Dear Smug Ones:
This is a note to the smugly insured: you who believe that your Blue Cross (or Aetna, Prudential, United ...) card is as solid-gold as your solid-gold VISA card -- that your health insurance is as rock-bottom solid as Social Security, that you will never ever find yourself among the 42-million mass of "uninsured." Impossible. Never happen. Some of those rock-solid insurers abandoned Medicare enrollees, but you are young. Your insurers would never drop you.
Besides, even if an insurer dropped you, you could get another one. After all, you have a job-with-insurance. You may suffer from lots of health problems, but lack of insurance won't be one of them. So you can blithely ignore every new government announcement on the rising census of the uninsured. When politicians ask for your vote, you can grill them on tax cuts, on school standards, on crime. Not "health insurance." You're safe.
After all, you are indispensable to your employer. Your company would never think of laying you off -- the company couldn't operate without you.
And your company isn't going to downsize. After all, it is a bastion of the American economy, run by the best and brightest ... like AT&T. Foreign competition won't muscle into its growing market share. That happened to Ford and General Motors; it won't happen to your company. It couldn't.
Your company isn't going to disappear either -- like Enron. It won't turn into one of those footnotes in economics texts, like Lucent. The executives of your firm haven't borrowed from the till, haven't loaded up on stock options, haven't bled the company to give themselves mega-perks. The public's watchdog, the Securities and Exchange Commission, vigilantly alert to malfeasance, has been overseeing your company. Its stock might roll a bit, in sync with a rolling Dow; but those are temporary dips.
Nor would your company suddenly drop health insurance. That would be reneging on an implicit social contract between you and them, and they are honorable people. Of course, those honorable people may have reneged on insurance for retirees. But you and your colleagues are different: you show up every day, create the "product" behind the much-vaunted productivity. They wouldn't stiff you, the way they did their retirees, who left with gold watches and bills from insurers.
But two policy wonks, Richard Kronick and Todd Gilmer, in a recent issue of Health Affairs, raise a new worry. They declare that the census of the uninsured depends on two trends: personal income, and health care costs. When health care costs rise higher than income, the number of the uninsured will rise. That is the case today, with a projected 15% rise in premiums. In a recessionary time, companies may well pass this cost onto employees, or downsize (dropping even people who believe themselves essential).
So you may still be working at a company that provides health insurance, but the question now becomes: can you afford it?
Perhaps it is time to add "national health insurance" to your political concerns.
Forty-two million Americans who discovered they weren't "safe"
Joan Retsinas is a sociologist who writes about health care in Providence, R.I.