By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

During eight seasons playing the dedicated Dr. John Carter on ER, actor Noah Wyle has dealt with innumerable healthcare crises. Off screen, Wyle says the real emergency is getting all Americans health insurance.

"About 41 million Americans don't have health insurance," Wyle says. "Over 8 million are children. Seven million people are uninsured in California alone where we're seeing more hospital closures than any other state in union."

And the problem may be far worse.

A study just released last week indicates that as many as 75 million Americans were uninsured at some point during 2001 or 2002. To raise awareness about this health insurance crisis, Wyle is helping promote Cover the Uninsured Week which runs March 10-16 and was funded by the Robert Wood Johnson Foundation and 140 other national organizations.

"I cannot even imagine what it would have been like to go through the recent birth of my child without health insurance, without prenatal care," Wyle states. "When my wife got pregnant, she and I became instant students and advocates of new approaches for delivering a child into the world - a lot of it had to do with avoiding as much medical intervention as possible. But what little we did have was absolutely necessary and would have been damn near impossible without health insurance."

"This problem particularly affects single parents and part-time workers where there's been a shift by employers to not provide insurance," says Neal Baer, a physician and executive producer of Law & Order: Special Victims Unit. "But this is increasingly a problem facing the middle class not just the working poor."

"Often times people are afraid to get care because they're afraid of the financial costs," Baer adds. "People lose their homes. I think medical bills are the second most common reason cited for filing personal bankruptcy in the United States."

"I have great health insurance and I'm still reticent to go to the doctor," Wyle says. "I can only imagine how many people who have to ask, 'Do I want heat or do I want to get this checked out? Do I want to feed my kids or do I want to get my prescription filled?' They'll wait to the last possible second and something that was extremely treatable at its outset has become a major health issue because of neglect."

Real health costs

In fact, studies show that uninsured patients often wait far too long before seeking treatment.

"So they become more ill which then causes them to require more care and that's more expensive," says Baer, who began as a fourth year medical student and completed his residency while working on ER. "People without insurance also tend not to get good preventive care so patients with chronic illnesses like diabetes really face some serious problems. For instance, African-American men with diabetes have a much higher rate of amputation than any other group. I think the reason is because they don't get good care when they need it. They just don't have adequate access."

Additional fallout caused by lacking insurance includes:

• Uninsured women with breast cancer are twice as likely to die as women with breast cancer who have coverage.
  
  
• Men without health insurance are nearly 50 percent more likely to be diagnosed at a late stage for colon cancer as men with insurance.

"The system needs fundamental change because we aren't spending our money wisely," says Dr. Arthur L. Kellermann, professor and chair of emergency medicine at Emory University School of Medicine, Atlanta. "If you're uninsured and have diabetes and you're not getting decent medical care so your kidneys are failing, we're going to step back until your kidneys shut down and then, 'Congratulations, you qualify for dialysis.' It would have been a hell of a lot cheaper and more humane to provide a decent level of medical care and adequate insulin so the patient never needed to lose their kidneys in the first place."

As the demographics grow, so does the problem of caring for the uninsured. Many experts argue that as emergency rooms increasingly are flooded by the uninsured seeking primary care, the economic and social costs will be staggering.

According to Kellermann, we're conservatively paying as much as 38 billion dollars just for care of the uninsured. Eighty-five percent of that is coming from public sources.

"When people tell me can't afford to deal with this problem, I tell them we can't afford not to," says Kellermann, co-chair of the committee that just issued an Institutes of Medicine report entitled A Shared Destiny: Community Effects of Uninsurance.

"We cite compelling evidence that the financial strain of treating people without health insurance can hurt the viability of local governments and local healthcare providers," Kellermann states. "This can in turn produce spillover effects across the community including reduced access to emergency services and trauma care, loss of access to specialists and reduced availability of key hospital-based services. These effects can compromise access to healthcare community-wide and can ultimately damage a community's economy."

Medical emergency

As the ranks of the uninsured grow, predictions are more and more hospitals and trauma centers will buckle under the financial strain.

"We're required by Federal law to care for anyone in need who comes through the door day or night without regard for their ability to pay," Kellermann says. "We actually already have universal access to healthcare in America. It's called, 'Go to the ER.' But it is a completely unfunded mandate that is not supportable."

Of particular concern to Kellermann is that the IOM report found that despite September 11 and Homeland Security, our trauma system and our emergency medical system have been "completely ignored."

"It's dumbfounding," Kellermann states. "Understandably we are concerned about bio-terrorism but the last two big events in the world involved bombings. That requires an intact emergency medical service system and an intact trauma care system. It is precisely the area of our healthcare system that our report revealed has been most directly and severely affected by the growing toll of the uninsured."

And if you think insuring everyone isn't your concern because you and your family are covered, Kellermann says think again.

"You can be covered but that doesn't help you if you're in the back of an ambulance suffering from chest pain and you hear the paramedic get diverted to the third hospital, or there's no neurosurgeon on call, or the trauma center in your community is closing because it's hemorrhaging financially," Kellermann adds. "You do have interest here - there's a selfish as well as compassionate interest in this issue. Sooner or later we're all in the same boat when it comes to healthcare."

Wyle is maintaining a proactive attitude.

"I see a wonderful opportunity here to capitalize on this growing groundswell of understanding that health insurance should be a #1 priority going into the next national election," Wyle says. "If you can't treat your child's diabetes -- if you can't afford to treat your kid's tuberculosis -- worrying about anthrax and smallpox really seems ridiculous because these health issues are affecting everyday people every day. It's not theoretical.  It's real. We need to get people covered."

For more information about Cover the Uninsured Week, click here.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 3/15/2003  -  John Morgan & Stephen A. Shoop, M.D.