In this article from the U.S. Catholic archives, Kevin Clarke explored the state of our U.S. health care in 2004, capturing the effects of a crisis that we're still trying to solve five years later. 

Chris and Lisa Wilson were living a just-about picture-perfect middle-class life in New York's Duchess County when America's health care crisis came pounding on their front door last spring. Chris had a mid-level management job with an IT services firm; the couple had recently purchased their own home; and Lisa was a stay-at-home mom to 10-year-old Max. But in May, his company battered by three years of a high-tech slowdown, Chris was laid off.

In addition to the normal problems and anxieties that accompany any job loss, the Wilsons found themselves facing a wholly new worry: finding affordable health insurance now that Chris had lost his company benefits. Like millions of other suddenly tenuously middle-class Americans, they tried to balance their monthly expenses against the security of a costly private health plan, but the nearly $700 they would have had to set aside each month just for basic coverage was too much. The Wilsons opted to hold their collective breath and hope for the best--or at least for a new full-time job with benefits.

"We had a 'choice'--we could pay the COBRA [the federally mandated group rate 'bridge' insurance for laid-off workers] or pay the mortgage," says Lisa Wilson.

Going without health insurance is a risk being accepted by an increasing number of Americans. Last year 44 million--more than 15 percent of the population--did not have health coverage, and an estimated additional 40 million were underinsured.

Those are shocking figures for a nation that spends more on health care than any other country in the world--almost $1.6 trillion in 2002, 15 percent of the nation's gross domestic product and an astounding $5,400 per capita. That's well over twice the per capita median of other Western economies and almost three times the per capita spending run up by the much-maligned Canadian system. In fact, our northern neighbor's single-payer network, long the foil of conservative pundits, is now fast becoming the pharmaceutical provider of choice for the U.S.'s cash-strapped seniors and state governments looking to trim costs.

At the same time record numbers went without health coverage of any sort, white- and blue-collar workers in the U.S. fortunate enough to have company-provided health packages have been forced to make record contributions to their plans, coughing up anywhere between 10 and 45 percent of their monthly premiums. At the high end of that scale it's little wonder that more low-paid, full-time workers are "choosing" to leave their health benefits on the table.

But making ever higher co-payments for health insurance premiums is becoming the lesser of two evils for many working Americans. As businesses confront double-digit increases in insurance rates for three straight years, many have simply dropped coverage altogether. Two years ago 65 percent of firms employing 200 or fewer workers provided health insurance. Today that number is down to 61 percent and falling. By some estimates, half of all labor disputes, like the ongoing grocery workers' strike in California, are centered around health care.

In the near future more companies will be forced to juggle plans, eliminate levels of care, shift costs to workers, or drop health benefits altogether, says Tom Hadrych, a vice president in compensation, benefits, and corporate services for DaimlerChrysler. "The trend is that fewer companies are providing fewer benefits, and that trend is going to continue." As more workers lose benefits, they will end up in the gentle embrace of the public system on the public nickel.

His company may have a vested interest in fixing health care since each increase reduces competitiveness and cuts into profits, but Hadrych says the problem is much bigger than its impact on U.S. corporations. The health care industry is on track to eventually lay claim to as much as 25 percent of the total U.S. economy.

"That means that you and I and anyone else who is on the bill-paying side of this has an interest in [resolving] the health care crisis," says Hadrych. The current "traveling" rate of increase is not sustainable, he suggests. In 5 to 10 years, he says, "something's going to have to change."

Prescription drug spending remained the fastest-growing item in health care in 2002, and drug costs are predicted to outstrip the overall growth in health care spending for the next 10 years, a projection that does not take into account the impact of the new Medicare drug benefit that begins in 2006. Many economists believe Medicare's drug package, a "reform" that explicitly prohibits cost-control mechanisms, will prove a windfall for pharmaceutical companies and lead to an even greater acceleration of prescription drug costs.

The short-term perspective offers little relief. The National Coalition on Health Care estimates that hard economic times and a continued runaway escalation of health insurance premiums and prescription drug costs could raise the number of uninsured to as many as 54 million people by 2006, when it estimates average family coverage could cost as much as $14,500 a year.

In response to the looming crisis, the current administration seems determined to move health care even deeper into the for-profit sector, recently giving Medicare a historic rate bump to encourage for-profit HMOs to include Medicare patients.

Those most likely to lack health insurance include large chunks of politically unthreatening demographics: young adults, part-time workers, people with low levels of education, Hispanics, or people born outside the U.S. But the profile of the "typical" uninsured U.S. resident is changing as more members of the middle class, like the Wilsons, find themselves downsized out of company plans. That changing profile portrays a cultural and economic crisis that reform advocates believe offers a historic opportunity to redefine health care in the United States.

All for one and one for all?

With so many now uninsured and the suffering and dissatisfaction so broadly distributed, could the U.S. public finally be willing to seriously consider a national health plan that will include everybody?

An ABC-Washington Post poll conducted last October indicates that average Americans may indeed be ready. The poll found that the public favors national health insurance to "the current health insurance system, in which most people get their health insurance from private employers, but some people have no insurance" by a 2-to-1 margin (62 percent to 32 percent). It reported that 8 in 10 people think it is important to cover all the uninsured "even if it means higher taxes."

Responding to the poll, Dr. Quentin Young, national coordinator of Physicians for a National Health Program (PNHP), says, "What's striking is not the high level of public support for reform; our system's been in critical condition for years. Support for reform is a no-brainer." What's striking, and shameful, according to Young, is the way elected officials ignore remedies such as a national single-payer plan because of opposition from powerful forces in the for-profit sector.

How did we get to this point? Widespread and, some would say, ill-conceived privatization of what had been the largely not-for-profit health care sector during the 1980s helped, but the problems with U.S. health care perhaps most relate to another example of American exceptionalism.

Alone among advanced Western economies, the United States relies on private insurance to provide health care to a substantial percentage of its citizens--a social good that is perceived in most other developed nations as a basic public service, little different from police or fire protection or public education and financed accordingly. For decades the idea of a federally bankrolled universal health care program has been dismissed by America's policymakers, despite the fact that the federal government already pays for nearly 60 percent of all health spending and almost half of all Americans already receive their health care through a direct federal or federally subsidized program such as Medicare, Medicaid, Veterans Administration, or federal retirement accounts.

Supporters of the health care status quo argue that health service is best left to the private sector, that such an enormous extension of federal social responsibility will result in bureaucratic bloat that is bound to be too costly and inefficient, and that America's current system provides the best, most technologically advanced care in the world.

But proponents of a major overhaul of the current system ask: Are we really getting our money's worth out of the world's costliest health care system?

Not the best in the West

U.S. health care is a study in painful contradictions, according to Father Michael Place, president of the Catholic Health Association, the U.S. church's national organization of not-for-profit health care providers. It offers the most advanced technology and pioneers some of the greatest biomedical breakthroughs, but despite its impressive successes in specialized treatment and acute care, he says, the system in the aggregate--specifically at the primary care level--has substantially degraded over the last two decades. He calls its failure to provide basic coverage to so many uninsured citizens a "national disgrace."