The Real Policy Crisis in America

Excellent article in the Times about the failure of even families with good health coverage to stay abreast of mounting health costs when a serious and chronic illness appears.

When Health Insurance Is Not a Safeguard - New York Times

CAMBY, Ind. - Until the fourth trip to the hospital in 1998, Zachery Dorsett's parents thought their son was an average child who was having trouble getting over a passing illness. He was 7 months old, and it was his second case of pneumonia.

The Dorsetts, Sharon and Arnold, were concerned about Zachery's health, but they were not worried about the financial consequences. They were a young, middle-income couple, with health insurance that covered 90 percent of doctors' bills and most of the costs of prescription drugs.

Then the bills started coming in. After a week in the hospital, the couple's share came to $1,100 - not catastrophic, but more than their small savings. They enrolled in a 90-day payment plan with the hospital and struggled to make the monthly installments of nearly $400, hoping that they did not hit any other expenses.

But Zachery, who was eventually found to have an immune system disorder, kept getting sick, and the expense of his treatment - fees for tests, hospitalizations, medicine - kept mounting, eventually costing the family $12,000 to $20,000 a year. Earlier this year, the Dorsetts stopped making mortgage payments on their ranch house, in a subdivision outside Indianapolis, because they could not afford them. In March, they filed for bankruptcy.

"Zach was really mad at us when we told him we were going to lose the house," Mrs. Dorsett said. "We told him we had to make a choice: whether to pay for medical bills or the house
....

After decades in which private and government insurance covered a progressively larger share of medical expenses, insurance companies are now shifting more costs to consumers, in the form of much higher deductibles, co-payments or premiums. At the same time, Americans are saving less and carrying higher levels of household debt, and even insured families are exposed to medical expenses that did not exist a decade ago. Many, like the Dorsetts, do not realize how vulnerable they are until the bills arrive.

Lawyers and accountants say that for the more than 1.5 million American families who filed for bankruptcy protection last year, the most common causes were job loss and medical expenses. New bankruptcy legislation, which went into effect Oct. 17, requires middle-income debtors to repay a greater share of their debt.

On the Right people deny there is a problem serious enough for government to do anything about it. On the Left, the problem is typically cast in terms of the uninsured. But the problems are so much broader and deeper than that. For one there is the mounting costs. Or another, the declining quality of care -- yes declining. Talk to a nurse and she or he will tell you about staffing shortages, patient errors, and the health care crisis from the inside out. Premiums are rising annulaly. Often business picks up these costs. But the share of premiums born by employees is rising. As are annual deductibles and co-payments. Limitations on coverage and regulation in utilization. This is the health care system experiences by most Americans. The exceptions are the wealthy and the politicians who have voted themselves coverage sufficient to be immune to almost all aspects of the crisis. Congressmen don't feel it when an insurance company dubles premiums in one year. They don't have plans with limited prescription drug lists and large co-pays. They have little to no idea of the plight of small businesses and the self employed who struggle to get adequate coverage and receive almost no tax benefits -- unlike their employed bretheren.