Kaiser Commission on Medicaid and the Uninsured
July 2002
Though health insurance is one of the most important factors in assuring access to health care, gaps in coverage can create access problems even among the insured. Thirty-eight percent of insured individuals report that they or their families experienced at least one problem accessing medical services in the past year. Nearly one-fifth (18%) report that they postponed seeking medical care, 15% had a problem paying medical bills, 10% did not get a prescription drug they felt they needed, 8% were contacted by a collection agency about a medical bill, and 6% didn’t get care they felt they needed.
Many of these problems arise because some individuals’ health plans do not cover all the services they need. In other cases, individuals cannot afford the cost sharing associated with covered benefits.
While the uninsured are most at risk, researchers estimate that about a fifth of insured individuals are underinsured and face limits on coverage or substantial financial costs if faced with an illness. Given the recent increase in health care costs, it is likely that this problem will escalate in coming years.
Comment: Current trends in health insurance include defined contributions, greater price sensitivity through cost sharing, splitting risk pools into individual accounts, introduction of Spartan “basic” benefit plans, greater tiering of insurance options, and other measures that are moving away from the traditional role of assuring financial security through risk pooling.
Why this shift? These policies are designed to protect employers against increased costs. Yet employers pay only about 19% of the nation’s health care bill. These policies are designed to reduce risk for the insurance companies, assuring the financial security of this industry, at the cost of the financial security of patients. They are designed to support the views of those that are ideologically opposed to a government role in issues of social justice.
Do we really want to expand policies that protect an insurance industry noted for egregiously wasting our health care resources? Do we really want to continue to rely on employer “good will” to struggle to provide 19% of the funding of our health care system, when we have the capability of relieving them of this burden? Do we really want to cater to ideological elements that believe that funding through a tax system is more evil than funding through the private sector, even when it has been demonstrated that public funding provides greater value for health care dollars?
We already have more than enough resources to provide comprehensive health care benefits for everyone. Isn’t it time to establish policies that would enable us to utilize our resources much more effectively? We can continue with our existing private and public health care delivery system, but we desperately need a single risk pool that is publicly funded and publicly administered.
