In his address at the National Academy of Social Insurance last January 31st, Dr. Uwe Reinhardt, a top health-care policy expert, related our approach to health insurance to who we are as a nation and people.
Reinhardt, James Madison Professor of Political Economy at Princeton University, is aggravated--he even used the word "angry"--about how the high cost and limited availability of health insurance is adversely affecting hard-working Americans.
While the middle and lower classes are suffering income losses, they are paying a larger proportion of health care costs. Also, Reinhardt reflects on conversations with his son, a Marine officer who served in Iraq, about how health insurance and other benefits determine enlistments in our "all-volunteer" military forces.
As keynoter, Reinhardt dutifully recited the cost of American health care, $2.2 trillion, 16.2 % of the GDP now, and an anticipated $3.3 trillion in 2007 dollars in a $17 trillion GDP (also in 2007 dollars) in 2016, representing 19.4 % of our gross domestic product.
Even relative to the dismal future, Reinhardt expressed more concern about the waitress today who doesn’t have insurance, and today’s "veteran who doesn’t get mental health care."
Reinhardt hit three other pertinent themes: He cites the Institute of Medicine, which estimates 18,000 people died in 2002, for lack of health insurance. Meanwhile, President George W. Bush’s was contending people in America do indeed have access to health care: "You just go to the emergency room." It’s a well-known fact the president and his party opposed S-Chip, the expanded Medicaid program for uninsured children, because they believe anyone who can possibly afford insurance must buy it privately.
Reinhardt also mentioned the egregious law that pays insurance companies 112% of average Medicare regional costs to enroll Medicare D recipients--and realize great profits . (Only a filibuster-proof 60 votes in the Senate can repeal this increased burden on the squeezed Medicare dollar.)
He notes that with continuing 8% annual cost growth for employer-purchased health insurance, "Ten years from now half of the wage base will be eaten up by health costs alone."
"The argument is employers will simply go to high deductible policies--but that just shifts the agony of their payroll expense back into private households."
Reinhardt illustrates most private households are already relatively poorer than they were in the recent past: "The top 20% get 58% of all income earned; the bottom 40% get 10%." "The top 20% own 85% of the wealth in America." The result is more without health insurance.
Reinhardt recently interviewed Ulla Schmidt, German Minister of Health, who explained, "We have a contract of social solidarity. It is not right to have people uninsured. It is undignified to force people to beg for health care."
Well, maybe we are at least patriotic. Reinhardt is not so certain. His son, a Marine officer, gave his flak jacket to an enlisted man, because there were not enough jackets for everyone.
And, who are the enlisted personnel?
"Here is Staff Sergeant Lopez, ‘I don’t want to leave the Army and end up working for McDonald’s. Here I get a steady check and benefits for my wife and kids.’"
Reinhardt suggests, "Maybe deep down people are thinking, you know it’s not so bad to have a lot of economically depressed. Helps us to have an all-volunteer Army so my kid doesn‘t have to go."
He continues, "So in thinking about whether we can have universal insurance, I always have to ask myself, are we really a nation? Or are we just an economically, culturally diverse group of people who happen to share a geography, but who lack a strong sense of social solidarity and lack even patriotism, with each individual just trying to maximize his or her take from the country."
He believes at least half his Princeton students are in it for the take, and, it’s not incidental that only five of 1200 donned their country’s uniform after graduation.
Reinhardt, veteran of many health policy wars, closed wistfully with the thought "achieving universal coverage in this country is a major political challenge--and always worth trying."
Dr. Roy may be reached at firstname.lastname@example.org