... Mr. Thornton is one of more than 43 million people in the United States who lack health insurance, and their numbers are rapidly increasing because of ever soaring cost and job losses. Many states, including Texas, are also cutting back on subsidies for health care, further increasing the number of people with no coverage.
The majority of the uninsured are neither poor by official standards nor unemployed. They are accountants like Mr. Thornton, employees of small businesses, civil servants, single working mothers and those working part time or on contract.
It's like watching a slow motion train wreck; as inevitable as gravity. This may turn out to be the stealth issue of the 2004 elections; by then the effects will be noticeable.
Humans have a degree of empathy, but it's fairly limited. Our empathic tendencies evolved so that they are triggered by proximal input -- things we see and feel. We have more empathy for a wounded squirrel than for millions of Americans lacking access to reasonable health care (forget the rest of humanity, such as the Iraqi bystanders who are routinely omitted from fatality counts). It's not logical or admirable, it's just the way we are. So most Americans have ignored the healthcare crisis. They can't do that any more. Even if they don't feel it themselves, their friends, neighbors, and family will experience it. So now the real discussion begins.
We even know how it will turn out. We've known for at least 10 years, probably 20 years or more. A lot of money will drain out of healthcare. Pharmaceutical share prices, physician subspecialist salaries, etc. will fall dramatically. That's a side-effect though, it won't make the problem go away. We'll see some from of mandated risk pooling (single payor systems are just an extreme version of mandated risk sharing or pooling) and we'll see explicit rationing. The form those will take is less predictable (single payor, managed care, whatever); but only the surface forms can vary. The underlying principles -- risk sharing and rationing, are unavoidable.
Rationing doesn't require legislation. Risk sharing requires BIG time legislation. It's the risk sharing part that will be the issue in the 2004 elections.
I personally like some of the more modern variations on "medical savings accounts" aka "defined contributions" aka "patient-focused benefits" etc. etc. They're all aligning some aspects of cost, decision making and resource consumption, undoing the huge flaw in traditional insurance systems. These are details though, the real issues are rationing and risk sharing.
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