HEALTHCARE….I believe that national healthcare in the United States is inevitable. It won’t come without a lot of kicking and screaming, of course, but it will come nonetheless. Two recent articles demonstrate why.

In the LA Times today, we learn about the latest wrinkle in employer healthcare plans: extremely high deductibles paired with health savings accounts. Employers like them because they’re desperate to control costs and this is the only way to do it. Employees like them for essentially the same reason: employers have been forcing bigger and bigger premiums on them, and this is a way to reduce them. In the end, though, I think this is a mug’s game: no matter how you slice things, employers will still be caught in a spiral of increasing healthcare costs, but now workers will be caught up with them. In the long run, neither side is likely to be very happy with this kluge.

In Sunday’s New York Times we get the other half of this story. Robin Cook writes that advances in genetic testing are bringing us closer and closer to the day when simple diagnostics will allow insurance companies to decide who they will cover and who they won’t. Risk pooling will become a thing of the past, and anyone with the bad luck to have a risky genetic chart will find herself unable to get insurance coverage at all. Cook thinks the answer is obvious:

With the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I’d advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I’ve changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual’s confidential, genetic makeup.

All of these things are slow-motion time bombs. But they’re time bombs nonetheless. As employers become progressively less willing to pay for skyrocketing healthcare costs that their foreign competitors don’t have to shoulder; as workers are forced to pay more and more for ever stingier benefits; and as genetic testing prevents increasing numbers of people from getting any coverage at all, there will be a growing groundswell to ditch America’s peculiar and disfunctional system of employer provided healthcare and replace it with something better. My guess is that this will hit a crisis point sometime in the next 10-15 years, and eventually even conservatives will cave in.

It’s a shame that complete collapse is probably the only thing that will convince conservatives of the need for change, but that’s reality. In the meantime, all you can do is hope that you work for a generous employer or that you don’t get very sick. Good luck.

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