"Will We Let Conservatives Do To Health Care...": The Facts

116 million Americans are now uninsured, or underinsured, or financially vulnerable to unexpected medical costs—now the No. 1 cause of family bankruptcies.

• The Commonwealth Fund in 2007 found that nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses).

• Forty-one percent of working-age adults, or 72 million people, reported a problem paying their medical bills or had accrued medical debt, up from 34 percent, or 58 million, in 2005. An additional 7 million adults 65 and older also reported bill or debt problems.

Sara R. Collins, Ph.D., Jennifer L. Kriss, Michelle M. Doty, Ph.D., and Sheila D. Rustgi. Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families. The Commonwealth Fund. Volume 99. 20 August 2008. [1]

•In a 2005 survey of 1,771 personal bankruptcy filers in five federal courts, which included in-depth interviews with 931 of them, about half cited medical causes. That indicates that as many as 2.2 million Americans (filers plus dependents) have experienced medical bankruptcy in recent years.

•Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.

David U. Himmelstein, et.al. “MarketWatch: Illness and Injury as Contributors to Bankruptcy.” Health Affairs. 2 February 2005. [2]

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Those who have insurance are paying higher costs for policies that often have gaping holes in coverage. And insurance companies flat-out refuse to sell coverage to those already sick.

• Adults with individual market policies, rather than those with employer-based plans, are the most likely to have gaping holes in coverage. For example, about 22 percent of adults with individual insurance lack prescription drug coverage, while only 4 percent with employer coverage do. More than 70 percent of adults with coverage through the individual market go without dental insurance, about four times the rate of adults with employer coverage.

• People with individual policies are also more likely to have high out-of-pocket premium costs compared with people covered through employers, who generally share the costs with workers. More than half of adults with individual market coverage have premium costs of $3,000 a year or more, versus 18 percent of those with insurance through a job. Nearly one-third (32 percent) of those with individual market coverage spend $6,000 or more, compared with 5 percent of those with employer coverage.

• Adults with individual market coverage are also more likely to face high deductibles, on average, than are adults with coverage through a job. Thirty-seven percent of people with individual market coverage have deductibles of $1,000 or more, compared with 8 percent of those with employer-based insurance.

Sara R. Collins, et.al. Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families. The Commonwealth Fund. September 2006. [3]

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In today’s financial crisis and economic slowdown, millions more will lose jobs and health coverage, increasing the demand for change.

•The nation's employers continue to cut payrolls, with jobs down by 159,000 in September, the ninth consecutive month of job losses, according to the Bureau of Labor Statistics. So far this year, payrolls are down 760,000 overall and 969,000 in the private sector (the latter loss began in December).

• Unemployment, at 6.1 percent, is up 1.4 points over the past year, and over the past year, the unemployment rolls have expanded by 2.2 million, to 9.5 million, the highest number of unemployed since December of 1992.

Jared Bernstein and Heidi Shierholz. Jobs Picture: Jobs Decline for Ninth Month in A Row as Labor Market Recession Deepens. Economic Policy Institute. 3 October 2008. [4]

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But the cure conservatives are selling is worse than the disease: They propose to tax, as income, the health benefits that 160 million people get on the job. This is purposefully designed to destroy the incentive for companies to provide health insurance to their workers. The EPI Policy Center and other experts predict that 20 million Americans would lose good employer-sponsored group health insurance.

• Recently a team of prominent health economists estimated that 20 million people nationwide would lose employer-sponsored insurance if the health care plan proposed by Senator John McCain were to become law. Because the centerpiece of the McCain plan would impose taxes on health insurance benefits—which are now untaxed—employers would be less likely to offer them.

L. Josh Bivens and Elise Gould. McCain Plan Accelerates Loss in Employer-Sponsored Health Insurance: A State-by-State Analysis. Economic Policy Institute Policy Center. Research Bulletin #100. 1 October 2008. [5]

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Instead they’d be left on their own—perhaps with a partial tax credit--trying to buy inferior and expensive coverage directly from deregulated insurance companies.

• The conservative Heritage Foundation advocates for a "Tax Equity: A refundable health care tax credit for individuals would level the playing field between what an employer may offer and what an individual can buy for himself. President Bush recently proposed a measure to accomplish this. In the absence of this tax reform, employers could designate the health insurance exchange itself as their "plan" for the purpose of federal and state taxes. An employer's defined contribution on behalf of an employee would then be tax free, just as it would be for conventional employer-based health insurance, and the employee would have the freedom to select a plan of his choice."

