Monday, July 28, 2008

The Foraker-Rasmuson Health Insurance Plan

The July 27, 2008 issue of the Fairbanks Daily New-Miner carries an article based on an earlier one in the Anchorage Daily News describing what it calls a “bold insurance plan” being put forth by the Foraker Group and the Rasmuson Foundation aimed at lowering the number of uninsured persons in Alaska. The idea is to make it easier for the 6,000 employees of nonprofit organizations to buy health insurance for employees, thereby getting the employees off the rolls of the uninsured.

While laudable in its intent to help some Alaskans with their health care expenses, the Foraker-Rasmuson plan, like many other proposals, focuses on the wrong problem. The real problem is affordable health care, not the affordable health insurance the plan proposes. If health insurance actually paid for the full cost of health care, then having affordable health insurance would be a great idea. Unfortunately, that is not the case. Most commercial health insurance pays only a part of the bill, and the proportion it pays declines with greater need for health care. It is generally true that the more affordable a health insurance policy is, the lesser portion of the health care cost it pays. The majority of Alaskans need comparatively little health care each year, so whether or not they have health insurance, their health care costs are limited, perhaps only to what they pay in health insurance premiums if insured. If they have no health insurance, their cost is even less. Insured or not, these are the lucky Alaskans.

But woe is the Alaskan, insured or not, who needs a lot of health care. At no fault of his own perhaps, he has a serious car accident that puts him in the hospital, she has a complicated birth, or he contracts cancer or Alzheimer’s that requires extensive or long-term care. By the time this person pays for any premiums, deductibles, co-pays and all other out-of-pocket expenses associated with his or her health problem the person may face a bleak financial future that might well include bankruptcy.

The Foraker-Rasmuson plan fits right in with the current trend of shifting risk from employers and insurance companies over to individuals by means of high-deductible insurance policies and health savings accounts. While lowering the cost of health insurance, the plan places more of the cost of health care onto the individual, often at a time when the health problem also curtails family income because of inability to work.

One fault that I see with the plan is that it can lull people into thinking that, by having high-deductible insurance and health savings accounts, they are protected from high health care costs. They think they are safe right up to the time when a health crisis occurs, and then they find out just how bad it can get. The statistics are compatible with that pertaining to playing Russian Roulette with a 10-chamber revolver. If the person is commercially insured, only one chamber of the gun contains a bullet, but if he is not insured, two chambers contain bullets. Obviously it is somewhat safer to have insurance, but complete safety is an illusion. Real safety comes only with having a system of universal health care, in which case there are no bullets in the gun.

Sunday, July 20, 2008

Latest review, from Alaska Health Policy Review

Lawrence D. Weiss, Anchorage Daily News blogger of Health4all and editor of the online journal Alaska Health Policy Review, has come out with a detailed and positive review of Mired in the Health Care Morass. The review appeared in the July 16 issue and the excerpt below is reproduced by permission of Alaska Health Policy Review, Weiss has extensive experience in public health (PDF of his CV) and designed the Master of Public Health program at the University of Alaska Anchorage.
I found this book to be interesting, challenging in some of the more technical areas, extremely informative in those same areas, and especially interesting because of the Alaska focus. I recommend this book to anyone faced with large medical bills. I recommend this book to anyone who has a serious interest in the structure of health care financing in Alaska or nationally. I recommend this book to all health care and public health professionals, and I think this would be an excellent book for classroom use at the university. I commend the author for his ability and desire to turn personal tragedy into a public resource that will educate and help others.
One aspect of Weiss' review that is unique is his attention to the images of Patricia Davis' artwork that were used as chapter ornaments. Most of the figurines depicted were created during her ordeal of chemotherapy, and had significance for her that related to her health issues. The images were selected with this in mind.

Weiss describes the book chapter by chapter, commenting that the author's "writing style is straightforward and factual" and that "[t]he book includes an excellent glossary and, unlike many books in recent years, a detailed and useful index."

Addendum: this review also appeared on Health4all in two parts (see links at right).

Wednesday, July 9, 2008

Doctor Shortages?

How many doctors does it take to adequately serve 1000 people? The number varies with country, it seems. In 1997, two countries with highly rated health care systems, France (WHO rating 1st) and Germany (WHO rating 25th), had about 3.3 doctors per 1000 population, but Japan, also highly rated by WHO at 10th, had only 2.0 doctors per 1000 population. Similarly, the United Kingdom (WHO rating 18th) and Canada (WHO rating 30th) had 2.1 doctors per thousand. The less-highly rated United States (at 37th place) had an intermediate number of 2.7 doctors per 1000.

More recent data indicate that the number of doctors in the United States has declined to about 2.38 per 1000, but, curiously enough, a report from the Organization of Economic Cooperation and Development states that the number of doctors in Canada has been stable at 2.1 per 1000 for at least 20 years. The number in Alaska is about the same, 2.05 doctors per 1000 population.

Obviously, the quality of medical care in a country does not critically depend on the number of doctors the country has. However a recent report from the Alaska Physician Supply Task Force notes that because of Alaska's size, rural nature, and extremes of weather, the state really needs more doctors than it has. It should have about 10 percent more doctors per 1000 than the United States as a whole, the report recommends. Presumably the same is true for Canada because of its similar geography.