Aug 20, 2002
State must take lead on health care
San Diego Union Tribune
by Jamie Court & Frank Smith
Mr. Court is executive director of the Foundation for Taxpayer and Consumer Rights. Mr. Smith is a senior fellow at the Civil Society Institute. They are co-authors of "Making a Killing: HMOs and the Threat To Your Health." The following commentary was published in the San Diego Union Tribune on August 20, 2002.
The recent Capitol Hill burials for a Medicare prescription drug benefit and HMO reform signal that California must take matters into its own hands. Gov. Gray Davis should convene a special session of the Legislature to lead nationally on a crisis of new salience for an important voting bloc confronting tremendous fear.
Children born in the wake of World War II could be facing the battle of their lives, simply affording their health care. The stock market's bust may take its greatest toll on baby boomers' ability to pay for escalating health care costs. An aging population facing withering health and skyrocketing costs can least afford to lose such a massive amount of wealth.
The reason health care stocks have remained one of the best bets on Wall Street is that as baby boomers get older and sicker, and medical technologies improve, there will be a huge demand for expensive health care services. Absent a government policy to protect patients until they reach Medicare age, health care costs could be the death of the baby boom.
Health insurance premium costs for the elder generation not yet eligible for Medicare have soared annually as much as 80 percent, particularly if the patient is unable to work and cannot take advantage of a group discount. Many pre-Medicare boomers have not retired specifically to retain their health care benefits. The move in the 1990s from retirement plans that typically included health benefits to 401(k) accounts that did not has made matters significantly worse.
In addition, the evolving ethos of the new health care economy is cost-shifting from employers and insurers to patients. Patients are forced to pay greater co-payments and deductibles for hospital stays, prescription drugs, diagnostic tests and doctor visits. The government currently has no say on such matters.
While the unregulated costs of medical technology and services are soaring, those without insurance are asked to pay the heftiest price since they do not have the negotiating power of an insurer or employer. Unlike other essential services such as telephone, water and electricity, those who can afford to pay the least are charged the most. A three-day hospital stay that costs an insurer $4,000 can cost an uninsured patient $25,000 or more. Then there is the cost of long-term care, in nursing homes or in private homes, that is not covered by the government unless all of one's assets have evaporated.
Since baby boomers are the most reliable voters, convening the Legislature to focus solely on these issues would be both good politics and policy. The statehouse should deal specifically with recent developments that may merit creating a California Medicare program which brings cost controls and access guarantees to medicine:
- A recent Davis administration study of extending universal health care options through a variety of mechanisms found significant savings for the health care system, in the tens of billions of dollars, if all Californians were insured. Now legislators should debate the options without other matters to distract them.
- Annual double-digit premium increases for small and mid-size businesses, 30 percent for many, has created an unprecedented desire among businesses for state regulation over health insurance premium increases, similar to state-approval systems for auto and commercial insurance.
- Budget shortfalls threaten to devastate county hospitals, emergency rooms, trauma centers and clinics. Now is the time for talk about a comprehensive solution rather than face more piecemeal crises.
- Discontented physicians, nurses, hospitals, patients and employers never had greater common cause to make the health care system more cost effective.
"In Life Before Medicare," a Canadian woman described her mother's battle with ovarian cancer before universal health coverage was enacted in Canadian provinces during the 1940s, ironically when the baby boom was born.
"After she had been in the hospital for a week, we went to visit her after supper and found her crying almost inconsolably. Some idiot in the business office had left her bill for her surgery and first week on her bedside table. My parents' savings of 22 years were gone."
It's a story that could be repeated in California today with a working family. The generations born into a great promise of prosperity deserve better. As one province, Saskatchewan, led the Canadian health care revolution, one state can lead America's.