We Need Order, Not Chaos, In Health Care Financing
by Jack Bobo
As I write this column, two unions representing workers at General Electric have called for a two-day strike to protest increased co-payments in their health insurance plan. GE, like many other companies, is struggling to cope with increases in health care costs, which over the past three years have exceeded 45%. Another rise of 15% is expected this year, and no relief is in sight.
Given the fact that GE is usually regarded as a progressive corporate employer, I can readily surmise that conditions are even worse in other business settings.
At the same time, it is being reported in the media that increasing numbers of doctors are “firing their patients,” in the sense that they will no longer take patients covered by Medicare or what they call “penny pinching” HMOs because of inadequate reimbursement for services rendered. Doctors are also striking in some states in protest over the outrageous cost of medical malpractice insurance.
These events, plus many others, make it clear that the pressure on our health care delivery system is coming from both ends with increasing numbers of people being squeezed out as a consequence.
Additional problems are being created by people who are not being squeezed out, but rather are opting out because they do not wish to pay for health insurance. This is particularly true when working couples are insured by their respective employers–but neither is willing to pay for dependents coverage, thereby leaving the children exposed.
Despite the many virtues and advantages of our health care delivery systems, it is all too clear that we have manifold problems that are growing and must be solved. Systems in other countries have, at various times, been hailed as models that we may replicate in this country–Canada and Scandinavia to mention two. But after a closer look, those systems have problems of their own and would not solve or replace the difficulties in our own system.
It seems to me that we must build our own model capitalizing on our present strengths, while at the same time recognizing the demographic, cultural and economic challenges we face that differ from other countries.
I believe we have learned a lot from our experience with Medicare, and while not perfect, it is a lot better than some of its critics would have you believe. Often, problems in the system are more the result of political posturing than systemic failures.
It seems to me that we should try to build upon the foundation we already have, but with a greater role for private insurance than we have at present in Medicare. Perhaps we could structure a plan for people pre-age-65 that provides Medicare benefits after a deductible of some level well above the post-65 level in present Medicare. Such a deductible might be 10 or 20 thousand dollars.