Broke and Broken
Millions of Americans are uninsured. Here's how it may affect your health
It was just before dawn when the phone rang. Kay Whitecotton heard that her husband, Mike, hadn't yet arrived to pick up his fishing buddy. She knew in her gut something terrible had happened, even before she jumped in the car and followed the short route Mike would have taken.
She saw flashing police lights. She saw his mangled red convertible, which had flipped tail over hood and landed on its canvas top. She didn't see Mike.
It had been only half an hour since Mike pulled out of the driveway, missed a construction jog in the road, and smashed into a concrete barrier. He was already in a helicopter, on his way to the trauma center at Lee Memorial Health System in Fort Myers, Fla., when Kay arrived at the scene of the crash. "I truly, truly believe that if it weren't for the trauma center, he wouldn't be here now," says Kay. Mike sat with her in their sunny Bonita Springs vacation home in February, when his speech was still halting, his right eye taped shut. Follow-up surgery would restore his eyesight, and he should recover fully.
Golden hour. As the owner of a home remodeling store in Crawfordsville, Ind., Mike Whitecotton, 61, has good health insurance. But at the nation's 520 Level I and II trauma centers, no one checks for coverage during that first "golden hour" when lives can be saved. That commitment to serve every victim--the insured, the underinsured, and the uninsured--has put the trauma center that saved his life, as well as dozens of others across the country, in jeopardy.
Thirty Level I and II trauma centers have closed since 2001. In healthcare parlance, trauma centers are designated by Levels I through IV. Levels III and IV are primarily in rural or suburban areas and set up to stabilize patients until they can safely be sent to a higher-level regional center. Levels I and II, by contrast, must have trauma surgeons and nurses on site, dibs on operating and ICU beds, and up to 16 different subspecialists on call 24 hours a day. It is at those two levels that the fast-paced, life-or-death care is put into practice.
Nearly 6 in 10 trauma patients are injured in motor vehicle accidents, followed by falls (13 percent) and assaults (12 percent). Unlucky skiers, boaters, and bungee jumpers also show up at trauma centers. While emergency rooms are equipped for anything from heart attacks to broken legs, trauma centers are super-prepared for the sudden multiple organ damage caused by glass, steel, bullets, or failed parachutes. "We don't just treat gunshot and stab wounds from a drug deal gone bad. Trauma can happen to anyone," says Drew Mikulaschek, director of Lee Memorial's trauma services and surgical critical care.
In the American healthcare system, the fate of the fully insured is irrevocably intertwined with that of the uninsured. Among the greatest threats to a nationwide system of regional trauma care is the growing burden of uninsured patients, now more than 43 million people. About 18 percent of trauma patients, costing a national average of $14,896 apiece for treatment, are uninsured. When hospitals bill them, they're able to recover only 8 percent of the total cost. Even Medicare and Medicaid payments don't cover the full cost of care. Hospitals used to shift those costs to the bills of insured patients, but with negotiated insurance contracts, such cost shifting is no longer possible. The centers are expensive, income losers for hospitals. Across the country, they lose $1 billion a year.
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