The Time Has Come for New Rules

States are receiving failing grades for their inability to adequately protect their residents against the bad practices of the insurance industry. The overwhelming majority of states do not require insurers to sell insurance to all applicants and most do not protect people with health conditions from exorbitant premiums or policies that exclude coverage for their conditions. Many state legislators are former insurance company employees and lack the political will to fairly regulate the insurers and guarantee their residents quality, affordable health care; others lack the resources.

Poll after poll shows that the overwhelming majority of Americans want to give people the choice between private insurance with predictable costs and benefits and public insurance; they want the government to step in and serve as a watchdog, left us ranking 37th in the world on health performance, below Saudi Arabia, Morocco and Chile.

The plight of the 47 million uninsured in America, to a large extent people for whom private health insurance is either unavailable or unaffordable, continues to worsen. A recent report published in the Annals of Internal Medicine shows that millions with chronic disease get little to no treatment. And that report does not touch on the financial and medical plight of tens of millions more people with chronic disease with insurance that does not meet their needs.

The Commonwealth Fund released new survey findings showing that 72 million adults under 65 are in medical debt or still paying off medical bills. If that’s not reason enough to undertake major health care reform, the Commonwealth Fund reports that “In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses).”

Any person who has used private health insurance or has friends or family who have needed insurance to cover a costly or complex condition recognizes how unaffordable health care has become even with insurance. The stories abound. Just recently, in New Orleans, the Times-Picayune reports that an AmeriCorps volunteer, working to help rebuild New Orleans, has a hospital bill of more than $90,000, and his insurance company is paying only one-ninth of his health care expenses. His reward for being a good Samaritan who got shot in the abdomen and arm trying to stop a car theft is $80,000 of medical debt.

Rather than making it risky for people to care about anyone other than themselves and their families, collective risk and responsibility makes far more sense. Because whether you or your loved one will need costly medical care is outside your control—anyone can be hit by a car, or diagnosed with cancer or diabetes any time. It happens to the best of us and generally through no fault of our own.

But, the private insurers like things just the way they are—pitting the healthy against the sick, the young against the old, fragmenting the risk pools and making bigger profits in the process. This was made clear by Wellpoint President and CEO Angela Braly when she reassured investors “We will not sacrifice profitability for membership.” The real surprise is that the profit-driven insurers are still able to get away with arbitrarily denying needed care and coverage, with virtually no accountability; that anyone still believes that they should be allowed to set the rules for who is covered, for which treatments, under what circumstances, and how much they will pay; that we should sit back and let the insurers decide what we will pay for needed care, who goes into medical debt or bankruptcy, is forced to forego needed care, suffers and, yes, perhaps even dies.

We need our government leaders to rein in these insurers, because history and experience has shown that unless they do so, more and more of us will find ourselves needing costly care and getting trampled instead. But simply writing and enforcing new regulations is not enough. Insurance companies have shown they can always circumvent the regulatory system. We need a guarantee of quality affordable health care we can count on. We need to be able to keep the insurance we have if we like it or to choose another private health plan if we want it, but we also need the choice of a public insurance plan, like Medicare, that ensures our financial and health security.

—Diane Archer, an attorney and health care authority, is Special Counsel and Co-Director of the Health Care for All Project at the Institute for America’s Future, an organization that combines research and advocacy to empower people to achieve economic progress and social justice. With Roger Hickey, Co-Director of the Institute for America’s Future, she is co-leading a national effort to discuss and debate progressive solutions to the challenge of providing quality, affordable health care to everyone in America. Ms. Archer is the past president of the Medicare Rights Center (MRC), a national consumer service organization dedicated to ensuring that older and disabled Americans get the health care they need, which she founded in 1989 and on whose Board she served until December 2007.

09-25-08 By Diane Archer | Comment (1)