No matter how you slice or dice it, no matter how you package it, HMO, PPO, POS, our health care system is still not working when individuals cannot get health care coverage in North Carolina. In fact, according to the Health Insurance Association of America, nearly 17 percent of non-elderly North Carolinians are uninsured. That means that out of 6.58 million residents in 1999, approximately 1.15 million are uninsured. That was the tally even before the recent economic downturn. It is highly likely that many more have joined the rolls of the uninsured over the past two years.
For much of the eighties and the early nineties, healthcare costs seemed to be out-of control. With costs rising at double-digit rates of inflation each and every year, federal and state governments attempted to regulate the health care industry to rein in costs. Instead of adopting a broad-reaching federal healthcare reform package in 1993, the healthcare industry reorganized and adopted “managed care” as its primary strategy for cost containment. HMO’s and PPO’s popped up in every community. Fee for service coverage from traditional health insurance companies became virtually non-existent.
Apparently managed care worked…at least for a few years. In April of this year, PriceWaterhouseCoopers (PWC) released a report showing that premium increases actually fell during the early to mid –1990’s and were at record lows from 1994 to 1998. However, health care costs are again increasing at double-digit rates. PWC projected the overall increase to be 13.7 percent from 2001 to 2002 for large employers. If that is the increase for large employers, then you can surely bet that small employers should expect at least 15 percent increases and maybe as high as 25 percent even if their employees are healthy. If they have any major infirmities within their employee populations they will experience even higher premiums. With costs increasing at that rate, the number of uninsured individuals will continue to grow even more rapidly than expected.
Our American health care system relies primarily upon employers to provide health care coverage to their employees. Since World War II, the federal government has encouraged employee health care coverage by providing tax deductions for health care premiums to employers. Over the same period, individuals and persons with sole proprietorships have not been allowed the deductibility for health care premiums from their income.
Small business problems within the current health care system go beyond the costs experienced by all employers. Many small businesses do not have adequate access to insurance for all of their employees, certainly not at an affordable price. While the U.S. is spending more on health care — by any measure — than any other country in the world, we continue to have the highest rate of uninsured individuals in the industrialized world. Something is fundamentally wrong.
It is time to once again address health care reform. The argument against a federal health care reform package was that health care is delivered locally. It was argued that federal mandates and a federalized system of delivery were only more expensive and complex. It appears that we are bound to experience more double-digit health care premium increases for the foreseeable future. We simply cannot stand for that. It is time to fight for further reform, but more appropriately for reform that serves those with the greatest need… small businesses and individuals. Those are the unfortunate losers in our health care system.
The battle for health care coverage needs to be fought on two fronts…first, contain costs and second, increase access. Why not provide the same deductibility to self-employed and to individuals purchasing coverage for themselves and their families! Why not make sure that doctors and hospitals publish their rates and charges so that individuals can apply consumer pressure to lower costs! We must bring pressure locally and statewide to promote change. That change must occur on the state and national levels to succeed.
We always fear inappropriate change and the imposition of costs that we cannot stomach, but living with healthcare cost increases like those that are projected and watching the number of uninsureds climb is even more unacceptable. We have wonderful healthcare for those that can afford it. We need to open avenues so that more can afford it and participate in our wonderful healthcare delivery system.