A niece's cancer and mounting medical bills inspires a physician's renewed look at the failings of American health care coverage 

November 14, 2006 

WORCESTER, MA-With no organized health care system in the United States, the specifics of health insurance benefits often provoke serious and complicated questions from consumers and medical professionals. Increasingly, significant disparities in coverage for such key aspects of health care as preventive care, regular office visits and catastrophic hospitalizations, are encouraging the public, physicians and policy makers to call for drastic enhancements to the nation's insurance system. In "Bleeding Edge Benefits," published in the November-December issue of Health Affairs, Director of the University of Massachusetts Medical School Center for Health Policy and Research Jay Himmelstein, MD, MPH, details an intensely personal family medical situation that highlights the serious need for change.  

Dr. Himmelstein-a board certified physician in Internal Medicine and Occupational Health/Preventive Medicine-was stunned when his niece Emily, a 24-year-old graduate student, was diagnosed with an aggressive form of cancer. In addition to the obvious and immediate worries about her health, Emily was confronted with mounting treatment bills in the face of a limited school insurance policy and seriously considered bankruptcy. 

In fact, Himmelstein describes, many college and graduate students face similar dire straits when dealing with a medical condition. Although some college students are still covered as dependents on their parents' plans, the number of students with coverage declines steeply after age twenty three-more than 35 percent of full-time students in this age group has no health insurance. Although most colleges and universities offer some form of student health benefit, an estimated three out of four public universities don't require health insurance coverage. Further, when plans are offered, coverage is often strictly limited-as it was in Emily's case-with restricted access to such services as lab, radiology and prescriptions or yearly and lifetime benefits caps for specific conditions, such as cancer. 

While Himmelstein proposes a number of changes to assist students, such as mandating coverage with appropriately designed benefits for all students, considering health insurance costs in making financial aid decisions, and creating explicit catastrophic coverage from a public system, he emphasizes that students are just one of many groups that suffer the uncertainty, inequality and inefficiencies of a highly fragmented voluntary insurance market. "Statistics suggest that more and more Americans are enrolled in high-deductible, limited-coverage policies and may be encouraged to make poorly informed decisions about their medical care on the basis of financial incentives." 

"It has been said that 'statistics are people with the tears washed off,'" Himmelstein writes, concluding, "It's true. Statistics on the uninsured and underinsured look very different to me now. When I think of Emily, I can see the people behind the numbers; I can see the tears and fears of sick people and their families fighting illness and a system that contributes to their pain. This is something we can't wash away and shouldn't turn away from. Our insurance system has to change." 

About the UMMS Center for Health Policy and Research
The mission of the UMass Medical School's Center for Health Policy and Research (CHPR) is to promote and conduct applied research, evaluation, and education aimed at informing policy decisions that improve the health and well-being of people served by public agencies. The UMass Center for Health Policy and Research was established in 1997 as a part of  Commonwealth Medicine's division at the University of Massachusetts Medical School, to provide resources to health policy research activities on the UMass campus, to promote collaborative evaluation and policy development efforts between UMass and state agencies, to support innovations and quality initiatives in the UMass Memorial Health Care Clinical system, and to enhance and develop educational programs at the undergraduate and graduate level.

About the University of Massachusetts Medical School
The University of Massachusetts Medical School is one of five campuses of the University system and one of the fastest growing academic health centers in the country.  It encompasses the School of Medicine, the Graduate School of Biomedical Sciences, the Graduate School of Nursing, a thriving research enterprise and an innovative public service initiative called Commonwealth Medicine. The mission of UMass Medical School is to serve the people of the Commonwealth through national distinction in health sciences education, research and public service. 

About Health Affairs
Health Affairs is the leading journal of health policy thought and research. All papers are peer-reviewed, and the acceptance rate is 10-15 percent. Published since 1981, Health Affairs is nonpartisan and presents a wide range of timely research and commentary on health issues of current concern in both domestic and international spheres.

Kelly Bishop