The state of health care

As a recent college grad, I have come to learn the new terminology of the working world. "Entry-level" has been replaced with words like "internship," and "temp." While certainly useful in providing job experience, the ambiguous connotation of these words often masks a stark reality: little or no pay, and no health benefits. As a young AlterNet commenter wrote in response to a recent article, "The price of everything keeps rising, yet we are paid less. My friend is forced to work as a 'temp.' It's the new thing. You create a job and list it as a temp job, and you do not have to pay benefits. Welcome to America!"

The National Coalition on Health Care (NCHC) reports that young adults (18 to 24 years old) are the least likely of any age group to have health insurance. The figures for 2003 show that some 30.2 percent do no have any health insurance. And these numbers have only been getting worse.

It's not just the youngsters facing a shortage of coverage. The U.S. Census Bureau predicts a grim future for health care in America, no matter your age: "Growth in Medicare and work force trends promise to drive down the portion of the work force with employer-paid health insurance to below 50% before the end of this decade." That's probably a conservative prediction considering that already, only 59% are covered by health insurance at work.

A friend of mine (a "temp") recently took a trip to the doctor, thinking she had strep. Feeling slightly embarrassed, she told the doctor that she didn't have health insurance. The doctor encouraged her to always tell doctors this information. Instead of conducting costly tests, the doctor simply examined her throat. While noting that it didn't look like strep, the doctor laid out some of the symptoms to look for in the coming days that would signify it had progressed. The doctor then wrote her a prescription for the medication she would need if necessary -- so that she would not have to pay for another doctor visit if she experienced the discussed symptoms.

This episode got me to wondering how often it was that doctors administer tests that might not have been necessary. Indeed, because of the ever-present fear of lawsuits, doctors are conducting more tests than ever. A 2002 U.S. Department of Health and Human Services Report notes that in a survey of medical professionals, physicians reported that because of liability concerns, 79% have ordered more tests than are medically necessary, 74% have referred patients to specialists more often than they believed was medically necessary, 51% have recommended invasive procedures such as biopsies to confirm diagnosis more often than they believed was medically necessary, and 41% reported prescribing more medications than they would have ordered based only on their professional judgment.

So, while erring on the side of caution is nice, it's also very expensive -- and oftentimes unnecessary. My friend's experience definitely inspired me to be clear with doctors about my financial situation, and to speak openly about whether or not certain medical care is necessary. It's more important than ever to not blindly put your health in the hands of doctors -- and to realize that you are your own best advocate. I imagine there are some AlterNet readers out there who have minimal or no health insurance. How do you navigate the health care system, and what would you suggest to other readers?

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