My Los Angeles Times colleague David Lazarus crystallized why we may never pass a measure to reform health insurance. Lazarus, whose columns I generally like, said on Sunday that health reform wasn't about socializing the health care system, it was about helping people like Lisa France of Hollywood.
What's Lisa's problem? She's a healthy 42-year-old who has to pay $28 a month more for health insurance because she sees a chiropractor two or three times a year. If she didn't, she'd only have to pay $113 a month for health insurance. As it is, her insurer charges $141 per month.
Let's be clear: Health insurance reform was never going to help people like Lisa France. France is healthy; has no problem buying insurance; can afford insurance; and is paying a paltry amount for coverage, chiropractic care or not. In fact, the health measure that was being debated in Congress was going to cost France a heck of a lot more than $28 a month. (My column on health options, linked here, explains why.)
Reform was (and is) needed for people who cannot get coverage at any price and are sick with serious ailments, like cancer and Multiple Sclerosis, that would bankrupt a family trying to pay those bills on their own. And yet, we consistently allow ourselves to be distracted by the trivial--the woes of someone who doesn't think she should have to pay a modest amount more for health insurance because she's voluntarily getting a "little adjustment" so she can "feel awesome" after she works out.
Health insurance was never meant to cover every ingrown toenail. It was designed to cover major medical expenses that were rare and devastating. That kind of insurance could be cheap. But if we expect that our insurance carriers cover every sniffle; the lap-band that will keep us from overeating; the Malibu detox center to wean us from our own expensive bad habits, then we are asking for a system that will be so costly the average person would not be able to afford it. And, yes, it would create a massive bureaucracy to pay premiums for the "poor" people who cannot otherwise buy insurance at this exorbitant price. But the price is only exorbitant because we made it that way by demanding so much.
It's time to solve the problem--the real problem. Focus on one simple thing: Give everyone access to high-deductible health insurance coverage for major medical problems. Period. Yes, some people will whine that spending $500 or $1,000 annually on medical needs is tough. But show me one of those whiners who hasn't spent that much, or considerably more, on electronics for their home. If we stopped acting like a visit to the doctor was less important than a big-screen t.v., we might actual foster a society that could set reasonable priorities.
How about this for a health insurance reform measure: Everyone over the age of 25, who earns more than $30,000 annually, must buy a simple, health insurance policy that would pay major medical after a $1,000 per-person deductible. If Foster is any guide, that would cost the average American less than $2,000 per year. People who earn less would be covered by Medicaid, which would be standardized so that your eligibility for coverage wouldn't vary from state to state.
What happens if you don't buy coverage? You lose eligibility to get coverage for pre-existing conditions. If you choose to be irresponsible, neither insurers nor government would have to pay your way.
What about the people who can't afford the deductible or premiums? The government could encourage charities to address this modest need. Let people who can't set aside a small portion of their monthly income to pay for their own health explain why to do-gooders, who are likely to be sympathetic to any viable excuse--but not to those who say they needed premium cable more.
It's time we made health insurance available to the responsible people who can't buy it because they're sick; and we stopped paying the bills for the irresponsible people who choose to throw the cost on the back of their fellow taxpayers.
There are 47 million Americans without health insurance. It wouldn't take massive subsidies to get these people covered, if we provided coverage for catastrophe rather than coughs.