The Journal & Courier has an editorial entitled “Make health care available to all Hoosiers.” The editorial recognizes that about the only thing everybody can agree on is this: “Something must be done to make health care accessible to more Hoosiers.”
Beyond that, there are too many competing interests. It mentions that at any given time, there are ” 600,000 to 800,000 people — 9 percent to 14 percent of the state’s population — [who] are uninsured at any given time.” It does not go into the difficulties and thin coverage experienced even by those who are insured.
Uninsured or marginally insured are likely to avoid preventative treatment to see if the problem goes away and the cost can be avoided altogether. If the problem persists and gets worse, treatment will likely be sought in an emergency room where it’s more expensive and more difficult to treat.
The high premiums and Indiana’s high health care costs ripple through the economy. Employers spend more on health insurance, which diverts money from raises and investments and makes contract negotiations with unions difficult. It discourages entrepreneurs from starting a business. Companies looking to locate in Indiana might pass up the Hoosier state.
Huge bureaucracies are in place to manage the intricacies and vast oceans of paperwork associated with our healthcare system. Governor Daniels has suggested that part of the problem with our school systems is that too few of the dollars spent are spent on actually educating children. So too are too few of our healthcare dollars spent on treating the sick and maintaining the healthy.
The average American spends more and gets less for his or her healthcare dollar than citizens of other industrialized nations. If you’re loaded or have blue chip insurance and need bleeding edge medical procedures immediately, our system works perfectly. Otherwise, it leaves a lot to be desired. And it’s squeezing the middle class. The poor have some protection through Medicaid. The rich have a decent healthcare system. The middle class is potentially one illness away from ruin — judgments leading to a choice between bankruptcy on the one hand or decimation of savings, garnished wages, and home foreclosure on the other.
Doug–
This is a *great* point:
“…part of the problem with our school systems is that too few of the dollars spent are spent on actually educating children. So too are too few of our healthcare dollars spent on treating the sick and maintaining the healthy.”
Another problem, imho, is that so few dollars are spent on therapy and preventive treatments. We’ll willingly spend thousands of dollars for joint surgery when a course of preventive therapy could have resolved the health problem at a fraction of the cost.
The interaction of health care costs and employment should be of great interest to our politicians. However, while the Journal & Courier has done a service in keeping the issue in front of people, and has a fair point on the equity side of the issue, I think they partly miss the point on the economics side.
They assert that “[high health care costs] discourages entrepreneurs from starting a business. Companies looking to locate in Indiana might pass up the Hoosier state.” High health care costs in this state stem in part from Indiana being tied deeply into the auto industry and to the UAW’s labor relations model of “employment for life with benefits.” This model, over time, loads old line businesses with much higher benefit costs than startups. In other words, entrepreneurs are not discouraged from starting businesses, it is the Fords, GMs and Delphis who can’t stay in business. They are slowly being ground under by relative start ups of the auto world (e.g. Toyota). We have attracted some of Toyota’s and Subaru’s expansion into North America, but by no means can we expect the sort of concentration of auto industry jobs we had in the 1950’s with GM, Chrysler and Studebaker. The old auto industry model of labor relations forces us to constantly find replacements for old line industries, not because those industries are no longer viable, but rather because the business entities carrying out the activity carry difficult to afford benefits. Indiana may be further hurt in this respect to the extent that the state, or communities within the state, are picking up the pieces for retirees and those laid off who once had health care benefits from an employer.
Canada distributes health care costs across its economy (though I disagree with their limitations on private health care). I am surprised that Ford, GM and Chrysler haven’t moved all their operations to Ontario where health care costs are distributed across the whole economy, old line and new, rather than loaded onto established businesses.
At a moral level, if “we” decide that everyone should have access to some level of health care than “we” should pick up the ticket. However, I wouldn’t want that to occur with some mechanism for inserting market discipline to control costs and to limit demand.
The J&C went onto ask, “A central question is why are health care costs in Indiana so high? Why does a parent report that the same blood test for his son costs $35 in Puerto Rico but $240 in this state?” I am usually a free market devotee, but in this area I have become convinced that we already have quasi-socialized medicine in the sense that demand has been unfettered. The tax code encourages employers to provide health insurance because, while deductible to the employer, it wasn’t taxable to the employee (i.e., tax-free income). Those with jobs haven’t cared what health care cost for 50 years and have reacted to the situation as if it were a fully socialized good.
There is also the issue of ad hoc subsidies and the resulting weird pricing structures. Medicaid and larger insurers are able to obtain agreements to get the services — blood tests or whatever — performed for reduced prices. Many health care providers are obligated to provide services to those without means of payment, particularly at their emergency rooms. So, you have the government and big insurers paying probably about what the services cost plus some marginal profit. You have the health care providers taking a hit by serving those with marginal income. The difference is presumably made up by charging the solvent uninsured increased prices.
Then of course there is the issue of the insurers who may not be honoring the terms of their agreements when doing so looks to be particularly unprofitable.
But it has been pointed out to me many times, usually by conservatives who dont want a federal health care mandate, that everyone DOES have health care. This is probably true if we count ER as health care access.We all pay for ER service and maybe that’s one reason health care is so high with everyone receiving emergency care,but I’d guess ER health care is very high expense to the system ,costing as much as primary health care. Id like to see some statistics.
This ‘myth that we ALL have health care already may be making universal health care seem like a redundant goal for some constituencies. ‘Everyone already has it.’
They might also be suggesting, I suppose, that if one is sufficiently wiped out by health costs, one can qualify for Medicaid. Of course, expenses incurred before you were wiped out can be significant and won’t be covered.
As a matter of fact, Rep. Chris Chocola said the same thing: everyone has access to health care. That is why we have the emergency room.
Talk about out of touch. However, changing health care in America will be a long, costly battle. The medical insurance lobby makes the oil lobby look like a pre-school group. The amount of money entrenched in the system makes any health care reform an uphill battle, to say the least. Look at what happened to Hillary Clinton when she tried to push for change. It is especially bad now when you have someone like Bill Frist who’s ties to Humana are so intricate that he is like a lobbyist on the floor of the Senate. It will likely take many years and many brave Congressmen and Senators who are willing to literally sacrifice their careers to lay the groundwork for real health care in America.
As I recall the Clintons’ proposal would have made contracting privately for health services a crime, allocated medical students to practice areas based on government determined need, and made access to a specialist contingent on the judgement of “gatekeepers” at the point of entry to the system. I have sympathy to bringing coherence to our system and making care universally available, but the Clintons went way beyond what I would care to see.
I would consider allowing those who want, and can afford to do so, to opt out of the system as is done in Germany.
Health care was relatively inexpensive in The United States in the 1970’s and earlier.
In the 1970’s the government got into healthcare. Costs have skyrocketed ever since.
We pay by FAR the hgihest amount per citizen for healthcare in the world. This is due to many reasons; the largest are governmental invovlement and red tape.
We can fix out health care crisis. We just need to get the government out…
I have been invovled in some medical billing issues for relatives and clients. They system is broken…
Mike Sylvester