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Unhealthy Consequences

The federal government and advocates of a government-sponsored, single-payer health-care system are short sighted in their assertions that a massive overhaul of the system will stop medical bankruptcies.

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The nervous young man sat across the table from me at his place of employment in South Richmond. He'd recently returned to work after an eight-week absence and explained that the recent surgery on his elbow almost put him into bankruptcy. “Did you have health insurance?” I asked him.

“Yes,” he replied, “I have the insurance through my company.”

“Did it work like it was supposed to?”

“Yes,” he answered. “It paid almost all my medical bills. My problem was I didn't have any income.”

Wait a minute — isn't health insurance supposed to stop medical bankruptcies? The young man hit on the missing link: Health insurance is only part of the health-care problem; income protection is the other.

The federal government and advocates of a government-sponsored, single-payer health-care system are short sighted in their assertions that a massive overhaul of the system will stop medical bankruptcies. These advocates paint rosy scenarios of a nation of vigorous, fully covered citizens with not a health care in the world, fat and happy with their supposed cost-neutral, federally sponsored, one-size-fits-all coverage. They're consciously or not opening an even bigger can of government worms with their support of such a system.

According to a 2007 study by the American Journal of Medicine, about 60 percent of all bankruptcies are medically related, and even more astonishing, almost 80 percent of all those people who took out medical bankruptcy had either employer-provided or individual health insurance. Many companies, for cost considerations, have elected to make income-protection plans like short- or long-term disability available to employees on a voluntary basis. Though relatively inexpensive compared with health insurance, employees may forego disability in the hope that nothing bad enough to put them out of work for an extended period will ever happen to them.

Statistics are proving that the loss of income because of an accident or an illness is just as damaging financially to the covered patient as the out-of-pocket costs of treating the condition. Therefore, if the unthinkable happens — a car wreck, a diagnosis of cancer, a sudden stroke or heart attack — the doctors and hospitals get paid for their treatment but the employee has no way to pay his or her normal, everyday bills, including co-payments and deductibles, triggering bankruptcy.

In my work I talk to many low-paid employees who cannot afford employer-offered health insurance. It's a shame, admittedly. They instead buy supplemental coverage and small disability policies for a fraction of the cost of health coverage because in their words, if they get sick they can always get some form of medical care, usually through a local health department office. But if they have no income protection they have no other recourse. They realize they're more likely to lose their house or their car not because they have no health insurance, but because they have no income, as evidenced by the young Richmond man.

John Gall wrote in his brilliant 1977 book “Systemantics” that despite their design all systems eventually act in unintentional ways, with unanticipated consequences. Then they systematically fail anyway. Here's where government proponents of mandated health care are going to discover Gall's theory: Once health insurance is passed and every American is covered by a plan of some kind, either private or government, these proponents are going to be surprised when medical bankruptcies still occur. Seeing this, government may act to close the gap, perhaps by proposing compulsory single-payer disability insurance. Anybody want to hazard a guess what the cost of federally mandated disability would be to the government and the American taxpayer?

But then what does the American who has federally financed disability coverage do if their child or legal dependent is diagnosed with a chronic or terminal illness? Yet another unintended consequence; that person will miss just as much work and sustain just as much expense as if they themselves were sick. Does the government then order every citizen to have supplemental coverage to offset the parents' missed income incurred by a sick child to close that gap?

That slope gets even more slippery; what happens when a chronically ill person dies, and has no voluntary life insurance? Other than the $6,000 it cost to put that person in the ground, the loss of future income to dependents is more long-term and financially crippling. So the next logical step may be government-mandated life insurance — an unthinkably disturbing federal nightmare.

Make no mistake: Private health-insurance reform is sorely needed. My own family's premium almost doubled to an unsustainable amount at renewal after a serious illness. We had no choice but to drop that coverage and make concessions for something less expensive, if another provider would even take us, because of a pre-existing condition. We're experiencing the worst-case scenario, yet I maintain that government does not have the answer.

Imposing government health coverage on every citizen is the first step toward even more massive government-sponsored systems that will attempt to plug the leaks, gaps and loopholes created by the unintended consequences of the first. Government-run health insurance is only the tip of a huge and unmanageable iceberg, the first snowball in an all-consuming avalanche that would hand the federal government unimaginable control over our health, our employment and our lives.

Dale Brumfield is a payroll services broker and writer living in Doswell.

Opinions expressed on the Back Page are those of the writer and not necessarily those of Style Weekly.

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