Need More than a Universal Health Care System: Grassroot Participation Is Important

Like many in the United States, I am interested in the health care issues we face. In TIME magazine’s latest poll among the under-30 voters, the main concern for 62% of the respondents is the ability to afford health care coverage. In our current economic environment, employment does not guarantee access to health care. I visited the Blogosphere to update myself on the latest thoughts and developments in our health care issue this week. The first post I found, “Health Insurance Can’t Be Optional,” was published by Louise Norris, a co-owner of a health insurance brokerage company, Insurance Shoppers Inc., in Broomfield, Colorado. She discussed the implementation of a universal health care coverage in Massachusetts and favored a mandatory subscription. In the second post, “A Modest Proposal For Reforming the Health Insurance Industry" Winston Apple, author of the book Edutopia: A Manifesto for the Reform of Public Education, promotes an idea of catastrophic health insurance as a means to expand coverage and reduce health care costs. I offer my comments on the author's blogs as well as below.

"Health Insurance Cannot Be Optional"
Comment:
Massachusetts initiated a new universal health insurance system using a combination of incentives and penalties to get citizens to sign on (see image on the right of Mitt Romney signing Massachusetts Universal Health Care law). Massachusetts residents who are uninsured as of December 31, 2007 will lose their personal exemption – worth $219, when they file taxes in the spring. If they continue to lack health insurance into 2008, they will be taxed 50% of the price of the least expensive health insurance plan available. According to a report in the Wall Street Journal in February 7, 2008, only half of the previously uninsured currently enrolled; and no less than 20% did not qualify for subsidies and were granted exemptions because the costs were too much of a hardship (note the per capital money income of Massachusetts is reported as $25,952 for 2006). One lesson we could learn from here is that, in spite of government intervention, the cost of health care coverage in the U.S. could still be unaffordable. In the real world, it is difficult for us to acquire something that is not affordable. On the other hand, I would agree that health care coverage cannot be universal without a mandate, which may result in garnishing someone’s wage for failing to obtain health insurance coverage. Using the liability auto insurance as a parallel to present the logic of a mandatory health care insurance coverage for every U.S. citizen may not gain broad support because U.S. citizens have a choice of not owing an automobile.

The issue of affordability arises from the fact that everything has a price. Massachusetts’ mandatory health care insurance is costing the government about $158 million today, and is projected to reach $1.35 billion by 2011. On the other hand, Massachusetts is expected to incur a $1.2 billion budget deficit in 2008. To balance the budget in 2011, some other areas of government services, e.g. education may have to face deep cuts, or the tax needs to be raised. The current economic slow down will not help increase government revenue without new taxes. I believe health care reform in the U.S. will take a gradual approach, and it is going to be built upon the system we already have. In a few years' time, we will learn from the Massachusetts experience, what are the facts and myths of a universal health care system - its promises, the cost of delivering the promises, and the effect on people providing the health care services.

"A Modest Proposal For Reforming The Health Insurance Industry"
Comment:
The catastrophic illness plans are interesting, but may not contribute much to solving the problem of providing coverage to those currently uninsured. The product idea is not new, insurance companies do offer "high-deductibles" to cater to individuals who have affordability problems. If it is not mandatory, not all car owners may buy liability insurance. Our "health care" crisis is not just a health insurance crisis. In reality, health insurance companies are becoming the popular whipping boys. They are blamed for inefficiency, and bureaucracy, and being profit-minded (Blue Cross/Blue Shield are not-for-profit) at the expense of patients' well-being. We are not sure if we can safely remove the roles of insurance companies from our system without creating another form of crisis. Substituting the insurance companies with a government body may not be a better solution, as seen in the public transportation system or our public education system.

The aging population, the availability of more expensive advanced technology that treats diseases that were terminal previously, and even economic growth all contributed to our rising health care expenses as a nation. In the book entitled "The Fattening of America," by Eric A Finkelstein and Laurie Zuckerman, as shown on the left, it was reported that over two-thirds of Americans are overweight or obese. Over the past three decades, the number of obese Americans has more than doubled, across the socioeconomic spectrum, and for all racial and ethnic groups, most dramatically, for America's children. According to Eric, America's growing waistline is a by-product of our economic and technological success. It has been estimated that the annual cost of overweight and obesity in the U.S. is $122.9 billion, a sum that is comparable to the economic costs of cigarette smoking.

All health care crises have to be tackled on all fronts, and as you pointed out, reform could involve a grassroot movement. You suggested that we should band together to limit the role of insurers with or without help from the government. On the positive note, grassroot organizations have already started to direct the effort in discouraging smoking, addressing obesity, and adopting a healthy lifestyle. These are sure steps in bringing health care burden under better control in the long run.