Bruce A. Boissonnault: Reform needs to ensure access to medical services

Nothing says inequality like “separate but equal,” in health care or in education.

The dirty little secret is that we already have a two-tier health care system in the United States, a comprehensive one for those who can afford to pay, and an illusory system for those who can’t. Many people do not yet fathom that they will not have access to comprehensive health care when they need it most — if they lose their job, experience a costly medical problem with hollow insurance coverage or if they simply can’t afford to buy insurance.

Any prospective candidate for Health and Human Services secretary must confront head-on the fact that health care in this country operates like professional sports stadiums: We all are taxed to subsidize stadiums and health care, but too many of us can’t afford the price of admission. Successful reform involves turning the system upside down — making a system that serves the people first, instead of the reverse.

Failure will have ramifications that extend far beyond health care. Our credit crisis and our trade debt explosion and the potential for long-term civil unrest all are linked to the structure of our health care system. New York’s Commonwealth Fund reported that 72 million adults under age 65 had problems paying medical bills or were paying off medical debt in 2007, up from 58 million in 2005. Things are getting much worse today.

Health care also represents an unfair “export tax” on U. S. products and services because this country uniquely tacks the cost of health care for employees and family members directly into companies’ payroll expenses. This means many employers can gain a cost advantage if they export jobs and if they gut their health insurance coverage offerings to domestic employees. Many employers also gain a cost advantage if they recruit only younger, healthier workers than their competitors in order to minimize their health care cost exposure.

We already know what failure looks like. Until 1960, institutional care for the severely mental ill was the standard of care. Beginning in 1960, pharmaceutical advances allowed many more people to be mainstreamed into the community (theoretically leading to enriched lives), but as governments cost-shifted responsibility for care of the mentally ill away from government institutions, government failed to add key resources to community-based mental health services. Mental hospitals emptied. Mentally ill among the homeless and prison populations exploded.

Today, we are following a similar course in dealing with the spiraling cost of health care, but this time, we won’t disenfranchise a limited group of mentally ill patients. Instead, we risk alienating the majority of Americans who create value and do the real work.

Health care is integral to the very fabric of our civilized society. We are unraveling that fabric one thread at a time, and we do so at our own peril.

Bruce A. Boissonnault is president & CEO of the Niagara Health Quality Coalition.