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Not whether, but when

February 1, 2010
by Dennis G. Grantham, Senior Editor
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Some days ago, I remarked to a colleague that I thought “the worm has turned” on healthcare reform. I cited the same reason as most political pundits: the loss of that 60th Senate vote.

“The worm may have turned,” he replied, “but the apple isn't rotten yet. Reform is coming,” he asserted with a confidence born of his long experience in the field. “It's only a matter of time.”

After reflecting for a moment, I had to agree.

But I don't agree with my colleague because I think that reform is a political certainty in the near term, or that the nation's voters believe that healthcare insurance is an inalienable right. As recent events have shown, healthcare reform is competing with other important issues at this time, notably the economy, security, and, above all, jobs. And, President Obama's call for expanded spending on jobs, along with a multi-year freeze on discretionary (non-security, non-entitlement) spending-a concession to real concerns about the growing deficit-may complicate moves to restart the reform effort by strengthening those who continue to “what if” the cost projections of every proposal.

My belief in the inevitability of reform is based on what a growing number of American families see in their own finances. In the past 10 years, the average cost of a family insurance policy has risen by 128 percent, from $5,791 to $13,375, according to the Kaiser Family Foundation. While private, employer-sponsored healthcare coverage is wonderful to have, the run-up in healthcare spending and related insurance costs has had a major impact on everyone's take-home pay, as the average employee's share of premium costs has risen from $1,543 to $3,515 in the same period.

But the growth of employee cost sharing extends well beyond premium cost sharing, since employers have managed premium cost growth by limiting choices, boosting deductibles, increasing co-pays for office visits and prescriptions, reducing or eliminating retiree coverage, and, in numerous cases, eliminating employer-based coverage altogether.

For a typical employee in an employer-sponsored plan, these changes, along with a few prescriptions and maybe an ER visit, can easily add $2,000 to their real, annual cost for healthcare coverage. For those supporting family members who must deal with behavioral health or addiction concerns, these added financial burdens can be far, far higher. So, the implementation of mental health and substance abuse parity in insurance plans should be a godsend, provided there's not too much fine print in parity's now-released implementation rules.

Nevertheless, should healthcare insurance premium costs continue their steep rise while wages continue to flat-line, the cost lines will cross from manageable, to difficult, to unsustainable for more and more households. Add in a few other things-concern about the rising numbers of the uninsured, fears about losing coverage or exceeding limits, envy for the effective government-sponsored insurance already offered to retirees regardless of income (Medicare), and a bit of resentment about the still-healthy profits of health insurers-and I have come to the conclusion that reform is no longer a matter of whether, but when.

Dennis G. Grantham, Senior Editor Behavioral Healthcare 2010 February;30(2):6