Truth about health care: System was already broken

Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in Washington, Wednesday, Oct. 30, 2013, before the House Energy and Commerce Committee hearing on the difficulties plaguing the implementation of the Affordable Care Act. The Obama Administration claims the botched rollout was the result of contractors failing to live up to expectations  not bad management at HHS. As the public face of President Barack Obama's signature health care program, Sec. Sebelius has become the target for attacks over its botched rollout with Republicans, and even some Democrats, calling for her to resign. (AP Photo/J. Scott Applewhite)
Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in Washington, Wednesday, Oct. 30, 2013, before the House Energy and Commerce Committee hearing on the difficulties plaguing the implementation of the Affordable Care Act. The Obama Administration claims the botched rollout was the result of contractors failing to live up to expectations not bad management at HHS. As the public face of President Barack Obama's signature health care program, Sec. Sebelius has become the target for attacks over its botched rollout with Republicans, and even some Democrats, calling for her to resign. (AP Photo/J. Scott Applewhite) (AP)
Posted: November 11, 2013

If a picture is worth a thousand words, sometimes a handful of numbers can prove just as valuable. Take these:

The average annual health-insurance premium for a family that gets coverage through work: $16,351.

The median income last year for a family of four: $79,698.

The gross annual income for a full-time worker earning the federal minimum wage: $15,080.

Those numbers tell a crucial story getting lost in the noise over the troubled rollout of the online insurance exchange at HealthCare.gov and the anger and confusion over cancellation notices - about 3.5 million so far, by one estimate - blamed on the Affordable Care Act.

It bears repeating here. The 2010 law wasn't a needless intervention in a well-functioning insurance market. It was designed to address a failure of that market to meet a basic human need - a failure those three numbers reflect.

To cover the cost of an average employer plan, a median family of four - one that earns more than half of all similar families - would have to spend about 20 percent of its gross income, before co-pays and other costs. And a minimum-wage worker? There's no math to do.

A result of that market failure is that 47 million Americans - more than 1 in 6 of the non-elderly - still lack health insurance, according to the Kaiser Family Foundation. And millions more remain underinsured, which means they risk learning what they lack at the worst possible time: if serious illness strikes them or a family member.

I'll leave it to others to argue whether President Obama's repeated statement that "if you like your health plan, you can keep it" was a terrible lie or an ill-advised oversimplification by its pitchman-in-chief. Yes, the law really was designed to enable people to keep even lousy policies - if the insurer kept offering them with limited premium increases. But it was also designed to eliminate them, sooner or later, because of one key fact: Someone eventually has to pay for care they fail to cover.

Last week, I described some of the 24,000 Independence Blue Cross policyholders whose insurance has been canceled - including two who stand to pay less for better insurance thanks to the law's subsidies. (To see if you qualify, check the Kaiser Family Foundation calculator at http://bit.ly/13YLrxq.)

One reader called to say I'd missed critics' point. "We need to take care of people who don't have insurance, but not to discontinue people who have their insurance," she said. "It is not up to the government to decide what is better for me in my plan - not in America."

I'll grant this much: She's at the crux of this painful, national fight.

Obamacare was never what its foes labeled it - a "massive government takeover of health care" - but let's be clear: It was the culmination of a decades-long dream among Democrats and even some Republicans to bring America the universal coverage enjoyed since World War II in every other industrialized country.

To many liberals who would prefer a single-payer system such as "Medicare for all," Obamacare was a large concession at the outset. Its basic architecture was devised years ago by the conservative Heritage Foundation. It was tried out in Massachusetts - successfully - by former Gov. Mitt Romney, even if he tried to hide from it as last year's GOP presidential nominee.

How do you do what Obamacare intends: Offer universal access to affordable coverage without totally upending private insurers?

You do what Obamacare does. You require everybody to have coverage. You provide it at very low cost to the poor - a key feature of Obamacare that leaders like Pennsylvania's Gov. Corbett have shamefully undermined, after the Supreme Court ruled that states couldn't be required to expand Medicaid as the law envisions. And you subsidize coverage up the income ladder - to $94,200 for a family of four. The Urban Institute's Stan Dorn says about 6 in 10 such families would qualify if they lack access to coverage at work.

Oh, and you do one other thing: Set rules for the market, so that policies meet minimum standards for coverage, including capping out-of-pocket costs if someone faces cancer or a bad car crash.

Will some wind up paying more? Yes, especially some able to buy good coverage now at low rates because they look like especially attractive risks to insurers. Just like the job-related insurance most of us rely on, Obamacare is designed to spread the risks as broadly as possible.

That is the point I wish Obama had stressed, rather than the one that's got him in hot water now: We all pay something, and some may pay a bit more, but we all get a more humane system. That seems plenty American to me.


jgelles@phillynews.com

215-854-2776 @jeffgelles

www.inquirer.com/consumer

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