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Where is Claude Rains when we need him?  The Washington Post, in an article written by David Hilzenrath and dated tomorrow (go figure) comes to the amazing conclusion that the Senate bills currently being merged by Harry Reid offer the insurers a number of opportunities for gaming the system to their advantage - and our disadvantage.  What a surprise!  Details below the fold.

From the very beginning of this process, we wildly unrealistic single-payer advocates have been pointing out the near certainty that it would  be impossible to create a fair system that the insurers could not find a host of ways to game.  We pointed to the many ways in which they have been able to manipulate the Medicare Advantage program to make sure that they ended up with disproportionately young and healthy patients.  So it comes as no surprise that Max Baucus and their other employees in the Senate are working to make sure they can do the same on a much larger scale in whatever health care "reform" passes in the coming months.


Nobody wants to spend a lot of time, energy -- and taxpayer money -- and end up back where they started. But that's what could happen with one of the principal elements of health reform, the so-called exchange or gateway.

Legislators are designing this new insurance marketplace to protect consumers from many of the pitfalls and inequities in the current system. But even as they focus on the details of how the marketplace will work, senators have indicated that they would allow insurers to continue operating outside it, much as the health-insurance lobby has sought.

One of the Senate bills would preserve the possibility that insurers could tailor policies to draw healthy individuals out of the new markets, leaving coverage less affordable for those who stay behind.

Last week's house bill would require insurers selling policies to individuals to sell them within the exchange, so that all policies would be subject to the same disclosure rules and requirements.  Not so with the Senate versions.  While some new protections would apply both inside and outside the exchange, many of the most important - and highly touted - ones would not apply outside the exchange:

Senate bills guarantee that certain basic reforms -- such as requiring insurers to accept people regardless of preexisting medical conditions and banning annual and lifetime limits on coverage -- would apply both inside and outside the new markets for individuals and small businesses. But that would not be true for a host of other requirements intended to help consumers compare health plans on an apples-to-apples basis and force insurers to compete more directly on price.

For example, the bill written by the Senate health committee would not require insurers operating outside the marketplace to provide standardized disclosures about what they cover.

It would not prohibit health plans outside the exchanges from using marketing practices that discourage the seriously ill from enrolling, nor would it demand that they offer "a wide choice" of medical providers -- including "essential community providers . . . that serve predominantly low income, medically-underserved individuals," as the bill prescribes for insurers inside the exchanges.

Personally, I have my doubts that, even with the best will in the world, an exchange system couuld be created that the insurers would not be able to play to their advantage.  But our Senators aren't even pretending to try:

Why would the health committee create an elaborate system of consumer protections and then allow insurers to operate outside it?

"Some people may not want to purchase insurance through a gateway. The bill is about creating and enhancing choice," the committee's Democratic staff said.

The main lobbying group for the health-insurance industry struck a similar theme in a July letter. Karen Ignagni, president of America's Health Insurance Plans, wrote that offering plans to individuals outside the exchange would "improve choices for individuals and employers."

I don't know about you, but when the Democratic Senate staffers whoare supposed to be working on reforming our health care system are coordinating their talking points with AHIP, I tend to think something is seriously wrong.

I encourage you to go and read the rest of the article.  There's plenty more there not to like, and I've pushed the limits of fair use far enough.  And for all those still trying to salvage something at least marginally useful out of this bastardized process, I guess we have one more thing to worry about in the conference process.  Does anyone feel confident that the house conferees will stand strong for the better version?

Update: apparently the link above is not working, so try it this way:

Originally posted to Chico David RN on Sat Nov 14, 2009 at 02:07 PM PST.

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