Susan Dentzer takes a look at the real-life problem of the under-insured that inspired the Hollywood movie "John Q."
Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.
SUSAN DENTZER:
Reporter: When the movie "John Q." Opened recently, it was a top performer at the box office.
ACTOR:
Put your hands up. Put them up. Put them.
SUSAN DENTZER:
And it wasn't even the standard Hollywood shoot 'em up.
ACTOR:
Guy's got a gun!
ACTOR:
Hey!
SUSAN DENTZER:
The showdown here takes place in the emergency room of a big city hospital. And the subject at the heart of the battle is health insurance to pay for the heart transplant for a child.
DENZEL WASHINGTON:
(in "John Q") This is what I want, and if I don't get it, there's going to be some dead bodies on your hands in here. Do you understand me?
SUSAN DENTZER:
"John Q." Stars the academy award-winning actor Denzel Washington. Although most critics have panned the film as too preachy, the movie has struck a cord with audiences.
In some theaters, crowds after burst out clapping after key scenes. And that's in part because the film touches on a seldom recognized but real problem: Limits on health coverage that leave millions of people underinsured.
DENZEL WASHINGTON:
The hospital is under new management now.
SUSAN DENTZER:
In the fictional scenario of the movie, the character played by actor Washington is a part-time $18,000-a-year steelworker named John Q. Archibald. He's also the father of a 12- year-old son, Michael. When Michael collapses in the midst of a baseball game, he's hospitalized and diagnosed with major heart defects.
ACTRESS:
Blood pressure is dropping fast. He's going into cardiac arrest.
ACTOR:
Mike's heart is useless. He's going to need a transplant or he's going to die.
SUSAN DENTZER:
Michael's parents meet with the boy's doctor and the hospital administrator.
ACTRESS:
Transplant surgery is very expensive– in most cases, prohibitively so.
DENZEL WASHINGTON:
(in "John Q") We've got insurance. I mean, major medical. He's covered.
ACTRESS:
We've already checked with the carrier, Mr. Archibald. There are no provisions in your policy for a procedure of this magnitude.
SUSAN DENTZER:
That's because John Q's coverage was cut back when his employer put him on part- time work. The policy will now pay just $20,000 in expenses, a fraction of the $250,000 cost of the transplant. In some respects, this Hollywood version of reality isn't far off, says Karen Ignagni. She heads the American Association of Health Plans, a trade group of HMO's and other managed care organizations.
KAREN IGNANI, American Association of Health Plans: What I think the movie does well is really draw attention to an individual, however they get there, who finds themselves in a situation where the employer is no longer able either to continue coverage, or do as much as needed because of economic pressures. It's a very real scenario in this society now with the economic downturn.
SUSAN DENTZER:
Just how typical is it for workers to have the low levels of coverage in John Q's policy? We asked Jessica Banthin, a senior economist at the government's Agency of for Health Care Research and Quality.
JESSICA BANTHIN, Agency of Health Care Research and Quality: A vast majority of employer- sponsored insurance protects people from catastrophic illness and catastrophic hospital charges. A standard maximum is a million dollars.
SUSAN DENTZER:
At the same time, in a 1996 study for her agency, Banthin found that there are an estimated two million to three million policies in place that had far lower annual and lifetime caps. None were quite as stingy as John Q's, though, with its $20,000 cap.
JESSICA BANTHIN:
I didn't see anything exactly like that policy, but I did find, for example, a construction worker, age 44, male, with an $80,000 maximum, annual maximum on hospital room and board, and a $250,000 lifetime maximum on hospital room and board. They're largely employer- sponsored policies. They're from small businesses in areas such as construction, retail, manufacturing, and services.
SUSAN DENTZER:
And the low caps on benefits of these policies could easily be exceeded by the cost of one major catastrophic event, like a devastating stroke. Having low limits on coverage isn't the only way people can be underinsured. In an earlier study, Banthin and a colleague also examined the adequacy of American's coverage from another perspective: How much people might have to pay out of pocket for health care that wasn't covered by their insurance.
JESSICA BANTHIN:
Our definition looked at the risk of catastrophic illness, and whether you were at risk of spending 10% or more of family income in the event that you experienced a catastrophic illness, given your particular policy. We found that 18.5% of under-65 Americans with private insurance, in fact, had inadequate coverage. That translates into 29 million Americans.
SUSAN DENTZER:
Most experts believe that number of underinsured has probably risen since then, in large part because of rising health costs. A recent survey by the Henry J. Kaiser Family Foundation shows that employers have been shifting more of those costs to workers. That's in large part because average premiums for employer- sponsored health insurance rose 11% from 2000 to 2001. That's more than three times the rate of general price inflation. Trudy Lieberman directs the Center for Consumer Health Choices at Consumers Union, and writes about health issues for Consumer Reports Magazine. She agrees that the problems of higher health costs are beginning to affect more Americans.
TRUDY LIEBERMAN, Consumers Union:
It's even beginning to be difficult for people who have "good insurance." People who have good insurance are beginning to see higher and higher deductibles, more out-of- pocket costs, more higher co-payments for prescription drugs. Instead of having a $20 co- payment for a brand-name drug, people are now seeing a $60 co-payment. So we are seeing this over and over again.
SUSAN DENTZER:
Concern about costs is one reason Ignagni's group took out these ads in the Hollywood newspaper Variety and the Capitol Hill newspaper Roll Call.
The ads say that "John Q" is "not just a movie," and call on policy makers to take action to address the issues of high health costs and declining coverage. But while there is increasing interest in doing something to help the uninsured, the estimated 40 million Americans without any health coverage at all, the issue of the underinsured hasn't yet made it on to the agenda of President Bush or the Congress. And it's not clear that a Hollywood movie will change that anytime soon.
