Current Focus is on the Wrong Issues

Today’s topic: The real issues in the health care reform debate


Although the cost issues and the potential inclusion of a public plan option are important, there are real issues being largely ignored.

The primary issue in health care reform should be about increasing access and the best means to do it. Way back in April the health insurance industry offered some key concessions. AHIP, the largest national insurance trade association said that if the approved health care legislation were adopted without a public plan option, health insurers would drop two huge current health insurance practices.


*** Full disclosure: I consult extensively with AHIP so I’m fully acknowledging my perspective and biases. I also work with Medicaid policy to increase health insurance access for people with disabilities, so I see and understand both sides. ***


But the concessions AHIP offered are indeed huge.

1) No more individual plan underwriting. This means insurers propose to no longer cherry pick the healthiest potential customers seeking individual health insurance. They pledge to take all comers. Now of course they propose that because it’s beneficial to their business…. insuring more people, means more health insurance premium, and equals more revenue. Health insurance is a business and like every business, revenue is a good thing.

2) No more gender-based underwriting. This is a very good thing. This means that women of child-bearing age will not be charged a higher premium simply because they COULD become pregnant. Fellas, this of course means we might pay a little more, but I think we all agree it’s only fair. Ultimately, coupled with the first concession, this means that young, single women will no longer have the difficulty of obtaining health insurance on their own if their employer doesn’t offer it. And without the incredibly high premiums.

If there is mandated coverage on individuals and/or businesses it means that the insurers will benefit from an increased market and increased revenue so the elim- ination of underwriting and instituting equitable premium based on gender mean a fairer health insurance system.

Ok, So What Does This Mean?

Hopefully as the debate rages on Congress will realize it needs to resolve the public option issue speedily so that we get the more important issues of how best to increase access in the foreground. Those more important issues are- will coverage be mandated, how will it be financed, how will physicians be incentivized to achieve better health outcomes and reduce spiraling costs.

If health care reform does not eliminate the individual market and put us all into larger purchasing pools, therefore reducing insurer risk and decreasing premium, then we will have failed miserably. This needs much more attention than it currently is getting.


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You might ask how this would affect state Medicaid programs, Medicare and state high-risk pools available to the currently uninsurable? I’m glad you asked as that will be the subject of a blog entry next week. Stay tuned and please join in the discussion.