The High Cost
Health Care:
U in c e my election to the
Multnomah County Board of Com­
missioners some eight years ago,
the rising cost of health care has
been a continuing concern. The
pool of those who can afford to
pay seems to be dwindling as the
cost of medical insurance steadily
rises. There are many reasons for
this trend, of course, but that this
crisis coexists with a reported sur­
plus of physicians and hospital
beds is disquieting. Something is
wrong. What is it and how do we
fix it?
To be honest, the moment we
pose questions concerning health
care “ haves” and “ have nots,” we
place ourselves in peril. Advances
in medicine and technology have
opened a Pandora’s Box of ethical
questions. What do we mean by
“ health care?” Is it a basic human
right? As a society, how much care
do we give? How little? And very
importantly, who pays for the care
that is given?
The number oi Americans
without basic health care
coverage is somewhere
between 25 and 37 million.
One thing is certain: The num­
ber of Americans without basic
health care coverage is some­
where between 25 and 37 million.
The exact figure is unknown be­
cause many of these people are
not welfare recipients, but mem­
bers of the working poor: people
M EM
A FEW
By Caroline Miller,
Commissioner
Multnomah County, Oregon
engaged in part time or low paying
jobs for whom any expense be­
yond food, shelter and clothing is a
luxury. Like most of us, they work,
play and take their children to
school. Only one fact sets them
apart — they don’t get medical
attention as often as needed.
You w on’t find these people
thumbing the pages of an old
Newsweek in a doctor’s office,
waiting for a physical or flu shot.
Preventative medicine is out of the
question. Ironically, because they
ARE employed, they hover above
the poverty line, and so are ineligi­
ble for traditional assistance pro­
grams. As a result, they are most
likely to postpone health care until
their problems become acute.
Then the cost of treatment skyrock­
ets. If THEY can’t pay the bill, WE
do — those of us who are covered.
June 1988
That’s why insurance premiums are
high. Hospitals scramble to spread
the cost of the uninsured to those
who can pay. That’s one reason
why the problems of the working
poor are our problems.
The Oregon Need
According to a report pub­
lished in 1986 by the Kaiser Per-
manente Center for Health Re­
search (Health Insurance: Access
and Choice), the number of people
without health insurance coverage
in Oregon probably exceeds pre­
vious estimates of 425,000. The
Kaiser report found that:
* more than one-third of
uninsured households
were headed by persons
under age 30;
* greater than one-third of
the uninsured households
were headed by a woman
compared to approxi­
mately one-fifth of insured
households;
* more than 75% of the
uninsured reported having
annual incomes of less
than $15,000 compared to
24.6% of those who were
insured;
* approximately two-thirds
of the employed who were
uninsured worked for
companies with 25 or
fewer employees.
What can we do about this
condition? Plenty. Here are a few
suggestions.
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