Thursday, September 03, 2009

A few footnotes to all that

1. You want to know how bad it has gotten? Group health plans now generally cover about 80% to 90% of a policyholder's medical bills, according to the Congressional Research Service. Even though that is now the industry standard, the Senate Finance Committee first discussed a requirement the plans cover at least 76% of such costs. Now, the LA Times says, the committee may set the rate as low as 65% - 15 to 25 percentage points below current industry norms.

The claimed purpose is to enable insurers to offer "flexible, more affordable plans." Which it would do by dumping more of the cost of health care directly onto the consumer. Which means the very people more likely to go for those "affordable" plans, that is, the ones who can't afford better ones, are going to be the same ones facing greater out-of-pocket expenses. Great for insurers, not so much for the insured.

2. A few days ago, the New York Times ran a fawning article all gooey sentimental about how the people who work in the health insurance industry - specifically, at Humana, which set up a series of interviews - are not "monsters." It may be
easy to demonize insurance companies[, the article said]. But Humana’s employees want the politicians to know that, in the words of Aerion V. Miles, a customer service team leader, “We are human beings, too.”
But even in that sort of controlled environment, the truth still slipped through.
“I believe we’re getting the pushback because we are standing up for what we believe in,” said Cheryl Tidwell, 45, Humana’s director of commercial sales training. “We believe there’s a better way to control costs by controlling utilization and getting people involved in their health care.”
"Controlling utilization." That's insurance-speak for telling your doctor that the company will not pay for certain procedures and tests because (although they wouldn't say this part openly) they're not profitable enough for the investors. That is, it refers to the on-going, present-day, routine business practice of faceless insurance industry bureaucrats getting between you and your doctor to make decisions about your care - the very same sort of interference the very vague possibility of it being done by the government was so horrifying it sent GOPpers and Blue Dogs howling and mobs at public meetings screeching.

(I have to mention parenthetically that yes, it is a good thing to be more involved in your own health, a good thing to take steps you can take on your own to get and stay healthy. But please remember that when insurance companies say this, it's not you they're concerned with. It's the hope of having to pay out fewer claims and thus obtain more profit.)

3. A point that has not been raised enough is that, as I noted in this post, you can't do half the calculation. Weiner and Osserman mention the other half.
Opponents keep citing the CBO's estimate that reform may cost $1.6 trillion. ... The health cost is not only reasonable [in comparison to other major costs such as the financial bailout and the Iraq war] and now includes major cost-cutting strategies but most importantly will save consumers significant sums.

Responding to another question at the July 28 news conference, Pelosi confirmed that "of course" CBO should measure consumer savings. Ways and Means Committee Chair Charles Rangel has said, "The CBO does not score savings of people in their own pocketbook that could be $2 trillion."
I've tried to make this same point in the past. Arguing with someone who'd object to single-payer or a national health care system by saying "It'll make my taxes go up," I'd say "Yes, it will. But just suppose for the sake of argument it made your taxes go up $2000 a year. It's very unlikely to be that much, but just suppose. You think you're $2000 behind. But suppose those same taxes saved you $3000 a year in reduced insurance premiums and reduced health care costs. Are you $2000 behind - or $1000 ahead? You've got to do the whole calculation."

That's something else that too many proponents - including me - have often forgotten this time around.

4. This thus becomes a good spot to note another shortcoming in my arguments, one I to which I confessed yesterday in a comment over at Lean Left. After noting that I "simply have no faith that any 'reform,' lacking at least a strong public option, will succeed in significantly expanding access," I went on to say:
I have too often in the past slipped up and talked about “increased coverage” or “reducing the number of the uninsured” when the real goal is expanding access to adequate health care. The key difference is that the latter refers not only to the uninsured but to the “underinsured,” those who have insurance but who still do not have access to regular health care and/or are not protected against the choice of financial disaster or going without treatment in the event of a serious illness because the insurance they have is inadequate to the task.

I do not see the situation arising where an individual mandate will require more than bare-bones coverage – which means that the very most I think will come out of this in the absence of some countervailing force to private insurance is to move the bulk of the uninsured into the ranks for the underinsured via what amount to federal handouts to the insurance companies (those subsidies to lower-income folks). That will make us feel better but will not significantly advance the cause of universal access to adequate health care.
Even at that, I think I put too much emphasis on the quality of health insurance you might have - but it does serve, hopefully, to clarify the point that the real goal has nothing to do with "insurance." It has to do with universal access to adequate health care. That is the goal.

In the heat of debate, it can become easy to confuse a means - which is what insurance is in this case - with the ends. That's a mistake I am now determined to make no longer, particularly because, I believe, pointing out the goal will also point out the inadequacy of the means.

A strong public option at least has the potential to make a significant move toward that goal. Nothing else on the table does and so nothing else is acceptable.

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