Social workers committed to social justice must grasp the high stakes involved in the growing enthusiasm for market-based solutions to the United States' expensive and nonuniversal health care system. According to some critics, the U.S. health care system is "a paradox of excess and deprivation" (Enthoven & Kronick, quoted in Bodenheimer & Grumbach, 2005). Some Americans fail to receive even basic health care services because they are uninsured, underinsured, discriminated against because of their preexisting medical or psychiatric conditions, or unable to locate a physician or mental health provider who accepts their particular forms of public or private insurance. The call for market solutions to the nation's fragmented system has been issued by a cluster of business and commercial health insurance groups who advocate a policy direction they identify as "consumer-driven health care." Their vision includes massive marketing of health savings accounts (HSAs) to U.S. health care consumers as a cost-sharing approach to relieve burdened employers and restrain government's role in the financing and delivery of health care.
Though HSAs vary in structure, each assigns a larger role to the individual consumer in selecting health care providers and funding health care services. Basic to this approach are insurance plans that feature high deductibles, which are out-of-pocket contributions toward the first dollars spent on the account holder's health care in a given year. The increased front-end consumer contribution is supplemented by defined contributions by the employer. Shortages in meeting medical bills can be covered by cash withdrawals from the individual HSAs, whose deposits are not taxed but whose contents can only be withdrawn for approved personal health expenses (Beeuwkes Buntin et al., 2006). High deductibles associated with these new health plans were defined by the U.S. Treasury Department as $1,100 or greater for individuals in 2007. Under a health savings account approach, the expectation is that such deductibles will be indexed upward each year. Deductibles in most HSAs are anticipated to be $5,000 or more for a family (Impact of "Consumer-driven" Health Care, 2004).
ECONOMIC PRESSURES ON INDIVIDUALS, FAMILIES, AND COMPANIES
As U.S. health care costs spiral upward, both consumers and employers have difficulty financing health services. Insurance premiums increase so rapidly that some families are unable to make monthly payments to purchase protection against future catastrophic health expenses. The 2007 documentary Sicko, by U.S. filmmaker Michael Moore, included a poignant account of a middle-class employed couple with health insurance coverage who were forced to abandon their home and move into their adult daughter's spare bedroom due to personal bankruptcy resulting from the accumulation of health expenses connected with the husband's heart condition.
Increasing numbers of small businesses conclude that they cannot continue to offer insurance to their employees and keep their workforce at the current level. Health insurance premiums have been growing steadily since the early 1980s at annual rates that dramatically exceed both workers' earnings and overall inflation. Except for a brief respite in the mid-1990s, the annual rate of increase in health insurance premiums has ranged between 5.8 percent and 18 percent as compared with annual increases in workers' earnings and overall inflation rates, which have generally remained within the 2 percent to 4.5 percent range. Between 2000 and 2006, health insurance premiums for a family of four increased 87 percent, while workers' wages and general inflation increased at rates hovering around 19 percent (Kaiser Family Foundation, 2007).
Feeling the squeeze of health insurance premium costs on their profits, U.S. businesses increasingly look to cost sharing with their employees to maintain their dominant status in a highly competitive global marketplace. …