Correspondence
What's Ahead for Health Insurance?
N Engl J Med 2002; 347:1209-1210October 10, 2002
- Article
To the Editor:
Fuchs (June 6 issue)1 correctly points out that new insurance plans that decrease sharing of risk within companies will erode the social-insurance qualities of employment-based health insurance. This argument leads to the impression that tax saving would be the only remaining rationale for employment-based health insurance. Desire for control of costs and for fairness would then result in a switch to universal national health insurance, if and when political events undid the outdated tax code. However, this scenario does not account for a major rationale for employment-based health benefit plans: the profit motive.
Selective forces of business have produced health insurance benefit plans that, in addition to providing health insurance, also produce secondary effects that boost productivity and profit. Employment-based plans stimulate employment, ensure the provision of nondisruptive health care, decrease absenteeism, and foster loyalty. Information technology, globalization, diversity, and proliferation of health care options all increase the potential for selectively eliciting desired secondary effects. The use of defined contributions and universal coverage reduces the opportunities for companies to tailor and define benefits and thereby decreases their ability to elicit profit-generating secondary effects.
Employers will continue to purchase health benefits to enhance the health of their employees, but also to recruit employees, maximize productivity, and maximize profits. The use of defined benefits melds these goals. Defined contributions are, for both employers and employees, nothing but a crapshoot.
1 ReferencesLeslie F. Martin, M.D., M.P.H.
Medical College of Wisconsin, Milwaukee, WI 53226
lfmartin@mcw.edu 1
Fuchs VR . What's ahead for health insurance in the United States? N Engl J Med 2002;346:1822-1824
Full Text | Web of Science | Medline
To the Editor:
In his analysis of the future of health insurance in the United States, Fuchs observes that the new generation of health plans shifts the cost of medical care to those who use it. Their designers argue that those with high use should be responsible for the cost of care and that middle-class consumers can spend more of their disposable income on health care and less on gas for their sport utility vehicles. However, those with high use are also called the sick, and they are generally poorer than the well. Hence, the new health plans have the effect of further impoverishing those who are already poor. In my view, this trend is undesirable as public policy.
George K. York, M.D.
Kaiser Permanente Stockton Medical Center, Stockton, CA 95269
gkyork@ucdavis.edu
