we have a system skewed toward overuse by the haves and underuse by the have-nots, in which the healthiest people (highly paid employees) get the most generous health insurance. The Kaiser Commission reported that per capita spending on health care is $2,484 for fully insured Americans, compared to $1,253 for Americans who are uninsured for a full year...
Since it’s unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance.
Consider the example of patients with skull fractures. Uninsured patients were less likely to receive an operation on the nervous system, such as a craniotomy: 34 percent of the insured patients received such surgeries, compared with 25 percent of the uninsured. The uninsured with this diagnosis also had higher mortality (22 percent, compared with 13 percent for the insured). The lack of health insurance appeared to have a significant effect on treatment decisions across a wide range of health problems. These decisions may be the domain of the health care providers, who need only refer to patients' charts to determine their insurance coverage. They may also reflect decisions by crash victims themselves, concerned about large medical bills. Either way, lack of coverage is associated with a lower likelihood of potentially life-saving procedures. To give an idea of the magnitudes, if these estimates are applied to the nation as a whole, they indicate that about 2,000 lives a year are lost because of lack of treatment for uninsured people involved in auto accidents.
Health care reform proposals that focus on catastrophic care could go a long way toward closing this health outcome gap, while also relieving emergency rooms and other health care providers of an enormous financial burden. And catastrophic insurance premiums, with a high deductible, are relatively inexpensive when compared with more comprehensive plans. Coupled with health savings accounts to cover the costs of preventive care, a program to subsidize catastrophic insurance could give real substance to the political goal of restraining spiraling health care expenses as patients begin to consider the costs of care. Such insurance could also offer peace of mind that large bills will be covered and that life-saving treatments will be provided.
For Discussion. What challenges do Bailey's proposals for mandatory health insurance and health savings accounts not address?