This is what Michael Hiltzik opined that health insurers will end up offering as reformed health care in a piece in yesterday's LA Times in What do we need health insurers for anyway?
I've got to agree because, basically, I'm pretty pessimistic that anything called health care reform by the current congress and administration will be "gamed" by the insurance industry. Regardless of your optimism or pessimisim about HCR, this article deserves a read.
That HCR, rather than reforming health delivery, conflates delivery with insurance, is nearly criminally negligent. Hiltzik's article explains why. Because, as for-profit entities, their business model, even under HCR is unchanged from that of selling healthy people on policies that don't offer much coverage at all, while forcing older, less healthy people to pay for medical expenses out-of-pocket.
The problems that this creates for us and unaddressed by proposed law, or made possible by Republican calls for insurance sales across state lines without minimum coverage standards, is that states will race to the bottom to attract incorporation by health insurers that will be allowed to offer useless coverage. Sorta like credit card issuers incorporating in states that allow usurious interest rates. How is that working for us? And now it it health coverage on the block of unbridled avarice. An excellent example is Wellpoint's coverage mentioned in the article:
"Braly in her testimony assured the subcommittee that even with the latest California rate increases, "a 40-year-old woman in Los Angeles can obtain coverage with a $1,500 deductible for as low as $156 per month."
She didn't specify what kind of coverage. So let's check out what her company offers. Leaving aside whether that 40-year-old woman might have a preexisting condition that would drive up her premium or make her uninsurable -- anything from diabetes to a history of hay fever -- the insurer's California package with a $1,500 deductible requires the customer to pay up to 70% of the cost of "covered services," including routine mammograms and Pap tests, plus as much as $500 a day for hospital stays.
Maternity isn't covered at all, so our 40-year-old Angelena better have gotten her lifetime childbearing out of the way before picking up the phone to sign up."
So, why is it that we even discuss HCR in the context of health insurance? This is not even being incrementalist: it is the remapping of the status quo, much like squeezing a baloon where what is lost in one area is is made up by distortions in other parts.
Were we truly incrementalist, then we would be talking about the scope of minimum coverage offered to each person as a right of citizenship and where the burden of cost is universally shared (progressively). But, we aren't, and instead of getting health care reform we get discussions of insurance and costs, all to the detriment of actual health delivery reform or the actual health of the American public.
What do we need health insurers for anyway? That answer is obvious to the majority of Americans but unasked by our government. And, I'll predict that until we come to grips about the uselessness of health insurers any health care reform is destined to fail our population.