Columnists > Voices

Hard choices ahead

Health care costs: Who will pay for what seems owed to us all?

Issue: "The trouble with Tommy," May 4, 2002

When the Oregon legislature served notice late last month that it will be clamping down on the extravagant medical freebies it has tried to offer its citizens for the last several years, it simultaneously sent a wake-up call to the whole nation: Sobering choices are right around the corner.

I got the same alarm in a separate package delivered right to my own office. Word came from our corporate health insurance provider that coverage for our staff is likely to go up at least 20 and perhaps even 30 percent this coming year. The explanation is unarguable: Our claims were extraordinarily high, with at least four specific cases from our relatively small staff averaging over $35,000 each. That was in addition to all the routine care. A simple physical, just to discover you're healthy, can easily top $500 these days.

The math is simple and impersonal. This past year we paid our insurer something like $325,000 in premiums. Our insurer paid back something like $450,000 in claims. It's a quick formula for going broke, and neither our publishing company nor our health insurance provider is an unusual example in today's climate.

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The genius of insurance of any kind is that the premiums paid in by a large number of folks will cover the unusual bumps suffered by a few. Yet right now the very same thing is happening to the financial structures of health insurance that has happened to the Social Security system. The number of those paying in a modest and manageable sum each month, compared to the number of those making big claims, is simply getting too small.

Want a little real-life proof? Jot down the mega-claims you know about in your own extended family, your own church, your own workplace, and your own neighborhood. Those big budget items, once the exception, are a good bit more frequent these days in the experience of us all.

But if the math is simple and impersonal, the real-life implications are right now getting terribly personal. For both our expectations of the medical care we think we deserve and our actual consumption of those services will soon confront us with some choices so embarrassing we'd probably rather not talk about them.

With its extraordinary give and take, modern medicine more and more plays games with all of us. I have watched it in recent months help friends beat the odds of cancer (although some have also lost), survive debilitating strokes, walk comfortably again after having joints replaced, and watch babies who a generation ago would have died in infancy now mature into robust health. And the folks who experienced these modern miracles were neither millionaires nor royalty. They were middle-class people like me who can't afford most of the luxuries of life.

But now the question becomes: What is a luxury? And if these blessings are no longer luxuries, on what basis and in what order are they going to be owed to us all? And when any one circumstance like these can wipe out a whole year's earnings, or a substantial part of a couple's retirement nest egg, who is supposed to pay?

Not that most of us are really poor. Compared to most of the world, and to 99 percent of the people who have lived in the history of the world, we own comfortable homes, eat what we want, go where we want to go, and entertain ourselves extravagantly. It's just that when it comes to health care, bills of $20,000, $40,000, and $100,000 don't seem like middle-class bills. We're persuaded we deserve those luxuries, but we haven't yet quite adjusted to what they cost.

We're going to have to. Because even while our middle-class expectations are rising, so are a number of us getting older. There are tens of millions of us edging past retirement right now, and it won't be long until there are 100 million of us. Someone's going to have to decide just how many $20,000, $40,000, and $100,000 procedures we retirees are going to be allowed when we can't afford them on our own.

The questions aren't easy and no simplistic formulas will solve these issues. On life itself, of course, we'll continue to put high value, and to guard against evils like euthanasia. But God offers no guarantees for the quality of life, even when He chooses to extend it. And presuming on others to cover the monetary costs of heroic measures, when we can't cover those costs ourselves, brings up other difficult ethical issues.


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