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Hassle-Free Health Coverage: Politics and the Future of Health Coverage Introduction

With the end of the Cold War and the beginning of an information-based global economy, old crises have vanished and politicians -- desperate for something to do -- have more time to devote to reforming the American health care system. From the President of the United States to Congress...to angry people calling radio talk shows...everyone who thinks about politics has an opinion about what should be done.

This doesn't necessarily mean things will get any better for you -- as you try to decide intelligently what kind of coverage to buy. In fact, the political grandstanding could make things even more complicated. It usually does.

But health care remains a heavily regulated industry; so, the posturing pronouncements of windbag politicos matter. To conclude our look at the mechanics of health coverage, we'll survey some of the political issues that influence the health coverage marketplace.

For some people, adequate health care has become unaffordable.

However, many of those who claim that health insurance is unaffordable really mean that they elect not to spend their money on health insurance because they do not consider it a reasonable spending choice -- not necessarily that they don't have the money to pay for health care.

This can be a rational decision, especially if you are young and in good health.

The ranks of the uninsured are growing faster than rational decision-making would seem to support, though. In 1997, more than 43 million people -- almost one in five non-elderly Americans -- had no health insurance. The year before, the figure has been around 41 million. That's a 5 percent increase in twelve months.

If Congress addresses the problem, it will probably take only a few small steps: make health insurance fully tax-deductible for the self-employed or set up a system that lets private organizations (like religious groups and labor unions) negotiate health insurance deals for members...as employers do now.

But political action may not be the answer. And that's probably a good thing. Politics and medicine are an unstable combination.

Americans are rightly skeptical of politicians' attempts to reform health care. A poll conducted for the American Association of Health Plans found that 68 percent of respondents said that candidates who push for managed care regulations did so for political gain -- not for the benefit of patients.

As the November 1998 federal elections approached, Bill Clinton started talking a lot about health care reform. He asked voters to make the vote a referendum for the so-called Patients' Bill of Rights.

In a weekly radio address, Clinton said he would "ask the next Congress to guarantee your right to see a specialist, to receive the nearest emergency care, to keep your doctor throughout your course of treatment, to keep your medical records private and have other basic health care rights."

Americans didn't heed his call. A post-election survey conducted by the Health Insurance Association of America (HIAA) asked voters about the most important issues in deciding how they voted. Their answers: education, abortion, taxes, the economy and jobs and a decline in moral values.

"The survey shows crystal clear that there was no mandate for so-called patient protections or health reform by voters in this year's Congressional elections," said Chip Kahn, HIAA's president-designate.

"The anti-managed care activists are entirely off-base if they attempt to spin the election results into a misguided call for so-called patient protections, regardless of what they may say."

Another survey finding: More than 4 out of 5 respondents (81 percent) believed that the health care system -- as it is currently -- meets their needs. And, from a list of five goals for changing the U.S. health care system, most (33 percent) chose "providing basic health insurance coverage to all Americans" as the most important goal.

Of course, HIAA is an interested party in these matters. Its members are insurance companies and HMOs. But the results of the November 1998 elections -- though largely good for Clinton's party -- seemed to support the theory that voters don't care much for health care reform that would change the system dramatically. Most of the candidates who advocated a tighter rein on managed care lost.

Among these losers: Scotty Baesler, running for a Senate seat in Kentucky; Lydia Spottswood, running for Congress in Wisconsin; and Gail Riecken, running for congress in Indiana. Riecken ran a campaign ad in which a young mother held a child whose brain damage had been caused -- the mother claimed -- by her HMO refusing to pay for a cesarean section. The child's father also appeared, criticizing Reicken's opponent for defending rapacious HMOs. The loosely factual ad didn't work. But it was interesting to see old-fashioned, dirt-slinging politics wrapped around a mundane issue like health care reform.

Clearly, some politicians still think the topic has...promise. At least for campaign ads.

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