suffer heart attacks around the same time. In describing their uneven recoveries, in which the wealthy person is left better off, the middle-class man fighting through a setback, and the working-class woman struggling with increasingly complex medical and social problems, the author observed: âclass informed everything ⦠from the emergency care each received, the households they returned to, and the jobs they hoped to resume. It shaped their understanding of their illness, the support they got from their families, their relationships with their doctors. It helped define their ability to change their lives and shaped their odds of getting better.â
I saw a similar contrast between me and the women at the rural clinic. As a Duke student, I had health insurance. I didnât have to think about seeing the doctor or filling a prescription; everything was covered. For each clinic visit, Iâd see Dr. Katz and enjoy the benefits of a stable doctor-patient relationship. Tina and Pearl had to go to a monthly free clinic where doctors rotated each month; this meant they had to âstart overâ with the hopes that the next doctor would be as caring and competent as the previous one. While Tinaâs initial blood pressure pill was cheap, Dr. Watson worried that her blood pressure was so high that she would likely need a second or even third medicine that could each cost in excess of $50 or more every month.
So while Tina, Pearl, and I were all black and hypertensive, the similarities ended there.
Given these glaring differences, it should come as no surprise that the poor and uninsured as a group have worse health outcomes and higher death rates than people with health insurance. A 2002 Institute of Medicine report noted that in one study over a seventeen-year period, adults who lacked health insurance at the outset of the study had a 25 percent greater chance of dying than did those who had private health insurance. A major 2001 study found that a lack of health insurance is associated with an increased risk of decline in health for adults over age fifty. Diagnoses are delayed, and chronic conditions are poorly managed. Both factors result in a dizzying array of medical complications on the way toward a premature death.
As with so many societal problems, blacks as a group suffer to the largest extent, being nearly twice as likely as white Americans to live without health insurance. And while obtaining health insurance alone does not fix the health problems of the poor, it makes a real difference. A 2007 study found that previously uninsured adults, in particular those with cardiovascular disease or diabetes, reported improved health over a seven-year follow-up period after obtaining Medicare coverage at age sixty-five.
Back in the late-1990s, Tina was one of approximately forty million uninsured Americans, a tally that climbed closer to fifty million over the ensuing decade. Though Iâd heard snippets about the uninsured in college during the fight over the failed 1993 Clinton health plan, I had ignorantly allowed myself to assume that they lacked health coverage because they didnât work, and that they ultimately received medical care as part of our social welfare system. Because of my growing interest in the topic, I later learned that more than 70 percent of people who are uninsured are either working or, in the case of stay-at-home spouses, live under the same roof with a working person, and that having health coverage could be the deciding factor in whether a person sought health care, or if they could even receive services.
But I didnât know any of that when I met Tina. During the previous year of clinical rotations, we had a week or two devoted to an overview of the U.S. health care system. Although I vaguely recall some mention of how the United States lacked universal health coverage in comparison to Canada and Western Europe, the discussions seemed focused more on how managed
I saw a similar contrast between me and the women at the rural clinic. As a Duke student, I had health insurance. I didnât have to think about seeing the doctor or filling a prescription; everything was covered. For each clinic visit, Iâd see Dr. Katz and enjoy the benefits of a stable doctor-patient relationship. Tina and Pearl had to go to a monthly free clinic where doctors rotated each month; this meant they had to âstart overâ with the hopes that the next doctor would be as caring and competent as the previous one. While Tinaâs initial blood pressure pill was cheap, Dr. Watson worried that her blood pressure was so high that she would likely need a second or even third medicine that could each cost in excess of $50 or more every month.
So while Tina, Pearl, and I were all black and hypertensive, the similarities ended there.
Given these glaring differences, it should come as no surprise that the poor and uninsured as a group have worse health outcomes and higher death rates than people with health insurance. A 2002 Institute of Medicine report noted that in one study over a seventeen-year period, adults who lacked health insurance at the outset of the study had a 25 percent greater chance of dying than did those who had private health insurance. A major 2001 study found that a lack of health insurance is associated with an increased risk of decline in health for adults over age fifty. Diagnoses are delayed, and chronic conditions are poorly managed. Both factors result in a dizzying array of medical complications on the way toward a premature death.
As with so many societal problems, blacks as a group suffer to the largest extent, being nearly twice as likely as white Americans to live without health insurance. And while obtaining health insurance alone does not fix the health problems of the poor, it makes a real difference. A 2007 study found that previously uninsured adults, in particular those with cardiovascular disease or diabetes, reported improved health over a seven-year follow-up period after obtaining Medicare coverage at age sixty-five.
Back in the late-1990s, Tina was one of approximately forty million uninsured Americans, a tally that climbed closer to fifty million over the ensuing decade. Though Iâd heard snippets about the uninsured in college during the fight over the failed 1993 Clinton health plan, I had ignorantly allowed myself to assume that they lacked health coverage because they didnât work, and that they ultimately received medical care as part of our social welfare system. Because of my growing interest in the topic, I later learned that more than 70 percent of people who are uninsured are either working or, in the case of stay-at-home spouses, live under the same roof with a working person, and that having health coverage could be the deciding factor in whether a person sought health care, or if they could even receive services.
But I didnât know any of that when I met Tina. During the previous year of clinical rotations, we had a week or two devoted to an overview of the U.S. health care system. Although I vaguely recall some mention of how the United States lacked universal health coverage in comparison to Canada and Western Europe, the discussions seemed focused more on how managed
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