Pay for Your Own Health

Do you have an obligation to pay for others' health care? That post set off a small storm of comments and I have no doubt this one will be any more digestible to a certain segment of society.

Let's do the right thing: Insure Texas' children (link will rot)

Texas Children's Hospital is proudly celebrating a milestone this year: 50 years of providing exceptional health care to millions of children from Houston and all over the world. And although we have accomplished much over the past 50 years, we're deeply worried about the millions of children in this country who are uninsured.

First, let me say that I support the Texas Children's Hospital mission: high quality pediatric medical care. I see nothing wrong with starting a company, even if it's a non-profit, to help sick kids get healthy. There is also nothing inherently wrong, in my opinion, in being concerned with low levels of insured children...other than the assumption underlying this concern is that most (if not all) kids should be insured. Such a choice isn't ours to make for others. My healthcare situation is necessarily unique when compared to my neighbors', so I have different costs and benefits to weigh when making health consumption decisions. Similarly, if I have children, I'll be making their choices for them in light of their particular circumstances.

If my employer doesn't cover employee children, then if I value health insurance enough for my kids, I'll find a way to pay for it. When simple outpatient procedures cost thousands of dollars and the likelihood of my finances being able to afford such sudden economic shocks still far down the hypothetical road, having my children insured makes a lot of sense. Other people are willing to take their chances or ask their friends and family to pitch in, loosely connected in a support network. There are more than a few good reasons why some of the many children don't have health coverage.

Every day we see the health ramifications for children who have no insurance coverage. In Texas, more than 1 million children are without insurance and, thanks to funding cutbacks and tighter eligibility requirements in the Children's Health Insurance Program (CHIP), this number will only get worse. These children need help from all of us -- legislators, business leaders, health care professionals and parents -- to ensure they have a chance at long, healthy lives.

This hints strongly at some "right" that children have of taxpayers to support their healthcare needs, a stance I disagree with.

This week is "Cover The Uninsured Week." It is our fervent hope that by drawing attention to this growing problem, we will all come together to find and implement affordable and practical solutions.

377,051 kids are currently covered by CHIP and I advocate that they have their coverage terminated. That is the only "affordable" and "practical" solution. The government (i.e., the taxpayers) should not be funding what is rightly the responsibility of parents to take care of. If parents cannot take care of this, that does not require the state to step in and do it for them.

Health care should be treated as the commodity it rightly is.

Children who come to Texas Children's receive the best care we can provide, regardless of their ability to pay.

The problem of our current medical system, summed up in one sentence. Hospitals, out of the yearning for as many people to be healthy and strong, are trying to subvert the laws of economics in order to continue doing business.

Thanks to the generosity of individual and corporate donors, as well as donations from our employees, we provided more than $15 million in charity care for more than 22,000 inpatient and outpatient visits in fiscal year 2003. But we know it barely puts a dent in the overall need, which is why Texas Children's is an aggressive advocate for access and coverage.

That generosity should be held high and saluted. If I had the excess funds, I'd donate to worthy charities as well. Fortunately, enough people make enough money to be able to donate effectively. Unfortunately, more than a fifth is taken from me in income taxes, thereby increasing the importance of each remaining dollar towards my personal needs.

It is even more unfortunate, however, when people advocate expanding coverage in the form of government programs. They know where the money for these programs comes from: you and me. They know it isn't exactly handed over willingly. It is the opposite of charity; it's taken from you under threat of imprisonment and fines; physical violence in all but name. We should not be encouraging this at all.

Uninsured children go without preventive care, which means minor ailments become major, last longer and are more expensive to treat. Parents who can't afford a doctor use hospital emergency rooms, which can cost up to 10 times that of visiting a primary care physician. Sick children miss more school, falling behind their peers, and their parents miss work to care for them, depriving employers of productivity.

I have no beef with this argument, because it's true. I have a beef with what it's intended to relieve: individual responsibility for the costs of raising children.

The problem of uninsured children and adults is not unique to Texas. It is a national crisis. Nearly 44 million Americans do not have health insurance -- including 8.5 million children under the age of 19 -- and the numbers are climbing.

