Health Insurance Cries For Attention

The economy roars, and still more Americans find themselves without health insurance. A million more. True, the proportion of uninsured people stays steady. But wouldn’t you think that boom times in the land of plenty would bring about greater medical security for the population?

The subject of health insurance is complicated, but the nut of the problem is simple. The national government does not guarantee health coverage for everyone. (Let me correct that. Anyone who shows up in a hospital emergency room will get treatment at huge expense to the public. Thus, in a perverse way, we have universal coverage.)

Why can’t this nation get its act together and guarantee basic coverage for everyone?

There are many reasons. The main one, however, is our dependence on employers for health coverage. Most working Americans who have health insurance obtain it through their place of employment. This is the product of a historical oddity. During World War II, the government put controls on prices and wages. There was a terrible shortage of workers. Since employers could not raise pay, they tried to attract people by offering company-sponsored health insurance.

There is no logical reason our employers should be responsible for providing health coverage, anymore than they should write checks for the monthly mortgage or drop off a bag of groceries at everyone’s work station on Friday afternoons. Meanwhile, workers enrolled in health-maintenance organizations cannot choose their doctors. And although many companies labor valiantly to find good quality coverage for their workers, others just obtain the cheapest policy they can find.

Now, rather than face up to the obvious conclusion that employers should not be responsible for covering the nation, politicians in Washington come up with proposals to make the broken system appear whole. Exhibit A is attempts to make HMOs behave more responsibly. For example, there’s legislation that would allow patients to sue their HMOs for malpractice. Opponents of the proposals (which, of course, include the HMOs) say that allowing people to take their HMOs to court will drive up the cost of the insurance. That could cause more companies to drop their employees’ coverage altogether.

These critics may be right, but where does that leave the patients? Yes, laws requiring insurance companies to offer certain services may raise the cost of coverage. Similarly, forcing a car maker to put in an engine is going to increase the price of automobiles.

If cars didn’t have to come with engines, more people could afford them. What’s the point of having health coverage if insurers won’t let someone with chest pains run to the nearest hospital?

Another reason the political class does not seem overly impressed with demands for universal coverage is that a key group of the electorate already has its government health plan. The elderly receive Medicare, and they vote. Thus, politicians fall over themselves to funnel more coverage to this group while going mute on the subject of the uninsured.

Before leaving this subject, let us note which groups of Americans tend to be uninsured. About a third of the poor lack insurance, never mind substandard coverage.

Although 70 percent of the nation’s workers are covered through the job, nearly half of low-income workers in full-time positions get nothing. Many in this group are mothers who left welfare for jobs and lost their Medicaid coverage. The lower-income groups also include many people of Hispanic origin.

Texas has the largest proportion of uninsured people in the nation (25 percent). You sometimes have to wonder what Republican presidential candidate Texas Gov. George W. Bush means by “compassionate conservatism.” Does it mean telling people in Spanish that they’re not going to get any health coverage?

Right now about half of the American population wants the government to provide insurance for most everyone, according to the Harvard School of Public Health. That’s a pretty good number when you consider how little serious discussion in Washington centers on the problem of uninsured workers. Candidates for elective office will have to find their tongues. The system is just too crazy to ignore.