Insured or Not, Few Are Secure in US Health System

The Zammit family of Deltona is the victim of two staggering injustices. No one can be blamed for the first, at least no one here and now. Nathan Zammit, 16, has had a brain tumor and half his skull removed. He faces eight months of chemotherapy. The second injustice is more like a crime because it's man-made: A health care system that punishes and ruins instead of insuring against catastrophes. The Zammits are insured. But rather than being able to focus exclusively on their son's battle, and like a growing number of middle- and working-class families facing medical crises, the Zammits are having to raise money to pay the family's medical bills. They face debts exceeding $10,000 and growing. Even generous fundraising can only go so far when co-pays for medicines are $50 a pop, when 20 percent co-pays apply to medical services and when coverage is riddled with fine-print exceptions that give the lie to that cynical misnomer of our day: insurance.

When I look under "insurance," my old "Etymological Dictionary of Modern English Origins," published in 1958, refers me to the word's antecedent -- "cure," from the Latin, cura, from which derive the words "anxiety, care, medical care, hence a medical cure." In the Middle Ages, cure got linked to secure, mixed with the Anglo-French enseurer, and gave us insurance, then taken to mean "to render safe or secure." We can only wish. The modern meaning of insurance is a take-it-or-leave-it business transaction giving consumers choices only within the narrow parameters set by employers' benefits packages and the even narrower parameters set by the insurance policy itself. For consumers, it reduces the word insurance to something closer to "gambling," "deception" and "not covered under the policy." Then the premiums: Between $3,500 and $5,000 a year for family coverage, not including out-of-pocket expenses that typically add up to several thousand dollars a year, making health costs the single biggest tax on middle- and working-class households.

That's not insurance. It's an insidious system designed to fleece consumers while pretending to provide a degree of security against the costs of illness. What a laughable degree it is, as the Zammits can tell you. Florida just bought into the joke with its new law providing for $150-a-month "insurance" for those who are currently uninsured.

Health insurance in civilized countries -- including in most "underdeveloped" or developing countries -- means coverage for all medical conditions, no questions asked, except, obviously, when it comes to elective surgery. That's not "socialized" medicine, the juvenile epithet of choice for Americans who insist on judging others' health needs instead of urging solutions for them (often enough the judges are among the 40 million Americans benefiting from Medicare, the "socialized" health care plan for the elderly). It's a moral minimum, health being a basic human right, not a privilege or a choice.

Florida law regulates what health insurance plans cover at a minimum, including some 50 standards and conditions. It's far from a comprehensive list. Instead of eliminating it and replacing it with a comprehensive-coverage mandate, Florida is going backward under the guise of Tinkerbell improvements for the uninsured. (At 20.3 percent, Florida, where quality of life is increasingly joining the state's other famous promises of fantasy, has the third-highest proportion of uninsured people in the country after Texas, the other state that enjoyed the health benefits of a Bush governorship, and New Mexico). Under Florida's new plan, insurers would be allowed to provide skimpy coverage that doesn't abide by the state's minimums.

It's another gift to insurers: They get their $150 a month in premiums, consumers put up with fat deductibles, co-pays and unregulated coverage, and lawmakers writing insurance lobbyists' policies get to pretend that one more devolution of society's responsibilities toward its own is another leap toward universal health care. Meanwhile, the proportion of disposable income that goes to health care (16.6 percent) now tops housing (14.4 percent), food (13.1) and clothing (3.6).

So long as health insurance is understood as a set of conditions and submission to the insurance industry's profit margins rather than a moral responsibility to individual health, all the minor reforms under the sun aren't going to improve matters. They're delaying a true solution. That solution will be defined by the day when a family like the Zammits will be allowed to deal with their son's illness without having to worry about the first dime for how to pay for his care, and hopefully his cure. That's insurance that "renders safe and secure."

Tristam is a News-Journal editorial writer. Reach him at ptristam@att.net or through his personal Web site at www.pierretristam.com.

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