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Health Care: Neither You Nor Your Company Can Afford It Print E-mail
Written by David Batstone   

I just received notice from my primary employer, the university, that my personal contribution to cover health care premiums will rise 20 percent per year for the next 3 years. My per medical visit deductible fee also went up 50 percent. I promised that my family would not fall ill anymore, but my plea fell on deaf ears.

If you work for a U.S. company, I am sure you could share your own story of rising medical insurance costs; that is, if your employer still covers you. Employer-sponsored health insurance is becoming scarcer and more costly according to the annual health coverage survey conducted by the Kaiser Family Foundation and Health Research & Educational Trust. Their report shows that premiums for job-based health insurance is rising 9.2 percent on average nationwide in 2005, about three times the general rate of inflation. More worrying, the slice of companies even providing health benefits to employees dropped to 60 percent in 2005, down from 69 percent in 2000.

I don't blame my employer for the bigger bite out of my paycheck, nor should you. The problem resides way beyond your bosses' control. Health care costs have become a major burden on businesses that provide insurance coverage: General Motors now spends about $1,525 on health care for every car it produces - or roughly $6 billion in 2005.

Howard Schultz, the chairman of Starbucks, made the jolting revelation last week that Starbucks will spend more on health insurance for its employees this year than on raw materials needed to brew its coffee. Schultz, whose Seattle-based company offers health care coverage to employees who work at least 20 hours per week, said Starbucks has paid double-digit increases in health insurance costs over the past four years. "It's completely non-sustainable," even for companies like his "that want to do the right thing," Schultz told a gathering of U.S. senators.

Indeed, these costs are so burdensome to US corporations that more and more companies either don't offer health coverage, or coverage is so expensive that few employees can afford to participate in the plan. Clearly the system is broken.

The U.S. Congress rejected attempts to more tightly managed care in the late 1990s. Although a single-payer, universal health care plan works fine and dandy in most European countries, Australia, and Canada, a high-powered medical care lobby in Washington DC fights any attempt to reform the medical care system. So we are stuck with half-baked measures to contain runaway medical costs, and they consistently fail.

As a nation, the U.S. cannot rely solely on private-sector insurance. According to the 30-member-country Organization for Economic Cooperation and Development, "the United States spent $5,635 per person on health [in 2003], more than twice the OECD average and around ten times more than the lowest-spending countries, Mexico and Turkey." The United States devotes 15 percent of its gross domestic product to health spending.

Fortunately, American business leaders are engaging lawmakers in a new conversation around health insurance that transcends traditional conservative-liberal labels. For instance, last week, Schultz was joined by Dawn Lepore, president and CEO of Drugstore.com, Costco CEO Jim Sinegal, and Ivan Seidenberg, chariman and CEO of Verizon Communications in sharing concerns about what they identify as a growing health care crisis.

Shultz traces his passion about health care back to his youth in New York City when he saw his dad struggle to hold down a series of low-wage jobs, none of which included health insurance. "I wanted to try and build a company that my father never got a chance to work for," Schultz said.

The fact that skyrocketing health care costs make U.S. employers less competitive in the global marketplace will be the factor that will tip the scale in favor of a dramatic revision of the health care system. One clear sign: more U.S. companies are looking at Canada as a possible site to relocate their operations due to more affordable health care costs up North. Furthermore, as U.S. health costs continue to soar - and believe me, they will - more would-be entrepreneurs are reluctant to quit Corporate America and its blue-chip benefits to start companies. That trend impacts on innovation and job growth, when both are vital to the U.S. economy.

"As a company, we spend more on health care than we do on steel," Bill Ford, chairman and CEO of the Ford Motor Company told the U.S. Chamber of Commerce late last year. Ford followed this shocking admission to business leaders with a call to arms that makes more than sense: "What we seek is a partnership with the government to find solutions to America's health care needs. Our goal should be to make affordable, quality care more accessible to everyone."

