We are witnessing the breakdown of the American health care system. The system was built piecemeal over a half century. The consequent defects of the system are well known; it is complex, incoherent, inefficient and costly. What now becomes clear is that there is no way the system can be sustained.
The basis of the system - employer-sponsored health insurance - was born out of an historical accident. In World War II, when wage-and-price regulations limited what employers could pay in competing for scarce workers, they turned to giving additional worker-incentives in the form of health benefits, which were not counted as wages. After the war, large industries such as steel and automobiles, with well-paid workers, established health benefits as a standard part of wages, supported by the government's decision to allow benefits to be deducted as business expense.
Efforts to establish national health insurance from President Truman to President Clinton were unable to overcome opposition by the American Medical Association and the private insurance industry, despite strong public support.
Medicare and Medicaid, established in the 1960s, complemented employer-sponsored health insurance by providing coverage for the elderly and the poor. Since that time, a number of government programs were created at the federal and state levels to meet the needs of specific groups, such as children. Most of the insured still depend on employer-sponsored private insurance.
As the cost of health insurance rises, employers are shifting more of the expense onto employees, and increasingly employers no longer provide insurance. Small employers are hardest hit by rising insurance costs, and in Colorado in one year 6.5 percent of the employers stopped providing insurance. When employers do offer health insurance, employees often decline to participate because of the high cost, which accounts for more of the rising numbers of uninsured than employers' refusal to offer insurance.
Those without employer sponsored insurance are forced to buy private insurance, but they lack bargaining power and have to accept inadequate coverage and exorbitant premiums. More people are forced into public health insurance programs, such as Medicaid, that are already under-funded and have restrictive eligibility requirements. Finally, the uninsured are forced to seek medical service in hospital emergency rooms-the most costly and inadequate form of medical care-and the cost is shifted onto the insured and the taxpayers.
The current system leaves 770,000 Colorado residents uninsured (17 percent of the population). The United States spends twice the amount per capita on medical care as other industrialized countries, which have universal coverage, but we leave 47 million people (80 percent of whom are employed) without health insurance. The United States spends more on health care and receives less; comparisons of the quality of health care between countries leave the United States far behind the top nations.
American health care is in bad shape, and it is becoming worse. All the current health care measures are negative. The rising costs of health insurance and medical services far exceed the rate of inflation.
Public opinion polls show an increasing demand for health care reform.
Many states have instituted major health care reforms, and Colorado is now engaged in the process. The Blue Ribbon Commission on Health Care, created by Senate Bill 208 and signed by Governor Owens, has been assigned the task of recommending comprehensive reform of the Colorado health care system. Nothing less than comprehensive reform will meet the need, and given the rapid deterioration of the present system, it had better be soon.
Clark Bouton, Ph.D., is a retired professor of political science and sociology. He is a health care organizer with the Colorado Progressive Coalition |
