It's time to take health insurance out of the for-profit model

As long as most middle-class Americans were full-time employees covered by employer-paid health insurance, few people cared about the 40 million uninsured. But now that there is no job security, fewer employers are offering health insurance, and more of them are asking employees to bear a larger share of the cost, suddenly it's a middle-class issue. Perhaps now we can start talking about a single-payer system, rather than the for-profit model in which executives like UnitedHeath's William McGuire can receive over $120 million in compensation, paid for by cutting coverage for actual illnesses.

Something is very wrong with a country that holds itself up as a moral beacon to the rest of the world at the same time as executive compensation results in this:

Ms. Readling, a 50-year-old real estate agent, is one of nearly 47 million people in America with no health insurance.

Increasingly, the problem affects middle-class people like Ms. Readling, who said she made about $60,000 last year. As an independent contractor, like many real estate agents, Ms. Readling does not receive health benefits from an employer. She tried to buy a policy in the individual insurance market, but — having had cancer — could not obtain coverage, except at a price exceeding $27,000 a year, which was more than she could pay.

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Today, more than one-third of the uninsured — 17 million of the nearly 47 million — have family incomes of $40,000 or more, according to the Employee Benefit Research Institute, a nonpartisan organization. More than two-thirds of the uninsured are in households with at least one full-time worker.

Ms. Readling’s experience is typical; people who have had serious illnesses often have difficulty obtaining insurance. If coverage is available, the premiums are often more than they can afford.

While the government does not have an official definition of “middle class,” one commonly used point of reference is the median household income, which was $46,326 in 2005.

Katherine Swartz, a professor of health policy and economics at Harvard, said the soaring cost of health care was a major reason for the increase in the number of uninsured. She said it also reflected long-term changes in the economy, like the decline in manufacturing jobs and the growth in the share of workers in service industries and small businesses, which are less likely to provide health benefits.

Moreover, Ms. Swartz said, “Companies have become more aggressive in hiring people as temporary or contract workers with no fringe benefits.”

[snip]

“I am scared to get married because I don’t have insurance,” Ms. Readling said. “If I have to go to the hospital and I can’t pay my hospital bills, what happens? Do they go after him? Can they take your home?”

To collect unpaid medical bills, health care providers often obtain judgments against a patient’s spouse, as well as the patient, and file liens against their homes. Ms. Readling says she does not own a house, but her fiancé does.

[snip]

Ms. Readling said it was stressful enough visiting doctors every few months for her cancer follow-ups. Without coverage, she said, the experience is even more stressful.

“When you go to any medical person and they ask for your insurance card, you are so ashamed because you have to say, ‘I don’t have insurance,’ ” Ms. Readling said. “You just feel like you are dirt.”

Ms. Readling said she often woke up at night, terrified of the cost of getting sick without insurance.

“Anything that goes wrong with my health could destroy me financially,” Ms. Readling said. “I could be ruined.”

She said she had never voluntarily allowed her insurance to lapse and could not understand why she was being blackballed.

“What did I do wrong?” Ms. Read-ling asked. “Why am I being punished? I just don’t understand how I could have fallen through this horrible, horrible crack.”

Knowing her health benefits from her prior job would expire in January 2006, she began shopping for a new policy in May 2005. But in June 2005, she learned she had cancer.

“At that point,” Ms. Readling said, “I called everybody I could think of, begging for help. But no insurer would touch me.”

I'm fortunate in that my employer offers very good health insurance, through, ironically, United HealthCare. But if I were to become unemployed, even COBRA coverage would be untenable, because the premium would cost over $13,000/year. With premiums this high and no control over the cost of coverage, it's no wonder that employers are loath to hire full-time, permanent employees. My employer, in an effort to sustain the current quality coverage we have, recently instituted a sliding premium scale in which higher-compensated employees pay a larger share for their coverage than lower-paid employees. I don't have a problem with this, but many others find it unfair. I'm not saying they're wrong.

Health care is not something that can be left to "market forces", because such market forces leave people with illnesses or chronic conditions out in the cold. It's impossible to comparison-shop for coverage when your choice is among premiums that are Exorbitant, Preposterous, and You've Got To Be Fucking Kidding Me -- and that's assuming you can find coverage. I am healthy. I do not have diabetes, heart disease, overly high cholesterol, or high blood pressure. But because I am overweight, I shudder to think of the kind of problems I would have if I had to buy insurance in the private market.

A single-payer model is the only way to get the delivery of health care coverage away from the kind of corporate cronyism that has boards of directors granting multimillion dollar pay packages to executives. A single-payer model is the only way to spread the risk fully across the population. And a single-payer model is the only way to allow doctors to hire staff to help them in their practice of medicine, instead of having one technician, one nurse, and fourteen clerks to handle insurance paperwork.