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Vince Tidwell - Healthcare
2005-09-21 08:47:59
David,

That's a great summary of health care issue. I was helping a friend of mine move from his home in Buckhead (Atlanta), a very wealthy area with incredibly expensive homes and asked him who is moving into all of these new mansions. He informed me that the vast majority were in insurance. Could you write a follow up to your article and follow the buck to where it stops? When does "a fair and reasonable profit" come in and who enforces it? Perhaps we should all form our own insurance companies and create a virtual insurance pyramid? Call me old-fashioned, but I admire the times when my grandfather's house burned down and the townspeople put his family up in their homes as they all rebuilt a new home.

As we grow apart in this country we will destroy ourselves. Too bad our generation can't figure this out for our kid's sake.
David Welch, Austin, Tx. - U. S. Healthcare
2005-09-21 09:24:14
Mr. Batstone writes that "Although a single-payer, universal health care plan works fine and dandy in most European countries, Australia, and Canada...". No, it has not worked in those countries. This statement is flat wrong. Government run health care led to shortages, rationing and people fleeing to the U.S. for healthcare from those nations. Some of those countries have turned back to privatizing because government health care is such a wreck. Costs in the U. S. are high for several reasons such as high research and development costs for new medicines and equipment, lawsuit abuse, doctors practicing "defensive medicine" to avoid being sued, high goverment regulations and most of all because consumers use their insurance to go to the doctor for even the most trivial sniffles, pushing insurance company expenses higher and higher, thus leading to rate increases.
Tom Keyes - health care
2005-09-21 10:26:35
I am also concerned about the government run Medicare and what it has done to traditional health care costs. When medicare allots so little for most procedures the physicion's cost get allocated to the non-medicare payers. I believe that has been a large driver in the rising cost of retail health care. It's nuts.
Cynthia Astle - Why now?
2005-09-21 11:09:01
Forgive me, David, for being incredulous about your health care column, but where have you been for the past 15 years?

In 1990, while an associate editor for the national United Methodist newspaper, the Reporter, I co-wrote an award-winning special report on the cost of health care. Based on mathemtical extrapolations of the rate of rise of health care insurance for United Methodist clergy, my colleague Don Donato and I showed that within 10 years, the cost of health care would outstrip the income received from the annual giving of what was then a 10-million-member global denomination.

In 2004, as editor of the Reporter, I followed up our 1990 package with a report showing that the basic units of The United Methodist Church, the annual (regional) conferences, had developed a series of creative and often desperate means to keep their health care costs under control. While some opted for self-insurance schemes -- the most successful of which is Arkansas -- most annual conferences were still in extreme distress over the cost of health care. Solutions include wellness programs; cutting off high-risk clergy at the first opportunity, as occurred within the past few months in Iowa;, and increasing the payment burden on their limited-income retired clergy, whose original work covenant promised them paid health care in retirement.

As part of the Reporter's executive team during the last seven years of my 17-year tenure, one of my most painful annual duties was to review the health insurance proposals. Our small non-profit, which number fewer than 40 people when I left this past May, endured double-digit rate increases from 1993 on. It was nearly impossible for us to qualify for health insurance, even when we opted to join a co-employment arrangement with an outsourcing firm, because our employees couldn't afford it.

The average monthly cost of health insurance for Reporter staff with family was around $800, while United Methodist clergy and family average close to $1,000 per month. This still ranks behind most businesses, according to national insurance industry estimates.

So again, please forgive me if I seem a bit combative over your sounding a clarion to take on this issue now. Many of us have been suffering through this situation for nearly two decades. If someone has a solution to this quagmire, we small business owners and non-profit organizations would be delighted to hear it.
Jonathan Reams - Health Care Costs
2005-09-21 11:28:26
I wanted to comment briefly on your health care costs article. You mention single payer universal health systems in places like Canada working just fine. From the perspective of costs to the consumer it may be so, but in many other ways the system has huge issues. Health care was one of the major election issues in Canada recently, and concerns about the system still tops the list for Canadians.

My own recent experience highlights one of the issues. I had a problem with my shoulder, and was referred to a specialist. I received a letter from them providing me a time for an initial consultation that was five months in the future. I was told that if I required surgery or such, I could be looking at another six to ten months after that initial consultation.

There are many stories of such wait lists much worse than mine. On CBC radio a few months ago, they highlighted the growing number of Canadians who go to India for private medical care rather than wait in line in Canada.

