According to the World Health Organization in 2013: paper, “Equity in financial contributions is an essential goal of the health care system because it is a desirable outcome in itself.”
So are facility fees like those described in an Aug. 10 Press Herald article about Kelly Brignac’s obstetric emergency (“Unexpected bill for emergency room visit highlights hospital fee debate”) fair?
That is, is it fair to require insured persons who happen to need hospital services, as opposed to those who do not, to make additional contributions to keep hospitals “ready for patients”? A congressional task force to evaluate the impact of facility fees on patients? I don’t think so. In fact, given that situation, it makes me wonder about the fairness of the many other ways that we contribute to funding not just hospitals but the health care system as a whole — through traditional Medicare, Medicare Advantage, MaineCare, private insurance, copayments, etc.
For example, is it fair that traditional Medicare beneficiaries have no limits on their out-of-pocket costs unless they are eligible for a Medigap plan or are “dual eligible”? Is it fair that workers are subject to limits on their wages and other benefits so that their employers can pay the employer Medicare tax? I don’t think so.
Is it fair that taxpayers pay more for private insurers to cover Medicare Advantage patients than the government pays to cover traditional Medicare patients? Is it fair that Medicare Advantage beneficiaries have to pay more if they need to switch to traditional Medicare to get the care they need? I don’t think so.
Is it fair that people who qualify for MaineCare have to support the program through a sales tax that is more burdensome for them than those who are better off financially? I don’t think so.
Is it fair for privately insured people to pay premiums (based on an 85% medical loss ratio) that are inflated by 18% for administrative and benefit costs? Is it fair for them to have to pay up to $9,000 out of pocket on top of their premiums if they have an accident or get sick? Will workers’ premiums and cost sharing (deductibles, coinsurance) be determined by their employer? Will workers’ wages be suppressed so that employers can pay the employer’s share of premiums? Is it fair for workers who are not offered health insurance to have to turn to the more expensive individual market, Maine taxpayers (who, along with the federal government, fund MaineCare and CoverME.gov), or not have insurance at all? I don’t think it’s fair for employers who offer health insurance to be made uncompetitive because of the cost. I don’t think so.
Is it fair for the uninsured to be forced to pay unlimited out-of-pocket costs? I don’t think it’s fair for health care providers to have to cover the resulting bad debts.
If our health care system had[f]What would be the best system to eliminate “contribution fairness”? A publicly funded universal health care system where contributions are based on ability to contribute, not where you work, whether you work, whether you need care, or your age. This would be done through a simple and transparent health income tax. This would be politically difficult to implement, but would go a long way to achieving the WHO’s “original objective” of contribution fairness. And if this had been in place when Kelly Brignac was brought to the emergency room, it would have brought even more grief to an already dire time in her life.
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