BY QUENTIN YOUNG, M.D.
The Springfield State Journal-Register
May 14, 2007
The crumbling health system in Illinois cries out for fundamental reform.
More than 1.8 million Illinoisans lack health insurance. Millions more have coverage so skimpy that it leaves them without needed care or exposed to high costs. The current fiscal meltdown crisis in Cook County highlights the worsening plight of the poor and uninsured.
Gov. Rod Blagojevich has proposed to raise taxes which Illinoisans would then pay to insurance companies – but private insurers are the problem, not the solution. Hence, the governor’s plan is long on costs to consumer, taxpayers and businesses, and is short on remedies. To simultaneously expand coverage while controlling costs for individuals and businesses, the only effective solution is a single-payer public insurance program.
The $2.1 billon expense the governor’s plan would raise from business is a bad deal for Illinois. By the governor’s own admission, about two-thirds of the currently uninsured will remain that way. Millions of Illinoisans presently paying for inadequate coverage will get a tax credit whose value will quickly be erased by rising premiums. While large employers suffer a tax hike, smaller businesses will enjoy no relief from double-digit annual health cost increases. As these costs explode, employers will be forced to cut benefits or drop coverage altogether. The state is not prepared to take on the financial burden of ever-increasing numbers of uninsured and underinsured. We need a better plan.
To this tax-subsidy template the governor has added a little-noticed provision – the option to make being uninsured a punishable offense. This “get it yourself†approach might be reasonable if the problem wasn’t that existing private policies offer neither access to care nor protection from financial ruin.
Thus, right now, more than one-quarter of the insured go without needed care due to costs; and 75 percent of the 40,000 Illinoisans bankrupted by medical bills each year had insurance when they got sick. With the average family premium now costing $11,000 per year, it will take a steep penalty to force the average uninsured person into ponying up. In Massachusetts, which is currently implementing a similar plan, the penalty for being uninsured is greater than the criminal fines for drunk driving, domestic assault or making a terrorist threat.
Supporters of the Blagojevich’s proposal to redistribute money from businesses to insurance companies have painted the plan as a means to get companies to live up to their responsibilities in the health domain. Recent “fair-share†campaigns have rightly focused on a few large firms, such as Wal-Mart, which provide bad benefits and rely on public programs to pay for the health care of their low-wage workers.
However, rising health-care costs are not the fault of business, and we burden them with further taxes at our own peril. Raising Illinois’ companies health taxes will only encourage them to cut benefits, wages or jobs. The cost of insuring workers on an inefficient firm-by-firm basis has degraded the competitiveness of American businesses compared with nations that provide national health insurance. Thus, Ontario now produces more cars per year than Michigan, and our Big Three auto manufacturers have fall behind while European and Japanese automakers gain.
This international experience should be instructive for us in Illinois. We pay the world’s highest health-care taxes already – at least double the per capita spending of nations that provide comprehensive, universal care. While Canadians live longer and healthier, they spend just over $3,000 per capita, compared to our $7,000.
Other nations not only have healthier economies, they have healthier citizens. A recent survey of 38 high-quality studies comparing patient populations in the United States and Canada found that care quality north of the border is at least as good, and an exhaustive 2004 study of 21 international quality indicators in five countries found that the United States performed noticeably better on only two.
Because we rely on private insurers, we pay more for less care. Rather than compete to reduce costs and improve quality and access, they create expensive bureaucracies that squander money on marketing, fighting claims, issuing denials and screening out the sick. In turn, physicians and hospitals must maintain costly administrative staffs to deal with insurance hassles. Businesses are saddled with the cost of administering their own health benefits. In sum, this administrative waste consumes nearly one-third of our health spending. It is this fragmented, multi-payer system which produces ever-rising costs that burden Illinois families and businesses.
Replacing private insurers with a single public coverage program – a kind of “Medicare for All†– would recover enough funds currently lost to administration to cover all Illinoisans without additional cost to the state, businesses or consumers. Such a system would also control health costs, restoring the competitiveness of our businesses and ensuring that quality health benefits are sustainable.
Unfortunately, the Blagojevich proposal accomplishes neither universal coverage nor cost control because it fails to disconnect from the private insurance model. A healthy future for all Illinoisans will require leaders willing to stand up to insurance companies in the interest of the public.
Dr. Quentin Young is co-founder of Health Care for All Illinois and national coordinator of Physicians for a National Health Program.