Ronald Bailey takes this whimsical stat-tossing on directly in Reason Magazine:

First, how much of a crisis is it, really? Politicians typically claim that 41 million Americans do not have health insurance. Please note that lack of health insurance does not mean lack of health care. However, a new Congressional Budget Office study has found that the number of Americans who are uninsured at some point during the course of each year is 59 million. But before someone screeches that the "crisis" is 50 percent worse than we thought, the study also notes that the number of Americans uninsured over the course of the entire year is actually much lower, between 21 million and 31 million, depending on which of two surveys one accepts.

Who are the people uninsured for a year or more? It turns out that 60.5 percent are under the age of 35, and 80.2 percent are under 45. Furthermore, 86.1 percent of those uninsured for a year consider their health to be "good" to "excellent," and they are not wrong. Consider the risk of death faced by those under 35. In 2000 there were 134,419,000 Americans in this age bracket. Of the 2,404,598 Americans who died that year, 112,005 were under 35, or about 4.6 percent. Using death as a crude measure for serious health risk (can't get more serious than death), the under-35 uninsureds were risking one chance in 1,200 of dying from whatever causes in 2000. And while 60.5 percent seems like a high number, keep in mind that the rate of the uninsured among the population as a whole remained small - only 7.3 percent of those under 19 were uninsured for the whole year; the 19-24 bracket was at 14.4 percent; and the 25-34 group came in at 12.3 percent.

So the vast majority of those who died under age 35 died with health insurance. But it may be specious to emphasize such correlations anyway. After all, we don't blame the 1,801,459 deaths of people over age 65 in 2000 on the fact that they are the beneficiaries of the federal government's Medicare program.

Though it would be tempting...

At what point does this stop being a crisis? When 40 million Americans have health insurance? 20 million? 1 million? Half a percent? At the very least, I'd like to hear that the tipping point would be. Otherwise, we'd be heading into yet another "War On [insert here]" without end and without limit.

Many Americans who have private health insurance through their jobs are at risk of becoming uninsured. Rising costs are placing coverage out of reach for millions of working Americans and beyond the means of business owners who would like to provide their employees with affordable insurance.

The reality is that more than one in four uninsured adults has severe problems paying medical bills, whether their own or their child's, forcing them to skip meals, cancel utilities and even forfeit their homes. In fact, medical bills are cited as a reason for half of all personal bankruptcy filings.

So the solution is to make more people pay for the bills of others? To reduce our individual wealth further? Increase the weight of the socialized costs of providing services to people? This is injust.

Through strong leadership and the will to take action on the local, state and national level, there are ways to ensure that children and adults have access to affordable health care:

* Use the more than $469 million in state dollars that the Texas comptroller says are available now to restore the cuts to CHIP and shore up the shortfall in the Medicaid program.

* Of any additional taxes on tobacco, earmark a portion for insurance coverage.

* Move forward on applying for a Health Insurance Flexibility and Accountability waiver.

* Provide tax credits or other rewards to people who adhere to a healthy lifestyle and seek preventive care.

* Inspire insurers to take a more innovative approach to developing affordable coverage products.

Strong leadership: a euphemism for using the force of government in ways that doesn't quite resemble tyranny on the surface.

If we want to ensure as many people as possible "have access to affordable health care," how about stepping back and taking an axe to the government-imposed burdens of doing health care-related business? That'd drop costs without a doubt. How about cutting taxes - really cutting taxes - so more workers will have more money to spend at their discretion?

City and county governments must continue to look for ways to consolidate health care programs, eliminate duplicate services and add more federally qualified health centers. Chambers of commerce and elected officials must find ways to stimulate job growth and assist employers with providing coverage through employee plans.

L.E. Simmons is chairman of the board and Mark A. Wallace is president and chief executive officer of Texas Children's Hospital in Houston. Copyright 2001-2004 Cox Texas Newspapers, L.P. All rights reserved.

And further distort an already distorted market for health coverage?

No thank you. I say let people make their own choices, pay their own way, and let charity pick up the rest.

Posted by Drizzten at May 12, 2004 03:16 PM