The Devil We Know (Gwen Moritz Editor's Note)

My boss, Jeff Hankins, said in this space last week that we should all be nervous about health care reform because "the wealthiest Americans will pay for it while having little input and no assurances of improvement."

He's right, of course, as far as he went. But it would be just as true to say that the wealthiest Americans are already paying - with little input - for a system that was never perfect and is clearly unsustainable.

We have a system in which health care is a right for the very poor, an affordable commodity for the very wealthy, and an uncertain financial burden for the vast majority who fall in between. We have the most expensive health care in the world, yet dozens of countries have better health outcomes than we do.

As consumers, we shouldn't have to put up with that. But we have a system in which consumers are virtually helpless when it comes to controlling their health care costs - and even consumers who make an effort to be informed are at the mercy of providers who profit personally from running up unnecessary bills. Recommended reading: "The Cost Conundrum," by Atul Gawande in the June 1 issue of The New Yorker.

(And people who worry that universal coverage will create an entitlement mentality among even more patients need to consider the current entitlement mentality among doctors. A lawyer recently told me of a comment he heard come out of the mouth of a client, whom he identified only as a medical doctor in Arkansas: "How do they expect me to live on $675,000 a year?")

We have a system in which three out of every 10 dollars spent on health care may be utterly wasted, in which most dollars are spent extending the last few months of life, and in which the cost of providing medical services to the uninsured is shifted to those who are paying for insurance - to the tune of about $1,000 a year per family.

We have a system in which a person's workplace - primarily the size of the employer - does more to determine how much his health insurance costs than his health or personal habits. We have a system in which a catastrophic claim by one employee of a small business results in a huge increase in premiums for his employer and coworkers - or may result in the employer dropping group health altogether, creating even more uninsured Americans.

We have a system in which 15 of every 100 Americans have no health insurance at all on any given day - and the percentage is much higher for Americans over 18 but under 65, since government programs do a pretty good job of insuring the young and old. (However, the cost of those programs is about to overwhelm all other government spending.)

Our current system keeps would-be entrepreneurs shackled to their current employers if they or any member of their families has a pre-existing condition. Our system complicates the recruitment and hiring of talent, and it compounds the financial impact of the loss of a job.

We have a system that helped cripple the once mighty American auto industry and is stressing other industries that have global competition. Under our system, employers who buy group health plans get tax breaks but individuals who have to buy their own insurance don't.

We have a system in which young adults, regardless of income, often forgo insurance because they are "healthy," spreading the costs across a smaller pool of insurance customers and leaving the rest of us to foot the bill when they crash their cars.

Yes, I'm nervous about health care reform - particularly since the Obama administration seems intent on maintaining the utterly artificial connection between health insurance and place of employment. If we're remaking the system, that should be the first thing to go.

I'm also nervous because the parties that have profited the most from the inefficiencies in our system are the ones who can afford the most political clout in this country, and getting a handle on health care costs is going to require the goring of someone's ox.

But I truly don't think that reforms that make it through Congress could be significantly worse than what we have right now in terms of individual cost, ease of access and medical outcomes. The only thing going for the status quo is that it is the devil we know.

(Gwen Moritz is editor of Arkansas Business. E-mail her at gmoritz@abpg.com.)