No more Band-Aids

by Sandra Feldman

It's not a secret that one American out of every six has no health insurance. The majority--85 percent--are employed, but many work in nonunion jobs that do not provide health insurance, and buying their own coverage is far beyond what they can afford. So they have to pray that no one in the family gets sick enough to need a hospital stay or any long-term treatment.

Until recently, however, middle-class workers, especially union members, have felt relatively safe. No more. Take the people insured through their jobs, even those with comfortable salaries, who get laid off. They can temporarily continue family coverage and pay the entire bill, which is typically in the neighborhood of $7,200 a year. That way they probably risk not having enough money for other basic expenses. Or they can give up the coverage and take a chance on everyone's staying healthy. No matter what they do, they cannot continue this coverage beyond two years. If they don't find a job offering a health insurance benefit by then, they'll have to buy more expensive, and probably more limited, coverage on the open market--if, of course, they can afford it.

But things can be very tough even for people who hold on to their jobs. As insurance costs rise--and they went up 56 percent between 1997 and 2002--employers who used to provide good healthcare benefits are now cutting back on coverage and passing on more of the cost to their workers. So employees pay bigger premiums and greatly increased deductibles and co-pays. And they get less coverage.

Where will this stop? If premiums go on increasing at 14 percent a year, we can be sure that more people will lose coverage as small businesses stop offering it, more retirees will see their coverage severely cut, and more people about to retire will find that the benefits they counted on to supplement Medicare have disappeared.

I could go on with a litany of well-documented healthcare danger signs and horror stories. I haven't even mentioned the spiraling drug costs, which hurt retirees most of all (a situation that will not be remedied by the Bush administration's proposed reform plan). Or the problems facing Medicare. Or the danger that "fixing" Medicare could do more harm than good. But it all comes down to this: Our nation, which is second to none in the sophistication of our medical technology and the procedures available to those who have decent health insurance, is also second to none among industrialized nations in the percentage of people who have no coverage. As things now stand, this discrepancy can only get worse.

What did we do to get into this quagmire? And, more important, how can we get out?

Whatever we do, it won't be easy. I have been talking only about access to medical coverage, but there are many other problems, including the big one--how to handle the additional costs for a system that would provide adequate coverage. No wonder serious reform, despite how urgently it is needed, is a political hot potato that few are willing to touch.

One important exception is Sen. Edward Kennedy (D-Mass.), a longtime leader in the fight for universal health coverage. He has already opened the discussion by proposing that employers, as a normal cost of doing business, provide healthcare coverage for all their employees, with a subsidy for small employers. Others have talked of allowing people under 65 to buy into Medicare or of expanding access to SCHIP, the federal and state program that provides health insurance for low-income children. Another idea is to form purchasing groups. They would help to control costs for people who already have health insurance by allowing small groups of employees to band together to purchase coverage on more advantageous terms.

So there are ideas out there, but we will never find our way without an honest national discussion of the problems and options. And we urgently need some risk-taking on the part of our leaders. We need them to carry through this discussion and pass legislation that establishes a healthcare system that is second to none in the care it offers all Americans. Admittedly, the problems are daunting, but great problems can lead to great solutions. We saw that with Social Security and Medicare, and the present situation requires nothing less.

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