Milk or medicine? Fuel or physical? It's not news that more people are dividing their dollars between the ever-climbing costs of daily necessities.
And it's not really news that almost 50 million Americans currently live without health insurance, or that medical care costs can send a person into shock.
But a recent study shows that more people facing exorbitant medical care costs actually have health insurance: it just doesn't cover enough, leaving many critics saying that it's just too expensive to live healthy.
Washington, D.C.-based Families USA released a study in March that found that in 2006, of the 4,271,000 Virginians between 25 and 64, 15.1 percent had no insurance at all.
Last year, the organization reported that in Virginia 427,000 people under 65 are in families that will spend more than 25 percent of their pre-tax income on health care this year. Nearly 80 percent of them have health insurance.
Locally, figures are a little higher.
Public Access to Health Services (PATHS), which recently opened its Main Street office, serves people in Danville, Martinsville, Chatham and Pittsylvania and Henry counties.
A 2006 grant proposal from the organization reports that 20 percent or 36,700 residents in its area don't have insurance. Add the number of people who are underinsured, said executive director Kay Crane on Thursday, and the number of people who don't have adequate access to health care jumps to about 30 percent.
In the grant, PATHS said it hoped to serve 12,053 people in 2008. In the second week of July, they've already reached that goal.
"That just shows you the need in the area," said Crane.
Inadequate coverage can have dire consequences. Those without sufficient insurance are likely to go without preventative care and screening and not seek medical care until there is an emergency. By the time they do get to the doctor or the emergency room, they are likely to be diagnosed with advanced stages of diseases requiring more intensive and expensive care, the report says. A publication by the Institute of Medicine found that uninsured adults are 25 percent more likely to die prematurely.
A quick peek into PATHS would prove that, said Crane.
"People are train wrecks by the time they come here because they have not had ongoing, consistent care."
Underinsured
Who is underinsured and where exactly the gaps are in coverage prove "difficult to track" said Crane. Those who are underinsured face different obstacles. Some people have company-offered insurance plans they simply can't afford. This situation hits low-income earners particularly hard because, as many health care organizations point out, they may earn more than a cut-off for government assistance, but not enough to afford a costly plan. Some can afford single-person insurance, but may not be able to buy-in their kids or spouses, leaving the household with high out-of-pocket expenses.
At PATHS, said Crane, they see a lot of people who can afford to get to the doctor under their insurance plans, but can't afford medications, another common problem.
Climbing Costs
The latest available census figures show that the average household income for Danville is $27,904. Though this is a post-tax figure, plugging Danville into the report from Families USA means that roughly 28,810 Danville residents are in families that spend at least $6,976 annually on health care.
Much of that has to do with the fact that health care costs from insurance premiums to hospital visits have jumped dramatically.
A study conducted by the Kaiser Family Foundation shows that between 2000 and 2007, the average annual premium for job-based family health coverage rose more than 90 percent from $6,351 to $12,106.
Local organizations are feeling that jump.
"There are plenty of options," Rita Smith of the Danville Cardiology Clinic said of insurance companies in Danville at a meeting of small businesses in June, "just no affordable options."
Data crunching by Families USA found that annual spending on prescription drugs more than doubled from 2000 to 2008 from $120 billion to a projected $247.6 billion.
Common conditions
Patients arriving at PATHS most commonly suffer from conditions the whole country is dealing with.
"Diabetes and hypertension," said Crane, without needing to check any documentation. Her explanation isn't a new one: lifestyle, diet and exercise.
"In this country we have the education about how we should live, what we should eat," said Crane. "But our patients don't have access to education."
As other reports have shown, she said people in the South tend to have high-fat and high-sugar diets, leading contributors to obesity and related conditions.
She said a common misunderstanding she hears is about eating canned vegetables; people don't realize they're very high in sodium.
In Danville, she said, the Riverwalk Trail was a great first step, but there are few viable locales and options for routine exercise.
Healthy living in a tough economy
A weak economy only exacerbates the problem. Danville unemployment rates in May were 7.1 percent, up from 6.3 percent in April. Martinsville continued to lead the state with a rate of 10.5. (To be fair, graduates tend to push rates up in May.)
"It's cheaper to by fatbacked meat than olive oil," said Crane.
"To eat healthy is very expensive. Fresh fruit, vegetables, lean meats ... now we're seeing the cost of food go up as well and high rates of unemployment. Along with that goes loss of insurance and a loss of income."
Treating the problem
It would be extremely difficult to find a health care provider or policy maker who thinks the system doesn't need a serious overhaul, and there are myriad proposals of what should be done.
What everyone can agree on is that there is no overnight solution to providing adequate health care for all. But in the meantime, experts agree, health education is critical and access to it more so.
The best way to avoid exorbitant medical costs is to take preventative steps. Outside the hospital, taking measures against prevalent chronic conditions, like eating right and exercising, are the only nearly foolproof ways of avoiding them, doctors agree.
"We're making a difference, getting into it," said Crane "but you can't undo generations of poor health care overnight."
--Contact Sarah Arkin at (434) 791-7983 or To see more of the Danville Register & Bee or to subscribe to the newspaper, go to http://www.registerbee.com. Copyright (c) 2008, Danville Register & Bee, Va. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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