Editor’s note: This commentary is by Jeffrey Reel, of Lyndon Center, who is the general manager of Natural Provisions in St. Johnsbury, and the former sustainability manager of the Omega Institute in Rhinebeck, New York.
[S]ome individuals level criticism toward progressively minded Vermonters advocating for a more socialized medical and health insurance system in the form of universal primary health care or mandated state-approved insurance. What critics don’t understand is that our health insurance systems are already socialized.
I was required to pay very high premiums for “private” health insurance. This money was not set aside for my exclusive use in the event I had to draw from it in the future. It was used to pay for the health care costs of others, all of whom were insured under the same insurance company. This isn’t news, but here’s the kicker: The better part of every insurance premium dollar is spent treating illnesses that are within people’s ability to control and even prevent.
It is now common knowledge that many of today’s leading, and expensive, health problems can be slowed, halted and even reversed through dietary and lifestyle changes. These illnesses include obesity, Type II diabetes, heart disease, hypertension and many forms of cancer. Smoking and the excess consumption of alcohol and dietary fats are behind millions of chronic and acute illnesses in the United States each year. Nationwide, annual expenditures on treating heart disease alone are on track to reach $800 billion by 2030, which does not take into account over $275 billion annually on the indirect costs of heart disease such as lost productivity, which puts us over $1 trillion annually for that one lifestyle choice alone. Add to that projections for treating Type II diabetes ($500 billion annually by 2020), and throw in for good measure the $2.3 trillion spent annually by our health care system.
The cost of treating these preventable illnesses is crippling – emotionally and financially. Most people know enough now to make solid and significant changes in their diets and lifestyles but just choose not to, including those critics of universal coverage (all of whom, no doubt, are insured). And, so, the financial burden of caring for them then shifts to the rest of the insured population like myself, who must then pay, out of pocket, through costly monthly premiums, to cover the cost of medical care for fellow insureds neglectful of their health. This is the nature of socialized medicine. We are our brother’s keeper.
A recent commentary (John McClaughry: A state health insurance purchase mandate?) in VTDigger took exception to the idea of mandating a state-approved insurance plan because it believes “mandating that people buy health insurance of the state’s choice is an invasion of their freedom” and is punitive in nature. It instead advocated for what it called an “income tax-based recapture” for unpaid medical bills incurred by uninsured persons in order to hold them personally responsible for paying down those bills. “We have long done this for ‘deadbeat dads’ who won’t make court-ordered child support payments,” the commentator writes. The plan reserves the right to pursue people for their entire lives to make sure they cover the costs of any and all medical care they have received. But what happens when those bills – from, for example, expenses related to treating an aggressive cancer, or recovery from a devastating and crippling accident – runs into the hundreds of thousands of dollars, annually? Even treatment of an individual’s stroke or chronic heart disease costs on average $19,000 per year. (1) How does that person – the moral equivalent of a “deadbeat dad” according to the commentator – pay down that annual tab? And when it becomes clear that individuals will never be able to even begin to defray the cost of their care, sometimes through no fault of their own, what then? Who pays? Or do you simply cut off their care? An example of tough love I suppose. A punitive and contemptible plan.
The commentator goes on to observe: “If health insurance premiums are set according to an age group’s risk of incurring medical expenses, the premiums for 60-year-olds will be as much as five times the premiums for 20-year-olds.” I can relate. As part of a private insurance plan, my monthly premiums were likely five times higher than they should have been because I was expected to pay for the medical care of other insureds neglectful of their health. And, as a 60-year-old, my medical expenses were negligible when measured against the medical costs of millions of younger insureds. That won’t always be the case, but it has been for the first 65 years of my life. Through my “private” insurance plan, I subsidized the high-risk lifestyle habits of millions of other insureds.
The commentator continues: “… when the small business and individual insurance pool is community rated … all policyholders must be charged the same premium for the same coverage regardless of age. Thus young, healthy people will be made to pay far above their age group’s expected medical expenses … The state requires young people starting off in life, at the bottom rung of their lifetime income ladder, paying off education loans, planning to raise a family and buy a home, to subsidize people 40 years older, at the top of their lifetime earnings, their children grown and gone, and their mortgage paid off.”
Don’t take out your violins for the younger, youthful generation just yet. (And there’s a whole discussion about the cost of a college education embedded in that statement.) That characterization of seniors paints a pretty rosy picture of retirees in Vermont. It should come as no surprise, though, that Vermont falls 37th in state rankings when it comes to seniors having adequately prepared financially for life after retirement. (2) Most seniors are in no position to cover the costs of their health care, especially in a medical system that charges extravagant fees for even the most modest of services, and one that richly rewards specialists to conduct, and charge for, every test imaginable. Of course, once reaching the age of 65, seniors qualify for Medicare, which House Speaker Ryan dreams to dismantle.
Critics of universal primary health and mandated state-approved insurance do believe in socialized medicine – but their own particular version of it, and one they personally benefit from. No, they don’t want their own hard-earned dollars to be taxed to pay for those who lack any medical coverage at all; but, yes, they seem fine having my hard-earned dollars siphoned off through health insurance premiums to defray the costs of those already insured, tens of millions of whom are neglectful of their health, including those very critics. This is what socialized medicine and insurance look like. Don’t be misled: It is not only the uninsured who cannot afford today’s medical costs. No one can afford to pay for the cost of medical care today – not even the insured, alone.
So, critics of so-called “socialized” medical and insurance systems can stand up and beat their chests over what they believe to be the quality of our present-day medical and insurance systems, but just know that it is socialized medicine of which they speak. And, personally, I am just as willing for the government to use my tax dollars to make sure every man, woman and child in this state has health coverage as I am for my insurance premiums to pay for those who are already covered but who remain neglectful of their health, and who assume that others like myself will be there to cover their unnecessary medical costs. It’s only fair.
Someday, as we embrace preventive health practices and lifestyle choices, we will provide the only lasting solution to lessening the cost of health care: by lessening the need for it. Until then? Socialized medicine is here to stay, in one form or another, as it always has been.
Just ask John Dunne.
“No man is an island entire of itself; every man
is a piece of the continent, a part of the main;
if a clod be washed away by the sea, Europe
is the less, as well as if a promontory were, as
well as any manner of thy friends or of thine
own were; any man’s death diminishes me,
because I am involved in mankind.
And therefore never send to know for whom
the bell tolls; it tolls for thee.”
Notes
(1) The American Journal of Managed Care, March 2010.
(2) Bankrate study: Seniors’ incomes in 47 states don’t go far enough
