SAN JOSE MERCURY NEWS Friday February 26, 1993 INSURANCE CRISIS CALLED HEALTH RISK Scientists cite upturn in TB, other diseases By R.A. Zaldivar WASHINGTON- The medical insurance crisis has reached a level where it is blocking improvement in the overall health of Americans, the National Academy of Sciences warned Thursday in a bluntly worded study. "Stagnation is the single best word to characterize our current state," said the report by the academy's Institute of Medicine. "Successes like improvements in breast cancer screening are counterbalanced by the return of diseases that can be avoided." The study painted a demoralizing picture of a society split into insured and uninsured, increasingly vulnerable to tuberculosis, syphilis and other health scourges of generations past. "Underlying most of the (trends) is a growing division between the haves and have-nots in our society," the study said. Those who don't have coverage are going without care and getting sicker as a result, it said. While much research has documented the rising number of uninsured, the study goes further by linking the gaps in coverage to a loss of momentum in dealing with the nation's pressing health problems. The academy, an independent organization chartered by Congress to provide top-flight scientific advice, urged government to track health- care access problems with the attention it devotes to measuring shifts in the economy. It listed 15 indicators of access to health care, from level of use of prenatal care to the numbers of people receiving care for chronic illnesses, that could serve to track the effectiveness of health-care reform under President Clinton. The indicators would work much like the unemployment rate, the inflation rate and other measures used to assess the state of the economy. Estimates are that Americans will spend $940 billion on health care this year- far more than residents of any other country. But the system of employment-based health insurance is leaving 37 million people without coverage at a time when costs have become prohibitive. Clinton has promised a reform plan to control costs and secure adequate coverage for all. "Evidence is building that no or inadequate health coverage is the reason why many... people fail to obtain the timely and appropriate care that would make a difference in the state of their health," the study said. It estimated that as much as one-third to one-half of the gap between the death rates of middle-aged blacks and middle-aged whites could be due to the access problems faced by blacks. The death rate for middle-aged blacks is 75 percent higher than for their white counterparts. Overall, blacks are twice as likely to be uninsured. A Profile Of Health Care Have-Nots A recent study shows the ill effects of lack of health insurance on American health. Some indicators: MORE SICK PEOPLE WITHOUT INSURANCE FAIL TO SEE A DOCTOR Percentage of the sick who did not see a physician, 1989: Uninsured people: 22% People with private health insurance: 9% MORE POOR HOSPITALIZED FOR CHRONIC ILLNESSES Number of hospital admissions for controllable chronic sickness per 1,000 people: People from low-income households: 15.1 People from high-income neighborhoods: 3.2 PREVENTABLE DISEASES ARE ON THE RISE Number of cases of congenital syphilis among infants up to age 1: 1970: 1,953 1980: 277 1989: 941 1990: 2,899 Source: National Academy of Sciences