What Should Be the Goal of Health Care Reform?
In his New York Times op-ed, "The Misguided Quest for Universal Coverage," Ramesh Ponnuru argues that the goal of health care reform should not be universal coverage. On that point, we agree. The goal of health care reform should be to guarantee everyone in the United States has access to quality, affordable health care.
But that is where our agreement stops because what Ponnuru proposes would not achieve that goal.
People need health care insurance for the same reason they need fire and auto insurance. To protect them from bankruptcy should they be faced with a disaster, be it a fire, an accident or an illness. If they or someone in their family is among the 5 percent of the population that uses up 50 percent of all health care dollars, they need insurance to cover those high costs.
And everyone needs to be covered for the same reason. Those of us who are lucky enough to not have fires, accidents or serious illnesses help cover the costs of those who do in exchange for the security of knowing that we will be covered if the need ever arises. That is the very basis of insurance and it is why universal coverage is a vital first step towards guaranteeing everyone has access to quality, affordable health care when they need it.
Or as Winston Churchill put it we have "a real opportunity for bringing the magic of averages to the rescue of millions."
Having health insurance is important to our health as well as our bank accounts. The Urban Institute estimates that 137,000 people died from 2000 through 2006 because they lacked health insurance.
But it is only the first step. Simply giving people health insurance coverage does not guarantee them access to quality, affordable health care. That is clear from the millions of people who are already insured and still cannot afford the health care they need.
A report by the Commonwealth Fund found there are 25 million underinsured adults in the U.S. Underinsured: that means those of us who have insurance but can't count on it for financial protection. It's a frightening number--but still a huge underestimate.
Who did the study count? People who said they spent 10 percent or more of their income (or 5 percent if they had very low incomes) on health care--even with their insurance--or who had deductibles at 5 percent of their income. Not counted? Lots of people who haven't been hit with hefty health care bills yet. That's why you may be underinsured and not even know it.
Even by the Commonwealth Fund's undercount, the number of underinsured adults is up by 60 percent from 2003. That's because health insurance is covering less and less. A Harvard study found that 75 percent of people who had filed for bankruptcy because of medical debt had health insurance at the time they got sick or injured.
To guarantee everyone has access to quality, affordable health care when they need it requires system-wide reform that will lower the cost of health care and slow its ridiculously high inflation rate. That cannot be accomplished through Ponnuru's suggestions.
Simply aiming to "make health insurance more affordable and portable" does nothing to keep health care costs from continuing to skyrocket, thus continuing to make insurance more and more expensive over time. Massachusetts reform has proven that.
The way to lower overall health care costs, stem their inflation rate and guarantee everyone access to quality, affordable health care is to give everyone the choice of a public health insurance option. Making people with good employer-sponsored insurance pay taxes on that benefit does nothing to further that goal.
As Jacob Hacker, Professor of Political Science, U.C. Berkeley and Co-Director, Center for Health, Economic & Family Security put it in his report "The Case for Public Plan Choice in National Health Reform: Key To Cost Control and Quality Coverage," (PDF):
"Without public plan choice, on the other hand, we will continue to lack strong institutional mechanisms to rein in costs and drive value down the road, putting the broader goals of reform and our nation's public and private budgets at risk. Although expanding insurance and upgrading inadequate coverage will require substantial up-front investments, any viable proposal for affordable quality health care for all must be able to contain long-run health costs. Ensuring that mechanisms for effective cost restraint are embodied in national health reform is essential--and a key argument for public-private competition." [Emphasis added]
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