From the Publisher / Arnold G. York
The Senate is beginning to debate the health care bill and there is a great deal of noise and nonsense being disseminated by all the political players and special interest groups. Our health care system is truly in crises. We have 40-plus million people who are uninsured. Although we spend more money on health care than most other western countries, we don’t seem to do as well overall. Counties and cities are buckling under the cost of maintaining hospitals and emergency rooms, and trauma networks are closing down throughout the country. If you listen to the commentators you would think that it’s because it’s all been badly handled and politics has kept us from fixing our system. Most of the analysis I’ve seen is just simplistic and plain wrong.
The reason that health care is in crises has little to do with politics and a great deal to do with population changes, which is both good news and bad news. The good news is that we’re all living longer and staying healthier much longer. When I was growing up, 60 was considered old, dying at 70 was not unusual, 80 was thought to be a long, full life and when someone hit 90, it was miraculous. Today, many of our friends have mothers who are in their 90s. Karen’s mother is 95. My mother died three months shy of her 100th, birthday and we’re not unusual. But what’s wonderful on a personal level can be disastrous on a governmental level. Many of the assumptions the government made about how to pay for everything like retirement plans, Social Security and health care are being turned upside down, and deficits are growing.
Again I’ll give you a personal example. My mother retired from the New York City school system at age 58, after 30 years of service, with a pension, which included cost of living increases linked to some CPI. When she died 40-plus years later, her pension benefits were several times higher than what she was earning when she retired. And she’s not the only one, so the city of New York is now struggling to pay their pension obligations.
Another thing that is turning the system upside down is the ratio of workers to retirees. For example, in 1960 there were 5.1 workers for each retiree. In 2008 there were 3.2 workers for each retiree. They’re predicting in 2030 there will be 2.2 workers for each retiree. That means with each passing year there are more people receiving benefits and fewer people paying into the system.
Right now the first of the baby boomers are reaching retirement age, which also means they’re eligible for Medicare. All along, the baby boomer generation has had a major impact on the country as they moved through the pipeline. They have now reached the age when they will be larger users of medical services because the older you are the more medical services you use. Medical costs are going to skyrocket, not because the baby boomers are sick, but just because there are so many of them.
For purposes of explanation, I’ve sort of lumped both health care and retirement together. The solutions for each are really quite different but the basic problem underlying both is the changes in our population demographics.
So let’s take it apart and just turn to the proposed health care bill now before Congress.
We know from the polling that somewhat less than half of you are against the bill and think it’s a terrible idea, even though you haven’t read the bill.
On the other side, slightly more than half of you haven’t read the bill either but you think it’s a good idea because we’re at least tackling a major problem and you don’t really care about the details.
Fundamentally, despite all the posturing, the solution is not that complicated. It’s the politics that’s complicated. What’s the answer?
Everyone has to be in the insurance pool. The young and the old. The sick and the well. Those with preexisting conditions and those without. Those with genetic predispositions for certain illnesses and those without. Why? We need the young in the system because we need their insurance premiums, and besides they balance out the old who use the system more. Everyone has to be insured. If not, the cost of care is merely shifted to the county and city emergency rooms and hospitals, and they’re all going broke, along with the trauma networks. Some people at the lower end of the economic scale can’t afford it and the government is going to have to subsidize part of their cost to put them into the system.
Health insurance has to be portable. Today, many of our population get their health insurance through their jobs. That no longer works very well because people work for several companies during a lifetime and their coverage isn’t transferable. Besides, if you get laid off there goes your insurance coverage. Of course there is COBRA, but it’s expensive and only good for 18 months. Today, most of the personal bankruptcy in America is from medical bills
Insurance carriers have to accept everyone without exclusion for preexisting conditions. They can’t be allowed to cherry pick their customers, but at the same time all the higher risk people with preexisting conditions have to be spread fairly between all the carriers so no one carrier gains an advantage. What the carriers get in return are the roughly 40 million Americans who are currently uninsured who will be going into the insurance pool.
Lastly, there is no silver bullet. The magic answer is not necessarily a public option or socialized medicine or maintaining fee for services or insurance exchanges. Once a health care bill passes it probably will take us 10 to 20 years to work out all the details, experiment with different delivery systems, try and find some way to contain costs, and make some very hard choices.
I believe that it’s manageable and I’m hopeful that they pass a health care bill. It’s not going to be perfect but neither was Social Security, which started in 1937, and Medicare in 1965. When they first passed, people shouted “socialism” and “bankruptcy.” Well, we’re all still here and I suspect 20 years from now some sort of nationalized health care, in whatever shape it finally takes, will seem as ordinary as Social Security and Medicare are today.