Multiplied across thousands of middle-aged workers each year, that scenario extracts a steep economic price. The nation would be better off if patients were encouraged to get colonoscopies paid by a national plan.
As he attempts to reform health care, President Barack Obama has celebrated the seeming cooperation of industry leaders, who have agreed to participate in some of the reforms the president wants — including cost-cutting. That's certainly a step in the right direction, since the industry spent millions to kill President Bill Clinton's health care proposals in the early 1990s.
But industry execs came to the table because they want to preserve their profits. They understand how much the public mood has changed since 1993; substantial health care reform is coming — with or without them.
So what price is to be paid for their participation? Insurers are lobbying furiously to kill any proposal to create a public health insurance plan to compete with private insurance plans, claiming a public plan would be "too attractive" and lure too many of their customers. That's probably true. Though legislators propose to finance a public health insurance plan with premiums, not tax dollars, it would likely still be cheaper than private plans because it wouldn't need to make money for shareholders.
If the public plan gets up and running, it won't supplant private insurers — not yet, anyway; health insurance companies are deeply entwined in the nation's economy. But a couple of attractive public insurance options could shrink the private market over time, leaving private insurers to offer policies only for catastrophic illnesses. That's the business they ought to be in, anyway.