Health reform prospects in the wake of Black Sunday

"Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation," said John McCain to a reporter in an interview in Contingencies magazine. The article is titled: "Better Care at Lower Cost for Every American."

This isn’t a Photo-shopped, made-up comment. See page 30 of the publication, the last paragraph in the left hand-column which continues into the right side.

Contingencies is the magazine of the American Academy of Actuaries. These are those sober professionals who, according to their mission statement, "put a price tag on risk." They do that through evaluating the likelihood of future events, and, in their words, "designing creative ways to reduce the likelihood of undesirable events."

Let’s think like actuaries, then, and consider prospects for health reform following last week’s major implosion of the financial services sector. That is, what are the risks of not taking on a comprehensive approach to health reform in the next administration?

Uninsured and under-insured rolls increase. We learned in April 2008 from the Kaiser Family Foundation that every 1% increase in unemployment translates to a 1.1 million more uninsured. At the same time, there is a 1-million person increase in the number of enrollees in Medicaid and SCHIP. Whence the funding for these new enrollees’ coverage?

State and city tax revenues are falling. I listened to the eloquent Michael Bloomberg, Mayor of New York, tell Tom Brokaw yesterday morning on Meet the Press that he expects New York City’s tax revenues to fall 12% in this fiscal year. His low tax-expectations will be echoed throughout the nation as state governors and city mayors will receive lower revenues while demand for services will increase. Remember that health care is the #1 line item for a vast majority of governors.Plan on more ER visits for primary care. The health provider for people without a medical home or an ongoing physician relationship is the emergency room. Uncompensated care is a major fiscal challenge for the vast majority of hospital CFOs. More visits from uninsured people will lead to an even greater percentage of unpaid bills by consumers who, until they can find steady work and a "good" paycheck, can scarcely cover the growing costs of food, gas, and utilities.

Consumers will forego necessary care. Today’s Wall Street Journal published an article by the smart Vanessa Fuhrman who agrees with me that consumers are foregoing care — even important, ‘non-discretionary’ care. I have been documenting this trend for the past year. Most recently, on June 28 I covered the Center for Studying Health System Change study on consumers putting off necessary health care.

And so on…

Jane’s Hot Points: Senator McCain’s article in Contingencies concludes with the following sentence: "Any ‘solution’ that robs us of that essential sense of ourselves is a cure far worse than the affliction it is meant to treat."

I take this sentence to be a version of the instruction, "be careful of unintended consequences" when you meddle with public policy.

We are at a turning point in American society — given globalization, the oil business, the decline of public education, and the growing number and serious nature of challenges facing the U.S. As I write this post, for example, the price of oil per barrel has just jumped 25% and the dollar is sinking.

I am absolutely for stabilizing financial markets ASAP. But I am also advocating addressing comprehensive health reform in the immediate term based on the mini-implosions that are already happening in our system. If you take a bird’s-eye view over the entire landscape — and not just in your own town, or in your own health benefits — you can see from my exercise in connect-the-dots that health care in this nation has been imploding for some time.

The lesson from financial markets is not to put off to 2012 what we can and should do in 2008.