The Truth About American Health Insurance: Not a Pretty Picture

The Truth About American
Health Insurance: Not a Pretty Picture


Leonard Zwelling

         The Obama Administration is proud of passing health care
legislation in 2010, the famous Affordable Care Act or ObamaCare. I am not at
all sure it should be because it is not at all clear that the ACA really makes
health care affordable for many Americans.

         As Margaret Sanger-Katz reports in the New York Times on January 6, “Here is the surest way to enjoy the
peace of mind that comes with having health insurance: Don’t get sick.” Boy,
does she have that right!

         She is reporting on a NY Times/Kaiser Family Foundation
survey that focused on the financial consequences of the new increased access
to health insurance provided by the ACA and the outlook is less rosy than the
Obama Administration would have you believe for the simplest of reasons. Health
care and the insurance for it is still a commodity and subject to the whims of
supply and demand. As such, those supplying the insurance are demanding that
their incomes not be curtailed by including sicker people on their rolls. To do
that required some manipulation of the system, which it always does. Adam
Smith’s invisible hand can be a fist in a moment’s notice.

         So while 15 million more Americans have health insurance
than did in March of 2010, medical bills are still the commonest cause of
personal bankruptcy in the country. Of those with difficulty paying their
bills, 39% have insurance through their work, 34% have no insurance, 14% have
public insurance and 7% purchased their own coverage. Thus having insurance is
no guarantee that medical bills will not undermine your family’s financial security,
that which insurance is supposed to protect. Fully 20% of those under 65 with
insurance are having financial difficulties paying their medical bills. Yes,
that goes to 53% for those without insurance, but the presence of insurance is
no panacea for medical bill-related poverty. Why?

         The insurance carriers are not stupid. Along with upping
their premiums, they are upping the deductible payments that are the responsibility
of the insured functionally increasing the impact of medical bills on household
income. Even with the slowing of the rate of increase of health care costs,
these factors are negatively affecting many Americans, even those with newly acquired
health insurance. Fully one quarter of Americans under 65 are feeling this
stress. Prescriptions are going unfilled and doctor visits unscheduled by those
hoping to avoid slipping deeper into debt.  

         In summary, as long as the solution to the health care
crisis in this country–inadequate access, rising costs and uneven quality–is
to be market-based, the market will have the final say and the insurers will
not be stuck with the bill. If sicker people have more access to insurance,
they will just have to pay more or we all will.

         Notice that many of these problems seem to evaporate for
those over 65. Why? Medicare. That is the single payer system that America is
supposed to abhor that covers the older among us. We seniors all love it. Why
the heck not? Buy yourself a supplemental policy to cover what Medicare does
not and you are probably set, even if on a fixed income.

         Now if Medicare is good for grandma, why isn’t it good for
her children and grandchildren? Got me.

         Sooner or later, America will get with the program that the
rest of the civilized world uses. There will be some guaranteed universal
health care for Americans. That does not preclude concierge medicine or even
concierge insurance. That does not preclude doctors refusing to see patients
although it may necessitate drafting doctors to do a few years of national
service before they set up their Park Avenue practices. Hey, it beats getting
shot at.

         We physicians need to lead in the push toward national
health insurance, full coverage, lower costs and increased quality. One sure
way is to put most insurers out of business. After all, if you want to have
your own army you are allowed to, but most of us forego the privilege and let
the government do it. The same could be done with the payment of health care insurance.
We are all at risk for something as genomics is proving. Why not be one risk
pool? We just have to want to do it. If we can do it for those over 65, we can
do it for everyone.

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