Our sick system of medical coverage High costs leave thousands of families 'just one paycheck away from disaster'


KATHLEEN NEWELL and her husband had been living nicely on his more than $100,000-a-year salary. But in the space of four years, her husband's was eliminated, -- and with it their medical coverage -- they had to trade their lakefront town house for a small apartment and she was diagnosed with cancer and now depends on doctors and hospitals to treat her despite her lack of insurance.

"They made me sign at the hospital that we would pay as much as we can every month," said the Columbia woman, who has not been able to get private medical insurance because of her pre-existing condition. "And when I was taking radiation at the hospital, I would see police bringing in people from prison for treatment. For free."

Ron Lewis works as a truck dispatcher and his wife in food service, but neither gets medical benefits. With their two paychecks, the Towson couple makes too much to qualify for public medical assistance but not enough to buy private insurance for themselves or their two children.

"I'm just one paycheck away from disaster," Lewis said.

That fear -- that one serious illness could send them over the financial edge -- shadows millions of Americans today. In fact, three out of 10 people polled by the New York Times and CBS News in September said they or someone in their household stayed in a job only to keep their medical benefits.

An estimated 35 million Americans -- including more than 500,000 Marylanders-- live without the safety net of medical insurance. Others face rising premiums for insurance, as well as higher out-of-pocket costs for procedures and drugs not covered by their policies. Still others worry that they will have to deplete their bank accounts before they can qualify for government assistance for expensive propositions such as long-term nursing care for the elderly or the treatment of debilitating illnesses like AIDS.

Health care concerns, after percolating beneath the surface for several years, have risen to the forefront of the political agenda in recent months. Presidential candidates are seeking to position themselves favorably on the subject, and, today, about 200 Democratic congressmen are hosting "town hall" meetings in their districts to hear the public's ideas for reforming the current health care system.

"It's going to influence my decision on who I vote for for president," declared one respondent to a recent poll conducted by SUNDIAL, The Sun's telephone information system, which asked readers to relate their concerns about the current health care system.

The woman, a 60-year-old retired teacher in Baltimore who asked that her name not be used, said that while she was satisfied with her own health care coverage, she realized many are not as lucky. "It's such an inequitable system," she said. "Health care is like education -- everyone should be entitled to it."

The predominant concern expressed by some 75 readers who responded to the SUNDIAL poll was about the cost of health care today -- a valid worry given that per capita health care spending continues to rise. (The most recent figure available is $2,566 in 1990, up about 9 percent from the previous year.) Callers also spoke about the difficulty in getting medical care when not covered by insurance. Some families, in fact, reported that they found insurance priced beyond their means even though both parents worked.

Uninsured children were a particularly worrisome issue, both to their own parents and children's advocate groups -- in fact, the Children's Defense Fund last week reported that more than 25 million children are not covered through their parents' employee health plans.

"You would not believe what we've been through with our kids," sighed Diane Kornblatt, a Pikesville woman whose husband's job does not provide health insurance. "My 12-year-old daughter has these seizures that caused her two broken arms. My mother-in-law paid for that. My 3-year-old son has had to have an ear operation. It cost $1,500, and the doctor and hospital mercifully let that go. We're constantly begging and pleading with doctors. God forbid the kids should need a tonsillectomy or a specialist."

Like some other working people, her husband made too much for the family toqualify for Medicaid, the public health assistance program, she said. They've been able to get some assistance for the children's care but occasionally have to let their own needs slide.

"My husband is sick, I think it's from the stress. I've begged him to see a doctor, but we can't afford it," Kornblatt said. "The lawmakers, they should put their heads together and fix things. There are just too many people suffering."

Self-employed workers who called SUNDIAL said they are hit with exceedingly expensive premiums, compared to what workers in a group plan offered through an employer pay.

Colleen Barsotti, whose husband owns two small businesses, recently had another increase in premiums -- they now pay $425 a month for an HMO for themselves and their two children.

"We still have a $5 co-payment for every visit, and it doesn't cover prescriptions or dental," the Parkville resident said. "And when I was pregnant this last time, I never saw an obstetrician, even though I had problems with my first pregnancy. I saw physician assistants and nurse practitioners instead. As much money as I was paying, I never saw an OB."

Even some people who have qualified for public assistance said the problems don't stop there.

"When you're dealing with social services, it's sometimes impossible to get through. Or people lose your paperwork," said Adrianna Snyder, who received medical assistance when she was pregnant and was promised that her baby, now 7 months old, would be covered through the first year of life. "But when the baby got a cold, they sent me first to billing, and they told me she wasn't eligible. I called the social worker, but I was put on hold for half an hour."

After hanging up in tears and frustration, Snyder found a nurse who agreed to see her daughter and give her a free sample of a cold medication.

There was little consensus among the callers on how the current system might be improved. Many, however, said they favored a nationalized system much like that in Canada, where health care providers are paid through higher taxes. Other plans currently under discussion in Congress and among health policy makers include the so-called "play or pay" scheme in which employers would either provide insurance for their workers or contribute

into a public fund for use in caring for the uninsured.

"We need a Canadian-type system where everyone is taken care of," said one caller.

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