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Buggy whips, garter belts and for profit health insurance

Fri, Jan 26th, 2007
Posted in Commentary

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

~Martin Luther King Jr.

When I started practicing medicine most rural doctors still made house calls. We could carry most of the diagnostic tools available to us in our bags. Health insurance then was sold as a risk sharing product and the actuarial form was just starting to take hold.

Risk sharing meant a 60 year old with health problems paid little more than a healthy 25 year old. The 25 year old could look forward to little increase in cost throughout his life.

Actuarial form of insurance demands a risk assessment of how likely it is the policyholder will need to use the insurance. If it is likely to be used the premium will be higher or the insurance will not be available at any cost.

The Presidents' radio proposal on the 20th was that we "treat health insurance more like home ownership" shows how completely out of touch with the common man this administration is. Worse, if they really do understand the problems the less wealthy and healthy have with health insurance, it represents the most callous and cynical affront to decency in our government in my lifetime.

People who are living paycheck to paycheck do not go without health insurance by choice. They cannot afford to pay the premiums. It is frightening for them. They know they are one illness or injury away from financial disaster. Tax deductions will not pay the premiums.

Some who have preexisting conditions cannot buy policies for any price. Tax deductions are useless.

Tax deductions will benefit only the wealthy and the healthy that now choose to go without because they can afford to pay for medical care. This is a small percentage of the uninsured. It will do nothing to relieve Medicaid and other stressed programs. All this administration's health care programs are boons to the healthy and wealthy including Health Savings Accounts and Association Health Plans.

His tax on workers who have employer provided plans considered as "Gold Plated Plans" he claims raises premiums for everyone is totally delusional. Other than elected people in Washington, I want someone to show me workers who believe they have "gold plated" health insurance from their employer.

Requiring folks to buy insurance from private for-profit companies that report obscene profits (United Health 1.2 billion in three months ending 12-31-06) and pay enormous amounts to executives or face fines or tax penalties is manifestly immoral. This is not the same as requiring liability insurance for the privilege of driving on the roads.

The states of Massachusetts and California at least have tried to have some provision for controlling cost as they approach this problem. Instead of the old saw it's the economy stupid, it's the cost of health care (and profit/overhead in health insurance) stupid. The only way costs can be controlled is by returning to the risk sharing philosophy of health insurance. The risk should be shared by all 300 million Americans in a single payer plan. It's time we took the 30+percent overhead and profit out of the equation. Medicare has a 2 percent overhead and 98 percent goes to providing health care. Medicare is not socialized medicine and neither is one party payer.

The administration is pandering to business and industry by pushing people out of employer provided insurance. This is a reasonable goal but the method is not. Employer provided health insurance started during wage controls in WWII as a means of keeping and attracting good employees. Paying good wages and having safe and pleasant as possible work conditions would be much better. The difference in the costs in the paragraph above can be shared by employers and employees. Business and industry should be leading the call for one payer system. They seem unable to identify their own self interest. It would cut their costs and make them more competitive. Possibly our auto manufacturers would quit moving their plants to Canada.

All the old arguments, such as "do you want someone in Washington or your doctor deciding about your care", and equating it with socialized medicine has come out of the closet again. As long as Bill Frist is not going to be in Washington, diagnosis from the Congress and Washington probably won't happen anymore.

We need serious, reasonable debate on health care. We didn't worry about saving the buggy whip and garter belt manufacturers. Standard health care insurance should go the way of the buggy whip. The insurance industry will get by without the standard health care policies. The CEO's may have to get along on a couple of a million per.

Robert Sauer lives in Preston. He can be reached at r.sauer@mchsi.com

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