I live in a relatively remote rural region of British Columbia. Another issue facing health care here is restructuring of service provision facilities. The recent scaling down of services to rural areas in favor of centralizing services to keep costs manageable has led to people in many areas being being told that if they need emergency services they can take a two hour or more ambulance ride. In the winter time that in itself can be hazardous to one's health!

The list goes on and on. Hearing about rising costs in the US, and knowing the same issues are being faced here, I can see deeper systemic issues underlying this trend. The growth in technology available for medical practitioners has led to them referring patients for expensive tests more than developing and trusting their own capacities for diagnosis. While such testing is in many cases appropriate, I think that it can also create an unhealthy dependency, leading to increased costs for all. As well, people are only minimally encouraged to take proactive action to maintain health and be responsible for their own conditions. A growing victim consciousness in relation to health issues also feeds the rising costs.

So what happened for me and my shoulder? Motivated by the thought of surgery, I did two things. One was having my massage therapist do some intensive work on my shoulder. The other was to seek an alternative approach, in this case medical Qi Gong. The combination has worked, and I have canceled my appointment with the specialist. It may have cost me a bit more out of pocket money, but far less than it would have cost the traditional system to deal with me, and I'm healthy again much sooner.
David Batstone - How Long Shall We Sing This So
2005-09-21 11:43:12
Thanks for your note, Cynthia.
It just goes to show that you're smarter than me...:-).

But I, too, have been sounding the clarion on healthcare for a long time.
Unfortunately, you have to present it anew over and over. How many new ways, for instance, do we have to say, "Where your treasure lies, there will your heart lie also"?
Cynthia Astle - Tipping Point on Health Care
2005-09-21 12:22:58
Thanks for your gracious response to my peevishness. Obviously you touched an old wound that has been aroused anew by the latest inanities of our government. I'm about to go for a weekly volunteer stint at the Katrina Hurricane Relief Center at St. Luke Community United Methodist Church, the flagship African American congregation here in Dallas, where I'm hearing a lot of stories about what is wrong with our country, including the lack of health care for our most needy citizens.

My sense is that we are close to a tipping point on this and many similar
issues. I guess we'll just have to keep pushing. Again, my thanks.
Victoria Saunders - Sounding the clarion
2005-09-21 12:29:45
I hear Cynthia's concern and want to say that many of us have been watching this degradation of the health care system take place for years. The problem with Social Security, I am told, is not the cost of Social Security but the rising costs of Medicare. The problem with many pension systems across the country is not keeping pace with pension payments per say, but paying for retiree health benefits. This is national disaster of epic proportions. We are being held hostage by lobbyists, capitalists and people who care more about thier homes in Buckhead County than ensuring that people like you and I can afford even primary health care. My individual policy has gone from $119 per month to $273 per month in two years. And of course my benefits are being reduced. I don't have an answer and I don't know that the Europeans have it figured out either but I truly believe that we as a nation are smart enough to figure out something better if we can think about the good of the whole rather than the selfish interests of corporate stockholders and certain special interest groups.
David Batstone - Does Health Care Work Better E
2005-09-21 12:38:44
I have lots of readers from Australia, Europe/UK, and Canada. I sure hope some of them weigh in about their experience with the health care systems in their own countries. Americans love to believe that your health care systems are horrendous - long waits and inferior care. Jonathan Reams suggest in this week's blog (see below) that controlling costs and delivering service do not always go hand-in-hand.
Phil Hood - Employers Are Hurting on Healt
2005-09-21 12:43:19
A storm is brewing. Lots of corporate CEOs are telling Congress they've had
enough. It was in both Forbes and Business Week this month. We are the only nation where employers have to pay for health care and it's killing them.
That's why I say it's going to be a huge issue. That and the fact our system costs more than the socialized systems and don't get better results. You're right that we have to ration care but to be socially acceptable it has to be based on need as well as wealth. Friends of mine who are experts and study the problem
say: Patients need to feel the pain of paying insurers and drug companies and doctors have perverse incentives - the
sicker you are, the richer they get.
Lawyers lead to lots of of unnecessary defensive treatment. We've become a nation of pill poppers, especially after TV advertising of drugs was allowed
It's more expensive for the poor to go the emergency room than to get them into insurance programs.

