Economic growth hasn't stopped the number of Americans without health insurance from climbing by 10 million people since 1989, to 43.4 million, according to a study in today's American Journal of Public Health. "By the time Congress finishes with the impeachment debate, another half- million people will have lost their health insurance," according to Dr. David Himmelstein, an author of the study and Associate Professor of Medicine at Harvard. "Unfortunately, none of them will be members of Congress." The study, the first comprehensive look at insurance trends in the 1990's, found that the number of uninsured is rising at a rate of over 100,000 people losing coverage every month, despite the nation's strong economic growth -- including more than a 25% increase in the Gross National Product and a doubling of the Dow Jones industrial average since 1989. One in six Americans (16%) is now uninsured, up from one in seven (13.6%) at the start of the decade. "Not having health insurance is a major catastrophe for patients -- medically, financially, and emotionally," said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program and an internist in Chicago. "It's a silent, devastating epidemic sweeping across the nation." Among those most affected by the loss of insurance are young adults aged 18-39, blacks, and hispanics. From 1989 to 1993 the majority of the increase was among low-income families, but since 1994 middle-income families have been increasingly affected as well. In several southern and western states (Texas, Arkansas, New Mexico, Arizona), nearly one in every four persons is uninsured. However, northeastern states (New Jersey, New York, Connecticut, Massachusetts, and Maine) had the largest increases in the percentage of their residents without coverage since 1989. "Incremental reforms have had no impact on the rising number of uninsured," noted Dr. Olveen Carasquillo, co-author of the study and an internist at New York's Columbia Presbyterian Hospital. "Two states which have been held up as models of reform -- Oregon and Hawaii -- both have experienced increases. The Kennedy-Kassebaum Insurance Portability Act has helped few people between jobs keep their insurance, and the Children's Health Insurance Plan is not and will not stem the rising tide of uninsurance among children." The number of uninsured children increased from 8.5 million in 1989 to 10.7 million in 1997. "The tragedy is that this a preventable epidemic. Every other industrialized country, from Denmark to Japan, Canada to Australia, Norway to Germany, England to Taiwan, has a national system of universal coverage," said Dr. Young. "They aren't perfect, and you may have to wait a few weeks for an MRI, but almost uniformly you can choose your physicians, receive excellent primary and specialty care at the same or higher quality as in the U.S., and the health outcomes are better. It's time for the U.S. to adopt a national health program once and for all." The study analyzed Census Bureau data from 1989 to 1996. An additional year of data was analyzed by the authors after the article went to press, and is available from PNHP.
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