"We're headed for a time when almost nobody is going to be able to afford insurance at all," he said. "Maybe I'm getting old, but I think we're like frogs in cold water.
"They say that if you put frogs in a pan of cold water and gradually turn up the heat, they'll just sit there and cook and never jump. I think that's what's happened to us in health insurance. These changes have happened gradually over time. All of the sudden, a near-disaster is here, and we don't understand what happened."
How did we get here?
Tom Kasey was 2 years old in 1934 when Franklin Roosevelt decided to take national health insurance out of the Social Security Act. If Roosevelt had left it in the bill, Kasey said, U.S. health care and insurance would probably look more like European and Canadian programs today. It would cost less, too, if only because administration would be simpler.
The United States did not adopt the European model, in part because the doctors' lobby was much more in the United States, writes Paul Starr in his Pulitzer Prize-winning book, "The Social Transformation of American Medicine."
Five American presidents proposed national health insurance: Theodore Roosevelt, Franklin Roosevelt, Harry Truman, Richard Nixon and Bill Clinton. The American Medical Association campaigned against each proposal, sometimes defeating it before it got to Congress.
In 1917, opponents of national health insurance printed pamphlets that called it "a dangerous device, invented in Germany, announced by the German Emperor from the throne the same year he started plotting and preparing to conquer the world." In the '20s, as anti-Communist fears rose, opponents called it a bolshevik idea. When Truman proposed it, the AMA ran ads that contained an alleged quote from Lenin.
With no central administration to pay health bills, Americans developed an unplanned, patchworked non-system that covers some people and not others.
Part of the non-system developed in the private sector: In World War II, commercial insurance companies began to sell health insurance in earnest. Companies used it to attract scarce workers. People came to expect it with the job. Unions developed insurance plans. In Appalachia, the United Mine Workers set up a much-needed system of hospitals and health funds.
Part of the non-system is public: Roosevelt left a clause in the Social Security bill that said the federal government would give states money to provide health care for needy children. Later, the Veterans Administration and advocates for disabled people set up their own programs. Later, Medicare insured people over 64.
Each new funding system — public or private — created a new bureaucracy. Each new bureaucracy cost money. Each new set of rules forced the other bureaucracies to adjust. By 1985, American hospitals and doctors were hiring troops of people to deal with multiple funding channels.
It all adds to the cost of insurance. In 2003, the New England Journal of Medicine reported that U.S. health-care administration alone — per person — costs three times as much as it does in Canada. Most Canadian medical bills go through one central provincial administration.
'Don't they even want to save money?'
"It's gotten more complicated, but not more logical or fair," Kasey said. Government insurance programs get big discounts, uninsured people pay top dollar, and private insurance pays whatever price they can negotiate.
In the mid-'50s, when young Kasey went door to door collecting premiums for Life of Virginia, there was no such thing as a self-funded company insurance plan, and the alphabet soup of HMOs, PPOs and PSOs had not yet been created.
"By the mid-'80s, I was telling my wife, 'Maybe it's time for me to quit,'" he said. By then, he said, "Insurance companies had stockholders, and everybody was suing everybody. I'd take my boy to the ER when he got hurt playing sports, and they'd run tests they never would have run before, to limit liability."
Kasey thinks the recently passed Medicare bill will drive up prices. It bars Medicare from even asking the drug industry to give discounts. "Now why did they do that?" he said. "Forty million people, and they can't negotiate discounts? Don't they even want to save money?"
The cost of health care keeps rising. "I see more and more people asking for the highest deductible they can get," he said. "I hear them say, 'Well, at least I won't have to worry about being wiped out.' And given the prices, maybe that's the only way to look at it."
What advice would he give the average person? "Educate yourself," he said. "Something has to change, and there's a better chance of that if people know what's going on.
"We're part of the problem, too," he said. A lot of people don't take care of their health and don't try to understand what's happening. They won't even read their own policy," he said. "That's when we're like those frogs. Suddenly, we're in hot water, and we don't know why.
"I keep thinking about that movie where the guy sticks his head out the window and yells, 'I'm fed up, and I'm not taking it anymore,'" he said. "If enough people did that, we might all get some relief."
To contact staff writer Kate Long, use e-mail or call 348-1798.