Is President Obama tackling too many issues? At a time like this, with the economy teetering, is it really wise to try to reform the health care system?

Pundits and politicians have been debating that question a lot of late. “This is no time to be taking on something as big and complex as health care,” the naysayers admonish. It’s no coincidence that many of them are politicians or high-profile media talking heads–among the lucky few who don’t have to worry about health care coverage. Most of them don’t have the foggiest idea what the rest of us are up against.
 
All you have to do is listen to the plights of millions of Americans who have been laid off and lost their health insurance–and millions more whose premiums keep going up even as insurers cut back on what they’ll cover–to know that health care is a big part of the current economic crisis. And it’s likely to get worse. Much worse. The Wall Street Journal reports that only 62 percent of large U.S. companies were confident they would continue covering workers a decade from now, down from 73 percent last year. If the economy continues its downward slide, that number could fall even farther.

For a measure of how sick–even deranged–our current system is, consider this: most insurers negotiate discounted rates with doctors and hospitals. But people who are uninsured can’t take advantage of such rates. Indeed, their bills, if they happen to land in an emergency room or hospital, can be five- and ten-fold times higher than what insurers pay for the very same care. The people who can least afford it, in other words, are charged the most.

Even for those of us with health insurance, deductibles keep going up on many policies–meaning higher out-of-pocket expenses. If you’re among the millions of self-employed Americans who have to shop for health care coverage, for example, one way to trim monthly payments is to choose a policy with a high deductible. That makes sense if you’re in good health. But if you get sick, you can end up spending $5,000 or more a year on medical bills even when you have health insurance. That’s on top of your monthly insurance bills.

And that’s assuming your insurer agrees to cover your medical expenses. Not long ago my insurer, Blue Cross, refused to pay a penny for a visit I’d made to the doctor. The astonishing reason: the insurer doesn’t cover preventive care. I’d made the mistake of going to the doctor to have my cholesterol, blood sugar levels, and blood pressure checked as part of a routine visit.

I should be grateful. When I ruptured my knee in a bad fall a year ago, my insurance company did pay for the surgery and doctor visits afterwards. (I still had to pay the first $5,000.) But thousands of Americans who think they’re covered are in for a shock when medical problems arise. Some companies don’t cover certain life-saving drugs. Others find ways to elude responsibility by claiming that a particular problem was a “pre-existing condition” and hence not covered. For a shocking story of one such case, check out the cover story in Time magazine’s March 16, 2009 issue, “So You Think You’re Insured? (Think Again.)”  Journalist Karen  Tumulty tells the moving and infuriating story of her brother’s battle with his insurance company, which tried every trick in the book to deny him coverage when he actually needed their help.

Deep worries about unexpected–and sometimes astronomical–medical bills are one reason Americans are increasingly afraid to spend. Just as damaging, our irrational health care system has made it impossible for many people to plan rationally for the future. In her article, Tumulty points to a 2005 Harvard University study of more than 1,700 bankruptcies in the U.S. Half were directly caused by medical problems. And get this: three-quarters of those bankrupt people had health insurance. “Nobody’s safe,” Elizabeth Warren, who helped conduct the study, wrote in the Washington Post in 2005. “A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs–until illness struck.”

If you didn’t catch NPR Terry Gross’ fascinating and impassioned interview with Princeton University health care economist Uwe Reinhardt on Fresh Air, “Hidden Costs of Health Care,” check it out. Not everyone will agree with Reinhardt’s policy suggestions. But all of us can agree with his assessment of how dysfunctional and cruel the current system is.

A strong economy requires a solid foundation of security. That’s what health insurance–and homeowner’s and car insurance and social security–are all about. A society like ours begins to fray when millions of our fellow citizens face economic disaster simply because they are unlucky enough to get sick. And with each round of new lay-offs, more and more Americans find themselves without coverage–facing potentially catastrophic losses.

PDQhealth agrees with President Obama: fixing the nation’s ailing health care system is a critical link in our economic recovery. There’s plenty to debate in the details. But the fact is, all the bail-outs in the world won’t help until all Americans can feel confident that they can get basic medical care at a cost that they can afford.

© 2009 PDQhealth

Tags: health care, insurance coverage