To be sure, the survey relies on respondents' own perceptions, which may not always be realistic or consistent. And its definition of "sick" adults is broad: It includes everyone who said they had a serious illness, medical condition, injury, or disability requiring a lot of medical care, as well as anyone who was hospitalized overnight in the past year. By that yardstick, 27 percent of Massachusetts adults are regarded as sick.
But even if that number should be taken with a grain of salt, it is clear that universal health insurance is no panacea for health care's financial pressures -- especially those that affect people with pre-existing or expensive medical conditions.
The way to make medical insurance more affordable and accessible for everyone, above all those whose health problems are greatest, is not by forcing insurers to pretend that the chronically ill or those requiring frequent care don't have above-average costs. If companies that sell homeowners insurance were barred from taking into account the size, location, or age of the houses they wrote policies for, it goes without saying that premiums and deductibles would keep rising and fewer losses would be covered. Making it illegal for health insurers to craft policies and charge premiums that accurately reflect the needs and risks of people with significant medical issues has a similar effect.
Rather than outlawing insurance for pre-existing conditions, health-care economist John C. Goodman argues, we should be encouraging it. In a new book, Priceless: Curing the Healthcare Crisis , Goodman offers an abundance of ways in which an unfettered market could address the problems of people with chronic medical needs. One proposal: employers could buy health insurance that was fully portable -- employees would own their policies and could take them from job to job. Another idea: Health Savings Accounts for the chronically ill that would allow disabled patients to manage their own budgets and choose the goods and services that best meet their needs. Still another: "Health status insurance," which would allow individuals to protect themselves against the risk that a pre-existing condition could emerge down the road and cause their insurance premiums to rise.
What America's health-care landscape needs is more freedom and competition, not less . True reform would end the tax-code distortion that links health insurance to employment. It would tear down the barriers to buying health insurance across state lines. It would roll back the mandatory benefits that make everyone's health coverage too expensive. Massive health-care "reforms" that restrict choice, suppress prices, and block innovation aren't reforms at all. In sickness and in health, they generally make things worse.
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