Required Reading! (New Yorker (8/29/05)

The article entitled "The Moral-Hazard Myth" by Malcolm Gladwell should be required reading for everyone, because it exposes policies that are being put in place that will have an effect on everyone's well-being. Gladwell begins with a graphic description of tooth decay, leading up to the point that people who can't afford dental insurance end up not going to the dentist. He concludes that bad teeth have become "an outward marker of caste." He quotes from the book by Susan Starr Sered and Rushika Fernandopulle, "Uninsured in America" that the U.S. health-care system "has created a group of people who increasingly look different than others and suffer in ways that others do not." He explains that one reason health-care is such a mess is an idea known as 'moral hazard' that seems to come out of think tanks and other places where policies are formulated. The idea is that people with health insurance spend more on health-care and this is true, but those without health care cut back on useful as well as frivolous care, whatever that is! I don't believe that most people go to the doctor just because they can. But many don't go if they have to pay for the full cost out-of-pocket. Recently, my family was offered a health savings account, which is how the Bush Administration wants to solve the health-care problem in this country. Under this plan, we would get catastrophic insurance only and pay for our own health-care out of a tax-free savings account into which an amount equal to the plan deductible, $5000 plus, could be deposited. Once we have paid out the deductible, we would be covered by the plan. If we don't use the money, it stays in our account and can be rolled over into the next year's plan. Sounds great, right? The problem is that it undermines the whole idea of 'social insurance', that is spreading the risk out among everyone. Under social insurance, healthy people pay into the system to subsidize the care of the sick and rely upon others to subsidize their care when needed. Under the new plan, the sick will pay more than the healthy. As Gladwell concludes, "in the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be." In addition, the U.S. has 45 million people who are uninsured. The health care savings account does nothing to address this problem.