from Ezra Klein/The Washington Post
Barack Obama is going on the road today with a retooled pitch for health-care reform. In particular, he’s emphasizing how reform will help the rest of us. To dramatize this, the White House has come up with the eight guarantees that will be written into health care bill:
No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.
These protections would help a lot of people. Or, to be more precise about it, these protections will keep a lot of people from receiving a terrible blow when they’re most vulnerable.
These are all important inclusions, and there’s an interesting segment on last week’s This American Life about point four — recission of coverage when one becomes seriously (read: expensively) ill, but where’s the public option?
I’m sorry but these are simply not possible without a marked increase in monthly premiums. New York has what’s called “community ratings” meaning everyone pays the same premium and, in exchange, insurance companies cannot discriminate based on pre-existing condition. New York has the third highest average premiums in America because you simply cannot receive a lower premium because you are young and healthy. The argument is that if a population enrolls a larger amount of the previously uninsured and increases its pool, premiums will decrease. However, insurance premiums have not decreased (as promised by the insurance companies).
Again…the fundamental problem of healthcare is the process of healthcare delivery:
Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.