THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Monday, August 15, 1994 TAG: 9408130001
SECTION: FRONT PAGE: A6 EDITION: FINAL
TYPE: Guest Column
SOURCE: By PAUL BOYNTON
LENGTH: Medium: 91 lines
Tony Snow's columns on the health-care-reform debate (op-ed, July 14 and 18) are both misleading and inflammatory. They contrast markedly with two columns appearing on July 15, wherein Cal Thomas basically agreed with Ellen Goodman that the Federal Employee Health Benefit Plan is unbureaucratic in nature, comprehensive in scope of coverage and allows patients to select plans, physicians and hospitals.
Goodman argues for 100 percent rather than 95 percent coverage. Thomas says, ``What Congress and nearly 10 million federal employees have is, indeed, what the country ought to get.'' That's a far cry from Snow's dictum, ``Universal care is for suckers.''
Snow maintains that ``The offer of universal care thus shoves prices higher by urging people to go on shopping binges'' and ``Consumer demand sends prices soaring.'' Those claims rely on studies showing that patients forced to pay a 20 percent co-payment rate on billed charges tend to decrease utilization no matter what type of insurance coverage they have.
That's why many health insurers added co-payments to the deductibles that their enrollees were already required to pay. But Snow's claims ignore the fact that physicians still must determine what tests, therapies and hospital admissions are required in response to the symptoms patients present.
Moreover, Snow's claims carry the co-payment research to an extreme in that they ignore research that has shown that the poor and uninsured often wait too long to seek care precisely because they know they will not be able to pay for it. Thus, when they do get needed care, that care is often much more expensive than it would have been had they sought it earlier. The cost of such care gets passed along to those of us who can afford to pay, in the form of higher premiums paid by employers/-employees, higher product charges paid by consumers and taxes for such public programs as Medicare/Medicaid.
Like it or not, cost-shifting still occurs. Some large employers have been able to reduce the amount shifted to them that results in even greater costs being shifted to those of us who pay but don't have the clout of those large employers.
Unless necessary care is to be denied the uninsured, cost-shifting will need to continue until some form of coverage is arranged for them. That shifting is the invisible tax we will continue to pay for charity care; general tax increases or the elimination of tax avoidance (like non-profit status for organizations whose work is mostly non-charitable in nature) is still potential political suicide.
Thus, without such tax increases/-changes, the ``employer mandate'' comes to seem more compelling for three reasons.
1. Most health insurance is now provided by one's employer with the employee usually paying a portion of the costs.
2. More than 85 percent of the uninsured are employed and not on welfare, but with low wages they are not able to pay the rent, put food on the table and also purchase health insurance.
3. When some firms will not or cannot provide health insurance for their employees, the rest of us have to ``pay the freight'' through cost-shifting when one of the employees gets seriously ill or injured.
Also, for those believing that Medicaid pays the full health-care bill for all of the poor, it needs to be remembered that in Virginia and nationally, Medicaid covers only about 45 percent of those with incomes at or below federal poverty level. Moreover, unlike Medicare for the elderly, Medicaid often does not pay even the actual costs (not charges) for a patient's care.
The Virginia Hospital Association notes that Medicaid pays only about 71 percent of community-hospital Medicaid-patient costs, and low payments to physicians have also been a major cause of either refusing to serve Medicaid patients or refusing to increase the size of present physician Medicaid-patient loads.
Thus, when one realizes that Virginia hospitals have a financial incentive not to serve Medicaid patients since they stand to lose about 30 cents on every dollar of their costs and that they have an added incentive not to serve the uninsured since they potentially can lose every dollar of their costs and that about 1 million Virginians (about 15 percent of the state's population) are uninsured, it is easier to understand why the uninsured have increasingly become the health-care pariahs of this society. Basically, everything works against them, and it is to the great credit of providers who do serve them that rationing isn't worse than it is.
Of course, if one refuses to realize any of this, then it is much easier to hold Snow's view that ``Universal care is for suckers.''
I hold no brief for the Clinton plan, but one has to ask, ``Aren't we even bigger suckers to allow the cost shifting to continue when the magnitude of those costs and/or their rate of increase can be reduced by solving the problem of providing health insurance for those who can't provide it for themselves?'' MEMO: Mr. Boynton is executive director of Eastern Virginia Health Systems
Agency and a past president of the Virginia Public Health Association.
by CNB