The “hidden tax” is a phrase Governor uses a lot, to talk about the amount that health premiums are higher because of the uninsured population. The New America Foundation released a study last year often cited by Schwarzenegger. Families USA had a similar conclusion in 2005 with its study documenting “the increased cost of care.”
As I have previously said, I don’t like the the Governor’s rhetoric around a “hidden tax,” he tends to blame the victim: the uninsured person who typically is not offered coverage on the job, is not eligible for public programs, and who finds that buying coverage as an individual is either unaffordable or even unavailable, because of “pre-existing conditions.” This rhetoric has consequences: if the problem is that people are uninsured, rather than the barriers that lead them to be uninsured, it’s no wonder that Schwarzenegger and New America Foundation both see the “individual mandate” as a solution–something we disagree with.
But it is important to acknowledge that our current fragmented health system comes with a cost, to all of us. One of the problems is the lack of fair and equitable financing, with most employers providing coverage to all their workers, but many that don’t.
We all pay more when Wal-Mart and McDonald’s pay less. It’s the same health care system, of doctors and hospitals, and if some manage to not pay their fair share into the system, we all pick up the burden. (Let’s remember, the uninsured get it worst, getting charged more than others and facing collections and bankruptcy. But there are costs that are borne in the overall system.)
In some states, they actually have an explicit fee on insurance to help fund the safety-net hospitals and providers that care for the uninsured. So employers and purchasers are able to directly see, on their bill, how much they are paying for a broken health system that leaves people uninsured.
The New America Foundation, in its analysis defending its work, actually pointed out Hoover didn’t question the notion of a “hidden tax,” just its size. And the New America Foundation makes a credible case that it is bigger than what Hoover estimates.
The thing that rankled me most about the Walters column was the notion that reducing the “hidden tax” was “the most appealing premise” of health care reform. Let’s put aside the millions of uninsured who would get coverage, and no longer live sicker, die younger, and be one emergency away from financial ruin. Let’s put aside the community, economic, and public health benefits.
It seems to me that there are other reasons why an *insured* person would want a change in our health system:
* SECURITY: Even insured people recognize that they are one job change, one divorce, or other life event, from being uninsured. Reforms could provide more security that they keep the coverage they have now (through an employer or a universal system), are more likely to have coverage at their next job, are more likely to have a safety net if they fall upon hard time, and are more likely to have coverage even if they get sick.
* AFFORDABILITY: Aside from efforts to simply shift the burden of costs onto consumers, most of the ideas to contain costs in the health care system work better when more people are in the system. Whether its information technology, or prevention, or bulk purchasing, or better planning (not to mention fair financing), the cost savings work best in a universal system, rather than our current a fragmented system where it is hard to implement these efforts. For those who are insured, we can best slow the growth in health care costs better if we deal with the uninsured issue as well.
There’s no disagreement that there’s a cost to the status quo. But let’s recognize the other benefits of reform as well.