My recent birthday was an important milestone and my health care provider, Kaiser Permanente, thought so, too. When the important day arrived, so did a notice from Kaiser. My health care premium was being increased by nearly $300 a month. Never mind that my blood pressure is 120/60, my resting pulse is 60, my body mass index is 23, I watch my diet carefully, and I bicycle 80 to 130 miles per week. The actuaries have spoken, my wife and I must pay the piper, and our monthly health insurance now exceeds our mortgage payment. At least we have coverage.
One of the key elements in the recent election was the cost and availability of health care, something that may not seem important to younger Americans. One doesn't have to look very hard to find sobering realities about the cost of getting health insurance and necessary care in the US. And one doesn't have to try very hard to find a friend of family member who has faced difficulties with health care. Some candidates and voter adhere to a "free market" approach while others take a more socialist approach to controlling costs. We may worry about rationing of care and we may even worry about financial ruin should we contract a serious illness or be injured. Others take a public health approach and try to reduce risky lifestyles and choices that lead to chronic yet preventable illness. The degree to which this all concerns us depends largely on our age and the current status of our health.
Cost is King
At its core, the free market approach assumes only those who can afford health insurance actually deserve the insurance. For decades health insurance was tied to one's employment as a worker benefit. If you were employed, you and your dependents deserved health care. In the 1980s, as health care costs began to climb, employers required employees to contribute to a share of the costs. Health insurance was restricted to full-time employees and additional charges were added for dependents. By the 1990's, most workers were contributing to a significant percentage of the monthly premiums. And now many employers offer health insurance options that are a shadow of what this benefit used to be.
Group Coverage
One way to reduce insurance costs is to spread the risk (or cost) for the few people who face a catastrophic illness across a larger group, yet more and more workers are no longer traditional employees. I'm a self-employed flight instructor. My wife is a contractor for the US federal government. We applied for individual health insurance only to find my wife was denied due to a medical history that included pneumonia. So our solution was to form a partnership and apply for group health insurance because under California law, group health insurance cannot deny coverage based on a pre-existing condition. We pay a higher rate than we would for an individual plan, but - as mentioned earlier - at least we have coverage.
What's Next
As many aging baby-boomers are discovering, we must hold out through at least two more cost increases at ages 60 and 65. Not-so-subtle ageism in a very difficult job market makes the prospect of being unable to afford any coverage an all-too-possible reality. In just over a decade my wife and I will be eligible for medicare, if such a thing still exists by then. In the mean time, we watch our diet, exercise regularly, do our best to maintain our individual health, and hope that we don't fall victim to any serious illness. For the time being, the market-driven approach to providing health care is king and woe unto him or her who cannot compete in the health care market because it's everyone for themselves. American society can't seem to afford to care.
