While the debate over how we should provide health insurance in this country rages on, I thought it might be good to step back for a moment and consider how we got to where we are today.
Group health insurance plans first came on the scene in 1929. Prior to this time, people paid directly out of pocket for most of their health-related needs. This first plan was organized by a group of teachers in Dallas, Texas, who contracted with Baylor Hospital for room, board, and medical services in exchange for a monthly fee.
Group plans provided by employers proliferated in the 1940s and 1950s. Wartime (1939-1945) wage freezes imposed by the government actually accelerated the spread of group health care, because companies were unable by law to attract workers by paying more. Employers instead improved their benefit packages, adding health care to all employees.
This seemed to work fine until rapidly increasing costs in health care made these benefits more and more costly throughout the 1980s and 1990s. Most businesses, in an effort to continue to provide this benefit, moved to managed care plans. As costs continued to skyrocket, businesses began sharing the premium costs with employees, removed any participation in paying premiums for dependents, and in some cases, cut insurance benefits all together.
These ever-increasing costs have, unfortunately, meant an ever-increasing number of Americans are uninsured. The generosity of employers during World War II has led to crushing costs and benefit cuts today, with no easy solution available for many small employers. In response, some politicians have called for mandating that employers provide insurance to their employees, thereby dramatically decreasing the number of uninsured.
But this sort of “solution” begs the question, “how did seven decades of business providing a benefit of its choice become a mandate that we must pay for health insurance?”
If we are to truly fix the health insurance crisis in America, passing the buck to small businesses is about as far from the solution as we can get. A far-more comprehensive approach is necessary, including (but not limited to):
- Limiting the mandates for coverage placed on group plans so that a range of health insurance options are available.
- Promoting cost limitations through group buying for prescription drugs.
- Promoting health and wellness programs, including regular doctor visits.
- Reviewing, with an open mind, those countries which have had success in providing different aspects of health care and implementing best practices here.
In the end, we have to be honest about where we are. While we have allowed certain elected officials to demonize the health care systems of other countries (like our neighbors to the north), costs have gone up exponentially and the benefit to the American people has dropped precipitously. As we look at solutions, everyone must be brought to the table, including doctors, patients, health insurance brokers, hospitals, business, labor, etc.
As we know, the true definition of insanity is continuing to do the same thing year after year and expecting different results.