Compensation for labor is a major factor in a globally competitive marketplace. Companies that either have to pay wages high enough to provide workers with the resources to care for their families health needs, or provide insurance to pay for those needs, are at a financial disadvantage in any nation that does not provide at least a minimal plan to cover those costs. Industrialized nations, except the USA, provide some kind of guarantee for employee medical costs. Many of those countries also provide for the coverage of unemployed persons as well.
Virtually all protection provided in the United States is offered by private insurance companies. These plans are funded by premiums from the insured, or their employers. In the case of a small business, it is common to find the employer providing no coverage, and paying wages insufficient for the employee to provide for his own coverage. In some cases, the prevailing wage for the industry involved is to low, and in others, the employee considers health coverage an unnecessary expense. The end result is the same. Millions of working Americans are not covered by any insurance plan, or are dependent on insurance provided by the employer. If the employment is terminated, the insurance vanishes as soon as the former employee’s premium is not paid. As a result, millions of US residents are without any kind of secure insurance coverage until they are destitute, totally without resources or assets to pay medical costs. Those people are then covered by a hodgepodge of State and local plans.
Larger companies, and corporations, with resources to provide the insurance coverages do, in most cases, carry the burden, but the problem of the employee who departs from those companies remains the same as any person providing for his own health care. The cost of this insurance is reflected in the price of goods or services produced by the company, large or small. The company raises prices, or the employees are uninsured. It is a situation that damages the competitive position of American Corporations who employ insured workers. Either wages cover insurance premiums, or revenue of the company does, or there is no insurance of any kind.
A second problem faces both the insurance companies and those who have insurance coverage. This problem is subtle. It is the person with a chronic condition that can be controlled by medical intervention or the provider for such a person. That person will seek insurance as a first line of defense for his assets. Healthy young people frequently avoid health insurance, seeing it as unnecessary. The result here is high premiums. Since the insurance company must have enough revenue to cover the cost of claims, it is necessary to charge high premiums to the people who choose to be insured. In the meantime, the healthy uninsured are not burdened at all. You cannot choose to be healthy. You are either well or unwell. The vast majority of people are well, and many are not insured. They are the people who would oppose being taxed to pay for medical care. They are also the people who become the cause for high rates of unpaid medical costs. Accidents, and unexpected illness put them in the position of taking, without paying for, medical services. For them the gamble is disabling disease, loss of all assets, and destitution before the government steps in to keep them alive. Those unpaid medical bills are also a factor into high insurance premiums. If the providers of medical service are not paid, they cease to exist. The insured, to keep the hospital doors open, pay additional premiums to cover the costs incurred, and not paid, by the uninsured.
A single payer national health insurance program addresses all of these factors, in a fair and equitable manner. The choice of what to insure against or leave up to private choice is not easy, but it can be made. Even universal catastrophic coverage would be an improvement, providing coverage for those who become unable to work from day one would protect those individuals from destitution. Providing coverage through childhood would be an improvement. It would take the burden of insuring children off the employee with no children or family to care for. Federal insurance of people over a specific age, say 50, would also be an improvement. It would drastically lower the cost of claims for private insurance companies. Of course, this leaves everyone between age 18 and 49 in an insurance pool of healthy, vigorous (possibly pregnant) people. Insurance for the cost of pregnancy could be made available under a federal plan, and that would have tremendous benefit. This mixed bag of programs could make a huge difference, but they leave the group between 18 and 49 as involuntary payers of medical costs for everyone else, and still responsible for their own medical costs. Fortunately that does not have to be.
Using the models provided by other industrialized nations, it is possible to craft a single payer universal health care plan that is financed from the general revenues of the country, and is a lighter burden on both the providers of health services and their clients. Virtually every nation in Europe and, with the exception of the USA, North America provides universal health care. Each of these plans have some problems, and each has unique advantages. Using them as examples, the USA is positioned to become the world’s leader in providing for the health care of her residents.
There is one other point to be made here. While we battle heroically over the fate of millions of undocumented aliens, the health care issue languishes in the back rooms. While we beat our chests about the need to drive these foreigners from our streets, the Iraqi resistance continues to kill and be killed and we can't seem to get the flock out of there.
It is about time we started picking our fights more carefully.
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