Mandatory Health Insurance
By E. Noel Preston, MD

   Some of the politicians are arguing whether a National Health Insurance program, if there is one, should be voluntary or mandatory. The whole concept of health insurance is to spread the risk over a large group of people, so that the average cost of providing benefits to some of those people will be significantly less than the cost of each sick person paying for his or her own individual care. If an insurance program is voluntary, the young and healthy will choose to opt out of the system, leaving the only ones funding it the ones who will be using it -- namely the elderly, weak, sick, and debilitated.

   When Susan's son turned 25 and was no longer covered under her family health insurance, she bought him the first three months' premium for his own individual health plan. When those three months were up, he decided he would rather have tickets to rock concerts than pay for health insurance, and he let the coverage lapse. Less than a year later he had a kidney stone, and his emergency room visit, two ultrasound studies, laboratory tests, intravenous fluids, medications, and physician care totaled more than $12,000. To her great credit, Susan declined the emergency room's request for her credit card, and it took her son more than three years to pay his medical expenses.

A National Health Insurance program absolutely should be mandatory.

   Nobody likes to buy anything they need. I had to spend $600 on four new tires for my car, instead of buying a hard drive digital camcorder. And most people don't think twice paying monthly cable or cell phone or credit card bills for tennis racquets, movies, or restaurants — but they hate like the devil paying for auto, homeowner, or health insurance. People who don't bat an eye at paying $800 for a Labradoodle puppy howl like stuck pigs when they have to pay an emergency room charge for sewing up a cut on their child's arm.

   And so yes, It should be mandatory for people to buy their own health insurance. I'm a Republican, and I say if you can't get a license tag for your car without auto insurance, you shouldn't be eligible for income tax refunds, Social Security, or Medicare benefits if you haven't paid for your own health insurance.

   How would you like sitting in an emergency room, knowing the health insurance plan you paid for was subsidizing the cost of providing care to some 30-something-year-old birdbrain, whose's $450 ski boots failed to save him from a broken ankle? Especially if he spent the money on ski boots instead of on health insurance? His not being insured drives up the costs of your care, and your next year's premiums will rise, and he's not the slightest bit concerned. That uninsured ski bum with the ankle fracture is a dead-beat, and you and I are paying his way.

   People who claim they can't afford health insurance still buy auto insurance. They still buy movie tickets or hunting licenses or six-packs. They buy satellite dishes or food for their Labradoodles or tickets to Vegas. For the really truly honest-to-God dirt-poor poor people, there already are Medicaid and Food Stamps, and there could be further subsidies for health insurance, like the Earned Income Tax Credit is for the working poor.

   But the health insurance industry is as corrupt as they come. Every year, premiums, co-payments, and deductibles go up; but allowed charges to doctors go down, and the insurance company CEO's make hundreds of millions of dollars in obscene salaries, bonuses, and benefits. When Bill Clinton was elected the first time, a doctor friend of mine said he wasn't as afraid of Hillary as he was of Aetna. There is no sense talking about a National Health Insurance program, voluntary or otherwise, until and unless the fat cat insurance executives are sent packing.

   I am disgusted that insurance companies can refuse to cover a medication I prescribe unless I get their prior approval, which many times requires the patient to get (at additional costs) an x-ray or lab test, or attempt earlier treatment with a cheaper, less effective medication.

   Wake up, people! It's not the doctors who are paying commercial office rent, malpractice insurance, staff salaries, medical supplies, and telephone and computer services and who can't afford a full set of tires and a digital camera at the same time, or the hospitals who can't afford to keep emergency rooms open for people who can't or won't pay — it's the INSURANCE INDUSTRY that has ruined health care. It is rotten from the inside out, and even the physician lawsuits against the big insurance companies have failed to contain it.

   It should be mandatory that everyone have health insurance, but it is essential that the industry be completely overhauled. That's not a Democrat or Republican idea; that's just plain common sense.

E. Noel Preston, M.D. is a pediatrician in solo practice in Peachtree Corners. 6063 Peachtree Parkway, Suite 202-A, Norcross. (770) 448-1553. More information can be found at www.PeachtreeCornersPediatrics.com

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