In the 1980s while negotiating a union contract I was trying to make the case for raising the deductible and coinsurance in the health benefits plan. As part of my pitch I made an analogy with other forms of insurance. What I said was that if you look at auto insurance, it doesn’t pay for an oil change or new tires. One union representative said his wife had just had surgery and did I expect him to pay for that. The point was that not everything is insurable and some cost sharing is fair and desirable. What I got back from the other side of the table was, “Are you comparing my wife to a car?”
Actually, I was comparing spending $20 on an oil change and $20 on an office visit coinsurance, but that didn’t matter. That “Are you comparing my wife to a car?” syndrome is not unusual because we cannot get past the attitude that paying for health care is not the top priority for spending our money.
Here is another way to look at this.
Georgia residents spent an average $470.73 on the lottery in 2010, or 1 percent of their personal income. Only Massachusetts (STOMA1) had higher spending, $860.70 per adult, more than three times the U.S. average. Georgia had per capita income of $34,800 in 2010, below the national average of $39,945, while Massachusetts’s was higher at $51,302, according to data compiled by Bloomberg.
In fact, in Georgia the median household income 2006-2010 was $49,347 and 15.7% of the population is below the poverty level. Under the Affordable Care Act a family with an income of $50,000 will receive a premium subsidy a little over $12,000 per year plus cost-sharing subsidies up to an additional $3,600 per year.
Clearly spending several hundred dollars on the lottery is not equal to the cost of health insurance, but the lottery is not the only non-necessity people spend money on. In other words, what is unaffordable is a lot more than health care, but we tend to reset our priorities so that the $80 office visit is unaffordable, but the lottery ticket is not. Go figure.
Logically our priorities would be more like this:
- Food
- Shelter
- Health care
- Clothing
- Saving
- Retirement
- Education
- Other stuff
- Vacations
- Gambling
Exactly where are our priorities? What is affordable?
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QUINNSCOMMENTARY 
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Dick, you have really good stories. Here is one of my most painful in 30+ years of benefits work.
I went to Syracuse NY to our regional office to conduct a focus group. I had maybe ten questions, and would simply put them out one by one and ask the group of ten to discuss.
At one point, one employee disclosed the fact that when her husband lost his job and family coverage, that she only enrolled herself in the highest cost option with the lowest copays. She did not enroll her two teenage sons and her husband because “she could not afford to sign up the whole family on the lowest cost plan” identifying not only the $50 a month contribution (just $10 more per month than she was paying for single coverage), but also because the low cost plan had a $25 Rx copay ($15 more than the high cost plan). When her coworkers indicated concern about the potential for a devastating financial loss, she turned to me and almost screamed: “You just don’t know what it costs to keep two teenage boys in Reeboks”
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Great story and very indicative of the view held by way too many people.
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I’m retired and will just be getting on Medicare in a few months. I wish we had a single payer health care system similar to Medicare for everyone but also that everyone must pay something if they have an income. My income and savings were basically stolen by women over my life (divorce and alimony). Now I can’t earn anything on my savings.
I think we need to charge working women more for SS and Medicare and higher tax in households where one spouse doesn’t work. Like life insurance where men get charged more. Women use more medical services, live longer and receive much more spousal benefits but yet they pay far less into the system. It is time for us to demand they pay more instead of making men subsidize them. This might also be considered for any national health care program but it has been called gender equality which is just a cover up. I also agree with the copay idea which I think Medicare does since it covers 80%.
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