Sunday, January 3, 2010

Universal health insurance: At what cost?

Last week a legislator from my home town of Barre, Vermont, proposed legislation that would create a public health insurance option for residents of our state, that sounded like a misguided idea on a couple of fronts.

On a national or federal level it can be frustrating when financial concerns are constantly raised as a reason for why we shouldn’t take care of people, but on a more local level financial considerations must be considered. Specifically, national healthcare funding is more realistic due to larger cash flow. The funding mechanism being proposed by my local legislator is a 10% payroll-tax increase for residents of my small state. Health insurance is a good thing, and should be a right in any industrialized nation. But simply having health insurance, or having it available to you, is meaningless. The goal should be a healthy population, not simply a well-insured one. And creating the environment that fosters health requires more than just insurance. The difference is important. Raising taxes has the potential to cause adverse health impacts by discouraging economic growth and taking money from the pockets of everyone with a job. How will people living on the economic margins adjust to even a few dollar-a-week decrease in income: Will they buy less food for their family? Turn the heat down a little lower? Avoid buying new winter boots for the kids? Cancel discretionary educational activities for their kids? Postpone new tires for the car? There are many ways to save, and many with long-term health implications. The view that simply providing cheap insurance to fund occasional health crisis is the best way to make people healthier, while reducing their ability to provide for the daily needs of life, is short sighted.

Then there is the logic of whether yet another stop-gap, under-funded financial bandage stuck to the ugly conglomeration that we call the US healthcare system is really wise. The current bureaucracy needed to manage the hundreds of health insurance options currently available is staggering. Not only is it wasteful and unsustainable, but it is also harmful. Try to fill out the necessary paperwork to enroll in Medicaid (for the poor), Medicare (for the elderly), or try to determine whether your 65-year old (Medicare-eligible) low-income parent is eligible for assistance to cover premiums. It is a recipe for frustration that without doubt leads many people to give up or drop out.

We do need a well-insured population that can access high quality healthcare. But we also need people to be able to afford food, clothing and warm homes. And no one is suggesting a 10% tax increase to fund safe, decent, affordable housing; or better education for our children; or public transit; only to pay more doctors, hospitals and pharmacies to do more things that we can only hope will make us all healthier and happier.

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