with recommended screenings– and the longer they went without insurance the higher this likelihood became. Chances are, someone you know had to make a choice between paying the mortgage or going to the doctor; feeding the family or getting the expensive prescription refilled. In 2014, some new provisions of the Affordable Care Act will kick in, making this scenario much less probable; insurance exchanges, free or low cost plans, expansion of coverage through Medicaid, and government subsidies will help millions more to obtain health insurance – and keep it, regardless of employment status.

It seems almost criminal that people should have to choose between paying the heating bill and paying the doctor bill. How do we as a nation rationalize this?

There are people on one side of this debate (and why is this even a debate?) that say the Affordable Care Act is too expensive, and that it should be up to the private sector to regulate coverage. They view health care much as they view a doorknob, or car, or any other commodity. Wait a minute – Isn’t this the same private sector that likes to drop people that get serious illnesses like breast cancer, right in the middle of treatment? Or raise rates so high that coverage becomes a pipe dream? Or refuse to cover obvious life-saving treatment because an actuary said the cost-benefit ratio was off?

Health care isn’t a commodity; not if you actually need to use it. Because unlike the doorknob from Home Depot, there is no a fixed production cost. It all depends on who, what, and why. Prices and fees change based on variables like how well a patient responds on a certain drug, or sticks to his wellness plan, or how quickly she recuperates after surgery. Does Mr. Brown need more physical therapy? Will another statin work better, with fewer side effects on Mrs. Riley? Or, will what worked for Ms. Jones also work identically for Ms. Smith? Not likely. That’s a lot different than choosing the Ford or the Chevy.

I wonder if anyone who is so determined to repeal ACA has ever had to pay COBRA premiums to ensure continuity of coverage between jobs? I have, as have many others I know. It’s a budget buster I hope I never experience again.

The “private sector” argument conveniently ignores exactly what this Commonwealth Fund report confirms: no insurance means no preventive care, delays in screenings and non-compliance with medication regimens. As a result treatment – if it happens – occurs later, costing more per person; when the situation is more dire, or even life threatening. For example, compare survival rate, options and costs for a simple PSA test and timely treatment for stage one or two prostate cancer (see Warren Buffett, Ryan O’Neal ) compared with no preventive screening, no early detection and treatment, more expensive and extensive care for a later-stage disease – not to mention higher risk of death.

Warren Buffett will never have to be concerned about gaps in his insurance coverage, or being able to pay for potentially life-saving preventive screenings, or getting the right kind of medical care in a facility of his choosing. Neither will members of Congress. Yet, it’s this very faction in Congress, and their supporters, that cry “foul” whenever there’s an attempt to level the playing field. I don’t understand how or why there is opposition to everyone having access to good affordable care, and to insurance coverage that won’t disappear if they lose their job or get sick. Isn’t that what insurance is for?

One-quarter of all Americans. Shame on us.

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