- by Jill Quadagno
Hank at Insureblog has written a thought-provoking review of my book, One Nation, Uninsured. I appreciate his willingness to take on this task and welcome the opportunity to engage in a debate about how we finance health care in this country.
First, let’s consider Hank’s claim that I consider our current system unfair. Guilty as charged. How can the wealthiest nation in the world leave 46 million of its citizens without coverage of their basic health care needs? Why should the United States be the only industrialized nation that places people at risk of losing their health insurance if they lose their jobs, become widowed or just get sick?
Is this a problem? Of course it is. Most uninsured people do not have a regular family doctor and thus do not receive preventive care like cholesterol-lowering drugs or screening for cancer and heart disease. Frequently, the care they do receive is in an emergency room where there are no follow-up services. Many receive no care at all because hospitals in poor neighborhoods, where there are large numbers of uninsured people, have been closing.
Can the private sector resolve this dilemma? I think not. The employer-based system that most people of working age have relied on since the 1950s is unraveling at the seams. Each year for more than a decade a smaller percentage of employers have offered health insurance coverage. The only reason the situation doesn’t look worse is that the government is picking up the slack – through Medicare, Medicaid and coverage provided to government and other public-sector employees.
Guaranteeing universal coverage does not mean nationalizing the health care system. There are many ways to achieve universal coverage without eliminating an industry. Most other countries allow, and some encourage, private insurance as an upgrade or second tier to a higher class of service and a fuller array of services. Some even depend on private insurance companies for basic coverage. But the practices of these companies are heavily regulated to prevent them from engaging in the more pernicious forms of risk rating. That is not the case in the United States, where private insurance companies are allowed to use sophisticated forms of medical “underwriting” to set premiums and skim off the more desirable employee groups and individuals.
If history provides any lesson, it is that vast, politically influential industries cannot be eliminated. But that doesn’t mean we shouldn’t hold them accountable. Nor does it mean that the government has no role to play, whether that be through more regulation of private insurance companies, expanded public programs for those who are uninsurable in the private market or vouchers for people cannot afford to pay premiums on their own.
LINK to review at InsureBlog.