Achieving health security

 

Reprinted from The Journal News   

Tuesday, May 11, 2004

COMMUNITY VIEW
Georganne Chapin

This is "Covered the Uninsured Week." With a long career in public health, I should be encouraged to see attention focused on the plight of the 43.6 million people without health insurance in this country.

But America's health-care crisis isn't just about "the uninsured," and presenting it as such diverts our focus from the real problem: how to achieve health security for our nation. It is true that lack of health insurance causes misery and hardship for millions. But simply expanding insurance will not create a healthy America. In truth, our continued reliance on health insurance perpetuates the most serious flaws of our system.

Health care is so fragmented, deficient and duplicative that we have trouble keeping even insured patients healthy. We spend more money per capita on health care than any nation, yet the World Health Organization ranks us 37th in overall performance.

The underlying message of this week seems to be that the current system should expand, that more programs should be created, and that people will enroll in insurance plans if given the opportunity. But this would do nothing to change what is fundamentally wrong and unsustainable about our system.
With the important exception of Medicare, health insurance is temporary in nature; the average person regularly experiences significant gaps in coverage. In any given year, 60 million people have no coverage at all for some period of time.

Employer-based coverage is lost or radically changed every time someone moves or changes jobs, when insurers merge or go out of business, when an employee switches plans or when an employer gives up offering health benefits.

Public insurance for low-income people is even more unstable.

Millions without insurance fail to enroll in state-funded insurance programs. More than half of the 7.8 million uninsured children who should be covered by Medicaid or state child-health insurance programs are not. Maybe their parents couldn't take time off from work to register them, or were baffled by the paperwork. Many simply don't know they are eligible. In these "safety-net programs" a staggering 40 percent of enrollees lose coverage each year. This is mostly because they fail to recertify their eligibility, not because they no longer qualify, but simply because of the unbelievable bureaucracy.

Creating even more government-funded insurance plans is not the solution. New York state has added Child Health Plus and Family Health Plus programs to cover the working poor who are ineligible for Medicaid. While we welcome extending state coverage to more people, adding separate plans makes the system more complex and expensive. Coverage under Child Health Plus is not identical to coverage under Family Health Plus, and both are different from "regular" Medicaid benefits. Enrollees have a bumpy transition from one plan to the other, after losing coverage for several months in between. Providers, too, are confused by the different benefit packages and payment protocols. Creating different plans for different populations fails to create any level of comfort or security for patients-and for providers. Both groups should be free to attend to matters of health, instead of pursuing the vagaries of a fragmented payment system.

We must start looking at how to provide universal access to health care, to do what all other developed nations have done: adopt a single-payer system that provides access to basic health services for all.
"Socialized medicine"? Look at Medicare-a federally funded, universal entitlement to health care for everyone over 65. Remember, too, that this country once debated whether to establish equal, publicly funded education for all. Today, it is unimaginable that a civilized society would not educate its people. I believe that it is equally indefensible not to provide universal health care, paid for by society as a whole.
Under a single-payer system and universal coverage, people would be able to develop long-term relationships with their doctors. Doctors and hospitals will know they will be paid, and they won't have to waste time and money navigating their way through the different rules and protocols of hundreds of insurance plans. Providers of care can invest resources in prevention and can be assured that, should a patient be diagnosed with an acute or chronic illness, that patient will have the ability to follow through with treatment without fear of losing doctors or coverage.

We must construct a system in which the money now wasted on insurance-churning and unnecessary administrative tasks goes toward helping people to stay healthy.

The writer is president and CEO of
Tarrytown-based Hudson Health Plan,
a provider of state-assisted insurance.