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Tuesday, May 02, 2006

cover the uninsured

May 1-7 is Cover the Uninsured Week.

The past 100 years have given us medical advances that have doubled the average human life span. Unfortunately, medical advances are not free. Indeed, health care costs have increased, over the past several years, faster than any other segment of the economy. In order to control costs, every industrial nation except the United States has built a system to ensure universal healthcare coverage. Some, like Canada, have single-payer systems, in which the government acts as the sole insurance provider. Others, like Germany, have multi-payer systems, in which the government and private payers both provide insurance, and everyone is guaranteed some form of coverage.

In the United States, private insurance companies write healthcare coverage plans for employers, who choose a plan for their employees. The employees then have the option of buying the plan or not. Some employers choose not to offer health insurance to their employees. Many people cannot afford to buy the health insurance their employers provide. As a result, more than 42 million people in the U.S. have no health insurace at all. That's about one out of every seven U.S. citizens.

In theory, the competition among insurers drives the cost down. In reality, Americans pay about twice as much per person as the rest of the industrial world. In part, the higher costs are a result of the high number of uninsured. If medical providers are forced to write off one out of every seven charges, they need to recoup the money from somewhere.

Physicians aren't the only ones who stand to gain by making health insurance universal. Employers would benefit as they would shoulder a smaller burden of rising health care costs. And, of course, the 42 million people who currently do not have insurance would benefit.

So what is the answer? Although some, even in the medical community, are advocating for a single payer system, it is simply not going to happen in the current political climate. A multi-payer system would be easier to implement -- in fact, our current system is essentially a screwed up multi-payer system. The problem is, we need to find a way to provide health insurance for the 14% of our population who now lack it.

But who has the money and the will to get there? Private insurance companies are not going to add beneficiaries as charity cases.

The federal government has run up too much debt in the last five years to take on any additional financial responsibilities. State governments are being squeezed already as the federal government cuts its subsidies to the states.

Employers are not going to lead the way in reform. The ones who currently don't provide insurance don't have the resources to do so. Any additional expense might drive them out of business.

The uninsured themselves aren't going to solve the problem. If they could afford health insurance, they'd have it.

So is there an answer at all?

Ultimately, I don't think we can get there from here in our lifetime. The United States health care system is the largest industry on the planet, and it's not going to change overnight. Indeed, if the 1996 HIPAA law is any indication, it will take more than a decade to bring about even modest reforms to the system.

But what sort of reforms could we put into place before this generation is beyond the need of health care? Here are a few ideas:

  • Several states have already established health insurance pools that allow high-risk patients to buy medical insurance when they are unable to afford it elsewhere, or have previously been turned down by a private insurer. This concept could be extended to offer affordable group insurance for the self-employed and for small business owners who cannot afford to buy insurance for a handful of people.

  • Some churches offer health insurance plans for their members. This idea, too, could be extended. Maybe some churches could provide health insurance as a ministry. Civic groups, possibly, could establish health insurance pools. Genuine competition in health insurance plans should benefit everyone.

  • Although most Americans are wary of "government health care," Congress's health insurance plan is one of the best and most affordable in the country. One intriguing idea, proposed by John Kerry in his 2004 presidential bid, is to open up this insurance plan to allow others to buy into it.

  • The COBRA law of 1986 allows an individual to keep the same insurance from a previous employer until the insurance plan kicks in at the new employer. The individual must pay the entire cost of the plan. Most people in job transitions need help paying for this temporary coverage. It's just a matter of finding a source for the money.

At best, these are all stopgap measures. None of them will get us to universal coverage. But as thoroughly inefficient as our health care system is today, and as cold as the political will is, we can't hope for much.

In fact, there's only one reason that we don't have universal coverage already: apathy. Americans have let ourselves accept a second rate health care system even while our medical facilities are the best in the world. In no other industrial nation would such a state of affairs be tolerated. Other health care systems have their problems, but nowhere else can 42 million people fall through the cracks at the same time.

So that's what Cover the Uninsured Week is about. It's time to acknowledge that the United States is shooting itself in the foot with its current health care system. It's time to acknowledge that we could do much better, and save money at the same time. It's time to raise the awareness that we don't have to settle for second rate health care. It's time to let our elected officials know that we want -- and deserve -- something better.

It's time for the United States to make health care for all its citizens a priority.

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