I promised an item on healthcare, and here it is. As a polite reminder, the 40+ million Americans without health insurance — almost one in every 7 people — are breathing their germs on you every day.
Yesterday morning I was listening to comments to a gathering of state Governors by the CEO of Wal-Mart. And you know what? even though he may be part of the problem of healthcare insurance, he is right about one thing:
“The soaring cost of health care in America cannot be sustained over the long term by any business that offers health benefits to its employees. And every day that we do not work together to solve this challenge is a day our country becomes less competitive in the global economy.”
He went on to say that mandating he spend a certain percentage of his payroll on health coverage was just not going to work. Like it or not, I tend to think he is right.
As I listened to people commenting on what Mr. Scott had said, again and again I heard how the problem was at least in part that people had no incentive to limit their healthcare costs. This was interspersed with survey results showing that the overwhelming majority of respondents were paying more towards healthcare than they were a year ago. The commentators implied that the problem would be solved if corporate America offloaded more of the costs to the end users of healthcare, for example through HSAs and high deductibles/copays. After all — I actually heard someone say this — if people had to pay more of their healthcare costs they would think twice about “unneeded” emergency room visits or medical tests.
Let me take the spin out of that for you: the cost of healthcare will come down if you just don’t worry about that crushing pain in your chest at 3 AM. And somehow it will be more affordable if you pay for everything instead of letting the insurance company cut a deal with the hospital.
Let me start by puncturing a great myth of healthcare costs: healthcare costs are directly controlled by insurance companies, who alone determine what they will pay healthcare providers. You cannot go into your doctor’s office and say “Okay, you can run that cholesterol test, but I’m only paying you $X.” First of all, you are one person with no bargaining power. Second, it is illegal for your doctor to make such a deal with you. Your insurance company, on the other hand, has the ability to arbitrarily decide how much they will pay for any given procedure, and your doctor only has the power to accept the insurance payment, or not do business with that company. The fact that insurance companies are not able to contain costs in this environment is evidence that the system is broken.
I am going to say this again and hope it sinks in: if you want to “unload healthcare costs to consumers,” change the tax rules so everybody can deduct health insurance premiums. Couple this with state-level rules simplifying premiums and eligibility; who knows how many businesses are never started because the people involved can’t get individual coverage? This way, Joe and Jane Average can look at their employer’s health insurance plan, and if a better deal or better coverage is available elsewhere, they can just buy it. Of course, this does little to help the many people who can’t afford a few extra hundred dollars a month for private coverage or an HSA.
A better plan, one that will benefit everybody, is universal health care. You know, the CEO of Wal-Mart would look really progressive if he supported such an idea. Oh, and for the record? He supports a higher minimum wage too. He says it’s to benefit his customers, and while that may be true it will almost certainly impact the wages he pays, too. That sword cuts both ways.
If you want to read more on healthcare in general, please visit my friend Elisa Camahort and her colleagues over at Healthy Concerns.
The nail that sticks up is that insurance companies have no interest in the good of the country. Reaping record profits without increasing the benefit of the countrymen who pay for your living is, while perhaps good buisness, obscene in a humanitarian sense. Once upon a time there were charters of incorporation that defined the benefit to the community that your proposed commercial venture would offer. Now that economy has no geographical boundary there is no sense of community or obligation to it. I am relieved that I am so old as I do not feel that this will get better before it gets way worse. (and not being able to afford health care insurance, much less visits to the E.R. at any time of the day, will certainly serve only to hasten my demise. Cynical? yes, but realistic, ne?