When your coverage gets cut, would you buy into Medicare?

By Jack Bernard
Charleston (W.Va.) Gazette, May 12, 2012

CHARLESTON, W.Va. -- If the highly politicized Supreme Court overturns the individual mandate -- and possibly all of Obamacare (the Affordable Care Act), where do we go from here?

Do we throw up our hands and say the sky is falling, as the Democrats are currently doing? Or do we stick our heads in the sand and go to a Dickensian free enterprise system like some on the right advocate, the uninsured sick be damned?

My party, the GOP, clearly does not want to talk about the elephant in the room -- health insurance coverage trends. According to a recent Gallup poll, the number of uninsured nationwide has gone from 15 percent in 2008 to 17 percent in 2011. So, the private model insurance system is not only failing, it is failing at an increasing rate when it comes to covering the uninsured.

In West Virginia, the situation is more stable, with no rise in the last few years. However, the uninsured are still 18 percent of the population, above the national average.

For those who are still insured, the situation is problematic. In West Virginia, premiums for those enrolled in full family coverage have been going up substantially, from $12,554 in 2009 to $14,542 in 2010, a 16 percent increase in just one year, according to the Agency for Healthcare Research and Quality.  Yes, $10,150 of this cost is picked up by the employer, but that just results in lower wages over the long run. Or, even worse, relocation of West Virginia factories overseas. How long can this go on?

As a small employer (I am a County Commissioner in a rural county near Atlanta), I know that we have a tough choice each year. We can:

* Increase employee deductibles and co-payments because of higher insurance charges to us.

* Cut programs like road maintenance, EMS, the sheriff and the courts.

* Raise property taxes yet again.

I mentor small businesses that face the same situation, only worse because they cannot raise revenues through taxation. Larger companies are absorbing more of the premiums, but they are moving their operations out of the United States in part because of steadily rising health care costs.

The answer to our problem is Medicare For All. A single payer system will restrict the rise in costs and cover every citizen. Single payer is what the majority of developed nations have enacted and their per capita costs are much less than here. A respected group, Physicians for a National Health Program, has examined this scenario in great detail. There is more at their site

At a minimum, we should seriously reconsider the Reid plan to expand Medicare incrementally. In 2009, Sen. Harry Reid proposed a voluntary buy-in for folks 55-64 who did not have private insurance. Unsurprisingly, there were immediate outcries from the insurance, physician and hospital lobbies. Some of their objections were reasonable, but most were just self-serving.

The affect of adverse selection -- having only the sickest people buy into the system -- was the most valid objection by insurance companies. Another was the unknown impact that the expansion would have on the financial side for both the government and providers.

The way to address these two issues is through expanding Medicare year by year. In other words, just take what Reid said and move to an incremental implementation. In 2013, folks 64 could buy in. In 2014, people 63 could buy in, and so forth. It would be slow, but eventually everyone over 55 would be covered. Then, it could be expanded to other groups. And, if the impact on providers is minimal... as I believe it would be... the phase-in could be revved up.

If we had a bi-partisan Congress dedicated to helping the country, rather than just the insurance company and medical lobbyists funding their campaigns, passing this legislation would be simple. As difficult as it is, elected officials of good faith on both sides of the aisles should come together and propose Medicare expansion as a bi-partisan compromise for the good of the nation.

If not, we can just wait another 10 or 15 years until many more West Virginians and Americans have lost their unaffordable private insurance, the number of uninsured is 33 percent or more here and elsewhere, our industries are uncompetitive internationally, and we are forced to go to a single payer model.

As Churchill said, "Americans can always be counted on to do the right thing, after they have exhausted all other possibilities."

Bernard is a retired senior health care executive and a county commissioner in Jasper County, Ga. He has worked with several W.Va. hospitals, including CAMC, and oversaw planning for Humana Hospital-Greenbrier Valley and the region.