Health insurance debate ails

STAYING AHEAD

April 04, 1994|By JANE BRYANT QUINN | JANE BRYANT QUINN,Washington Post Writers Group

NEW YORK -- No wonder you don't understand the Clinton health plan. Its opponents have tried for months to confuse you, in hopes that you'd be scared away. If the public backs off, health-care reform-- if it passes at all -- will reflect the interests of the medical- industrial complex, not yours. The drumbeat of disinformation has been pounding away on three major issues:

* Who's uninsured? The shoulder-shruggers say that those without coverage are mainly young workers who could buy health insurance but don't. Or they're people between jobs who will come under another plan soon.

Even if that truly described the problem (and it doesn't), I don't see why their lack of coverage is OK. The uninsured see doctors less often than the rest of us, are more apt to need hospitalization for illnesses that could have been treated at home, go to the hospital in worse shape and die there more often. The cost of their treatment comes partly from taxes and partly from higher charges to everyone else.

The uninsured are counted by the Census Bureau's annual population survey, which numbered them last March at 37.4 million. That's up from 32.6 million in 1988, with most of the losses falling on small-business workers and the self-employed.

But many more people probably lacked coverage during at least some of the year, reports Lewin-VHI, a health-care research and consulting firm in Fairfax, Va., that develops data for government and business clients. The total number of uninsured during any part of 1993 probably was more than 51 million-- almost one in four Americans under 65. The rest are only a pink slip away.

Less than two out of 10 of the uninsured are young people 18 to 24. Most of the rest are working adults (plus their spouses and children) who have no employee plan.

Only 28 percent are officially classified as poor. Nearly 60 percent earn low to middle incomes; for a family of four, that means $14,300 to $57,300, pretax. The cost of family medical coverage can easily run from $6,000 to $11,000 a year. So even among higher-income people, insurance isn't an easy buy.

Around 3 percent lack policies because of an illness insurers won't cover. Only 7 percent go bare by choice.

The voluntary health plan proposed by Rep. Jim Cooper, D-Tenn., assumes that competition will cut health-insurance .

costs by so much that small-business employers will choose to help workers buy policies. But according to a 1991 Harris Poll, more than half of small-business owners aren't likely to purchase coverage even if the price drops by 50 percent.

* Can you pick your own doctor? Without health reform, the answer is increasingly no. Cost-conscious health plans are rapidly smothering fee-for-service medicine, where insurers allow you any doctor you want. In 1988, 89 percent of the employees in company plans could choose fee-for-service, KPMG Peat Marwick reports (its survey covered medium-size firms and up). By 1992, that number had shrunk to 65 percent and by now is probably lower yet. Employers are choosing health maintenance organizations (HMOs) instead.

Ironically, the Clinton plan-- which critics claim will wipe out doctor choice -- might actually preserve it beyond its likely free-market life span, says John Holahan of the Urban Institute.

If Clinton gets his way, your health-service choices would have to include at least one fee-for-service plan and one HMO with a "point-of- service" option. With a point- of-service option, you normally see the doctors at your HMO. But you can also visit an outside doctor, whenever you want, for a higher fee.

At present, most employers don't offer both these choices. None of the competing managed-care bills require them.

* Can you pick the best coverage for your family? Clinton would group most people into purchasing co-ops (alliances). Once a year, you'd get a booklet describing the various plans in your region. Alliance members could choose the one they liked. Every plan would cover the same things, so you'd pick based on competitive factors like quality, convenience and price.

The Health Insurance Association of America (HIAA) has sponsored TV ads suggesting that the better plans won't be on your alliance's list. But the only plans the alliance could refuse are those costing 20 percent more than average (although there must be a fee-for-service plan, regardless of price). There would, however, be many fewer health insurers, which explains the HIAA's concern.

Clinton's health plan can't pass as written; there are serious questions of cost and reach. But simply tinkering with the system just preserves the status quo.

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