By Christopher Lee
The Washington Post
January 27, 2008
A small but growing number of American families beset by major medical problems are learning the hard way that simply having health insurance is sometimes not enough.
Those who need organ transplants or who have hemophilia, Gaucher disease or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies.
That has left some very sick people facing health-care tabs of hundreds of thousands of dollars or more, prompting their families to seek help from the government, or to scramble to change jobs or even divorce for no other reason than to qualify for new health insurance.
Statistics on how many people exceed the lifetime caps are hard to come by, but advocates note that the amount of many caps hasn’t changed in decades, or at least has not kept up with health-care inflation and the sky-high cost of lifesaving new therapies, making it more likely that people will reach the limit.
An annual survey by the Henry J. Kaiser Family Foundation found that 55 percent of workers with employer-based coverage had a lifetime limit in 2007, including 23 percent with a cap of less than $2 million. That was up from about 50 percent who faced a cap in 2004.
Mohit Ghose, a spokesman for America’s Health Insurance Plans, an industry group, said the answer to the problem lies not in raising the caps but in tackling the ever-spiraling cost of new therapies, drugs and medical devices to get more value from every health-care dollar.
“Are we in a position to pay a quarter-million dollars for a course of treatment as a nation, or is there a way that the public and private sectors can work together to shore up the mechanisms that are used to pay for those high-cost treatments?” Ghose asked.
http://www.washingtonpost.com/wp-dyn/content/article/2008/01/26/AR2008012601058.html
Comment:
By Don McCanne, MD
Those of us who support single payer national health insurance believe that access to health care should not be impaired by erecting financial barriers to care. Others believe that individuals should be responsible for “modest” costs that enable access to care, such as high-deductible plans (conceding that low-income individuals would need some assistance). But everyone agrees that we should all be protected from catastrophic health care expenses. So why do private health plans place a cap on catastrophic losses, forcing financial ruin on those with the greatest of catastrophic health circumstances?
The reason is that private insurers must make every effort to limit the exposure of their risk pools to high health care spending lest the premiums they charge would no longer be competitive in the private insurance market. Capping losses is mandated under the rules of market justice. But under the rules of social justice, individuals must be protected from financial hardship, no matter the intensity of their health care needs.
So what is the recommendation of the private insurance industry (AHIP)? The “public and private sectors” should work together. In fact, their proposal specifically calls for segregating the healthy into the private plans and turning those with significant health care needs over to the government. They profit on the healthy while we pay taxes to care for the sick.
Caps for catastrophic losses for private insurers is good business, but it’s terrible health policy. As stated in these messages before, it is long past time to change from a health care financing system that follows the rules of market justice to one that follows the rules of health care justice.