COVERAGE: Marrying the Forces for Reform

What's love got to do with health insurance, our colleague Joanne Kenen asked in April after a survey from the Kaiser Family Foundation found that seven percent of adults reported that in the past year that they or someone in their household decided to get married in order to get health insurance from a spouse. (Explanation of the survey's finding's here).

Last week, the New York Times put a human face to those findings, telling stories of couples who rushed to the altar for insurance or delayed a divorce so the spouse could be treated for breast cancer. One couple even considered getting a divorce so the wife could qualify for subsidized coverage in their home state's high-risk pool.

Not surprisingly, the piece garnered strong reactions, both in the article's comments section and in the letters section of today's paper. Joshua Schulman-Marcus, a fourth-year medical student writes:

I was dismayed by the familiar anecdotes highlighted in your article. It is easy to blame this mess on insurance companies, overpriced medications or a glut of specialists (all contribute), but the real culprit is inertia.

The consequences of such a fatalistic mind-set are increasingly warping our most precious relationships. How much longer can we accept this inexcusable status quo?

The answer, we hope, is not much longer. While we wish that there were Newtonian laws to health reform, there is much to suggest that today's moment of inertia can be transformed into a period of real change. Here are a few deltas for your consideration:

• Individuals: 
  In 1987 it cost seven percent of a median family income to buy health insurance. By 2007, that number had jumped to 17 percent. A 2005 study suggested that half of all bankruptcies are at least in part caused by illness and medical bills. The high cost of health care in this country affects all Americans.
• Businesses:
  Businesses compete in an increasingly global economy, yet American manufacturers spend $2.38 per hour per worker on health benefits—more than twice the average for manufacturers in similar advanced industrial economies like Japan and Germany. And unlike previous reform efforts, businesses large and small appear determined to play a role in shaping health reform--such as CED, the NFIB, and coalitions, like the National Business Group on Health or the National Business Coalition on Health
• Government:
  At every level of government, politicians and policymakers are struggling to balance budgets with the burgeoning costs of health care. The CBO, GAO, MedPAC and a host of government agencies, have all called for reform of what they view as an unsustainable system. And, politicians on both sides of the aisle seem actively involved in finding real bipartisan solutions.
• System:
  Overcrowded ERs, medical errors, and the hidden tax of uncompensated care—all are trends which not only illustrate the crisis of our current system, but also reveal the crucial linkages between cost, coverage, and quality that make comprehensive health reform a necessity.

The calculus of change is complicated, but together these forces give us hope that we have reached a tipping point in health care, where the inertia of the status quo gives way to the forces of needed reform.