Patients often ask me which health insurer I recommend for their families. Other than Medicare for people 65 and older, there aren't any. Monthly costs to the subscriber increase by 20-40% per year. But that isn't the only economic burden. Copays, formerly $10 per visit, are now $40.00 to $50.00 - in some cases, more than the visit cost. Deductibles -the annual amount required for the individual or family to spend before insurance pays the first dollar, are now thousands of dollars. And doctors aren't the beneficiaries either, with lessened pay that occurs each January 1st like clockwork. The lingo that health insurance companies when referring to payments for doctors and hospitals are "losses", which clearly defines their primary motivation with their subscribers. My opinion is now backed up by Consumer Reports, a not-for-profit magazine. In November 2011, the magazine published a report rating the largest insurers, state by state. Here is how the largest health insurers on Long Island, New York stacked up with Consumer Satisfaction, on a scale of 1 (Worst) to 5 (Best):
Medicare, with higher levels of satisfaction, is financially underwater. And as the population continues to shift to an older average, that will worsen.
So what is the answer?
I believe that Canada provides the template for a reasonable solution, although when that country instituted universal health care, it wasn't initially true.
Canada provides all of its citizens with a basic level of coverage. Initially, it was the only way in which patients could see doctors or seek hospital care. In its early years, doctors were financially penalized for earning above a certain level of income, leading many of them to take four-month "holidays" (the term that Canadians use for vacations). And stories of patients waiting 6 months to obtain MRI's were legendary here in the United States as to why they system was unworkable south of the border.
Doctors and patients both screamed to be allowed to go outside the basic universal health care system. The Canadian government balked, stating that they refused to allow a "Two tier health care system."
But as the system evolved, the government began to bend. And it is now true that companies and individuals who can afford it can now go outside the system for care that is above the minimum.
Americans scream for universal health care, but cry for lower taxes.
And you can't have both.
Canada's top tax tier is 48%. And up north, there is no such thing as a mortgage interest deduction.
With the United States presidential election less than one year away, you're going to be hearing a lot about the unsustainable, broken health care system. And prior to the election, no politician, not even our incumbent President, will tell you something that you don't want to hear.
But the 3 requirements are:
- A beneficial tax environment for businesses, in order to foster employment and a mighty economic system.
- Higher personal taxes. Yes, higher taxes. Of course, no politician will tell you this in an election year.
- Basic Universal Health for all, with the availability to go outside that system.*