Anyone who has read my posts knows I believe there is a great deal this country can learn from the experience of other countries and our own states when it comes to confronting the conundrum of expanding health insurance coverage. We may not agree with or wish to emulate the choices they have made, but we can benefit from their experiences.
In a recent article in Hospitals & Health Networks, author Emily Friedman reflects on the recent experience of Hawaii in pursuing the elusive goal of universal coverage. Below are some of the lessons which struck me.
In 1989, Hawaii passed legislation providing on a sliding scale basis a subsidy to purchase a limited benefit package from a number of health insurers and health plans. In 1993, the benefit package was significantly enhanced and costs went up markedly. The value did not increase proportionately and as a result enrollees dropped coverage because it became too expensive.
The lesson that can be gained from this is that when expanding coverage, a reduced benefit package may be the only alternative that can stand the test of time.
If costs are not controlled, no health insurance expansion will survive in the long term.
As Friedman points out, if costs keep escalating, there is no coverage program in the world that can continue to function - public or private, employer-based or individual. It is a losing battle when costs double every seven to 10 years.
She would likely agree with reporter T.R. Reid. Reid mentioned recently that unless we have solidarity among all our citizens in supporting the premise that all Americans have a right to health insurance coverage, we will continue to pit the haves against the have-nots in what will become an intensely partisan political battle.
Acting on what other countries and states have learned from their own attempts at healthcare reform will require political courage on the part of our elected representatives.
To do this we will need, as Pulitzer Prize winner Thomas Friedman recently wrote, citizens who will convey to their leaders that they are ready to sacrifice, even pay for the expansion of healthcare coverage and will not punish politicians who ask them to do the hard things necessary to make this a reality.
Mike Stephens blogs regularly at Action for Better Healthcare.