Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, May 6, 1990 TAG: 9005080497
SECTION: EDITORIAL PAGE: F3 EDITION: METRO
SOURCE: JAMES G. NUCKOLLS
DATELINE: LENGTH: Medium
Most Americans are fortunate to be under the system that allows them to obtain affordable health insurance through their employer. They can obtain the latest in treatments, along with regular preventive care from their own physicians.
Most importantly, they know they can get good care when they need it - without worrying about how they will pay for it.
But more than 30 million Americans don't have health insurance. They receive care, if they are able to obtain it at all, in a completely different world.
For them, delays in obtaining care are common, and preventive care is virtually unknown. A major illness can mean personal bankruptcy, and even minor illnesses can represent an intolerably high expense.
Who are the uninsured? They're neighbors, the clerks in the store down the street, the waitress at your favorite restaurant, the construction crew putting up a building across town. The problem can affect anyone: Even Americans with good health-insurance are at risk of joining the ranks of the uninsured if they lose their jobs or suffer a major illness.
As an internist, I see firsthand the problems that occur when people don't seek needed medical care because they're afraid of how much it will cost.
The United States traditionally has relied on the employer to provide insurance for employees. But about 60 percent of the uninsured either work full time or are dependents of someone who works full time. Twenty percent work part time or are dependents of a part-time worker.
The Congressional Budget Office estimates that requiring all employers to provide health insurance for their employees would cover about 23 million of the 30 million or more currently uninsured. This method enjoys extraordinarily broad public support - approximately three out of four Americans questioned in recent polls believe employers should be required to provide health insurance.
Small businesses, understandably concerned about how much the requirement would cost, should receive special assistance to make health insurance more affordable.
Many policy-makers support this approach. It's the basis for a plan proposed by the U.S. Bipartisan Commission on Comprehensive Health Care (known as the Pepper Commission) and for legislation introduced by Sen. Edward Kennedy, D-Mass., and Rep. Henry Waxman, D-Calif.
Even if employers are required to provide insurance, there still will be some people left without coverage - the unemployed, the self-employed and part-time workers. Medicaid, which currently covers just the poor, should be turned into a source of funding for health insurance for all individuals, regardless of income, who are unable to obtain employer-based health insurance.
To control the costs of medical care, research is being conducted to provide physicians with more scientific information on what treatments are the most effective and in what cases.
Armed with this information, we can eliminate ineffective care. Reducing bureaucratic paperwork and complex claim-procedures, along with instituting reforms in the medical-liability system, would also help to moderate costs.
In addition, some level of patient cost-sharing is necessary in all insurance plans to encourage both patients and physicians to use medical services judiciously.
Reforms in insurance and medical liability should contribute to reducing the cost of care.
Finally, Congress should enact measures to encourage the availability of private insurance for long-term care. Right now, insurance that would cover an extended nursing-home stay is too costly for the majority of Americans.
A national health-insurance program run by the federal government could cost more than $300 billion a year and force a significant federal tax hike. Providing more insurance through the workplace would cost the government much less.
In addition, building on our current system would allow Americans to keep the freedom to choose different insurance plans to suit their individual needs.
Millions of uninsured Americans are effectively held hostage while policy-makers in Washington argue over whether now is the time to act.
Ask my patients. Better yet, ask those who never get to see me because they lack health-insurance coverage and are too proud to ask for charity.
They'll all tell us the same thing. They want action - not next year or the year after, but now.
by CNB