POLITICS

Re-thinking our approach to health care
Maybe we should stop legislating madness

HEALTH CARE has been a major topic of discussion during this presidential campaign season. Every Democratic candidate has put out a plan for cutting health-care costs, while increasing the number of people insured.

On the Republican side, only former New York Mayor Rudy Giuliani has offered a plan and it has been roundly criticized by health-care advocates around the country.

The decision by candidates to make this issue a part of their campaigns has been prompted by a citizenry that is seeing its health care premiums increase, while the quality and access to care declines.

The issue is one of the most complex in a time when complex problems are the norm. It involves not only hospitals and insurance companies, but drug companies, federal and state funding mechanisms, and an aging American population.

The candidates are quick to mention all or most of these issues in their plans, but repeatedly fail to deal with what is the hub around which all these problems revolve — the disconnect between those who use health services and those who pay for them.

Americans with health insurance — either private, employer-provided or government controlled — have grown used to going to the doctor or hospital for virtually every ailment from a sinus infection to cancer, from a sprained ankle to a heart attack. There is little regard for cost because most or all of the medical care they receive is paid for by some third party.

A perfect example of an action by government that will undoubtedly drive up health care costs is Senate Bill 183, which was signed into law at the end of this year's New Hampshire legislative session. That bill forces any insurance company operating in New Hampshire to insure dependent children up to the age of 26.

The previous age at which family insurance covered a dependent child was 21 and, while there is no way of actually knowing how many more people insurance companies will have to cover as a result of this bill becoming law, it is safe to assume those additional costs will be passed on to all of us and further spur the increase in health care costs.

Giuliani's "free market" approach to health care would do little more than create a situation in which insurance companies could "cherry-pick" those clients with the lowest risk and charge prohibitive amounts for policies for everyone else. We saw that happen here in New Hampshire in 2003 when Senate Bill 110 was passed by the New Hampshire Legislature. It took a couple of years — and a new governor — to mitigate the negative impacts of that legislative misstep.

But the former New York mayor is correct when he says that health insurance isn't really insurance in the same way as car or home insurance. With car insurance, we don't expect the insurer to pick up the cost of an oil change or a blown tire. With home insurance, the insurer is not required to put a new roof on your house or replace an aging boiler.

Those insurances are there for the unusual expenses incurred by anyone owning a home or a car — a major accident or someone falling on icy stairs. Those other expenses are paid for by the car and home owners out of their own pockets and, as a result, car and home insurance rates have remained affordable for most Americans.

Changing the health-care system in the United States requires a rethinking of what we really need and should expect from our health care coverage. Perhaps to be able to offer some sort of health-care insurance to all Americans we have to limit our use of the health-care system to real emergencies or chronic diseases.

Perhaps we can learn simple techniques for treating our sprained ankles and sore throats at home without involving health-care professionals and increasing the pressures on an already stressed and over-priced system. Perhaps we can go to the doctor every two or three years for a physical instead of every year, and learn how to take better care of ourselves so some of those chronic illnesses don't happen.

Maybe we can have insurance with only slightly higher deductibles and lower premiums if we used physicians and hospitals — along with the drugs they prescribe — sparingly and as partners in supporting our physical health. And maybe costs would come down if we stopped putting additional government mandates, such as Senate Bill 183, on those insurance companies.

Shir Haberman is the business and political writer at the Portsmouth Herald. He can be reached at shaberman@seacoastonline.com