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OPINION – Health Care: Victims Caught in the Line of Fire

Health Care: Victims Caught in the Line of Fire

Opinion by Dr. Larry N. Francis and Martyn Hopper

Swing those cameras over here. Move the microphones in closer. Start pushing pencils across those reporter’s notebooks.

We have a story about millions of innocent victims trapped in the line of fire between two governments that are themselves surrounded by outside forces and influences.

Sound like the daily drama of the Middle East?

No, it’s a tale of the everyday struggle of the medically uninsured.

We know where most of them are. About six of every 10 of the estimated 39 million Americans without health insurance come from households where someone either owns or works for a small business.

Small businesses, roughly those firms of 25 and fewer workers, have a doubly difficult time providing health care than larger companies do because of cost. The yearly double-digit increases in health-care premiums are pushing more and more people into the ranks of the medically uninsured.

For 15 consecutive years, members of America’s largest small-business organization, the National Federation of Independent Business, have ranked health-care costs as the No. 1 difficulty out of the hundreds of barriers to solvency. In California, only about 62 percent of its 38,000 state members provide health care for themselves and their employees.

20 Percent Premium Increase

Modesto-based Managed Care Online, a health-care information company, reported small-business owners being hit with 20 percent increases in premiums last year, which comes on top of 17 percent increases in 2000. Compare that with the 8.2 and 7.3 percent increases big businesses with more than 1,000 workers had to pay. To get a real feel for the gravity of the situation, consider a Lewin Group study that showed for every one percent rise in health insurance costs, 300,000 more people are added to the ranks of the uninsured.

Here are the culprits contributing to the crisis:

– The federal government. It has steadfastly refused to allow small businesses to band together across state lines to form large purchasing pools for health care. Big businesses benefit from economies of scale, being able to buy in bulk and spread risks over thousands of employees. Here’s another advantage given to big business and large labor unions, but not mom-and-pop firms.

Federal law, the Employee Retirement Income Security Act, allows big business and big labor to ignore thousands of state requirements on health plans. Having one set of rules instead of 50 lowers the cost of administration. Small businesses have begged for the same rights as big businesses.

A study commissioned by NFIB showed that if small businesses were allowed to form large purchasing pools, 8.5 million more workers would immediately gain access to health coverage. That’s about a 20-percent dent in the number of the uninsured , an excellent first start.

– State governments. States contribute their fair share to driving up the cost of health care with their incessant mandates, which are legal orders to insurers to add more and more medical procedures and classifications of people. Insurers pass on the higher costs to their customers. At the end of this markup food chain are small-business owners who are faced with decisions on whether to eat the cost, have their employees contribute some of the money, or, as is often the case, drop health care altogether. Idaho has eight such mandates, Oregon about 25, California 44, with eight more sitting in the state Assembly Health Committee awaiting approval.

Perhaps sensing the reach of critical mass, Assembly Health Committee Chair Helen Thomson has called for a time out. “We simply can’t afford to cover every possible service,” said Thompson.

She is right. Sufferers of any malady all make justifiable cases for funding of their treatments. But policymakers must bear in mind that requirements on insurers to pay for such things as wigs for cancer patients, as one legislative proposal suggests doing, comes at the expense of pricing people out of coverage for heart attacks, broken bones and punctured organs.

– The outsiders. To name the only two: lawyers and insurers. As their reward for bringing the next generation of Californians into the world, obstetricians and gynecologists are among the most sued practitioners in medicine. Lawyers have made a banquet out of nearly 80 percent of ob/gyns.

There is now a competition between doctors and malpractice insurers to see who can get out of the Golden State faster. When doctors are not in court defending themselves against some frivolous lawsuit, they are spending their time waiting for payment for their services.

Most doctors envy business owners who have to wait only 30 days for payment. HMOs, insurance companies, and federal and state governments can take three months to a year to cough up the money owed physicians, and that comes back pre-negotiated down to pennies on the dollar.

By law these entities are required to pay by 30 days, but through paperwork chicanery, it can be extended months to a year. California is staring down a deep fall in physicians as fewer and fewer of them want to start each day feeding the tri-headed dragon of creative lawyers, voracious insurers, and lethargic debtors.

Rectifying The Problems

Before we reach for that panacea of socialized medicine as a way out, we should seriously study the innumerable problems nations with it have. We believe most Americans will find single-payer systems more placebo than real medicine.

There are things we can do to rectify our problems: barriers to forming large health care pools could be torn down; financial responsibilities for non-essential medical care could be borne by individuals; legal excesses could be curbed; doctors could be paid their full amounts on time.

But don’t expect any of this to happen soon. Federal and state employees have their health care. So, too, do employees of large media concerns. It’s the people working second jobs to make ends meet who don’t have it. The people who live in daily fear of their little ones saying, “I have this pain that won’t go away.” Government doesn’t feel the pain, and the people who do are too busy to make their voices heard.

Francis is a practicing ob/gyn in Murrieta. Hopper is California state director of the National Federation of Independent Business.

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