41 million and rising

In one week, holders of individual Blue Cross health plans are going to demonstrate with their checkbooks why the debate in Congress over competing health care bills is meaningless. These holders soon will by joined by millions of Americans paying a greater portion of their incomes to ensure they can still get access to the world’s finest medical care.

Oct. 1 is the day a 48.5 percent increase in the Blue Cross individual plan goes into effect. But for those covered by this plan who think they will simply switch to another, the depressing surprise is that the Blue Cross increase is not that unusual. Several other plans have been given approval for rate increases and more are likely to follow with predictable results. The rising cost of insurance has pushed up the number of uninsured people in this country by a million a year for the last decade. For the 41 million uninsured, the question isn’t about portability or whether they can sue an HMO; it is about how they can pay for basic care for a sick child or whether they can buy heart medication and still have enough left over to cover the rent.

A prime reason for the increases can be found in the way insurance companies have operated during the last five years, which saw the spread of health maintenance organizations in Maine. The HMOs that successfully competed here needed to sign up a lot of customers quickly to spread out costs over a larger base, which then allowed them to beat out the competition by negotiating deals with desirable customers. Blue Cross kept its prices low to stay in the game. That ends, in part, next week.

What begins is even more disturbing, according to a study at the U.S. Department of Health and Human Services. Economists there predict that national health care costs will increase from $1 trillion in 1997 to $2.1 trillion by 2007. Worse, almost all of that increase will come through rising expenditures in the private sector. Worse still, after a lull in the increasing number of uninsured — now at 41 million Americans — that number, too, the percentage of Americans whose primary access to the health care system is through the emergency room, is expected to increase.

These depressingly rising figures show why the congressional debate should not be over a question of whether to give a tax break to small businesses that offer insurance but why those businesses are expected to cover health costs at all. Congress will remain at the fringe of the real debate while it sees health coverage as a burden of business rather than a right of citizenship.

And the number of people cut out of the system because of its cost will continue to go up.