The fact that millions of Americans do not have health insurance is said to be a major problem, if not the major problem, of the United State health care system. Estimates of the number who are uninsured vary widely. There are also widely different indicators of how much difference uninsurance makes. One of the strange features of the U.S. health care system is that the health plan most of us have is not a plan that we chose; rather, it was selected by our employer. Even if we like our health plan, we could easily lose coverage because of the loss of a job, a change in employment, or a decision by our employer.
Most employer health insurance contracts last only twelve months. At the end of the year, the employer may choose a different health plan or cease providing health insurance altogether. Strangely, the only people with private health insurance guaranteed to last longer than one year are people who purchase insurance on their own. A switch of health plans might mean changing doctors as well, if the two plans do not have overlapping networks or if cost-sharing arrangements penalize the patient’s previous choice of doctors. If an employee (or family member) has a health problem, that could interrupt the continuity of care. In addition, different plans have different benefit packages. So some services, such as mental health, might be covered by one plan but not the next.
These disruptions affect some families more than others. For people who are healthy, they amount to minor inconveniences; for others, the problems can be severe. One study of chronically ill workers found that relying on one’s employer for health coverage reduced job mobility 40 percent. Older workers, who are more likely than younger workers to have health problems, are also disproportionately affected. Further, as more employers cut back on postretirement health care benefits, many baby-boomer early retirees will have to shop for individual insurance and pay for it with after-tax dollars. The same fate will confront many younger spouses of retirees who enroll in Medicare.
Discussion Question
What is your approach to determine an action that can resolve these problems in our system? Can we have one without the other?
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