WHO SUFFERS?

“In the long run,” concluded a recent report by the National Citizens Board of Inquiry Into Health in America, “every one pays for a deteriorating health care system; in the short run some groups pay more than others.”

Here are excerpts from the board’s report on the problems facing the groups “most grievously affected by the shortcomings of American medical care”:

The Poor and Near-Poor

“Our health care system operates on a double standard,” the National Citizens Board found. “It segregates the poor from the affluent. This has always been the case, but during the Reagan years, health care segregation has reached record proportions.”

Among the cutbacks: 270,000 senior citizens and 700,000 children have been dropped from Medicaid. Six states have ended coverage for families with unemployed parents; 10 states have dropped benefits to residents between the ages of 18 and 21. And each year, an estimated 200,000 uninsured patients are refused emergency care solely because of their inability to pay.

The Disabled

“Recent federal efforts to purge the Social Security disability rolls have made life more difficult for a half-million disabled Americans,” the board found. “Many families of the disabled are forced to absorb a disproportionate share of medical costs, due to inequitable eligibility standards for public programs and to discriminatory practices by private insurers. . . . Many private insurance policies will not cover pre-existing conditions, and some policies have a 24-hour exemption on newborns, designed specifically to exclude severely disabled children born with birth defects such as spina bifida.”

Displaced Homemakers

“A major, frequently overlooked segment of the uninsured population is comprised of displaced homemakers--the 4 to 6 million women who cannot obtain health insurance, many of whom have lost their status in a group plan and cannot get private insurance,” the board said. “These women are not technically ‘unemployed’ because homemakers are not part of the paid labor force. Their health insurance has been lost due to divorce, death, disability or retirement of their spouse. The displaced homemaker is not eligible for Medicare or Medicaid.”

The Elderly

The older people are, the sicker they tend to be and, as a result, the more they must pay for medical care.

“Many elderly are using a larger percentage of their income on health care than they did before the enactment of Medicare,” the National Citizens Board found. “Refusal by most physicans (to accept direct payment for Medicare, thus forcing patients to pay their bills before receiving payment from the government) frequently is cited as a major problem for older adults,” the board said.

Complaints about hardships include the high costs of doctors’ bills and services not covered by Medicare--long-term care, prescription drugs, eye and dental care, hearing aids and foot care. According to the board, many senior citizens “with high blood pressure, heart disease and arthritis are choosing to forgo care because of the high cost.”

Children

According to a report from the Children’s Defense Fund, “American children are more likely today to suffer . . . sickness . . . than . . . three years ago. Furthermore, they are less likely to be born with adequate prenatal care, to be immunized and to have access to preventive health and dental care.”

One of the reasons for this, the National Citizens Board said, is that over the years, government programs for expectant mothers and young children have been reduced, and in some cases, eliminated.

As in all categories, minorities suffer more than other groups. Infant mortality among blacks, for example, is double the rate of whites.

The Unemployed

“A large portion of unemployed workers have lost their health insurance. As a result, they suffer from . . . pain . . . untreated illness . . . (which) can mean more expenses later. It can even mean death,” according to the National Citizens Board.

One indication of the impact of the economy on health can be seen in a study by Harvey Brenner of the Johns Hopkins School of Public Health, according to the board. Brenner found that the economic recession of 1973-74 contributed to 165,000 additional deaths from heart disease and stroke alone. . . . The health impact of the 1981-82 recession will be at least 400,000 early deaths over the next 10 years, the study estimated.

The Employed

With insurance coverage declining and premiums and medical costs rising, those who do have medical coverage are finding that they are spending more of their income and getting less for it than a few years ago. Indeed, the costs have become so high that medical coverage has become the chief stumbling block in many labor negotiations.

Although estimates vary, between 24% and 33% of the American workforce lacks health coverage of any kind.

Health-care experts report that, at all income levels, increasing numbers of patients are delaying visits to their doctors for routine problems, which can worsen and in the end cost more to treat.