Broken health care system best served by regulation

Wednesday, January 23, 2008

By Will Richardson

Health care reform has become a hot issue in both state and national politics, and a look at some statistics tells us why.

More than 47 million Americans are without health insurance, many because employers can no longer afford the high premiums charged by insurers.

Each year, the number of Americans losing employer-provided insurance grows by 3 percent, and the cost of insurance premiums increases at three times the rate of inflation. The per-capita health care cost for Americans is a staggering $6,401 a year, by far the highest in the world.

Coverage for health care has long been a problem for the sick, disabled and older adults in our country, creating the need for the Medicaid and Medicare programs. But now, loss of coverage is creeping up through the middle class at an alarming rate.

The American health care system is like the gradually sinking Titanic. Poorer passengers on the lower decks are consumed first, while wealthier passengers on the upper decks are still in denial that a problem exists.

As the water rises through the decks, the middle class -- represented by the third-class and second-class passengers -- becomes affected. In the case of the health care crisis, the cries for help have become too loud to be ignored by politicians.

Most politicians now concede that some form of universal health care system is inevitable. The devil however, is in the details. Some leaders, including U.S. Sen. Hillary Clinton and Missouri Gov. Matt Blunt have proposed private insurance as the answer, but the track record of private health insurers is an ugly one.

Internet research reveals scores of complaints by consumers who thought they were covered, but when confronted with a health crisis learned otherwise.

Denial of coverage for pre-existing conditions and other loopholes have caused many bankruptcies and other hardships. Insurers cherry pick for the healthiest consumers while discarding the less fortunate like a bad investment. Our health care system cannot be run like any other business. The health of our citizens, not profit, must be the driving force.

The Medicare Advantage program is a classic example of privatization gone amok.

Federal lawmakers wanted to allow those on Medicare to move to private insurers. What followed was chaos. Private insurers pounced on older adults with a marketing blitz making false promises about coverage and misleading many into believing they were being offered a supplement to their existing Medicare coverage. Many unknowingly left Medicare only to find that they were under-insured and that many providers would not honor their private policy. Many thousands have returned to Medicare, and the government has sanctioned numerous insurance companies for their unscrupulous tactics.

In Missouri, workers' compensation is a shameful example of the failure of private-sector insurance.

Most workers probably don't realize that employers must buy workers' compensation insurance from private insurance companies.

Several years ago, Missouri lawmakers claiming the system favored the worker over the employer, made a number of changes. The system now so favors the insurance carriers that they can wage a war of attrition against injured workers in order to force them into accepting a minimal settlement and terminate medical care long before the worker is able to return to work.

Insurers evaluate injured workers using contract doctors who are beholden to the insurer and often turn a deaf ear to the wishes of family Doctors and surgeons.

The Internet is littered with horror stories about these practices and the resulting financial ruin and medical miseries suffered by victims of it.

I am personally familiar with the case of a restaurant worker who suffered a broken hip and knee injury on the job. Medical help and pay were cut off to her after the carrier's doctor ignored pleas from therapists who recommended extended therapy. He pronounced her ready to return to work when, in fact, she still requires a cane in order to walk.

In this case and many others, the worker's health, financial well-being and return to productivity were clearly secondary in importance to the carrier after profits.

Other countries have developed successful universal health care systems that rely on private insurers.

What we have learned from them is that strict government regulation and oversight are prerequisites to a fair and workable system.

Lobbyists for special interests such as the insurance and prescription-drug industries are certain to fight until the bloody end to prevent regulation and oversight. It will take a groundswell of support at the grassroots level to eventually break the strangle hold these industries have on our health care system.

Will Richardson is director of outreach and education at the SEMO Alliance for Disability Independence in Cape Girardeau.

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