SIOUX FALLS, S.D. -- From her seat behind the reception desk at Raven Industries, Becky Lyon picks up all the company gossip. The scuttlebutt about next year's health insurance premiums -- which are not due out for several weeks -- has been terrifying.
Twenty percent, she's heard. Twenty-five. Maybe even a 30 percent increase.
"With a 2 percent pay raise, that's a really big hit," said Lyon, a wiry 35-year-old with more debt than her age would suggest. "It really makes me nervous."
After surgery in January to remove a benign lump from her breast, Lyon was deluged with bills for her portion of the cost -- from the surgeon, the anesthesiologist, the hospital -- each more ominous than the last. "You owe this much now," the bold print screamed.
After paying $250 in cash, she put the remaining $750 on her credit card, where the interest keeps piling up. "And," she adds in a tone wavering between irony and fatalism, "my car is dying a slow death."
Raven chief executive Ronald M. Moquist parks his Mercedes in the company garage and has no big hospital debt to pay off, but he, too, is worried, over the rising medical bills his firm pays. The anxiety he and Lyon share is making the cost crunch in health care one of the most potent domestic issues of the election year.
Rising medical bills touch every U.S. family and firm, affecting wages and profits, not to mention health. Since 2000, health insurance premiums have risen 59 percent while pay grew 12.3 percent, according to the nonprofit Kaiser Family Foundation.
In each election season, it is a given that candidates and voters will put health care on the agenda. But not since the recession of 1991 has the subject of cost sparked so much unrest in the electorate.
This year, health care ranks fourth on the list of voter concerns, behind the economy, Iraq and terrorism, according to an analysis of 22 national surveys conducted by Kaiser and the Harvard School of Public Health. "The health care issues of greatest concern are the affordability of health care and health care insurance," the analysis said.
Though President Bush and his Democratic challenger, John F. Kerry, acknowledge the high cost of care, neither has devoted an entire speech or advertisement to the issue, and their platforms offer only minor attempts to deal with it.
To control skyrocketing costs, Bush supports creating an electronic medical record for everyone within a decade to reduce administrative costs and enacting legislation that would limit noneconomic malpractice awards at $250,000. Analysis by the Congressional Budget Office has found the caps would reduce malpractice premiums for physicians but would have a negligible impact on insurance premiums for patients.
Kerry has a proposal to reimburse companies up to 75 percent of the cost over $50,000 for "catastrophic" cases if the employer offers insurance to all workers and implements wellness programs. Because the "reinsurance" plan would reduce the guesswork in risk adjusting, analysts say it could lower all premiums by 10 percent, or about $1,000. Like Bush, Kerry is enthusiastic about modernizing the health care system; he has promised to create electronic medical records by 2008.
For the most part, those proposals have not reached the 800 workers at Raven. They hear a great deal of talk about Iraq and a fair amount of personal mudslinging, but few believe the candidates have focused enough attention on what they see as a threat to their livelihood.
At this vibrant manufacturing company on the Big Sioux River, there is no escaping the cost crisis in U.S. health care. Stress over escalating medical bills permeates conversations from Moquist's corner office to the plant floor.
