Healthcare in America

     People care about the state of healthcare in the US.  Of course, they may not be talking about exactly the same thing when they express their concerns.  Ninety percent favor some kind of change to the system, either fundamental change or a complete overhaul.  Two thirds think that government should guarantee health insurance for all.  By a factor of two to one, people feel that providing health insurance for all is more important than keeping costs down.
        That is probably the most you can say at a global level.  If you dig deeper, perceptions of the problem separate most clearly among certain large groups defined by their economic stake.
      There are 47 million uninsured in the US, about 16% of the population.  Most elderly people are covered by Medicare so the uninsured are younger than 65. Twenty percent of the uninsured are children.  Only 13% of the uninsured are white;  22% are black and 36% are Hispanic.  Of the uninsured, the head of the household in 64% of those families works full-time, all year.
        Americans feel that access to healthcare is more important than controlling its cost but only 16% are uninsured.  One can speculate why people put such value on wide access to healthcare.  They may be close to effected individuals and understand their personal circumstances.  They may deplore the vulnerability of children or minorities.  There may be a well-developed civic sense that healthcare is as important as education for the vitality of a community.  Most likely, people recognize their own vulnerability as their benefits are threatened by rising premiums.
      Shareholders and business managers recognize the growing cost of healthcare as one of the biggest threats to their bottom line.  Firms make a strong argument that unavoidable costs of a company’s healthcare benefits pose an irresistible assault on the competitiveness of that company.  Jobs are lost as companies move offshore to countries that provide no expensive benefits to their workers.  The link to national economic health is undeniable.  What is the indicated reform:  To disassociate healthcare from job benefits entirely?  To shift the additional cost burden to the worker? 
        Medicare and Social Security have protected seniors from poverty and lack of health care. By their own reports seniors 65 and older are generally satisfied with their Medicare coverage.  But Medicare recipients have to pay premiums and co-payments.  They have to pay 20 percent of costs above the allowable rate.  Preventive care, dental care vision and glasses are not covered.  Premiums and co-payments – including the shared dollar amount for the costs of prescription drugs – are increasing.  The costs of non-covered services are not inconsiderable and are also increasing.
      Prescription drugs are a weak link in both Medicare and private insurance plans.  Many people who depend on expensive prescription drugs buy them in Canada.  Canada produces more generics of brand name drugs years before they are available in the US because of differences in their patent laws.  Patented medicines are also cheaper in Canada because their prices are controlled by a federal review board that caps their price below the average prices in seven other countries (“international peers”).  This differential has been addressed somewhat by changes in Medicare.
        The insurance industry just adopted a new benefit standard for so-called Tier 4 drugs.  Tiers 1 through 3 have progressively higher but fixed co-pays, typically $10, $15 and $25.  Tier 4 drugs are the most expensive.  They are the most intensively managed because of potential side effects, variable dosage requirements and the complexity of the treatment regimen.  That they have no effective substitutes also puts them into Tier 4.                
        Consumers will have to pay a percentage of the cost rather than a fixed co-pay for these drugs.  Twenty percent of a lot will still be a lot.  This change will add hundreds or thousands of dollars to out-of-pocket costs for many.
        An obvious criticism of the Tier 4 plan is that it is a dramatic departure from what insurance is supposed to do.  The insurers are shifting potentially catastrophic costs to a minority of insured (sick people) to lower premium costs for a majority (healthy people).  This is upside down to the traditional mission of pooling risk to protect everyone from individual calamity.
        The squeeze that will ultimately make the difference is on the middle class.  In 2004, a third of the uninsured were in families making more than $50,000 a year.  Employers are shifting healthcare costs more and more to their employees – higher premiums, lower benefits, cutting dependent coverage or ending coverage entirely.  Or people lose their coverage due to changing circumstances such as divorce, job change, or moving. In the face of that they may face impossible obstacles to restoring their former protection – single-party premiums, pre-existing conditions. 
        As more and more people are priced out of any coverage at all – or worse – as more and more join the ranks of the poor, the political will to address these issues in a comprehensive fashion will magically appear.  But then the change will not be incremental.  It will be breathtaking.

Comments

[Margaret]

I would suggest looking at the Oregon Health Plan as it is being used as a test kit for ideas to formulate a national health plan. Also look at Thialand's new health care strategy. They looked at Canada's, some European country's, America's and Mexico's and totaly canned their health care system and re- wrote it from scratch. They have redone their health care from the funding of doctors' education, medications, to universal health care not dependent on age or income. It has currently been hailed by medical professionals and economists world wide.