Health Insurance as a Tool, Not a Solution
It is the most visible failing of the healthcare system – 47 plus million Americans without health insurance. Given the soaring cost of care, insurance is the only true bulwark against the financial risks associated with interacting with our healthcare system, especially in the event of a chronic condition or accident. This is current prevailing domain of health insurance: to protect our interests and assets in the event of illness or trauma. However, in discussions over health care reform the role of insurance in our system can become tainted by the politics of both the left and the right. For one, health insurance can be seen as an all encompassing savior to the nation’s healthcare woes, for the other it is viewed only as a means of exacerbating existing problems.
The truth is somewhere in between. Providing universal health insurance cannot alone solve the American health care crisis, nor can it be disregarded as a central and necessary component to solving it. Whether one views health care as an economic imperative or a moral one, it is how we are insuring people that matters, in other words we need to focus on how insurance influences the American people’s health status and interactions with the health care system. By focusing on these true ends to healthcare reform, we start to arrive at the necessity of addressing the health care’s systemic curses of rising costs, reduced quality and misaligned incentives. Reforming health insurance can be a powerful tool for addressing these very issues.
If we wanted too, it would be very cheap to insure everyone – we just give everybody a $25,000 deductible and barebones coverage and there you have it, 100% universal coverage! But what good would this really do? Would it provide financial security in an accident (how many of us have 25 g’s laying around)? Would it alleviate the tremendous costs of seeking the care needed to manage a chronic condition? Would it incentivize people to get regular checkups? Would it improve quality all while stemming the tide of health care cost inflation? In fact, many of the current stakeholders(including insurance companies and hospitals) would love to see a spirited drive for universal coverage - as long as someone else is footing the bill (government, businesses, individuals etc..). Covering everyone without regard for what that coverage does and how it improves people's healthcare, is tantamount to just pouring more cash into a broken system.
On the other hand, disregarding the need to cover everyone by politicizing calls for universal coverage can also damage efforts aimed at addressing the roots of the health care crisis. Aside from its ability to prevent the financial ruin of patients in the event of a problem, health insurance can be structured to influence the various domains within the healthcare system. For example, health insurance is essential to reducing the number of emergency room visits, the most costly way of utilizing the health care system. Insurance is also a crucial factor in the management as well as the prevention of disease and it should be structured in a way to provide the right kind of care and incentives to reduce the risks for incidence of catastrophic episodes. We can already observe the well known power of insurance reimbursements in impacting the kind of care that is delivered, in turn suggesting that insurance can play a role in monitoring quality and effectiveness. Insuring all Americans can not only contribute to containing the cost of healthcare, but it can be also used as leverage for driving systemic change. These ideas are nothing new and should be inserted into the debate regarding how to address the problem of the uninsured.
In sum, it is not enough to merely cover all Americans; doing so without also addressing how healthcare is delivered and paid for signals little more than another incremental political victory. That said, universal health insurance is also an important element in building a system that promotes health, prosperity and opportunity for every American and the nation as a whole. We must resist the temptation to view reforms aimed at the uninsured in adversarial terms. In order to make this system more effective and sustainable, the pursuit for universal coverage must go hand in hand with other reforms aimed at driving quality, transparency and prevention.
- By SHOUTAmerica
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