Uninsured in Fits and Starts: How Stable Is Health Insurance Today, and What Difference Does It Make?
Alliance for Health Reform
December 12, 2001
Washington, DC
During Q & A:
Edward Howard, Executive Vice President, Alliance for Health Reform:
"I do have a couple of questions that have been submitted in advance, and let me try one of those, if I can. The questioner starts by noting the inability of employers to protect themselves from rising health insurance premiums compared to, for example, their domestic competitors who provide nothing, their global competitors who have access to a universal system. Also the lack of effective cost containment in a highly fragmented system. Given that, whatever merit employer-sponsored health insurance offered to spread risk equitably through the population, isn't this a good time to create more equitable risk pools at the state or community level? Lynn, you sort of had some notions along that line."
Lynn Etheredge, an independent health policy consultant:
"Thanks, Ed. All I can say is that, what we've discovered in health insurance debates is that one person's-when people start talking about equity, they're talking about reallocating costs to someone else. And, while it may, for the person who's suddenly hit with a double digit rate of increase after several years of single digit, the idea that it's more equitable to shift that cost to someone else, to the person to whom it's shifted, who's already also facing a double digit rate of increase, the willingness to think it's equitable to pay someone else's bill on top of theirs is somewhat diminished. So I'm not sure that it's-theoretically, it might be a good time to do it but, in practice, we-it makes it somewhat harder I think."
And later,
Mr. Howard:
"Stuart, you were talking about a voluntary system, and I wonder if you have any current thoughts about the idea of an individual requirement for insurance purchase, in the way that many states have individual requirements for auto insurance purchased for those who want to have licenses to drive, and whether or not that idea is getting any sort of receptivity from that broad spectrum of folks that you were talking about earlier."
Stuart Butler, Ph.D., Vice President, Heritage Foundation:
"Well, you know, the wounds I suffered when I last proposed that are only just beginning to heal now! I mean, look, in principle-I'm a conservative. In principle, I have no problem with the idea of saying that the rest of society should be protected against individuals who use our existing laws and good nature to provide them with a service that they're not prepared to pay for. I think that we should have a requirement for at least that. Whether we should have it beyond that, is much more open to question. But I still think that there are other kinds of soft ways in which one can achieve the same kind of objective. I mean, the various tax proposals that are on the table and other subsidies basically say, unless you get at least a minimum protection, you don't get any of these. You don't get any subsidy for your prescriptions, for your-you know, for your visit to the doctor or anything. That's an inducement."
"There are proposals from, I think NCPA and others that say, okay, what-let' s take the people who just, whatever you try to do, still don't sign up. Well, let's calculate some of those and give the state the equivalent money and let them deal with those people directly, which at least is better than we have today. So I think there are ways. But I certainly feel that there ought to be a requirement for at least a minimum protection, much like, as you said, third party insurance for automobiles, because I don't see why I should pay because somebody runs into me. And, you know, those kinds of things I have no problem with."
<http://www.kaisernetwork.org/health_cast/uploaded_files/kff121201a.pdf>http://www.kaisernetwork.org/health_cast/uploaded_files/kff121201a.pdf
Comment: These unprepared responses during the question and answer session demonstrate the difficulty that those who are opposed to a program of universal insurance have with the concept of equity. It seems that achieving equity or fairness should be at the forefront in our efforts to reform health care. A suggestion for the topic of the next forum: "Health Care Equity: How Can We Achieve it?"
Tom Mainor, Pastor of Shady Grove Presbyterian Church in Memphis, responds to Jeff Huebner's comments on the ACP-ASIM proposal:
These observations are helpful. There really seems never to have been a lucid and rational national discussion, with helpful media coverage, of what we mean by "single payer approach." They are always side-tracked by the opponents of a universal system, and mis-characterizations by entrenched financial interests who want to get control of community-provided health resources for profit.
The suggestion re/ modeling them after the Canadian provincial system parallels my thinking that regional health systems, globally budgeted, with regional health councils that look at everything from prevention, to trauma, to cure and rehab, nursing home care and good public health structures--such an approach can blunt the objections to universal coverage, and remind us that "government" is "we the people" working together to do what needs to be done for the commonweal. We would not suggest that only those citizens who can afford it have safe drinking water, or fire and police, or Coast Guard or a competent and ready national defense force. Why should health care be left to the vagaries of a market place whose purpose is to create more customers rather than a healthy people?
Tom Mainor