Originally Published: January 10, 2008 8:11 p.m.
We appear to be moving steadily toward a more socialized model of health care in this country, and the current political debate suggests we may be leaping in that direction.
Currently, federal programs including Medicaid, Medicare, SCHIP, the VA and others already cover 17 percent of Americans.
The Democrats, in particular, frequently say that 47 percent of our population is uninsured, and we need, they say, more and expanded government programs and subsidies to assure their coverage.
We are a generous people and we all know that many people cannot afford either health care or insurance, and most of us are happy that the government does provide a safety net.
The annual cost of employer-based health insurance is about $12,000 for a family of four, and $4,200 for an individual. When employees participate in family coverage, they typically contribute $3,000 a year. However, about one-quarter of those who lack health insurance live in a household in which someone declined coverage offered at work. Perhaps they couldn't afford the employee contribution, or perhaps they didn't place a high enough value on such insurance and decided instead to spend the money elsewhere. Do we taxpayers need to pay for a program to include those folks?
Among uninsured adults, job changes are the leading reason why adults become uninsured. Individuals who work think they don't need health insurance and are more likely to be uninsured, and they are less likely to seek jobs that provide health insurance and to acquire employer-based health insurance when an employer offers it. Again, it's a question of how one values insurance against alternative uses for that money.
Health care policy is complicated and it deserves careful consideration before we tinker with it. We need to be skeptical and curious about the numbers candidates bandy about. For example, who are the uninsured?
Sixty-two percent of the uninsured are in families of full-time and/or part-time workers. Twenty-eight percent of the uninsured are in families with annual incomes over $50,000. Only 18 percent of the uninsured are in families headed by a non-worker.
Also, that 47 million number includes all those who were uninsured over the course of a year. At any one point in time, that number is much less. On the other hand, if we looked at all those who were uninsured over a two-year period, the number would be about 80 million. This is a dynamic situation in which many people move in and out of this status constantly.
Research shows that the primary reason for the lack of health care insurance is its high cost, and that's easy to believe. The question we should be asking is this. Is more federal coverage the answer to containing or reducing those costs, and thus providing more incentives for people to participate, or can we take other actions to reduce those costs and preserve as much of our current system as possible?
The current system has strong positives and negatives. It does provide choice, the quality of care is generally high and access for many is relatively quick.
However, the system is also suffers with inefficiencies, excess administrative costs, inflated prices, poor management, inappropriate care and tests, waste and fraud.
It also appears to be more in the interest of most health insurance companies to pass on costs rather than control them, and they are the true power brokers in the system. They are more likely to put the squeeze on us rather than providers, for obvious reasons. At the same time, providers are in a constant war with insurance companies and fiscal intermediaries for government programs to maximize their reimbursements.
Perhaps some people need more coverage. We have to identify clearly who those people are and why they cannot afford insurance. At the same time, we need to attack the inefficiencies and waste in the current system.
We also need to be clear on the cost of the current system over time, let alone enhancements. Take Medicare for example. In its current form, by 2035 the projected deficit in that program $465 billion. By 2030, Medicare projected costs are to be 4.4 percent of GDP, or twice its current cost. We cannot afford to ignore such problems and pay for more coverage for more people.
We have no reason to believe that more federal coverage, without concurrent improvements in the system, will result in a better system for all. In fact, just the opposite seems likely, if not inevitable.
Tom Bromley is a retired mental health care administrator. He has lived in Prescott six years.