What follows is my missive to Chris Van Hollen's {D-MD) office staff. I'll let you know if I ever receive a reply. But I'd like to know what you folks think of my narrative as far as reasonableness goes...
To [person A],
Earlier today, I stopped by Representative Van Hollen’s Rockville office to discuss healthcare reform with him and his staff. Unfortunately, neither he nor [person B], to whom I have spoken previously, were there. Instead, I talked to [person C], who graciously listened to my concerns despite his professed lack of deapth in this field of reform. He suggested that I communicate my concerns and position to Representative Van Hollen electronically through you as you are the legislative specialist on the topic of healthcare.
I had left my prior meeting with [person B]somewhat unsatisfied because I was not able to convey the entirety of my sense of the healthcare reform effort owing to the presence of other constituents, my five year son and the imminent closure of the office for the day. While I was reassured that, generally, Representative Van Hollen shares my desire for reform, I left in an ambivalent state of mind. I remain concerned about the details of the policies which Representative Van Hollen holds regarding healthcare cooperatives, which I consider a deeply flawed folly relative to a federally administered and subsidized public option.
I believe that healthcare cooperatives will not foster the competition the market requires, will not reduce prices through economies of scale, will not ensure that those currently uninsured will be able to obtain coverage and will not be portable. Additionally, I believe that such coops will be slow to start and gain members, will thrive in only sporadic localities and may eventually be prey to the very foibles that vex the for-profit healthcare insurance industry. I will make an example of my own circumstances to illustrate to you and Representative Van Hollen why I think coops are not a viable source of coverage for my family and by extension, many of the districts constituents.
Currently, I am a contract scientist working at the FDA, unlike my federally employed colleagues who have access to numerous options through the federal health insurance marketplace, my administrative entity provides me with a single option for healthcare coverage. I can take it or leave. Since I have a son and pregnant wife I need such insurance, so I give BlueCrossBlueShield 20% of my take home pay as a monthly premium. I expect this premium to increase once my second son is born. Ironically, I have been avoiding healthcare for myself for fear of the revelation of some previously unknown "pre-existing condition" that might allow my provider to jettison what will certainly be a more expensive time for them as we file for obstetric, perinatal and well baby related compensation. This fear is not unfounded as I know people who have found themselves in such a situation.
Previously, as a journeyman scientist, I have lived in Rhode Island, Illinois, California and Maryland. At each transition, I was forced to drop my prior insurance after some exhorbitant COBRA payments and enroll in the single option healthcare insurance offered by my new provider, if available. Each time risking the revealtion of pre-existing conditions and higher premiums. Except for my seven years in graduate school, where I lived on poverty level wages and was afforded no healthcare coverage whatsoever. Even as I worked at the West Los Angeles VA, as a contractor, I saw Veterans who had spent less time in military service than I had spent working at the VA, getting more affordable and reliable health care.
In many regards, the story I tell is the story of the many scientific professionals that populate our Congressional district.
The challenges of such circumstances would be well addressed by a federally managed and subsidized public healthcare option and would be poorly met by cooperatives. Because coops are by their nature, local efforts, most are unlikely to be portable for those who must move between marketplaces. Additionally, it is difficult to imagine how healthcare providers "out of system" would respond to a relatively small and probably unknown cooperative, they might in refuse service or charge enhanced administrative fees, and the coop would probably have its own "out of network" penalties. This assumes that the market in question has actually manifested a coop, that the individual qualifies for membership.
In principle, one has to wonder how coops will ever be a viable competitor to existing for profit health insurance companies? Again by their very nature, such endeavors will start out small and require time to accumulate membership. Being small they will be unlikely to negotiate rates comparable to those larger entities enjoying economies of large scale, nor will do I expect there to be a wide selection of "in system" options as they must also be negotiated from scratch. Thus I expect higher premiums than existing competitors but smaller pools across which to spread risk and greater likelyhood of catastrophic failure, despite savings accrued through the non-profit motive. Additionally, I expect existing providers to engage in the very same sorts of anti-competitive tactics employed by ENRON and Microsoft.
Given these concerns, I suspect you can understand my misgivings at the promotion of coops as some sort of acceptable (political) alternative. A federally administered public option, in conjunction with the other reforms being discussed, will address all the concerns regarding my personal circumstances and correct the fundemental flaws inherent in the healthcare insurance market as currently constituted. There is no competition in any real sense of the word, at least not in the sense that I observe in the federal insurance marketplace. That is because the demand for health coverage is inflexible, one cannot simply wait for a better price without courting dire consequences especially for acute care. Nor is the individual market competitive because the actuarial evaluation doesn’t vary much between companies, so you pay the same price anyways.
I would like Representative Van Hollen, and you, to address the concerns I have discussed above, and explicitly and concretely detail the precise position he will be taking on the issue of cooperatives. I would also like to know what plan of action Representative Van Hollen will undertake to ensure that the final legislation which emerges from conference will contain a federally-administered public option and not so-called cooperatives.
Earnestly,
[Person D]