Monday, January 4, 2010

The Paradox of Private Insurance and Universal Coverage

Great article from James Surowiecki in the New Yorker last week about the difficulty in reconciling the overwhelming public support for granting equal health insurance opportunities to all comers, regardless of pre-existing conditions, with the equally vehement public opposition to "single payer" or "governement run" health care systems. Key paragraph:
Congress’s support for community rating and universal access doesn’t fit well with its insistence that health-care reform must rely on private insurance companies. After all, measuring risk, and setting prices accordingly, is the raison d’ĂȘtre of a health-insurance company. The way individual insurance works now, risk and price are linked. If you’re a triathlete with no history of cancer in your family, you’re a reasonably good risk, and so you can get an affordable policy that will protect you against unforeseen disaster; if you’re overweight with high blood pressure and a history of heart problems, your risk of becoming seriously ill is substantial, and therefore private insurers will either charge you high premiums or not offer you coverage at all. This kind of risk evaluation—what’s called “medical underwriting”—is fundamental to the insurance business. But it is precisely what all the new reform plans will ban. Congress is effectively making private insurers unnecessary, yet continuing to insist that we can’t do without them.

And of course the health care insurance industry is totally on board with the pending reform legislation---makes one wonder what sort of backroom deals were cut to guarantee future insurance industry profits and therefore seal its support...


Anonymous said...

I've always known that the devil is in the insurance lobby.

Those who have never been self-employed or without automatic acceptance in employer-based group plans really have no idea. I'd go so far as to say that more than 50% of ya would be denied for any truly comprehensive individual market plan.

And yeah, you and all your details are in that big insurance database in the sky. And then there's the stuff they try to make up about you...

I've had employer based plans, bought my own plans, been part of professional group plans, and have handled insurance claims for private practice.

So Buckeye is right. Something evil this way comes.


HudsonMD said...

I can't wait for more government based coverage so that 95% of my payers can just stop procesing claims for two weeks like medicare just did.

Anonymous said...

I have health insurance. I have health insurance because I lied to my new doctor. Lied to the old one, too. Mostly I try to avoid doctors, because they write my medical records. I've never told a doctor that I was born with bilateral hip dysplasia. Both hips started to hurt twenty years ago. Now they hurt all the time. Sometimes I use a cane. I'm 40.

I haven't mentioned the bad heart valve to my doctor. Did you know you can hide a heart murmur by drinking a huge amount of water in the week before your insurance physical? It might be two bad valves; I can't remember what the cardiologist told me when I was thirteen. He said come back in a year, but the next year we were uninsured.

We were uninsured when I was eleven and a sore throat turned into Scarlet Fever, too. But I got a couple of weeks off school. That was pretty good! I got a week off in eleventh grade for pneumonia and a week in college for pleurisy. Always a bright side.

I didn't tell my new doctor that my back is bad. I didn't tell him I get migraines sometimes. I didn't tell him I have scoliosis and a blown disk at C5-6. Apologies to the neurologist I never returned to-- no student insurance after you graduate! I didn't tell him I have thoracic outlet syndrome and get woken up in the night if I sleep on my back because my arms fall asleep. But he doesn't know I have insomnia, either. My last gynecologist didn't know my period was coming every two weeks. I said I needed the pill because I was going to be traveling to Europe.

I have the shiniest, cleanest medical record anyone my age can have. Because I have never allowed anything to get onto my permanent record. My health insurance, which does not include any prescription drug coverage, will take care of me if I get hit by a bread truck or ever get around to taking down my Christmas lights and fall off my ladder. It won't take care of my inherited high cholesterol, which is 260.

If we had permanent electronic medical records tied to our social security numbers, I would obviously be uninsured. As it is, when my hips are unmanageable I'll be on a plane to India for some medical care. For the rest, I really don't know.

I'm sure you can appreciate why this comment is anonymous.

Debra said...

Health care "reform" is like Humpty Dumpty...broken in pieces and it's not likely to be put back together again.

It'a a great day for Insurance companies though and Nebraska.

I've enjoyed being a first time visitor to your blog tonight.