For the week of Nov 26 - Dec 2, 2003

The other,
greater threat

Commentary by Adam Tanous

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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 through.

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 than before.

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 others.

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.

 

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