Policy-ish

Health Overhaul: Who Pays?

To find the fault lines in America's health-care map, just follow the money.

Health care costs keep rising.

Where do the health-cost increases end? iStockphoto.com hide caption

itoggle caption iStockphoto.com

For starters, the insurance status quo isn't exactly static. Costs keep climbing. Premiums and out-of-pocket expenses for workers who get insurance on the job will rise 10 percent next year, the Chicago Tribune reports. All told, the average insured Joe is looking at direct health costs of $4,023 in 2010, according to data from HR consultants Hewitt Associates.

So if the country agrees to change things, who pays? An op-ed in the Wall Street Journal co-authored by ex-Health and Human Services chief Michael Leavitt and two economists says young people will foot a bigger part of the bill than they may have realized.

How come? By changing insurance rules to require policies be offered to all comers and restricting insurers' ability to charge a lot more for policies to cover sicker people, young folks would end up paying more for coverage than their underlying health status would otherwise predict, the WSJ piece says.

Over at the Washington Post, columnist Robert J. Samuelson chimes in with his own analysis, headlined "The Health-Care Ego Trip," saying the savings from a health overhaul are shaky and the benefits hard to quantify precisely.

When it comes to insurance premiums in the exchanges that would be created to help the uninsured and small employers, Samuelson essentially agrees with the WSJ piece. He cites the Congressional Budget Office's analysis that says premiums would tend to be higher in the exchanges than the current market today because of a ban on restrictions due to preexisting conditions and required coverage even for people with high costs of care.

To Samuelson, the proposal kicking around Washington don't do enough to root out the fundamental cost problem in health care. That's a recipe for fiscal trouble. The overhaul as currently envisioned, he writes, "might marginally improve Americans' health but would worsen the federal budget outlook and squeeze other public and private spending."

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