Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, August 31, 1993                   TAG: 9403170006
SECTION: EDITORIAL                    PAGE: A5   EDITION: METRO 
SOURCE: INGRID McGOWAN
DATELINE:                                 LENGTH: Medium

PAY NOW OR PAY (MORE) LATER

An analysis recently released by the nonprofit Southern Institute on Children and Families revealed that 373,000 children in Virginia (24.8 percent of the state's residents under 18) were without health insurance. The projection, based on responses to the March 1991 Current Population Survey conducted by the federal government, may well understate the size of this crisis. Meanwhile, we know that many more Virginia children are underinsured - their policies fail to cover essential preventive and primary services.

While minority children are much more likely than white children to be wholly uninsured, whites account for 76 percent of uninsured children nationwide. Similarly, even though poor children are more than twice as likely to be uninsured as the nonpoor, those with family incomes above the poverty level account for two-thirds of all uninsured children.

It would cost relatively little to provide these young people with basic health care. Between 1988 and 1991, children and pregnant women constituted more than 50 percent of the new Medicaid enrollees while responsible for only 11 percent of the increased costs of Medicaid during the period. Nationally, the average child's full medical costs are only $1,000 per year. Moreover, we are surely spending far more by denying them this care.

We know, for example, that every $1 invested in prenatal care saves $3 in later costs and every $1 spent now on childhood immunizations saves $10 later in life. Yet, many American women still give birth without ever having seen a doctor, and our nation has one of the worst immunization records of any industrialized nation. We know also that children who lack comprehensive health coverage are less apt to get adequate preventive and primary care, and are more likely to experience illness and expensive hospital stays for preventable diseases.

Beyond the high financial costs of not providing adequate health care to our children are the social costs. Children fighting disease or disability have less chance to learn, achieve and become productive citizens.

Nor are our problems limited to the many children who lack basic health coverage. Even families that do have insurance rarely have adequate coverage.

A child with an undetected vision or hearing problem who sits at the back of the classroom can develop permanent learning and emotional disabilities. Comprehensive screening for such conditions is crucial to the healthy development of children and should be a routine part of our health care. Yet, as with immunization, 90 percent of all private insurance policies do not cover such screening.

Five percent of children have disabilities significant enough to impair daily activities and require services outside a conventional benefit package. While most policies cover some services for children with chronic conditions, the policies often place limits on the care. These limits force families to pay exorbitant out-of-pocket expenses for home care or to institutionalize the child. The result is greatly increased unnecessary cost in our health-care system, not to mention much anguish on the part of families.

What children need in national health care reform is:

Easy access to health care, with an efficient subsidy system for low-income families without prohibitive cost-sharing in the form of deductibles and copayments.

Comprehensive coverage with an emphasis on primary and preventive health care, including full screening and treatment for dental, vision, hearing, mental-health and speech therapy needs which are crucial for the healthy development of children.

Adequate provision for the special health-care needs of children with disabilities and other vulnerable populations.

To do all this without creating a two-tiered health system, we must increase the recruitment, training and retention of primary-care providers.

This kind of reform is extremely cost-effective. We will pay more in the long run if we do not adopt it. And in the long run, the cost of not providing dependable, accessible, high-quality health care to our children will be a much weaker America.

Ingrid McGowan is a health educator with the Virginia Male Adolescent Network in Portsmouth.

\ Virginia Forum