Improving Conditions for the Insured


The irony is that some of the health reform proposals on the table this
year are a bit of back to the future. The health insurance exchanges
that Obama envisions — regulated markets that the government would set
up where insurers would compete for business — are the successors to
the managed competition that Clinton sought. The regulations on insurer
behavior and the out-of-pocket caps are direct descendants of the
Clinton bill.

There are important ways, however, in which the bills currently
working their way through Congress do not go as far as Clinton’s plan
did 15 years ago. In attempting to ensure that Americans can keep the
coverage they like, they do not always ensure that people can leave
insurers they do not like. The insurance exchanges, in particular, are
limited to the self-employed, the uninsured and small businesses.
Someone who works for a larger employer would not have any more choice
under these proposals. Indeed, the problem with trying to make sure
that everyone can keep what they have is that you can’t change very
much. This makes it hard for advocates to explain exactly how
health-care reform will improve conditions for the insured, at least in
the short term.

I get, I mean, ideally, that you want to help the most screwed people, the totally uninsured or uninsurable, first. But part of the problem with our current health care system is that even the winners are losers. Even if you’re on the best insurance plan imaginable and you have a job you love and would never leave, you can still get whomped for more money than you could ever afford to pay because something happened you couldn’t anticipate. If we’re going to completely reform health care in this country we’re going to have to deal with the fact that the best-case scenario in the world really, really, really sucks.


6 thoughts on “Improving Conditions for the Insured

  1. This is becoming a more key issue – it’s called the firewall, referring to the barrier to the exchange.
    The Senate plan would allow currently insured to change, the House wouldn’t.
    I have what is considered good insurance. But it doesn’t, under any circumstance ever, cover a procedure that my Dr. wants me to have. If the public option is firewalled, then I couldn’t change (unless I quit my job), so I am insured but won’t have access to the procedure which will likely be covered under the public plan (because it’s currently covered under Medicare).
    So the catch phrase “If you like your plan, you can keep it!” is disingenuous. It’s really, “Like it or not, if you have a plan, you have to keep it.”

  2. Agree with Virgo. I needed anesthesia last week – proceedure lasted all of 15 minutes. Even though the hospital leases from my school (and has all sorts of informal affiliations with the school), the cost to me, after insurance, is around $500.
    For minimum wage folks, even after the raise of the minimum wage this month, the $500 is over 2-and-a-half weeks of work (I’m guessing that $7 before taxes would easily come down to $5 after). Add to that that I was out of work for several days.
    How many folks can do without 3 weeks pay? Fortunately, I have great vacation and healthcare. (Unfortunately, this represents someone with great healthcare. If this is gold plated, how does the person with so-so benefits eke out?)

  3. The House bill had health care subsidies to people making up to 400% more than poverty level, which is $43K for an individual and an annual cap of $5000 out of pocket expenses – not ideal, but still a big improvement. It also has slowly expanding enrollment provisions for small businesses. It’s not fixing everything at once but it fixes things over time, a 3 year window, which is a relative snap of the fingers considering we’ve been waiting for public health care since Harry Truman. From Wonkroom, on the House Tri-Committee bill:
    – Individuals and employers with 10 or fewer employees in 2013
    – Individuals and employers with 20 or fewer employees in 2014
    – Individuals and employers with more than 20 employees in 2015
    There will also be some tricks to make yourself eligible for the public option in the short run, like getting a part-time job working for a small business, or switching jobs from your big company to a smaller company. These are less than ideal solutions to people who have major issues with their big company provided health care plan but they are short run oddities that will disappear over time if people like the public plan, which they will.

  4. You do know, of course, that the heart of this problem is that we will still get our insurance from insurance companies that are in the business as a business, so like all businesses, they are in the business to make…profits. Now, maybe if we all sit down and think really hard, for long enough, say 50 years (?), we can find a way to get around this seemingly intractable problem. I think I have a glimmer of an idea, but so far I just can’t…oh…maybe, something like…nah, that can’t work…oh, well maybe a system without insurance companies?

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