Copyright 2000 The Seattle Times Company
The
Seattle Times
September 18, 2000, Monday Second Edition
SECTION: ROP ZONE; Opinion; Pg. B7; Molly Ivins
LENGTH: 792 words
HEADLINE:
Health insurance is boring, but it's also a big mess
BYLINE: Molly Ivins; Creators Syndicate Inc.
DATELINE: Austin
BODY:
AUSTIN, Texas--When I was in my 20s, the subject of insurance was so vastly
boring that it was a way to describe a bad date: "like talking to an insurance
salesman." It's still sort of like your teeth--something you'd rather not think
about but have to take care of--so let's plunge in.
As Jonathan Cohn
pointed out in the May 1 New Republic, the object of health insurance is to get
as many people as possible into one big pool, mixing the sick with the healthy.
This way, the healthy pay a little more than they otherwise would, but those who
get sick pay a lot less. Since everyone gets sick eventually, if only from old
age, it works out fairly. Your chances of never being sick a day in your life
and then dropping dead of an undiagnosed heart condition at an early age are
less-than-lottery-slim.
In most advanced countries, this led logically
to national health insurance--everybody in the same pool, only one
administrative agency instead of hundreds. But because American insurance
companies go batwig at the mention of national health insurance, and because we
used to have doctors who insisted that it was "socialized medicine," we could
never get it through the political system. In recent years, many of our docs
have been radicalized and now even unionized by the unhappy experience of
working for corporate HMOs.
As a cancer survivor, I am now part of a
network regularly called upon to help raise $300,000 to
$400,000 for some individual whose insurance company has found
a way to drop her. Always a life at stake. The hundreds of thousands of you who
have had your HMOs fold under you know how chancy the present system is.
George W. Bush's solution is to promote medical savings accounts--MSAs.
Individuals buy a cheap insurance plan covering only catastrophic illness and
then put money aside, tax-free, to cover their medical bills. If there's any
left over at the end of the year, they get to keep it.
The theory is
that this will discourage people from spending frivolously on health care.
"In reality, MSAs simply allow people who expect to be healthy to opt
out of larger insurance pools," said Cohn. "Small businesses like the accounts
because they transfer the onus for medical coverage more squarely onto
individuals. But most experts who have looked at MSAs have concluded that, by
further segregating healthy and sick in the health-care market, they make it
tougher for people likely to incur high health-care bills to get insurance."
The other piece of the Bush plan is to set up association health plans
allowing small businesses to clump together to buy health insurance as cheaply
as the big corporations do.
The Catch-22 is that most states already
have small businesses clumped together in an insurance pool. The only difference
the Bush plan would make would be to exempt those plans from state
regulation--i.e., requirements for minimum benefits like mental-health
coverage.
The result would be further segregation of
health coverage--employees healthy, rates go down; a couple of
employees get very sick, rates go up; company can no longer afford coverage,
drops policy; end result, more uninsured.
Neither move is going to help
the 44 million uninsured in this country, and both are likely to increase their
number. This is not a solution. For the uninsured, Bush proposes a
$2,000 tax credit per family to allow them to buy their own
health insurance--but $2,000 doesn't nearly cover the cost, and
nothing is more expensive than buying health insurance as an individual.
You find the same problem with Bush's plan for prescription drug
coverage. Al Gore wants to make it part of Medicare for all seniors. Bush would
subsidize prescription drug coverage to some extent for seniors at all income
levels and subsidize all drug costs for the poorest seniors (less than
$11,300 a year). That plan would force many into the cheapest
HMO plans and leave others without coverage for necessary medicines.
In
general, you find Gore wanting to build on existing government programs and Bush
wanting to turn away from government programs and push health coverage back to
the private market, even subsidizing insurance companies.
For those
whose faith in the free market is religious, this is not something to debate.
But even Adam Smith admitted that the free market can't take care of everything.
And one of the things that no country has yet found a way to make it do is
health care. The upside to having government as the only insurer is that it's
cheaper because profits don't enter into it.
Worth considering, even if
boring.
Molly Ivins is a columnist for the Fort Worth
Star-Telegram. Her column appears Monday on editorial pages of The
Times.
LOAD-DATE: December 4, 2000
