The health care issue has a history of being named by voters as one of the biggest problems we face — until the problem de jour comes along and pushes it off the list. In 2008, that seems to be happening again with the economic downturn, the mortgage mess, and $4 gas surpassing health care as the big issues.
When asked to name the most important financial problem facing families today by the Gallup organization:
* 29% said energy and gas prices * 18% said the high cost of living and inflation * 14% said a lack of money and low wages * 9% said health care costs
Policy experts can point to the high cost of health care but Joe and Mary Middle- America are still clearly sheltered from the real impact of these costs largely by the employers who still provide so many of us with affordable health care.
It’s true the ranks of the uninsured are growing with the unemployment rate, and the number of people getting health insurance from small employers has been on a long decline. But the fact is that the vast majority of Americans still get very good health insurance from mid-size and large employers. And, what cost shifting has occurred has been relatively modest.
Last year’s Kaiser Family survey of employer-provided health insurance found:
- Health insurance coverage at larger employers is stable – In 1999, 99% of employers with more than 200 employees offered health insurance–that number was also 99% in 2007.
- Cost shifting has been only modest – In 2001, workers at larger firms (over 200 employees) contributed 4.4% of the cost of their coverage as a percent of their income–in 2007 they contributed an average of 6.9% of the cost of their coverage as a percent of their income.
- Consumer-driven plans remain a very small part of the market. More than ten years after MSAs became available, and five years after HSAs were expanded by the MMA, between 3% and 5% of workers are in various forms of these and high-deductible plans.
Most workers are still sheltered from the reality of health care costs, and they equate health care quality with access to whatever they want.
Conservatives, including John McCain, argue that we need to move away from third-party pay to a health care system that stresses individual responsibility so consumers can better understand the problems of high cost and respond with more efficient choices. Makes sense.
But to get that kind of far-reaching change it will take a groundswell of major support from voters.
Ironically, voters aren’t going to be interested in supporting that kind of change if they remain sheltered from the problem.
It’s a "catch-22"–conservatives believe we need voters to realize they need to be more sensitive to health care costs but to sensitize them voters have to be willing to let policymakers take their rich benefits away.
Voters sure don’t have a lot of incentive right now to give up those still rich employer plans.
Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of health care industry trends at The Health Policy and Marketplace Blog.