By Tim Bonfield
The Cincinnati Enquirer

Problems caused by the lack of health insurance in America have become so severe it will take a health care "revolution" to repair the damage.

BY THE NUMBERS

41 million: The estimated number of uninsured Americans 161,800: Tristate adults without health insurance 20.8 percent: African-Americans in the Tristate who lack insurance 8.1 percent: White Tristate residents who lack health insurance 30,000: Adults statewide who could lose Medicaid coverage under cuts proposed by Gov. Bob Taft $88.9 million: Amount that hospitals in the Tristate lost to uncompensated care in 2001 $1.3 trillion: Overall U.S. spending on health care, the most in the world 18th: Where U.S. ranks among nations in life expectancy for women 24th: Where U.S. ranks in life expectancy for men Source: Health Foundation of Greater Cincinnati and University of Cincinnati

So says Dr. Marilyn Gaston, a former assistant U.S. surgeon general who rose to national rank after years serving the needy in Cincinnati - and who returned to town as part of a nationwide awareness campaign this week about the uninsured.

About 41 million Americans, including more than 160,000 Tristate residents, lack health insurance. As a result, many people are skipping doctor appointments, delaying hospital visits, leaving medications at the pharmacy and cutting pills in half.

"We need a revolution because we have to radically change the statistics you've heard. We're the only industrialized nation in the world that does not have some sort of national health insurance plan," Gaston said.

Gaston was the main speaker at a "town meeting" about the uninsured held Tuesday at the University of Cincinnati. The event included comments from local politicians, the audience of about 150 people and officials with Ohio's Medicaid program, the Cincinnati Health Department, University Hospital and Cincinnati Children's Hospital Medical Center.

Lack of health insurance hits hardest among the poor and among African-Americans and other minority groups, speakers said, but strikes society as a whole in many ways.

Most speakers said health-care coverage should be considered a fundamental right, whether or not insurance is mentioned in the U.S. Constitution. To some, that means finding a way to cover all Americans is an issue of justice, not privilege.

Others said the uninsured issue affects society from high rates of infant mortality to shortages of dental and rehabilitation services, to financial damage for hospitals that hurts the quality of service.

More than 75 percent of people without insurance are working - often in restaurants, day-care centers, beauty shops and other low-paying service professions. Be it hepatitis or other communicable diseases, the public faces risk when the uninsured get sick and don't get treatment right away, officials said.

"From a public-health perspective, you want the person who is making your salad to have health benefits," said Dr. Malcolm Adcock, Cincinnati health commissioner.

To plug an estimated $4 billion hole in Ohio's budget, Gov. Bob Taft proposes slashing $1 billion from Medicaid spending that has helped thousands of Ohio's poorest residents avoid joining the ranks of the uninsured.

"This kind of growth (recently seen in Medicaid spending) is absolutely unsustainable," said Dr. T.J. Redington, medical director for Ohio's Medicaid program and director of community health for the Health Alliance of Greater Cincinnati.

To get more out of dwindling dollars, Redington said several "safety-net providers," including health clinics, hospitals and other agencies, have been working for months on ways to better coordinate care. But those plans are not complete.

Cincinnati Mayor Charlie Luken praised those efforts and said the solution to the uninsured problem can't just be about spending more money.

"The communication between the health-care system and the political structure has got to be more organized and consistent than it has been," Luken said.

America must address the uninsured issue as a nation, said Hirsh Cohen, a Cincinnati-based health-care consultant. Eliminating lack of insurance will take tax reform and fundamental changes in the employer-based health benefits system, Cohen said.

"Until that happens, we'll be struggling in Cincinnati and every other place," Cohen said.

E-mail tbonfield@enquirer.com