Cover Yourself!
Op-Ed
By Jack Lewin, M.D. and Ronald Williams
(Dr. Lewin is CEO of the California Medical Association. Mr. Williams is president of Aetna.)
Wall Street Journal
August 19, 2005
With 45 million Americans uninsured, achieving universal access to health care may seem daunting, but it’s not impossible. Encouraging work is underway in California to aid employers who don’t provide insurance to voluntarily expand primary and preventive care, and the innovative coverage options targeting groups such as students and part-time employees show great promise.
Employer-based coverage is beneficial and should be preserved. But the environment is changing and costs are crippling the system. Under an individual-coverage requirement, many more Americans would benefit from the private-sector health care that most enjoy currently in our employer-based system. This would foster the adoption of consumer-directed health plans, which typically include high-deductible plan features. These new plans create greater awareness of health-care costs by providing consumers with better information about available treatment options, including the cost of these services. Consumers then can make the treatment choices that are right for them without the third-party disconnect that divorces the consumer from costs.
With an individual-coverage requirement, people who want more comprehensive coverage and can afford the higher premiums could choose to buy it.
As it is, state legislatures are still mandating costly new benefits for insured persons, destabilizing employer coverage and, as a result, increasing the number of uninsured.
We urge the state legislatures and Congress to approach this debate with an open mind as the access to care debate intensifies. At the very least, let’s study and analyze this concept to determine whether its practical application can work to unite us in our quest to solve the persistent problem of the uninsured.
The status quo is the worst possible strategy. We need a new approach to financing universal access that is more practical and affordable, while still socially responsible and ethical.
http://www.calphys.org/html/editorials01.asp
Comment: Dr. Lewin has long been a passionate advocate of health care coverage for all. He shares with us the frustrations of observing the profound escalation in costs without a commensurate increase in coverage. He is well informed on the options, but is partnering with the private insurance industry the right choice?
This joint op-ed states that “the innovative coverage options targeting groups such as students and part-time employees show great promise.” Great promise? Many of these “innovative” products do not provide even bare-bones coverage, and it should be a criminal act to even imply that they are insurance products.
The op-ed also states that “people who want more comprehensive coverage and can afford the higher premiums could choose to buy it.” With current trends, this equates to a statement that you can qualify for services such as joint replacement only if you are willing and able to pay for coverage. For those who say that joint replacement would be covered, we should ask then what would be left out?
In addition, the op-ed mentions the “third-party disconnect that divorces the consumer from costs.” This is code language for requiring the patient to pay out-of-pocket as a mechanism of relieving the insurance intermediary of its responsibility to insure against loss. That impairs access due to lack of affordability.
The op-ed calls for study and analysis, as long as the solution is a consumer-directed, individual mandate that protects insurers while leaving patients exposed to financial disaster. Although more studies will continue – indefinitely – enough have been completed to draw conclusions about the perversities of this approach. For those who believe that they need more study, I would suggest reading, as a few sources, Health Affairs, Kaiser Daily Health Policy Report, The Commonwealth Fund, Families USA, National Coalition on Health Care, Physicians for a National Health Program, Consumers Union, and a Google search of the issue. Just be careful to separate health policy science from ideology (theirs and ours).
The authors are certainly correct when they state that “we need a new approach to financing universal access that is more practical and affordable, while still socially responsible and ethical.” We are already spending enough to do that, but, sadly, their model is not socially responsible.