The Cost of Healthcare Illiteracy

May 9, 2014
Jeff Brown, MD

Sociologists and late night comedians have made a good living on exploring how ignorant Americans are on any number of subjects. And our lack of knowledge regarding health insurance is alarming.

Sociologists and late night comedians have made a good living on exploring how ignorant Americans are on any number of subjects. You could even extend the argument to say that ignorance is the number one umbrella problem facing our civilization.

To a specific case in point, the Leonard Schaeffer School of Health Care Policy at the University of Southern California recently released a study detailing Americans’ lack of knowledge of health insurance, and the results are alarming.

What is most telling is that there did not seem to be a difference in findings based upon political point of view. There were key differences based upon age, economic status, and health status, however. For instance, the least informed often turned out to be the ones who could benefit most from the new Affordable Care Act (ACA).

This should not be surprising. The least-educated, the lowest economically positioned, and the unhealthiest people generally are the least aware of the elaborate programs constructed to help them. That’s just one of the many ironies of our culture and our sometimes inadequately thought through ideas about how to improve life for ourselves.

A couple of specifics from the Schaefer Center study illuminate these points further; 42% of those surveyed across all demarcating lines did not know what a deductible is and 62% did not know that an HMO has more restrictions than a PPO. These numbers jumped to 68% when only the uninsured were queried.

Additional dismaying results included 62% of people under 26 knowing even less than the median of older adults and 20% of all surveyed having never even heard of the ACA.

Who were the most well-informed? Older white males. While it is not politically correct to say it, the reality is that those who are educated, have discretionary income, and have a mature responsibility, have both the need and the means to learn about and obtain health insurance.

Young people may or may not have the means, but, psychologically, they do not think they have the need yet. Low-income and under-educated people may have the perceived need but lack the means to get the insurance and, therefore, the healthcare when they require it.

Each characteristic—need and means—is necessary but not sufficient, it seems, to prompt people to pay attention to health insurance information, let alone seek it out.

In our collective effort to get our arms around the relentless expansion of costs in healthcare through compromise, we have unintentionally made the situation worse. Acquiring even a basic understanding of the labyrinthine health insurance is so difficult that, unless circumstances force action, most folks just take a pass.

And the complexities of the health insurance situation mimic our healthcare delivery patchwork quilt. Ignorance, the moving target of rapid increases in scientific knowledge, and psychological denial are potent forces that increase morbidity, mortality, and run up costs in a way that has yet to be fully quantified.

Our great difficulty in helping ourselves medically and economically, both individually and collectively, in the healthcare sector is an ongoing challenge in the 21st century. We are well past a time when we ought to face facts, use the educational tools we have, and do a better job. Studies like the one from the Schaeffer Center are not just a call to arms, but a potent reminder of just how far we have to go.