According to a 2013 World Health Organization paper, “Fairness in financial contribution is an intrinsic goal of a health system because it is a desired outcome in and of itself.”

Are facility fees, then, like the one discussed in the August 10 Press Herald article about Kelly Brignac’s obstetrical emergency (“Surprise bill for emergency room visit highlights hospital fee debate”), fair?

Is it fair, that is, to ask insured people who happen to need hospital services – as opposed to insured people who don’t – to contribute extra to keeping hospitals “open and accessible to patients at all times” (a function of facility fees according to the Legislature’s Task Force to Evaluate the Impact of Facility Fees on Patients)? I don’t think so. In fact, considering that situation makes we wonder about the fairness of the many other ways we contribute to the funding, not just of hospitals, but of our whole health care system through traditional Medicare, MedicareAdvantage, MaineCare, commercial insurance and out-of-pocket payments.

Is it fair, for instance, for traditional Medicare beneficiaries to have no limit on their out-of-pocket costs unless they can afford Medigap plans or are “dually eligible”? For workers to suffer wage or other benefit restrictions so their employers can afford to pay the employer Medicare tax? I don’t think so.

Is it fair for taxpayers to have to pay more for commercial insurers to cover MedicareAdvantage patients than they pay for the government to cover traditional Medicare patients? For MedicareAdvantage beneficiaries to have to pay extra if they have to switch to traditional Medicare to get the care they need? I don’t think so.

Is it fair for people who qualify for MaineCare to have to help support the program through sales taxes, which are more burdensome to them than they are to people who are better off financially? I don’t think so.

Is it fair for the commercially insured to pay premiums inflated 18% by administrative and profit costs (based on the 85% medical loss ratio)? For them to face maximum out-of-pocket costs of up to $9,000 on top of their premium payments if they happen to be in an accident or get sick? For workers to have their premiums and cost sharing (deductibles, co-insurance) determined by their employer? For their wages to be restrained so their employers can afford to pay the employer’s share of premiums? For workers who aren’t offered a health benefit to have to turn to the more expensive individual market or Maine taxpayers (funders, along with the federal government, of MaineCare and CoverME.gov), or go without coverage? For employers who offer a health benefit to be less competitive because of the cost of that benefit? I don’t think so.

Is it fair for people with no insurance to face unlimited out-of-pocket costs? For providers to have to make up for any resulting bad debts? I don’t think so.

If our health system does not, then, include “[f]airness in financial contribution,” what sort of system would? A publicly funded universal health care system, in which people’s contributions are based not on where or if they work, whether or not they need care, or how old they are, but simply on their ability to contribute. They would do this through a simple, transparent health care income tax, which, though politically challenging to institute, would go a long way toward meeting the WHO’s “intrinsic goal” of contribution fairness. And if in effect when Kelly Brignac went to the ER, would have saved her a lot of grief at an already grievous time in her life.