So, I think the answer is not one thing, but about a dozen different things needed to change the behavior of Americans.
Bernard Marszalek - Universal Health Care
2005-09-21 12:57:23
OK socialized health care has defects, but talk to any American who has experienced the European system and you will hear nothing but praise for the care they received.

If the corrupt political system we are straddled with in the USA was NOT an issue we could "experiment" with other systems and see how they function, correct and improve them. We should have been doing this many years ago. We did it with welfare, we did it with energy development (TVA) we build great roads, so why not a great health care system? You all know the reasons.

I am hoping, since I live in California, that a state-wide universal health care system is adopted here, but I am not holding my breathe. The first State that makes this break-through will get the ball rolling nationally. Thanks for the article Dave!
Paula Parker - Healthcare Crisis in America
2005-09-21 13:46:29
Thank you for putting this article together so well. Healthcare costs are not a problem that is as apparant as war, poverty or crime--which only makes it all the more insidious. It's not popularly discussed. Your article helped to educate me in how large the problem has become, and how unsustainable it is (I thought the loss of my dental and vision benefits was because my company was being cheap--now I realize this is a symptom of a National epidemic.) It's good to know that such large business leaders are directly petitioning the Congress to help our ailing system. Thank you again for such a great article!!
Clark Quinn - Health Care and Overseas
2005-09-21 14:22:36
I lived in Australia for 7 years (actually have Aussie citizenship now, in addition to US), so I can say that, contrary to an earlier comment, it does work just fine. It's not flawless, but relatively speaking it's superb. Everyone's covered. Other countries laugh at us! And, their national coverage means when they travel to other countries, except US, they're covered their too (reciprocal relationships). We pay to be covered elsewhere, and people pay to come here. So it's hurting tourism as well.

In this country, the problem with insurance is as bad as the auto insurance talked about in a previous column. For instance, my son has a tiny hole in his heart. Doctor's say don't operate (too small, not growing), but the insurer says that they won't cover him without the unnecessary operation! So I have to pay a huge additional premium on top of my already exorbitant family policy to cover him.

In Australia, he's covered. Period. We survived fine on the baseline, but they do have supplemental insurance if you want to not share rooms, etc. Yes, there're inefficiencies, inequities, but nothing compared to here where I know so many people now just doing without health insurance, and playing Russian roulette. Doctor's are scrambling to pay off school debts with increasingly small payments from the insurers.

Great article, David, addressing my take on the major issues: too expensive, killing business and, consequently, national competitiveness. It's time for reform.
Barbara Hemmings Gray - Health Insurance
2005-09-21 14:27:39
As health care provider and a health insurance user I have seen all too often the problems in this area.
There are so many plans and so many differrent forms that in the past 6 years we have had to add 2 FT staff to handle billing ; we usd to be able to manage this ourselves!It
It is impossible to know exactly the insurance a new paient has w/o consultiing a notebook 2 inches thick. Even then we are not sure of receiving timely payment.!!
Patients think their coverage - which many pay premiums for -will pay for their treatment only to find after 3 or 4 appointments that it will not!!
Patients look up providers in their directory only to find most are not aaccepting new patients or cannot give an appointment for 2 months. Yet, insurance company throw up barriers to licensed providers being accepted into their approved lists.
In a recent report , it was stated that 40% of the cost of health care was lost in paper work - or administrative costs.!! Ironically, the plan administered by the federal government uses only about 4% of their money for the same costs. Medicare has its problems - very low rates paid to professionals and no decent prescription coverage but it has gotten something right!>
For those whe are afraid of having the government control their health care,the current situation has corporate for- profit companies controlling our health care! At least the government can be influenced by taxpayers, Not true for Big Business.


Barbara Hemmings Gray
Dave Elliott - Healthcare
2005-09-21 17:20:21
I'd like to see a comparison in the amount for medical treatment or theoretical coverage. How much more is spent in the U.S. per capita compared to nations with like healthcare - meaning don't throw any of South America or Africa into the mix.

