Commentary by Adam Tanous
As we are reminded daily, we are
surrounded by threats. Take your pick: al Qaeda, weapons of mass destruction in
Iraq—real or imaginary—and an increasingly militant Muslim world. But there is a
greater, albeit boring, threat right at home, one with little drama and no photo
opportunities: the health care mess.
Sadly for the president, might doesn’t
make right for the complex problems we face in health care. The crisis we are
spiraling into has economic, social and moral implications that together, in my
opinion, threaten our way of life more than potential terrorist attacks.
Part of the reason the problem is
difficult—and therefore treated by politicians like an envelope containing
anthrax—is it is a circular problem. There are several elements to the
circle—insurance costs, health costs, malpractice suits, the uninsured,
prescription drug costs—and any perturbation to one simply amplifies as it moves
The most obvious problem is economic.
Insurance premiums for those with employment benefit plans have increased 14
percent this year alone. Since 2000 rates have increased 50 percent. Other than
the occasional CEO or foreign exchange trader, I don’t know too many workers who
received 14 percent or greater raises this year. And a 50 percent increase in
three years means most people are probably taking home considerably less money
The premiums for the average family of
four cost a little over $9,000 per year, with the worker picking up about a
quarter of that. So, employers are feeling the same economic pressure. Some
simply stop offering medical benefits, others ask the employees to pay more. In
big corporations, health costs are hurting profitability. For example, Time
magazine reported that by 2005 the Boeing Corporation will pay out $2.5 billion
to cover health costs. President Bush would be naïve to think these cost drains
won’t affect the national economy.
Small businesses are in an even more
perilous situation because their risk pool—the number of people over whom the
risk is spread—is smaller and so the basic cost of insuring the group is going
to be higher. What’s more, small groups have less leverage when it comes to
negotiating insurance rates with the carriers.
These statistics don’t even address the 41
million uninsured Americans, roughly 15 percent of the population.
If you don’t happen to be one of the
uninsured, why should you care? Because from a purely economic point of view,
the uninsured have a large effect on the health care system. A 2002 Kaiser
Commission on Medicaid and the Uninsured study showed that 41 percent of the
uninsured postponed seeking medical care. Twenty-eight percent did not get
needed medical care. This adds up to the uninsured getting hospitalized for
avoidable conditions. It also results in the uninsured with various forms of
cancer being diagnosed with late stage cancer. And then there is the emergency
room problem. Uninsured patients inundate emergency rooms because, by federal
law, they cannot be refused service for lack of financial resources. While it is
morally right to admit these patients, it puts people into the health care
system at its most expensive entry point. All three factors drive costs up for
the whole system. What it all adds up to is $1.4 trillion spent on health care
in this country every year. For that kind of money we could do an Iraq-like
invasion 16 times a year.
As often happens in the U.S., the economic
forces affect the social climate. The economics of health care is driving a
wedge between those able to keep up with the rising premiums, higher deductibles
and reduced coverage and those who can’t. And increasingly the latter includes
not just the poor, but the middle class. According to a recent New York Times
article, the majority of the uninsured is neither unemployed nor poor as the
government defines it (an annual income of $14,128 for a family of three). These
people are not the indolent, homeless, drug addicted bums politicians like to
demonize. They are just regular, working people going through their lives and
they’re getting squeezed out. It doesn’t take much bad luck—maybe a car wreck or
a case of adult onset diabetes—to start an awful, financial slide down and out.
So what do we do? We attack the problem
comprehensively, much as it was in the early 1990s. That effort, unfortunately,
was politically doomed from the start. Someone as politically astute as
President Bill Clinton should have realized that an upstart First Lady like
Hilary Clinton would never make much headway with her health care initiative in
the tradition bound and idiosyncratic Congress. President Bush needs to risk
some political capital and face this threat.
The solution will eventually have to
address the problems of malpractice insurance and awards, drug pricing,
universal coverage, doctors’ fees, the overhead of high technology, among
Ultimately, though, health care cannot be
about economics. It seems to me that the entire industry, ever more market
driven, is steering into morally murky water. After all, we’re talking about
being able to get treatment for, say, an asthmatic child, not buying a fancier
car or a better house. Should citizens of this country be forced to decide
whether they can afford to get needed medical treatment? Is it right that a
mother of two might have to skip an annual mammogram for something more tangible
and seemingly important, like groceries? I don’t think so.
When the ability to pay for basic health
care becomes a factor in who stays healthy and who gets treatment, suddenly
we’re making valuations on human life. It seems to me that health equals life.
If we deny people access to health we deny them life, which the founders of our
nation affirmed to be endowed to all of us and "unalienable".
Equality is an all or nothing principal,
especially when it comes to simply drawing breath in this fine world.