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|August 27- September 2, 2009
• See Letters page
• Jim Hightower
• Danish Plan
Health ‘unsurance’ and the public option
Critics are questioning whether health care reform will force middle-class families out of the insurance plans that currently cover them. The better question is whether the insurance plans that currently cover them — or, more precisely, the price of that insurance — will force them out.
Premiums soared 119 percent between 1999 and 2008.
By 2020, premiums will nearly double again (to about $24,000 a year) unless big changes are made to slow the inexorable rise in health care costs. That would be catastrophic.
About 50 million Americans are uninsured. Almost 66 million could be uninsured within 10 years, analysts for the nonpartisan Robert Wood Johnson Foundation have estimated. Middle-class families would be hardest hit.
That’s what’s at stake in the debate over a so-called public health insurance option.
Princeton economist Uwe Reinhardt’s term for what most of us call health insurance is “unsurance.” It’s his way of emphasizing the uncertainty with which we live. We worry that a job change or big premium hike will eliminate our health insurance. We worry that a sudden illness will wipe out our savings and drive us to bankruptcy.
The 44 million elderly and disabled Americans with Medicare don’t have those concerns. Nor are they shared by citizens of any other industrialized country. The public option is designed to address two big problems with U.S. health care: instability and costs.
People covered by a public plan wouldn’t worry about losing it if they changed or lost their jobs, just as the elderly don’t worry about
Those covered under a public option also would pay lower premiums. The Congressional Budget Office estimates savings in overhead would mean public plan premiums would be 10 percent less than for a typical private plan. That would save the average family about $2,200 a year.
An analysis by the nonpartisan Commonwealth Fund estimates that introduction of a public option could reduce the growth of health care spending by as much as $3 trillion over 10 years.
But those savings depend on changing the way Medicare and the public plan pay doctors and hospitals. That probably will not be quick or easy.
Even without a public option, Congress could make those changes to Medicare. Private insurance companies probably would follow.
But a public option — contrary to what some on the left are saying — isn’t the only way to control spending and create stable coverage.
Switzerland, Germany and the Netherlands have done it without public insurance. But insurance companies in those countries are nonprofits, and they’re more regulated than American companies. They also rely on the government for creating a large risk pool to minimize the cost of coverage and risk adjustment so that insurance companies can’t unfairly profit by covering only healthy people.
Contrary to some claims, competition between private health insurance companies won’t control spending or create stable coverage. If it could, it would have already. Private insurance is no more likely to accomplish that than it is to cover the sick, the elderly and the poor without a government subsidy.
Some Republicans say things would be better if insurance were available across state lines, so people in Missouri could buy policies sold, say, in Texas. But if Texas insurance companies had only a few customers in Missouri, their ability to get discounts from Missouri doctors and hospitals would be minimal and premium costs would be higher.
Debate about a public option will only intensify when Congress reconvenes next month. Here’s something to remember when it does: If we really want stable coverage and cost control, we can choose between creating a public option or trying a more radical solution.
Doing nothing is no option unless we’re satisfied with unsurance.
— St. Louis Post-Dispatch / MCT
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