Maybe the votes just aren't there for the "public plan." Set aside the frustration of that for a moment. What might be doable and worthwhile?
I think the following would be a huge improvement on where we are now:
1. Health insurance plans should be purchased directly by individuals, not employers, and should be valid across state lines as long as the insurer operates there. Health insurance payments should be tax-deductible. Your employer can just pay you more instead of offering that benefit. More importantly, your insurer shouldn't know, care, or be permitted to care when you change employers.
2. Any rules that make it harder for insurers to operate in multiple states need to go away.
3. All insurers should cover all of their customers as a single pool, and shouldn't be allowed to refuse customers, drop coverage or change rates due to preexisting conditions. This is the big one. Without it any individual insurer who offers a single pool will have all of their healthy customers cherrypicked by those who do not. This is what happened to the nonprofits that tried to hold out and make a stand on that principle. I still have the letter from Blue Cross explaining why they had to switch to the cherry-picking, sick-people-pay-more policy. The letter pointed out that they were the last insurer in the tri-state region not to do so.
"Will this encourage people to engage in high-risk behavior?" You mean like getting old?
Seriously, people have other motives to limit high-risk behavior. Like seeing their grandchildren graduate. Or being able to enjoy sex again ever. And if insurers have to cover these people, then insurers will be motivated to help them get healthy.
4. Insurers should be required to cover a certain list of treatments for certain conditions. Yes, they should be able to refuse million-dollar unproven treatments, and there's room for agreeing to cover more for a price. But without a fundamental "must cover" list like this, insurers can avoid the old and the ill simply by not covering their conditions.
5. Yes, damage awards in malpractice suits should be limited. No, this won't solve the problem all by itself, but it'll help, and conservatives will vote for it. By "limited" I don't mean "limited to five bucks and a playful swat on the ass."
6. Doctor visit copays are good. They shouldn't be unaffordable but it's good to give people a reason to stay out of their doctor's office unless they are sick. $25 is a good number.
Under the above conditions, nonprofits (including "co-ops") would have a better shot at actually operating in the public interest because they wouldn't be "competed" into the ground by companies whose competitive advantage is refusing to insure sick people. This is the problem with "nonprofit" insurers today. If #3 and #4 are implemented, the environment will be very different, so it's not really fair to compare the behavior of Blue Cross today to what health insurance co-ops might look like after reform.
Now, back to the public plan option:
With the above in place, a public plan could be more easily created, either now or later— because the cost of insurance would be lower. The government (or a state government) could simply choose to purchase health insurance plans from companies operating under the above rules.
Thoughts? Tomatoes? Campaign contributions?
Tags: health, health insurance, politics