April 25, 2003

Commentary

Covering The Uninsured

By: James Santiago Grisolia, MD

Some 41 million Americans and 400,000 San Diegans lack access to health insurance. In San Diego, 31% of Latinos are uninsured, making up 58% of our local total. People without insurance delay seeing the doctor, because they fear finding something expensive or deadly. Uninsured women with breast cancer come to the doctor later, with worse disease, and are twice as likely to die. Without access to cost-effective outpatient care, the uninsured are up to 70% more likely to be hospitalized for diabetes, hypertension, pneumonia or bleeding ulcers.

So what are the solutions? This year, two major bills in the state legislature address these issues. Unfortunately, both are flawed. SB 921 by Senator Kuehl would create a single state health insurance covering all Californians, similar to a measure recently defeated in Oregon. The Kuehl bill keeps all the bureaucratic and economic flaws of MediCal, our current state-run insurance for the low-income and disabled. Today, most San Diego doctors cannot afford to see MediCal patients, so putting all Californians on a MediCal-like system will bankrupt hospitals, doctors and clinics, forcing all but the neediest to pay cash to escape a dangerously underfunded system.

Meanwhile, SB 2 by Speaker Pro Tem John Burton, the “Pay or Play” bill, would require employers to buy health insurance for their employees, or else pay into a state health insurance fund. Since 80-85% of California’s uninsured belong to working families, why not force the employers to cover them? The problem is that most California and San Diego employers are small and cannot easily afford health insurance, so most would rapidly opt for “pay” rather than “play,” resulting in a de facto single payer system like the Kuehl bill.

Health premiums, like worker’s comp and a host of other taxes and expenses, slap balls and chains on businesses, which can force them to lay off workers or move out of state. We must recognize that business growth will be the engine that lifts our state and local economies out of recession. Loading new mandates on business will only slow our recovery, costing jobs and raises to San Diego working families.

Right now, federal tax law still favors employers, rather than working families, owning the insurance policy. The SD County Medical Society supports individuals and families controlling their own health care, through changes in tax laws and employer policies. This is called Consumer-Directed Health Care, and intends to put people back in control of their own care. SDCMS, along with the SD Business Journal, will co-sponsor a conference for employers on Consumer-Directed insurance options on June 2.

Chief of Communications for the SD County Medical Society. Dr Grisolía is Chief of Neurology at Scripps-Mercy Hospital.

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