Ohio.com editorial: Americans have a health system that is morally unacceptable

Afflicting the afflicted

The best health care system in the world? Not when illness looms as a path to financial ruin

Ohio.com, Jun 26, 2008

This year, an estimated 1.4 million Ohioans have no health insurance. Thousands more who have some health coverage are underinsured, spending at least 10 percent of their household income on out-of-pocket payments for medical expenses.

Behind the statistics of the health-care crisis facing an increasing number of Ohio families are people like Ruth and Kevin Koelliker, the Brunswick couple whose experiences were described Tuesday by Tracy Wheeler, a Beacon Journal medical writer.

The Koellikers stand in for the underinsured and uninsured citizens not only in Ohio but across the country, the majority of whom are working people confronting a health insurance system that puts enormous pressure on their finances.

They are up against a mix of factors involving the status of their health, their employment circumstances and a crazy quilt of laws and regulations that are proving increasingly ineffective. The Koellikers' experience points to a critical erosion in the basic concept of health insurance — the understanding that people buy insurance to protect against catastrophic illness, and that insurance companies manage the inevitable risks by offering affordable rates to a large and varied pool of customers to spread widely and responsibly the cost of covering the sickest.

As in the Koellikers' case, many consumers discover to their dismay that a serious illness (a heart attack or a cancer diagnosis) or a chronic health condition (lupus or diabetes) shuts the door on affordable policies. With average premium rates rising at twice the rate of average incomes, the cost of coverage in the private market can quickly outstrip the means of a middle-income consumer with a chronic or ''pre-existing condition.'' They often must settle for coverage that excludes the health problem.

In a system where health coverage is often job-related, employment status also is inordinately important in whether coverage remains affordable.

Employers' negotiated contracts and contributions reduce the cost for workers. By the same token, a change or loss of employment or an employer's decision to drop coverage leaves workers with hard options: go without insurance or pay outrageously high rates (a policy for 40- to 49-year-olds of $20,525 for an individual and $55,492 for a family for a year?).

Of equal concern are laws and regulations that offer false hope. For example, a mandate on insurers guarantees potential consumers an open-enrollment period, but it does nothing to ensure that the rates offered (such as the $55,000 policy) will be affordable. In a weakening economy where workers are spending a longer time between jobs, it is also unduly harsh to allow a coverage gap of a mere 62 days, after which insurers can deny insurance.

Against such a stacked deck, Kevin Koelliker aptly observed, ''The average guy doesn't stand a chance.'' Unfortunately, the assessment is accurate. Americans have a health system that is morally unacceptable. Illness should not be a path to financial ruin.

From John Curry