I might get Health Insurance, but I still don't need Health Insurance

[Blue State Blues]

A reasoned, logical follow-up (I was going to say, "rant," but thought it would be false advertising) to I don't have Health Insurance and I don't need Health Insurance. Incidentally, I wrote most of that post while I was on hold with my insurance company.

I listened to the President's speech last night and I've been reflecting on it all day. I have a few thoughts and a lot of questions.

Part 1: I might get Health Insurance

To recap, right now the insurance I pay for every month could vanish as soon as a member of my family becomes ill. So in the sense that it's not going to be there if I really need it, it's not really insurance.

The President's plan would address the most egregious of these practices, practices which are industry-wide and routine. No pre-existing conditions. No dropping coverage when a customer gets sick. No higher premiums for women just because of gender. Limits on variation in premiums because of age. Out-of-pocket spending caps for customers. No annual or lifetime benefit caps imposed by insurers.

These are desperately needed reforms. People are dying. People are living in misery. People are living with physical pain and mental anguish. Right now. And they can't wait for change, real change, right now.

But.

But will regulation work? The major insurance companies have been found guilty and have been fined for defying existing regulations. What confidence can we have that they will not simply defy these laws as well? Why won't they simply continue to calculate the fine vs. the cost of the treatment vs. the chance they'll actually be forced to pay the fine after appeals, and then just go on with business as usual?

And since they've been right there at the table helping to craft the legislation, what are the odds that they've missed any opportunities to fill the legislation with loopholes big enough to drive a pre-existing condition through?

But let's just say the legislation is loophole-free. That still doesn't mean it will work. Eight years of the Bush Administration taught us that. As they so ably demonstrated in the areas of consumer and environmental protection, all a hostile Executive Branch or Legislative Branch needs to do to defeat good regulation is underfund the agency responsible for overseeing it ... and appoint opponents of regulation to head the agency ... and then systematically understaff the agency so there aren't enough people to handle the caseload. If the defying the law means money on the balance sheet and the chances of being caught are low, what profit-hungry corporation would resist temptation?

Part 2: Insurance still isn't what I need.

To recap, I buy insurance coverage for my car, my home and even my life so it will provide a benefit IF I need it. But when it comes to my health, sooner or later, I WILL need health care and sooner or later, it will be expensive.

From what I've heard last night, this scenario doesn't change.

A whole lot of people who currently don't have insurance will get insurance, and that sounds great. But insurance is not the same thing as care. Right now most of us have insurance, but too many of us still don't have access to affordable care -- subsidizing the premiums won't help if you still can't afford the co-pays.

Part 3: I don't need more choices.

I don't need more choices. I need good choices.

The exchange sounds like a good idea. But I didn't hear anything last night and I don't see anything in the materials on the White House website that guarantees this multitude of new choices among companies and plans would include good choices. I don't see guarantees for quality of coverage (though it's possible they're in there and I'm just missing it.)

But I'm still having trouble the idea of choosing a level of coverage. I can't predict the future. I can accurately gauge the minimum requirements I need in a plan, but there's no way that I can know the maximum.

I'm ethically troubled by the idea of low-cost, bare-bones, minimal plans, particularly after reading this article in Business Week. In a section talking about industry representatives pressuring Senators to reduce coverage levels, the article reads:

This is good news for UnitedHealth, which benefits when patients pick up more of the tab. In late spring, the Finance Committee was assuming a 76% reimbursement rate on average, meaning consumers would be responsible for paying the remaining 24% of their medical bills, in addition to their insurance premiums. Stevens and his UnitedHealth colleagues urged a more industry-friendly ratio. Subsequently the committee reduced the reimbursement figure to 65%, suggesting a 35% contribution by consumers—more in line with what the big insurer wants. The final figures are still being debated.

But if someone gets one of these bare bones plans because he or she is too poor to afford the premium without subsidies, how can they afford to pay a higher portion of their medical bills if they get sick?

If you're too poor to buy good coverage, how can you afford to have lousy coverage?

And speaking of options, what about the Public Option? That's assuming, of course, that a Public Option even makes it into the bill and, considering the President's tepid support, that doesn't seem to be a safe assumption. The Public Option would only be available for people who don't currently have insurance. So I can't get it, even though my insurance is over-priced. My insurance company knows I can't get it, so it doesn't provide meaningful competition for them, so they have no reason not to continue raising my premiums 20% a year, or more. Would it really provide competition even in the individual market if only 5% of eligible Americans would use it AND it has to pay for itself through their premiums? How can that be a large enough pool of people to spread out the risk and make the plan work?

Part 4: What I need

What I still need is affordable, reliable universal healthcare. What I heard last night, what I read today, does not begin to deliver on that.

I'm still reserving judgement until I can read it all a few more times, but I can't muster any enthusiasm for the plan I heard last night.

I still support the President. He's still a great speaker. I just wish, in this case, he had something more encouraging to say.

[glinda]

1. Excellent reasoning again.

Exactly what I am thinking.

[Blue State Blues]

2. Thanks - nt

[Blue State Blues]

3. Working up to a real rant

reading the transcript of the speech. After a catalog of the routine abuses of insurance companies with which we are unfortunately familiar:

Insurance executives don't do this because they're bad people; they do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."

They do all of these horrible things -- things that kill people -- and they're not bad people? Oh, Wall Street made them do it. It's ok then.

[Apollo11]

4. Like we should sympathize with the insurance companies!

Wall Street makes them cheat their customers.