Local Opinion: Is the American health care system healthy?
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Local Opinion: Is the American health care system healthy?

Charles Katzenberg

The following column is the opinion and analysis of the writer.

In the April 9 edition of the Arizona Daily Star, Henry Brean wrote about how St. Phillips Episcopal Church is using $35,000 in donations to leverage payment of $3.5 million in medical debt for 1,700 Tucson households. Medical debt is currently the No. 1 cause for bankruptcies in America, affecting over 500,000 families every year. In addition to medical debt, the coronavirus pandemic has stressed multiple parts of our health-care system. Is there a better road we might take?

At present, health insurance for most Americans is tied to employment. In 2018, 58% of non-elderly Americans, about 180 million, received employer-based insurance, according to the Kaiser Family Foundation. In the past three weeks, almost 17 million Americans have lost their jobs and filed for unemployment insurance. This represents 10% of the workforce. Some of these 17 million will lose their employer-based health insurance and some are already uninsured.

In 2018, 9% of Americans, 29.7 million, did not have health insurance. In addition, 13.5%, about 44 million who had insurance, were considered “under-insured” meaning that their out-of-pocket health expenses exceed 5-10% of their income, according to the Commonwealth Fund 2019 state scorecard.

For example, if a family’s annual income was $50,000 and they were forced to spend more than $5,000 (10%) on health insurance and other out-of-pocket health-care costs, this would be considered unreasonably high. So, approximately 74 million Americans either have no health insurance or they are under-insured, i.e. they cannot afford their premiums, deductibles and co-payments.

We know that those who are uninsured and under-insured will tend to avoid coming in for medical evaluation or care because the costs will come right out of their pockets and compromise their ability to pay rent, buy food, clothing, medications or other essentials.

What if every American had cradle-to-grave health insurance that was not tied to employment? You might say, “that would be nice but I don’t think it is affordable and besides, I don’t want to lose my current health insurance.”

However, what if you were able to pay less out of your pocket than you currently do for the same or better health insurance?

You might say that would be nice, but how is that possible?

What if you never had to worry about where your health insurance would come from if you moved or changed jobs or were fired or laid off in a pandemic?

You might say that would be nice, but how is that possible?

What if you had the freedom of choice to see any physician or go to any hospital in the U.S., rather than be limited to whatever local network your health insurance dictates? You might say that would be nice, but that sounds too good to be true.

What if over the next few months you develop a fever, cough and shortness of breath and wonder if you might have COVID-19? If you knew that all costs related to diagnosis, treatment and hospitalization were covered, would you be more likely to come in promptly for testing? You probably would say “yes.”

What if all of the above “what ifs” were part of an American health-care plan? Over the next year you will hear lots of discussion of how we can improve our health-care system to not only be more responsive to a pandemic, but to offer every American affordable and comprehensive health insurance. You might hear the term Medicare for All.

Check it out, kick the tires and see if it might make sense to you. What we currently have could be called health care for some while millions are left on the sidelines.

Charles Katzenberg is a cardiologist who retired from Banner University Medical Center in 2019.

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