New York Times - 20100227

"Hands off my health care" goes one strain of populist sentiment.

But what if?

Suppose Congress and President Barack Obama fail to overhaul the system now, or just tinker around the edges, or start over, as the Republicans propose — despite the Democrats' latest and possibly last big push that began last week at a marathon televised forum in Washington.

Then "my health care" stays the same, right?

Far from it, health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.

"People think if we do nothing, we will have what we have now," said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. "In fact, what we will have is a substantial deterioration in what we have."

Nearly every mainstream analysis calls for medical costs to continue to climb over the next decade, outpacing the growth in the overall economy and certainly increasing faster than the average paycheck. Those higher costs will translate into higher premiums, which will mean fewer individuals and businesses will be able to afford insurance coverage. More of everyone's dollar will go to health care, and government programs like Medicare and Medicaid will struggle to find the money to operate.

Policymakers, in the end, may be forced to address the issue.

"It will break all of our banks if we do nothing," said Peter V. Lee, who oversees national health policy for the Pacific Business Group on Health, which represents employers that offer coverage to workers. "It is a course that is literally bankrupting the federal government and businesses and individuals across the country."

Even those families that enjoy generous insurance now are likely to see the cost of those benefits escalate. The typical price of family coverage now runs about $13,000 a year, but premiums are expected to nearly double, to $24,000, by 2020, according to the Commonwealth Fund.

While some employers will continue to contribute the lion's share of those premiums, there will be less money for employees in the form of raises or bonuses.

"It's also cramping our economic growth," said Frank McArdle, a consultant with Hewitt Associates, which advises large employers and reported on the need for change for the Business Roundtable, an association of CEOs at major companies. Spending so much on health care is "really a waste of people's money," McArdle said.

The higher premiums will also persuade more businesses, especially smaller ones, to decide not to offer insurance. More people who buy coverage on their own or are asked to pay a large share of premiums will find the price too high. It doesn't take too many 39 percent increases, like the recent one proposed by Anthem Blue Cross that has garnered so much attention, to put insurance out of reach.

While estimates vary, the number of people without insurance is expected to increase by more than a million a year, said Ron Pollack, the executive director of Families USA, a Washington consumer advocacy group that favors the Democrats' approach.

There will be a cost in lives, too. Pollack's organization estimates that as many as 275,000 people will die prematurely over the next 10 years because they do not have insurance.