There is a commonly held view that one of the ways to fight the massive federal deficit is to curb entitlement programs such as Medicare.  But, an expansion of Medicare may be what we really need.

According to a 2010 report produced by U.S. Department of Health and Human Services (with the Centers for Disease Control and Prevention and the National Center for Health Statistics), by 2008-9, 19.5 percent of adults --one in five-- between the ages of 18 and 64 had “no usual source of health care.”   That kills people, beginning with the very young.

In 2009, among the 34 OECD (Organization for Economic Co-operation and Development) countries, the most developed nations in the world, the five with the highest poverty rates were, in order, (5) Turkey, (4) the United States, (3) Chile, (2) Israel and (1) Mexico.  As a result, U.S. Infant mortality was actually the fourth worst in the OECD, after Mexico, Turkey and the Slovak Republic.  One of the obvious problems is that the children of the poor, in a country with one of the world’s most productive economies, do not have adequate medical care.  According to Columbia University’s National Center for Children in Poverty (NCCP), among all children in the U.S. under 18, 16 percent of those living in low-income families –-5 million—are not covered by any health insurance.

For millions of people in the United States, the situation doesn’t improve as they grow older.  In 2008-09, for the 44-64 age group --a group that is particularly prone to a wide range of preventable or treatable diseases, including diabetes, cardiovascular disease, cancer, etc.-- 11.6% had no health insurance.  About fifteen percent do not get or delay seeking medical care due to its cost, meaning that conditions become progressively more complicated and costly to treat.  

We know, of course, that the new Patient Protection and Affordable Care Act has helped some of these people.  But, it will not be until January 2014, that insurers will be prohibited from discriminating against or charging higher rates for adults with pre-existing medical conditions.  In the meanwhile, such individuals ostensibly became eligible to join a temporary high-risk pool which would be superseded by a health care exchange in 2014.   But, according to the Washington Post this past February, while the Medicaid program's chief actuary forecast that 375,000 Americans would join the new high-risk pools (which operate at the state level) by the end of 2010, as of this past April 30, only 21,454 had.  This was not entirely surprising, however.  According to an article by Linda J. Blumberg in the New England Journal of Medicine in May, Pre-Existing Condition Insurance Plans (PCIPs) were never meant to be large, so that “Even people whose existing insurance coverage (or coverage held within the past 6 months) excludes the medical condition that would otherwise qualify them for a PCIP cannot enroll.”  For many people, premiums are also too high and they remain uninsured.

Millions who are still without insurance do not necessarily suffer from pre-existing conditions, however. One important group is pregnant women.  In its 2010 report, Deadly Delivery: the Maternal Healthcare Crisis in the United States, Amnesty International reported that “women in the USA have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries….the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain.”

Then, there are many people suffering from chronic diseases that, if left untreated, become life threatening and costly to remedy.  A good example is diabetes.  This is a disease which is increasingly common in the U.S. (and other developed countries) and which compromises the life style and shortens the life-span of millions of people.  A recent paper in the journal, Health Affairs (2010), for example, estimates that the median age of diagnosis is 24 for Type 1 diabetes and 57 for Type 2 and that, by age 60, one in five adults in the U.S. has diabetes and two in five has pre-diabetes. The article suggests that the national economic burden of these conditions, in terms of medical costs and productivity losses, was about $218 billion in 2007.   Yet, clearly, we cannot reduce that burden when many of the people at risk of diabetes or who suffer from it and will suffer its complications are not being adequately monitored and treated, due to lack of insurance.

Diabetes, of course, is not the only health condition that people are at risk of as a result of low income and insufficient or non-existent insurance.  It is estimated that approximately 17.4 percent of individuals aged 18 years and above in the U.S. have hypertension.  Among them, another study in Health Affairs indicates that hypertensive adults who have no health insurance are significantly less likely to have their hypertension controlled than those with insurance.   They are, therefore, at greater risk of heart disease and stroke.

Fortunately, for those over the age of 65, there is Medicare.  But, the sad reality is that, by the time that many people have access to it, medical treatment for conditions such as diabetes and heart disease, among others, is often less straightforward and far more costly than it would have been if everyone were insured from birth to 65.  The potential savings from universalizing Medicare, in terms of national economic productivity (including days lost due to illness) and aggregate medical expenditure, and the added value in terms of increased quality of life for those who are currently uninsured, would be immeasurable.