Friday, August 3, 2012

Thrown into the shark tank

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In a simpler time, doctors traded services for agricultural products and hospitals resembled small hotels. Now, the American health care system is a massive, complex interplay of providers and payers built around employers' coverage of insurance premiums to provide medical care for their workforces.

For decades, businesses of all sizes have done exactly that. It made sense. Insurance companies could count on pools that included both the sick and the healthy. Medical providers could count on being paid for their services. Businesses could count on everyone, including their competitors, to pay the cost of benefits.

The system made sense for employers. Health insurance attracts and retains good employees, and helps those employees stay healthy and productive. Many employers also recognized that charity benefits won't go very far in the face of a hundred-thousand-dollar medical bill.

Now the situation has changed as more businesses are offloading health insurance benefits, shifting health care costs onto society, individuals and, ironically, their competitors. They replace full-time employees with interns, freelancers and "part-timers" who do not have to be paid any benefits.

Underinsured workers end up in emergency rooms, and then are admitted to hospitals. Major hospitals are now incurring hundreds of millions of dollars in uncompensated costs. Hospitals then pass those costs to patients who can pay and patients who are insured. They pass them along to those businesses that still provide health insurance benefits.

We all still pay for health care in this current, broken system, just not directly. Some have to live with the anxiety of an illness devastating them. Businesses and individuals struggle with out-of-control insurance premiums. Managers are forced into the painful necessity of throwing their employees into the shark tank by dropping health insurance benefits.

Perhaps most ironic is that businesses struggling to pay rising premiums and maintain benefits for their employees are also covering the costs of their competitors' employees who are not covered.

This system is not sustainable. Eventually, when everyone but the very rich is without insurance and premiums cannot rise high enough to sustain hospitals, America might find the political and moral will to have rational discussions about options like those in place in every other industrialized country on the planet.

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