On the radio, Mr. Bush suggested that we should “treat health insurance more like home ownership.” He went on to say that “the current tax code encourages home ownership by allowing you to deduct the interest on your mortgage from your taxes. We can reform the tax code, so that it provides a similar incentive for you to buy health insurance.”
Wow. Those are the words of someone with no sense of what it’s like to be uninsured.
Going without health insurance isn’t like deciding to rent an apartment instead of buying a house. It’s a terrifying experience, which most people endure only if they have no alternative. The uninsured don’t need an “incentive” to buy insurance; they need something that makes getting insurance possible.
Most people without health insurance have low incomes, and just can’t afford the premiums. And making premiums tax-deductible is almost worthless to workers whose income puts them in a low tax bracket.
Exactly. If the full premium for my health plan is around $13,000 for family coverage, and that's a GROUP rate, how much is a similar plan going to cost on the open market? $18,000? $20,000? And just how does Mr. Bush think working families are going to afford this? Even if more bare-bones policies are available, how does Mr. Bush think that people living from paycheck to paycheck on Wal-Mart incomes are going to pay deductibles of $1000-$3000 in addition to their premiums?
Krugman goes on to identify the REAL problem with health insurance in America: the profit motive:
Of those uninsured who aren’t low-income, many can’t get coverage because of pre-existing conditions — everything from diabetes to a long-ago case of jock itch. Again, tax deductions won’t solve their problem.
The only people the Bush plan might move out of the ranks of the uninsured are the people we’re least concerned about — affluent, healthy Americans who choose voluntarily not to be insured. At most, the Bush plan might induce some of those people to buy insurance, while in the process — whaddya know — giving many other high-income individuals yet another tax break.
While proposing this high-end tax break, Mr. Bush is also proposing a tax increase — not on the wealthy, but on workers who, he thinks, have too much health insurance. The tax code, he said, “unwisely encourages workers to choose overly expensive, gold-plated plans. The result is that insurance premiums rise, and many Americans cannot afford the coverage they need.”
Again, wow. No economic analysis I’m aware of says that when Peter chooses a good health plan, he raises Paul’s premiums. And look at the condescension. Will all those who think they have “gold plated” health coverage please raise their hands?
According to press reports, the actual plan is to penalize workers with relatively generous insurance coverage. Just to be clear, we’re not talking about the wealthy; we’re talking about ordinary workers who have managed to negotiate better-than-average health plans.
What’s driving all this is the theory, popular in conservative circles but utterly at odds with the evidence, that the big problem with U.S. health care is that people have too much insurance — that there would be large cost savings if people were forced to pay more of their medical expenses out of pocket.
The administration also believes, for some reason, that people should be pushed out of employment-based health insurance — admittedly a deeply flawed system — into the individual insurance market, which is a disaster on all fronts. Insurance companies try to avoid selling policies to people who are likely to use them, so a large fraction of premiums in the individual market goes not to paying medical bills but to bureaucracies dedicated to weeding out “high risk” applicants — and keeping them uninsured.
Insurance companies are in the business of rejecting any applicants likely to cost them money, and if they can't do that, finding a reason to reject claims for medical care that people actually need.
Health care, and part of that is health insurance, is not a "free market" commodity. If you need it, you need it. There's no such thing as shopping around when you feel that lump in your breast, or when it shows up on the mammogram that may not be covered if you have a substandard plan.
Ask anyone who has ever dealt with a sick child or a spouse with cancer or a broken leg from a fall what they think about the idea of shopping around for the best price at their most vulnerable time.
Bob Herbert:
A disturbing new report shows that with health care costs continuing their sharp rise, low- and middle-income patients are reaching for their credit cards with alarming frequency to cover treatment that they otherwise would be unable to afford.
This medical debt, to be paid off in many cases at sky-high interest rates, is being loaded onto consumer debt that is already at dangerously high levels. Many families have been crushed by the load, driven from their homes, forced into bankruptcy, and worse.
The report, released last week, was jointly compiled by Demos, a public policy group in New York, and the Access Project, which is affiliated with a health policy institute at Brandeis University and is trying to broaden the availability of health care in the U.S.
Imagine for a moment the seriously ill patient who needs to be hospitalized. In the cold new world of health care, the primary message to such patients is often “Show me the money!”
In many instances, of course, the patient does not have the money. What the report found is that even people with health insurance are being drained by health care costs to the point where the credit card seems the only option.
“As deductibles and co-payments increase,” the report said, “hospitals are finding more patients unable to pay their medical bills. Some hospital management analysts are expecting an increase in self-pay patients and are bracing for higher levels of bad debt.
“In recognition of the evolving payment landscape and the risk of hospital bad debt, health care providers are more aggressively seeking upfront collection of co-pays and deductibles. A component of this strategy is to encourage patients to use third-party lenders such as credit cards to pay for medical expenses they cannot afford, which families frequently do to meet high medical bills.”
It’s one thing to reach for your Visa or MasterCard to pay for a Barbie doll or flat-screen TV. It’s way different to pull out the plastic because you’ve just learned you have cancer or heart disease, and you don’t have any other way to pay for treatment that would prevent a premature trip to the great beyond.
A society is seriously out of whack when legalized loan sharks are encouraged to close in on those who are broke and desperately ill.
The bottom line is that health care is not something that can be delivered in the for-profit model. People with bare-bones coverage may not have screening and diagnostic tests covered, but that won't prevent them from getting cancer. Of course then I suppose the insurance companies can deny cancer care on the grounds that the patient didn't have the screening test that wasn't covered.
Insurance company premiums rose 87% from 2000 to 2006. Are you getting 87% better coverage or better care? Has your income rose 87% siince then? I thought not.
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