AAO keynoter describes high health care costs for low-income Americans

ANAHEIM, Calif. — The third of Americans in the lowest income brackets will be faced with increasingly burdensome health care insurance costs if the nation’s health care system is not reformed, said Uwe E. Reinhardt, PhD. He delivered the keynote address at the opening session of the 2003 meeting of American Academy of Ophthalmology.

“At present, the government is unlikely to come to the rescue for the bottom third of taxpayers,” Dr. Reinhardt told meeting attendees. “These people are struggling while the top two-thirds of Americans are living comfortably.”

According to Dr. Reinhardt, a noted health care economist and Princeton University professor, the cost of health care in the United States for a family of four earning a yearly income of less than $35,000 is up to $9,000 a year.

Insurance premiums are highest for Americans whose employers do not offer heath insurance as part of a benefit plan, Dr. Reinhardt said. These employees are forced to seek individual insurance at high cost, he said.

Dr. Reinhardt estimated that, with a growing national deficit and health care premiums continually rising, health care costs for low-income families in the next 10 to 20 years will exceed 37% of their yearly income. More Americans will be unable to afford heath care insurance, adding to the 40 million people already uninsured.

“In 2000, taxpayers paid 5.2 times more for Medicare than in 1980,” Dr. Reinhardt said. “These figures can only go up.”

While Congress wrestles with Medicare reform issues, Dr. Reinhardt said that ophthalmologists must analyze the health care options that may lie before them. He described some of the possible alternatives to the current system.

"We can move to a single-payer system that enables patients to get universal coverage easily and gives them free choice," Dr. Reinhardt said. Disadvantages of a single-payer approach may include higher taxes and rationing of patient care, he said.

A second approach, first proposed by the Clinton administration, would offer patients a network of HMO providers. This plan would help the lowest-income third of the population and Medicare recipients, but it would accrue the largest administrative costs of any health care plan in the world, Dr. Reinhardt said.

"Our choices are limited, and if I had to guess where our health care system will go in the next few years, it will continue to muddle through in the state that it’s been, with the lowest paid percentage of the population losing out," Dr. Reinhardt said.