National Health -- Why It's Needed

In the last three and half years, during the reign of George W. Bush, the number of Americans without health care has increased by about five million. The cost of health care has metastasized at about 7% a year. That is twice the growth rate of the GNP. The longer this trend continues, the more people there will be without health insurance at all.

The injury to the economy is staggering. Already, at least 15% of GDP is absorbed by health care. Premiums for health insurance provided by employers have risen by more than 11% this year alone. Few employers can bear a hit like that, especially year after year, and many are forced to eliminate health coverage, to cut it back, or to shift the burden onto employees in the form of higher co-payments and deductibles.

Of the uninsured, more than 20 million are working full time.

The strain of covering workers also has led would-be employers to hold back on hiring, slowing the economy further.

Candidate Bush has reluctantly addressed the issue by proposing to offer tax credits to low-income people to help pay the cost of health insurance; and by calling for an expansion of the Health Savings Accounts program passed by Congress earlier this year to enable participants to put pre-tax money into savings plans similar to 401(k)s.

People using the shelter are forced to buy health insurance with high deductibles (at least $1,000 a year for an individual, $2,000 for a family). High deductibles, which shelter insurance companies from paying for routine medical care, are intended to hold down premiums (if you are paying a high premium on a policy carrying a high deductable, you're permitted to enquire if this works), but by discouraging doctor visits for minor illnesses and preventive care they end up adding to the cost of health care in the long run.

In theory, money from a tax-free savings account would be used to pay deductibles, and could build up over time, but the idea begs several questions, most notably where it is low-income people are going to get the money for their premiums, let alone how they will be able to find resources to build up savings. Bush says he wants to make premiums tax deductible as well. And he'll tackle the soaring cost of malpractice insurance with tort reform, long-sought by sectors of the business community, by for example capping awards for pain and suffering, fine unless you're the one experiencing the pain and suffering.

Bush's plan is expected to cost about $90 billion over 10 years, small potatoes compared to the cost of his war.

Candidate Kerry's proposal will cost 10 times as much or more, but it will cover 10 times as many people, as many as 27 million who aren't protected now.

Kerry would cover these expenditures by rolling back the Bush giveaways to taxpayers making more than $200,000 a year.

Kerry will create a government insurance pool to cover 75% of the cost of any individual claim that exceeds $50,000. Lower premiums for employers, it is hoped, will encourage more businesses to offer coverage, but there is no guarantee. Also, the senator would allow ordinary citizens to subscribe to the health coverage enjoyed by federal employees, such as members of Congress. And he would broaden Medicaid and the State Children's Health Insurance Program.

It goes without saying that Kerry's plan is a non-starter without Democratic control of both houses of the legislature, looking not likely as we make the turn into the home stretch of the campaign.

How much effect either plan would have on the heath care cost spiral is questionable.

The politicians focus on the price of health care, ignoring the fact that there are always more products and procedures to pay for and for much longer periods. Once upon a time, if you had hypertension, say, or high cholesterol, you lived with it -- without taking expensive drugs for decades on end -- until it killed you, that turn of events acting as a further brake on health costs.

The number of tests ordered by doctors has increased exponentially in the past decade. Whether this is because doctors are fearful of litigation for being "negligent" or because they're feathering their nests hardly matters here; the point is, the price to the consumer of the individual components of health care is only one factor affecting the cost.

If your health care is more costly but the length and quality of your life is also vastly improved, it does occur to you to wonder about the ROI. Though making health care affordable is vital to this country's continued progress, it may help to temper the tone of the debate if it is kept in mind that, given the extraordinary progress in the improvement of health care, it isn't extraordinary that it costs more than it used to.

Calculating the worth of health care is not easy. If your roof is leaking, you can figure out what it is costing you in damaged possessions or lost value, get estimates from a few reputable contractors, and make a reasonable decision about how fix it.

Most medical problems are far more subtle than a leaky rook, but even when the need is evident and immediate, as in the case of a broken leg, say, there is no way that you can be expected to shop sensibly either for the best price or even the best contractor. If you're insured you have no motivation to get the best price -- that's the insurer's problem, and they have probably made the decison about who you can hire to do the repairs.

It's clear that, in this as in most things, the enlightened and responsible choice in November is Kerry, not Bush. But it is equally clear that health care is not an issue that is going to be decided by the election. On the Wednesday after voting day, it will be time to start a new round of debate -- and, one hopes, on the part of the MoveOn.Orgs and True Majoritys a renewed enthusiasm for organizing -- on national health.