Universal Coverage Is Within Reach, If the Pain Is Shared Equitably
Ten years ago, a vicious cycle of rising prices and declining access forced health care to the top of the national agenda. Now that destructive spiral is spinning again -- with the same result.
Everywhere signs are proliferating that the health-care system is breaking down under the same pressures that inspired President Clinton's ill-fated crusade to guarantee universal coverage.
Three consecutive years of double-digit increases in health insurance premiums are straining employers and igniting conflicts with employees asked to bear part of the burden. Health-care costs have become a growing factor in labor confrontations, like the two bitter strikes underway in Southern California.
The rising costs are also compelling more employers to stop offering health coverage at all -- and more employees to decline it even when it's offered. Since President Bush took office, the number of Americans without health insurance has soared by 3.7 million, to 43.6 million, the biggest two-year increase since his father was president.
These problems of cost and access are inextricably connected. It's easy to see how rising costs translate into reduced coverage. But the reverse is also true. The growing number of Americans without insurance means that doctors and hospitals have to provide more uncompensated care that must be subsidized by the premiums of those with insurance. As Bruce G. Bodaken, chairman and president of Blue Shield of California, put it in a speech last winter: "In essence, we are charging the private health-care system a hidden tax, a tax that can't be sustained
That should be the real issue in the current struggle over health-care costs. As a group, employers are getting a bad rap. Some may be trying to shift an inordinate share of the health-care bill to their employees. But the employers providing coverage are not, en masse, abandoning their responsibilities.
Employers who provide health insurance are not shifting a larger share of the premium cost to their workers, according to the definitive annual surveys by the Kaiser Family Foundation. In fact, the trend is slightly in the opposite direction. Ten years ago, employees contributed 32% of the cost for insurance; now the number is 27%, Kaiser found.
And while total out-of-pocket health-care costs for employees have jumped 50% in the last three years, that's no faster than the rise in premiums paid by their employers, Kaiser's surveys show.
