Most Americans understand that our health-care system is not sustainable, and that without significant reform, it is headed for a complete meltdown. Too many people—47 million at latest count—lack health insurance; far too many do not have a regular source of care and use costly emergency rooms for routine care; per-person health-care costs are as much as 250% higher in the U.S. than in any other developed nation; and the quality of care, even for those who are insured, is—in the words of one recent expert report—"mediocre at best."
In that context, President Bush is to be commended for making health insurance coverage a top priority for his Administration, and for calling on Congress to address the matter. The President has already demonstrated that he's willing to invest taxpayer dollars in health programs that generate results. Since taking office, he's prodded Congress to expand funding for Community Health Centers, resulting in 5 million more Americans gaining access to affordable primary health-care services.
Dubious Tax Breaks
In his State of the Union address, Bush outlined a roadmap that involves tax deductions for insured individuals and families, designed in part to give the uninsured an incentive to purchase coverage. But it doesn't necessarily chart the right course, and it contains a few too many detours. In other words, you can't get there from here.
Changes in our current system of health care must simultaneously deal with three important elements: cost, quality, and access. Even if we follow through with the President's proposal to change the financing of health care for millions of people, there is little promise for progress on either cost or quality. More worrisome still is that the Administration proposal could unintentionally trigger a serious erosion of current coverage without making health insurance more affordable to those who need it most.
This is because the tax changes proposed could lead both those who presently have adequate coverage and those who may seek coverage to pursue insurance policies that fall within the limits of the proposed tax benefit; the maximum allowable premium is relatively low. Unfortunately, most policies available today in this less expensive category fail to cover crucial preventive and primary health-care services—the most cost-effective of all health-care services, because they lower the need for specialty care, reduce hospital admissions, and provide a vital, less costly alternative to emergency rooms.
Inadequate Primary Care
More than 6 million of the 16 million patients receiving care at health centers today are completely uninsured. Health centers tell us that they are seeing a new wave of people who are underinsured: those whose health insurance provides little or no coverage for the preventive and primary care the centers offer. Underinsured people often have policies that include very high deductibles—from more than $1,000 to as high as $5,000 per family member. Such plans leave all of their primary health care uncovered, beyond their meager ability to pay for out-of-pocket expenses.
The waiting room of Lake Superior Community Health Center in northeast Wisconsin offers an on-the-ground perspective on America's ailing health-care system. More than 60% of the health center's patients have incomes at or below the poverty level (see BW Online, 02/12/07, "Income: Too Many Degrees of Separation"), and almost three-quarters are uninsured. The demand for affordable primary health-care services is so high that the wait time to see a doctor can stretch to as long as three months.
The tax policies proposed in the President's plan would have, at best, exceedingly limited impact in this rural pocket of America, and would do nothing to shorten the wait to see a doctor. Indeed, the scarcity of affordable primary health-care services is the other half of the health-care debate missing from the halls of leadership. Some 35 million Americans have no access to basic services, even though many of them do have insurance. Coverage without an available provider is as worthless as currency without a marketplace.
Sabotaging the Safety Net
Perhaps the biggest flaw in the President's proposal is that it wagers a risky bid for giving broader flexibility to the states on the backs of safety net providers. The proposal, which likely won't pass muster with Congress, redirects funding that currently flows to safety net providers—the hospitals that see high volumes of Medicaid and uninsured patients—to instead fund his new insurance coverage initiatives.
Yet, no matter how successful these initiatives may be, there will continue to be millions of uninsured Americans who will need ongoing care from providers committed to serving them. It does no good to destabilize or decimate the already fragile health-care safety net to address the issue of coverage; the only viable approach lies in attempting to strengthen both.