Unhealthy numbers
Bankruptcies, uncontrolled costs argue convincingly for health-care reform
Editorial
Houston Chronicle
June 18, 2009
The health-care debate now cranking up in Congress is all about the numbers — dollars and people and, ultimately, better lives for us all. No number is more widely noticed or fretted over than this one: 47 million. That’s the number of Americans estimated to be going without health-insurance coverage, whether by choice or by circumstance.
At a glance, the plight of these 47 million appears to be much if not most of what needs fixing. But, as Chronicle business columnist Loren Steffy observes in his column this past Sunday (“Insured but not covered”), things are far from copacetic for those millions of Americans supposedly adequately covered by health plans through their employers.
They are not. As Steffy puts it, this umbrella leaks, and thousands of families are going under financially because their health insurance does not perform as advertised. Steffy cites a study in the American Journal of Medicine showing that two-thirds of all bankruptcies over the past six years were related to medical expenses, and that a surprising three-fourths of those filing for bankruptcy for medical-related reasons had medical insurance when they did so.
Or perhaps this is not so surprising. Certainly it will not astonish anyone who has attempted to navigate the maze of co-pays, deductibles, explanations of benefits and frequently inscrutable bills from hospitals, laboratories and other care providers. For the unwary and uninformed health-care consumer, these can all be a source of emotional and financial stress on top of whatever medical condition may afflict them or a family member.
Harvard Professor David Himmelstein , author of the study mentioned above, doesn’t mince words. “Private health insurance is a defective product, he says, “akin to an umbrella that melts in the rain.”
The notion of competition in the health-care insurance industry is mostly myth, Himmelstein contends. For most consumers, the choices are limited by what their employers offer and at what cost they choose to offer it. For some lucky ones the choices may be made broader by the option of insuring through a spouse.
What is also mostly myth is that the current system is somehow inherently more virtuous than alternatives, including the public option now being discussed by federal policymakers and the Obama administration. As Steffy notes, “Health insurers long ago stopped being concerned with quality of care. They answer to their shareholders.”
In our view, that is little short of reprehensible. It is reason enough for broad-based reform, including institution of the public option evidently so dreaded by many in the private health-insurance industry. In our system, there is room — and good reason — for profit that drives innovation and investment; but it should not come at the expense of doing what is right by the sick and infirm. The impression held by growing numbers of Americans is that some health insurers are little more than buccaneers whose loyalty is only to the bottom line. Count us among them.
That is not to mention situations such as the one in McAllen, in South Texas, documented recently by Atul Gawande in The New Yorker magazine. Medical costs in that border town are among the highest in the nation — almost double those in the rest of the country — and the reporter, himself a surgeon, went to McAllen to find out why. What he learned is thoroughly damning of the existing system: Many McAllen doctors are investors in local medical facilities and earn hefty referral fees for sending patients in for tests, for which the doctors often also receive a percentage. This lifts medicine almost completely out of the realm of healing and places it squarely in the arena of commerce. It is a situation the country cannot afford, either financially or ethically.
When health care reform failed in the early years of the first Clinton presidential term, a lot of blame was placed on first lady Hillary Clinton for being too secretive. Those criticisms were fair, and they bought the private health-care sector more than 15 years to prove that its methods were indeed superior to what Washington could offer. In our view, the private health-care folks blew it. Many chose, instead, to line their own pockets. Costs have soared and that tangle of loopholes and exceptions has grown like kudzu.
This miserable performance has forfeited opponents of reform the option of keeping the status quo. Over the coming weeks, congressional committees will have the opportunity to inform Americans about ways to improve this sick-and-getting-sicker situation. We encourage our representatives to use their time to get it right.