The United States has one of the best - and most expensive - health care systems in the world. Most Americans rely on medical insurance through their jobs to help pay their doctor bills. But more than 46 and a half million Americans do not have insurance and may put off medical treatment until it's too late. A recent government study ranked the southern state of Mississippi the most uninsured place in the nation, where nearly a quarter of the residents lack medical coverage.
Daniel has been without health insurance for most of his life. It didn't really matter to the 25-year-old until five years ago, when he was diagnosed with diabetes. The cost of his medications and doctor visits got so high, he had to quit school and go to work to pay off his medical bills. "I was having to take out credit cards and max them out, just to buy the medicine I needed to stay healthy and alive," he recalls. "The situation mushroomed and ballooned and got out of control. It got to the point in fact where I stopped doing a lot of the things I should have to maintain my health."
That's a common story in Mississippi, according to Lynn Cossman, a social scientist at Mississippi State University. In her research, she's found that the uninsured are not the poorest of the poor, whose medical care is paid for by government welfare programs. Instead, they are the working poor. "What we're talking about are, for example, construction workers who might work for one guy and be on a team of 10 or 12 people, if that. They're working fulltime and they're being paid by the hour but there are no benefits associated with that job."
At this construction site, many of the workers confirm that they don't have health insurance - though no one wanted to be interviewed about it. Their foreman, Larry, says he understands how they feel, adding that he's one of the few fortunate contractors with coverage - but it's not through his job. "My wife is able to get it," he explains. "A lot [of the other contractors] are not able to. The insurance she has is through the state. We still have to pay a certain amount, but if we had to pay the full amount of what it costs to go to the doctor, it would wipe us out."
For any business, providing insurance for employees is a major expense, and many small firms can't afford it. Cossman says many employers get around offering insurance by keeping workers hours below the full-time 40-hours-a-week level, thus keeping them
ineligible for benefits. "We saw some even larger employers across the state who sometimes employed people at 30 or 35 hours a week instead of employing them for 40…. The cutoff for benefits is around 35 hours a week. So if they can keep them below 35 hours a week, then they don't have to pay the benefits for those people." However, even when employees are offered insurance, Cossman points out that many choose not to take it, simply because the monthly payments or premiums are too costly.
That's the case for Alice, a single mom and fulltime student, who works part-time in a research lab. "If I get insurance, independent insurance, it would cost me at least $700 a month minimum," she estimates. "So if I could get some insurance that would cover me with a premium at $200 or $300 a month it would help, but individual insurance is too expensive; I just can't afford it."
Because of her income level, a government program pays the doctor bills for Alice's children, but she worries how the family would manage if something should happen to her. "I'm always worried about being sick. And another thing is that my mom died of breast cancer, and I'm always worried about getting sick, but I can't afford to have a mammogram done because I don't have any insurance." She admits it's a scary thought.
Alice, Daniel and the men on Larry's construction crew are typical of uninsured Americans across the country. But Lynn Cossman says people in different regions have different ways of getting care. For instance, Americans often travel across the U.S. border with Mexico or Canada, to purchase medicines in those countries at a lower price, usually without seeing a doctor. In other states, including Mississippi, they may go to a hospital emergency room, where the law requires that they be treated, even if they can't pay, and some people may try to ask a doctor for uncompensated care.
There are federal and state programs available to help uninsured Americans with health care costs, but MSU's Lynn Cossman has found they may not be aware of them, or assume they don't qualify. Some may find the process of applying too overwhelming, while it simply isn't in the nature of others to ask. "I think certainly there's almost a Southern gentlemen mentality of not wanting to ask for a handout. They don't want something that is not deserved," she says.
In addition to the national programs, many states, including Mississippi, have entered into a joint program with the federal government to ensure that all children under the age of 18 have access to health care, while many citizens of all ages are getting help from the nation's largest pharmacy. Wal-Mart is offering low cost generic drugs at all its stores in Mississippi, as well as more than two dozen other states.
Lynn Cossman says no matter who is uninsured, the bottom line for not being covered is money. "Health care is a commodity in the U.S.," she observes, "if you can afford it, you can buy it. In other developed countries they have national healthcare systems that cover minimal care for everyone. That's not all of it, but that's part of it. My ultimate goal is to reduce health disparities."