Half a million people. In Minnesota. Without health insurance.

That’s up from 7.2% of the population that was uninsured in 2007. Now this might not seem like a huge jump to you, but in terms of people, we’ve gone from about 372,000 uninsured in 2007 to 480,000 in 2009, a 28% increase in the number of people without health insurance.  

So who are all the uninsured?

• The highest rates of uninsurance occur among the young adult population: 22% of the 18 to 24-year-old age group is uninsured, as are 16% of those ages 25 to 34. (In contrast, about 7% of those under age 18 are uninsured.)
• Not surprisingly, the uninsured are more likely to have lower incomes: 18% of those living at or below the federal poverty level are uninsured, as are 17% of those between 100% and 200% of poverty and 12% of those between 200% and 300% of poverty.
• Uninsurance rates are higher for Minnesota’s populations of color, particularly Hispanics (29%), American Indians (19%) and Blacks (16%).
• The uninsured are more likely to live in Greater Minnesota (10.3%) than the Twin Cities Metro Area (8.1%).
• Men (12%) are much more likely to be uninsured than women (6%).
• Nearly three-quarters of the uninsured (71%) are employed.
• Most (61%) are potentially eligible for some sort of public coverage.

Speaking of public coverage, there was an interesting article in the Wall  Street Journal a couple of weeks ago reporting that next year for the first time, government programs will account for more than half of all U.S. health care spending (see chart). By 2020, about 1 in 5 dollars spent in the U.S. will go to healthcare—a proportion far beyond any other industrialized nation (many of which have universal coverage).

Healthcare reform, anyone?

Wilkinson and Pickett examine income inequality across 23 countries. (Income inequality is measured in many ways, but one typical measure is to compare the income of the richest 20% of the population to the income of the poorest 20% of the population.) In Japan, Finland, Norway, and Sweden, the richest 20% are about four times as rich as the poorest 20%. At the other end of the spectrum (i.e., the U.S. and Singapore), that is more than doubled, which is to say that the U.S. has very high inequality (only Singapore is worse).

Does it matter? Absolutely, say Wilkinson and Pickett. They tie inequality to many of our major social populations:

If you fail to avoid high inequality, you will need more prisons and more police. You will have to deal with higher rates of mental illness, drug abuse, and every other kind of problem.

Take the example of health and life expectancy. The United States spends more per person ($6,000) on healthcare than any other country. You’d think that would at least put us in the top half for life expectancy, wouldn’t you? But no. In fact, only 3 of the 23 countries have lower life expectancies than the U.S. (those would be Portugal, which spends about $1,800 per person; Denmark, which spends about $2,800 per person; and Ireland, which spends about $2,500 per person). Highest life expectancy goes to Japan, which spends about $2,200 per person. The same pattern holds for infant mortality and teen pregnancy (see chart).

Conclusion? The more equally wealth is distributed in a society, the better the health of that society. They examine social relations, mental health, drug use, life expectancy, violence and homicide rates, obesity, education, teen pregnancy rates, incarceration rates and social mobility. The pattern holds.

Not convinced? They also look at inequality within the United States, and compare many of these same social ills across states, and the same pattern obtains. The authors contend that if the United States could reduce its income inequality to the average of the four most equal countries (Japan, Norway, Sweden, Finland), we would see:

• The proportion of the population feeling they could trust others increase by 75%
• Rates of mental illness drop by two-thirds
• Rates of obesity drop by two-thirds
• Teen birth rates cut in half
• Prison populations reduced by 75%

Now that’s something worth striving for!

photo by interplast @ flickr

I recently read an article in the Strib about increases in applications for MinnesotaCare, the state’s insurance plan for low-income individuals. Applications are up 25% so far this year, and in July they were up 43% compared to July 2008.

So I began to dig around a little bit, looking for more information about what people are doing to meet their healthcare needs during the economic recession. According to “Rising Health Pressures in an Economic Recession,” a recent report by the Kaiser Family Foundation:

The uninsured and underinsured delay and forgo important healthcare due to cost. Many in jobless families delay or skip needed care or medicine for cost reasons, with adverse consequences for their health.

In Kaiser’s July survey, nearly half (49%) of adults reported they have put off some sort of needed healthcare over the past 12 months because of its cost. One in five have had problems paying medical bills in the past year. And about 1 in 3 are “very worried” about being able to afford healthcare services they need.

What are they doing to cut back on costs? One-third are trying home remedies or over-the-counter drugs instead of seeing a doctor. Depending on the illness, this may not be a bad thing—a steam bath of eucalyptus and tea tree oil can do wonders for the sinuses. On the other hand, if it’s a bleeding ulcer, eating TUMS like candy might land you in the hospital.

Perhaps more worrisome: More than one-quarter are skipping dental care or check-ups—this can have major negative long-term consequences if they are skipped for too long (and result in costly long-term treatment that could have been averted). About 1 in 5 have skipped a recommended medical test or treatment, and 1 in 5 have not filled a prescription. Fifteen percent have cut pills in half or skipped doses of medicine to stretch out a prescription.

Not good. And it’s only going to get worse. According to a story in the Washington Post, annual healthcare costs for employers are expected to increase 166% over the next decade, to $28,530 per employee. Let me repeat that astounding figure: 166%. That means that employee expenses will also likely increase 166%. Or more.

Clearly some sort of healthcare reform is needed. I don’t have the answers, but if you’re looking for a rather simple visual presentation of this really complex issue that’s relatively unbiased, check out this Back of the Napkin presentation.