Why it had to take another decade to get this back on the table is ridiculous. The problem didn't go away, but somehow our officials decided it wasn't important. If it were a crisis 10 years ago, no surprise it is today. Energy we don?t have complete control over, though we somewhat do own that issue too. Sure we?re all getting older and that isn?t free, but there is no excuse for this annual double digit increase. I hate to throw around words like socialism. But, if we cannot get some apparently unknown villain in check, maybe socialized medicine is the solution. Any solution is not a solution if it doesn?t address the underlying corruption.

We?ve handed off our manufacturing to others and recently many of service jobs. We cannot become a country with Healthcare as their major industry so people will work in the industry so they can afford the service. Much of the foundation that allowed healthcare to become so large, strong manufacturing and a well-employed America, doesn?t even exist anymore and yet the rates still increase as if they do. Sorry, just frustrated and using the whole Common Sense and Forward Thinking again.
Billy S. - U.S. Tops in Medical Field
2005-09-21 20:01:23
People from all over the world come here for health care...including Europeans and Canadians. More than half of drug patents come from the U.S.
Tell you something?
Jaime - Where We Are Headed
2005-09-21 20:04:11
We?re invariably headed to a combination of national healthcare and free-market competition, where employers provide catastrophic coverage and a medical savings account which employees will use to pay for everything else.

Then guess what will happen? Docs and other health providers will start competing on quality AND price because the customers are going to be very careful about where they spend their annual thousand or so dollars.

Until patients are forced to look at health care the same way they do, say, buying a house or a TV, costs won?t come down.
Kevin Miller - What about cause & prevention?
2005-09-22 13:05:06
This health care issue is a sore spot for me and our business. At www.48days.com we work with tens of thousands of people in helping them pursue fulfilling work. From college grads to high-level executives. Two problems health care costs create for us. One, is that many people remain in jobs they hate due to health care coverage, especially if they or a family member has any pre-existing condition. Two, it's a major inhibitor to people going into business for themselves, as David mentioned. At 34, I have been self-employed and self-insured since I left home. I have a 5th child on the way and my insurance is ludicrous. Which brings me to another point...beyond all the issues that have been covered in submissions prior to mine, what about America's horrid lifestyle decisions that are skyrocketing costs? So many self-inflicted ailments that are running rampant. And here I sit, paying out the nose like everyone else, and my family is vegetarian, an average body fat percentage of about 10%, habitual exercisers and we avoid the doctor visits like the plague... We are the insurance companies dream. This is not to toot my horn, but if we look at entrepreneurs and the self-employed, I know statistically they are in better health, act more responsibly with personal care and don't abuse the health care system because it's linked directly and immediately to their wallets. I'd love to see a health care provider that took more into account small business owners and healthier lifestyles. We have 61,000 subscribers and a nation of growing entrepreneurs who would jump all over it and be immensely viable for a lower cost health care scenario that they would qualify for.
SamuelS - Health Care Providers Fault???
2005-09-29 07:27:14
This has always been a sore spot for me, personally. We, here in the U.S., have always screamed for 'controlled' health costs, now we have it and people scream for more 'choice'. I only have catastrophic coverage and choose not to use any drugs for my current medical situation knowing that diet and exercise can help prevent it from becoming extream. In talking with friends who have similar conditions, it is easier for them to take the drugs and do what they want. Well, 'Freedom' has a price attached to it and most need to wake up and realize that before it is too late.

Thanks..
Mary J. Bevan - Health Insurance SOLUTIONS
2005-10-02 15:12:49
READ Paul Zane Pilzer's book "The New Health Insurance Solution" and write about it, talk about it and lets create a change that will sweep the country.
jenny miller - Affordable Health Care?
2006-03-28 03:16:28
We get quite upset with our healthcare systems, wherever we live. Maybe having a look across the borders of our country helps to put things into perspective: in Britain, less than 5% of your tax deductions (not of your salary!!) goes towards healthcare - no wonder there are waiting lists of up to 2 years for routine operations such as hip replacements. Germany's health care system is often called brilliant, but don't forget that people pay nearly 15% of their gross salary just for health insurance. Health care is expensive, and if you've ever lived in different countries, you know you'll get what you pay for...
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