Connie Marshner.“The Health Insurance Exchange: Enabling Freedom of Conscience in Health Care.” Heritage Foundation. WebMemo #1377. 1 March 2007. [6]

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Anyone already sick will have one hell of a time finding insurance at any price.

•Thirty states operate high-risk pools intended to offer coverage to persons denied coverage in the individual health insurance market. But in most states the high-risk pool mirrors the individual market’s problems: Coverage is expensive, the waiting period for coverage of preexisting conditions is long, and benefits may be limited.

•A few states with high-risk pools have addressed these problems by adequately funding high enrollment and comprehensive benefits; some also require the market to accept more risk. But most discourage enrollment in the high-risk pool in myriad ways and fail to ensure access to the individual market for persons with health problems.

Deborah Chollet. “Expanding Individual Health Insurance Coverage: Are High-Risk Pools the Answer?” Health Affairs. 23 October 2002. [7]

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Of course conservatives say this is all for the good--forcing us into “the free market” to shop personally for the cheapest policy. But for most of us it just means life gets harder.

•In 2007, the conservative Heritage Foundation advocated this “free-market" approach in its lecture, “Toward Free-Market Health Care,” ….This move toward more individual control over health care decisions and health care spending is part of the global movement toward health care consumerism. Giving people more power and control over their health care and health insurance creates new incentives for people to be more engaged in managing their health. Incentives work, and competition works. What we need to do is engage the power of consumers to transform our health sector to become more efficient, more responsive to consumer needs, and more affordable….

Grace-Marie Turner. “Toward Free-Market Health Care.” Heritage Foundation. Heritage Lecture #1019. 4 May 2007. [8]

•In 2007, former Republican presidential candidate Rudolph Giuliani also advocated for a “free-market” approach to healthcare during a GOP debate, Health insurance should become like homeowners insurance or like car insurance. You don't cover everything on your homeowners’ policy. If you have a slight accident in your house, if you need to refill your oil with your car, you don't cover that with insurance. But that is covered in many of the insurance policies, because they're government-dominated and they're employer-dominated. And the reality is that we need a free market…. Free-market principles are the only things that reduce [healthcare] costs and improve quality.

Rudolph W. Giuliani. “2007 GOP Presidential Candidate Third Debate.” 5 June 2007. [9]

•In the same GOP debate, Mitt Romney supported the “free market” healthcare ideology. Romney stated, As governor, I talked to people, and they say, "If I lose my job, I'm worried I'll lose my insurance, and my insurance premiums are getting higher and higher." And we said: We got to find a way to get everybody insured. And the last thing we want is to have the government take over health care, because anything they take over gets worse. We said: We need to find a way to get everybody in our state insured with private insurance. [We found] a way to get them insured without raising taxes, without a government takeover. It relies on personal responsibility.…We get all of our citizens insured. We have to stand up and say the market works. Personal responsibility works.

Mitt Romney. “2007 GOP Presidential Candidate Third Debate.” 5 June 2007. [9]

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That’s why people across the country are joining with Health Care for America Now to demand an alternative: quality, affordable health care for all.

•Health Care for America Now is a national grassroots campaign organizing millions of Americans to win a guarantee of quality, affordable health care for all. HCAN is grounded in organizations [10] that can mobilize people at work, at home, in their neighborhoods, and online; bringing together community organizers, nurses, doctors, small business owners, faith-based groups, organizations of people of color, and seniors who believe it's time they have an American solution that provides quality, affordable health care for everyone.

Health Care for America Now [11]

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This debate can’t be left to insurance lobbyists and politicians.

• The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. Among the six nations studied by the Commonwealth Fund—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004.

• Most troubling, the U.S. fails to achieve better health outcomes than the other countries and is last on dimensions of access, patient safety, efficiency, and equity. The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage.

Karen Davis, Ph.D., et. al. Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. The Commonwealth Fund. Volume 59. 15 May 2007. [12] [11]

• Almost $113 million was spent lobbying Congress on prescription drug issues in just the first half of 2008. Nearly all of that was spent by the leading drug makers. Another $32 million was spent on issues related to health services and HMOs, and almost all the big spenders were insurance companies. The two sectors combined are responsible for $14 million in campaign contributions so far this year.

Open Secrets.org. Lobbying: Health Services/HMOs, [13] Lobbying: Pharmaceuticals/Health Products. [14]