Tuesday, October 14, 2008

Health Care's Not Just An Issue To Us

Here's this week's column, which I originally wrote for the "He said, she said" Obama-McCain pieces the previous week, but the editor wanted more than one issue so this got bumped.

East Valley Tribune, Oct. 12, 2008

Few law firms these days are partnerships, but at mine we still refer to our colleagues as partners, and that's how we try to behave. We fuss endlessly over minor matters so everybody gets their say, and (on good days, anyway) worry about feelings almost, but not quite, as much as money.

Like most relationships, some days I drive my partners nuts and vice versa, but mostly we all pull in the same direction. One way we look out for each other is with health insurance.

One of my partners has a long-standing medical condition, completely unrelated to diet, activities, or lifestyle, which developed unexpectedly after law school so we can't blame heredity. The problem makes our annual search for group coverage more difficult and expensive. Most of us could get cheaper insurance for ourselves and our families without this medical problem in our group, but we're not going to abandon our friend and partner. Not only would it cut against the collegiality we strive to achieve, but forcing our partner to find separate coverage would be hugely expensive. A small savings for most would mean huge increases in costs for one - if an insurer would write a policy despite a serious preexisting condition.

The sailors may have calmed the seas by tossing Jonah overboard, but there's no guarantee an insurer would spit out our partner on dry land. (The more likely exit would be from the whale's other end.) Having a group means we cross-subsidize each other, because while one has a problem today, others could be the problem tomorrow, and we're all better off spreading that risk.

There's no magic to having health insurance tied to employment, and there are lots of reasons why you'd want to de-couple insurance from work. But there aren't that many other ways to form a group where we can share risk. We tried a voluntary group; we even joined the Arizona Hispanic Chamber of Commerce to get a group policy -- but that program fell apart as healthier individuals and groups opted for cheaper insurance, leaving only the less-healthy to face increasing premiums.

We don't want to risk the individual insurance market. It's not just tax policy that's keeping us out; as partners, we're taxed on our premiums. It's also because the individual market is more expensive, has higher administrative costs, and lets insurers pick and choose based on age, gender, geography, and preexisting conditions. Studies indicate that a typical family must pay more than $2,000 per year additional just to get the same coverage available in a group -- and the numbers would be far worse for our partner with the preexisting condition.

Why does this matter for this election? The two candidates have very different views of the problem. Barack Obama's plan would build on the current system, requiring all employers except small business to provide insurance directly or else contribute to the cost. Instead of the current individual market, he'd create an insurance exchange where small businesses and those lacking coverage could buy health insurance (either private or public) with tax credits. His plan also expands coverage under Medicaid and the State Children's Health Insurance Program, S-CHIP. In our case, we'd still have our little group, or could participate through an insurance exchange; we wouldn't have to cast our medically-challenged partner adrift.

We'd head in a very different direction under John McCain's plan. Apart from the tax hike on benefits, and the $1.5 trillion cut to Medicare, his plan would break apart employer-based coverage and force people into the individual market. The theory is that comparison shopping, along with increased price sensitivity and opening ourselves to potential costs of medical risks, will make us better consumers and ultimately save money. But that kind of individualized, economically-driven market means that we'd toss our friend and partner over the side.

So in the end, it's both a policy and a moral choice. Obama's plan will make health care more affordable, accessible, and efficient. A new study says his plan will cover 34 million uninsured, the competing plan only 2 million. But more than that, Obama's plan is designed for an America where we work together and assist each other, where helping a friend doesn't become a dumb economic decision.

So vote for change -- and for a better America.

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