The employer-mandate tsunami
The Mounting Crisis in Health Care
Universal medical coverage needs universal commitment
Bruce G. Bodaken, CEO, Blue Shield of California
Hardly a day goes by that we don't hear a story about turmoil in California's health-care system: the collapsing trauma network in Los Angeles; hospital overcharges in Redding; bankrupt medical groups in San Jose or nurses on strike in the East Bay. Health-care costs are rising at astronomical rates, thousands are losing their insurance and the state government is too broke to adequately fund health-care programs for the poor.
According to the U.S. Census Bureau, one in five Californians -- more than 6 million in all -- are uninsured. They include workers in small businesses who aren't offered insurance and can't afford to buy it on their own; and people who are eligible for public programs such as Medi-Cal and Healthy Families but don't know how to navigate the bureaucracy. A surprising number are wealthy and healthy enough to afford insurance but choose not to buy it.
With a weak economy, rapidly escalating costs and an aging population needing more services, a deepening crisis is inevitable. Something must be done.
What are the consequences of not having insurance? You're more likely to live sicker and die poorer. Each year, 18,000 people die unnecessarily because they lacked health insurance, and uninsured infants are 50 percent less likely to survive than newborns with insurance. If you're uninsured, you probably ignore the first symptoms of an illness and wait until you're really sick before seeing a doctor. More often than not, you'll go straight to the emergency room, a costly and impersonal place to receive basic medical care.
Meanwhile, well-off people without any symptoms are spending $900 for full- body scans they don't need. When the scan finds something ambiguous, they spend thousands more getting additional tests that prove they're healthy after all.
This unequal and inefficient system must be changed. A new model should be based upon individual, corporate and societal responsibility.
Here's what we should do:
-- Build upon the existing employer-based system: Preserve a paradigm that has successfully insured a majority of American workers and their families for six decades. Require employers, except smaller companies, to offer coverage or contribute an equivalent amount toward an essential benefit package for each employee.
-- Promote state programs: Enroll every eligible Californian in Medi-Cal or Healthy Families. The state and private sector should work together on creative and effective marketing and outreach strategies.
-- Require coverage: Require those who can afford insurance to buy it. Others would be subsidized based upon documented need.
-- Define essentials: Provide an essential benefits package, designed by independent medical professionals, that would guarantee preventive care, physician services, hospital care and prescription drugs.
-- Encourage savings: Achieve savings through expanded preventive care, earlier treatment of the formerly uninsured, reduced use of emergency rooms and more secure financing.
-- Establish tax-based funding: Supplement the additional business and individual contributions to the insurance pool with a modest, broad-based tax or fee as needed.
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2002/12/02/ED52155.DTL
Comment: To say that there is a tide of support for an employer mandate for health care coverage with a public program for low-income and uninsurable individuals would be a gross understatement. That tide is a tsunami that will soon engulf California. The employer mandate is now supported by politicians, business, labor, organized medicine, hospital administrators, consumer organizations, and the insurance industry. In March, the RWJ Covering the Uninsured campaign will unleash efforts to align public opinion in support of this model of reform. It is likely that this year the employer mandate will cross the threshold of political feasibility.
California will serve as a testing ground for political solutions for our health care crisis. Sen. Jackie Speier will be introducing legislation in support of the employer mandate/public insurance model, and Sen. Sheila Kuehl will be introducing legislation supporting a single payer model. Both are vast improvements over our current fragmented, wasteful and inequitable system. But there are major differences.
The single payer model has the advantage of reducing administrative waste, allowing more funds to be directed towards a more equitable system of health care. It would provide economic mechanisms to slow the escalation of health care costs. The employer mandate/public insurance model would perpetuate both administrative excesses and the inequities of a system in which multiple health plans game the system to shift costs. And the public insurance component inevitably would be underfunded as it would be perceived to be a "welfare program." But the employer mandate/public insurance model has one overwhelming advantage: political feasibility.
Our task is to make every effort to be certain that the public understands all options available. The other vested interests understand the issues and realize that the employer mandate/public insurance model comes closest to meeting their collective needs. The task to educate the public will be monumental. But the Canadian Romanow study confirms that a public that has decades of experience with a single public model emphatically rejects the suggestion that our system of private and public health plans would be preferred.
For the democratic process to function properly, it is essential that we have an informed electorate. Since the vested interests profit by disinformation, it is our task to be sure that the public really understands all options. Immediate initiation of massive grassroots coalition efforts is mandatory. The alternative is a system, by default, that primarily caters to the vested interests of those with money and power, relegating patients to a secondary position.