Entrepreneurs for National Health Care?
I have been meaning to share with a friend from Germany some thoughts on the absurdities I’ve encountered in the U.S. health care “system.” I’ve put “system” in quotes since whether the U.S. even has a health care system is subject to debate. Thomas Greaney of the Center for Health Law Studies at Saint Louis University has written (PDF):
“It is hard to imagine anyone creating a health care apparatus — the word ’system’ is totally inaccurate — such as the United States has today. Fragmentation, inequity, and inefficiency abound.”
While my German friend is no doubt aware of the broad contours of health care in the U.S., it is the details of the U.S. health care mechanism that can be most exasperating, both for Americans who have insurance and those who do not. That the closure of my former employer, the Rockridge Institute, requires me to find a new health insurance provider and new doctors for my family is just another absurd wrinkle. I have a feeling that my friend’s side of the conversation might resemble a classic comedy routine by Bob Newhart.
In his monologue Introducing Tobacco to Civilization, Newhart plays the head of a British trading company who is (anachronistically) responding to a phone call from Sir Walter Raleigh in the colonies. Raleigh has called to explain how tobacco leaves are used there and why he has purchased 80 tons of them to ship to England.
I can almost imagine my friend’s own quizzical replies as he listens to my explanations of the high deductible plan my family recently endured:
So you’re saying that you and your company pay more than a thousand dollars a month to an insurance company for what they call a “monthly premium”?
I see. Well, look on the bright side. After you get that out of the way, you get to see any doctor you want for free, right?
Oh, is that so?
You mean you only get to see doctors who work for the insurance company? Huh…
Well, at least they don’t charge you when you visit the doctor…
Oh, you mean they charge you again to see one of their doctors?
$80 each time? And they call that a “co-pay”? Hmm…
So, to get the $80 back, do you have to fill out a form or what?
What’s that? You mean you don’t get it back at all?
And you’re telling me that they send you more bills to pay months later for parts of the visit that they decided not to cover after the fact?
Sounds like a complicated system. But maybe it works out better for people who already have serious health problems when they sign up with the insurance company…
Uh-huh, uh-huh. They call that a what? A “pre-existing condition”? And they don’t need to cover it at all? That’s a good one! You’re kidding, right?
Okay, so I’m no Bob Newhart. But without even getting into the more severe problems of people denied necessary care by their insurance companies or people who lack insurance entirely, it’s clear that the run-of-the-mill problems of generally healthy people who have health insurance in the U.S. are often more than mere annoyances. As the New York Times reports today, Americans who have insurance are finding the cost of health care to be a significant and growing burden. Only 7% of those surveyed say that they feel financially prepared for their future health care needs.
The article also notes the impact on small businesses:
Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.
Health costs are “burying small business,” said Mike Roach, who owns a small clothing store in Portland, Ore. He recently testified on health coverage at a Senate hearing led by Ron Wyden, Democrat of Oregon.
One thing that I find particularly troubling is when people find that paying for insurance does not ensure appropriate health care when it is needed most. This finding was examined at length in a health care initiative by the Rockridge Institute, called Don’t Think of a Sick Child. Under an arrangement in which health insurers act as middlemen who intervene in the decisions of medical professionals, the motivation of insurers to profit by denying care can be overwhelming. Such a “system” can no longer be said to provide care reliably even for those whose companies offer insurance.
For those considering the entrepreurial route, these issues can be especially disheartening. While even large corporations are passing more of the burden of health care costs on to their employees, they at least benefit from lower rates due to the large pool of employees they seek to insure. For someone thinking about starting a small business, the cost of health insurance premiums alone can be daunting. Add to these the other costs associated with a high deductible plan and other pitfalls and the viability of the business itself could be called into question, a pattern examined in a 2005 article in USA Today on the role that health insurance costs may play in discouraging entrepreneurship.
It is true that there are industry or other associations that a small business owner might be able to take advantage of to obtain somewhat lower rates as a part of a larger risk pool. However, these are no panacea for entrepreneurs, nor a step toward a system in which health care for all replaces profit-first insurance. They do nothing to provide our neighbors (not to mention potential customers) with the protection they need.
As a nation that enjoys stories of successful entrepreneurs, the U.S. could certainly enable more people to start businesses by adopting a national health care system. A system that puts care above profits in health care could accelerate innovation and promote mobility by lifting a barrier that now blocks many Americans from pursuing their dreams.
Community entrepreneurs start out with a recognition that success does not come from individual effort alone, but from the strengths and contributions of many. These contributions include the creation and preservation of the common wealth from which we all benefit. Clean air and water are part of that common wealth, as are public schools and universities, the postal system, the Internet, and the courts. All of these advance opportunities for businesses to succeed, as is clear if you imagine trying to start a business in a country that lacks such essentials.
As entrepreneurs, we must ensure that our voices are heard in the debate over health care, and that the stifling effects of our insurance-based system become widely recognized. We do not have the resources to lobby Congress that that nation’s largest corporations have, but small businesses create a large proportion of America’s jobs and our voices can resonate. Small business owners, such as Mike Roach from the Times article, have testified in Congress before about high health insurance costs, but our stories need to be told and retold to make an impression and to demonstrate why mere tinkering with our insurance-based health regime isn’t the answer. Perhaps we could envision a project that might be called Entrepreneurs for National Health Care to provide a forum for such stories.
Transforming our economy into one that breaks free of carbon-based fuels will likely require far more entrepreneurs. A challenge that big requires small business; we can’t count on the likes of BP and ExxonMobil to do the job. The United States can no longer afford a clumsy health care apparatus that, among its many unfortunate effects, discourages people from starting new businesses that would benefit our society and environment.
And I’ve got a phone call to make.
Evan
