In This Corner
Behind the Musical
With rollicking performances by an undergraduate cast, the classic Cole Porter show Kiss Me Kate is a hit at Balch Arena Theater
The Overlooked Epidemic
It affects all manner of Americans and it’s a silent killer—and now is the time to deal with it
By Ron Hollander
“By any commonsense measure, a threat this pervasive and deadly should prompt a public outcry for a swift and effective response,” says Ron Hollander.
A serious and often-fatal epidemic is spreading across America. Although the elderly are largely protected and the very young can be as well, it strikes indiscriminately at all age groups. This condition respects no geographical boundaries. In some areas it quietly infects individuals and families without neighbors knowing; in others it can strike wide swathes of the entire community with sudden and devastating impact.
This condition affects all social classes and ethnicities. It can be particularly ruthless in its attack on seasonal and low-wage workers and those employed in service industries, but middle-class individuals and professionals are not immune.
Sufferers live in poorer health, and estimates of deaths related to this condition number not in the hundreds or thousands, but possibly the tens of thousands every year. People often incur significant health-care expenses that put them and their families in severe financial straits, driving some into bankruptcy every day.
Even if you and your family are not afflicted, the condition can compromise your access to health care, since emergency rooms and hospitals typically become overburdened whenever it is rampant in a community.
By any commonsense measure, a threat this pervasive and deadly should prompt a public outcry for a swift and effective response.
The condition—for which there is no vaccine, no acquired immunity and no end in sight—is called uninsured, and it is almost unique to America among industrialized nations. A study released in September by researchers at the Cambridge Health Alliance estimated that the uninsured are 40 percent more likely to die of a range of conditions. It put the number of such unnecessary deaths at about 45,000 a year, more than twice the initial estimates of 18,000 made by the Institute of Medicine in 2002.
Given this staggering toll, why don’t the public health alarm bells go off? Perhaps because the “cause of death” isn’t “uninsured”—it is lupus that wasn’t effectively treated, complications from unmanaged diabetes, cancer that was diagnosed too late.
Maybe as individuals we don’t feel a sense of urgency because we think the “uninsured” includes neither us nor those close to us. Yet when I recently asked my class of graduate students how many of them had been uninsured at some point, about half raised their hands. With the unemployment rate still climbing, who among us doesn’t know someone who is losing or about to lose health coverage?
This is not about some faceless group of people we don’t know—it is about us. It is about your daughter who just graduated college and can’t be covered by your insurance, and for whom you hold your breath every day, hoping she isn’t in a car accident. It is about your neighbor who just got laid off. It is about your sister who had a pre-cancerous condition years ago and now finds that she can’t get coverage because of her “pre-existing condition.”
As with any public health crisis, we need swift and coordinated public and private action. Now that Congress has developed several versions of a response, we need our elected officials to move beyond politics to get something significant done. At a minimum, Congress should expand coverage to as many as possible, stop the insurance practices that deny or remove coverage when we need it most and put us on a path to control the costs that if unchecked could undermine it all. We need employers, health-care providers, insurers and individuals to assume their share of the responsibility for making new initiatives work, even if the step we take today isn’t all they hoped it would be.
Most importantly, we need to keep at it. Even a major reform will have its gaps, its unanticipated outcomes, its challenges. But we wouldn’t walk away from a virulent epidemic of disease, and we can’t afford to miss the opportunity to stop or at least contain the epidemic nature of the uninsured—now that we understand the threat to all of us.
Ron Hollander is a lecturer in the Department of Public Health and Community Medicine at Tufts University School of Medicine and former CEO of the Massachusetts Hospital Association.
