- Prohibit pre-existing condition exclusions for children in all new plans.
- Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;
- Prohibit dropping people from coverage when they get sick in all individual plans
- Lower seniors prescription drug prices by beginning to close the donut hole
- Offer tax credits to small businesses to purchase coverage
- Eliminate lifetime limits and restrictive annual limits on benefits in all plans
- Require plans to cover an enrollee’s dependent children until age
- Require new plans to cover preventive services and immunization without cost-sharing
- Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions
- Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs. “By enacting these provisions right away, and others over time” the Caucus declares, “we will be able to lower costs for everyone and give all Americans and small businesses more control over their health care choice.
All of this is great right? Absolutely. I fully support these initiatives…in theory.
Now if we can only convince the uninsured, families, and businesses that they should spend $11,000 a year for a product that doesn’t fit peoples’ needs. And ten years from now if we could only convince them that they should spend $29,000 a year on a product that doesn’t fit peoples’ needs.
This is the largest handout to an industry in the history of our country. Has any of the main players opposed mandates? Of course not. All they see is the federal government mandating citizens to purchase a private insurance product. They see dollars and a government saying “Carry on with your inefficient processes, your laughable patient experience, and your out of control costs."
Of course they’re "doing something” about cost control. What does this mean? Instead of insurance premiums doubling every 8 years, they’ll double every 9 years?
Only about 15% of the uninsured will purchase insurance. And in just a few years they’ll be back in DC wondering why this initiative to reform health insurance (not healthcare) didn’t work to make healthcare affordable.
It doesn’t matter who writes the check to pay an industry that’s designed at its core to ensure costs skyrocket out of control. If doctors and hospitals profit off sickness, the older and sicker a population gets, the more expensive healthcare becomes. And that’s the real issue…the business model of the sickness industry– how and what we pay for in healthcare. What are they doing about that? Decade-long pilot studies to study a potential new payment paradigm? It’ll be too little, too late. The average person can’t afford health insurance today…let alone in 2014 when the average policy will cost employers and/or families nearly $20,000 a year. Incremental change could have worked if enacted 30 years ago.
Health reform should have been about laying the foundation, the incentives and initiatives to disrupt the current sickness industry. Instead, it’s just putting it on life support for an indefinite amount of time ensuring the young people take care of the old because the olds are writing the legislation. But may I ask who’s going to take care of us when we’re old?
I hate being negative because I truly believe that our country could offer affordable sick care for all (and I’m desperately trying to design solutions)…but not under the current business model and not under the current broken Congress. As Larry Lessig says:
Fixing the problem doesn’t mean voting out the feckless Democrats or the obstructionist Republicans. It doesn’t even mean voting out Senator Lieberman. As long as our legislative process is held in thrall to an economy of influence that nearly requires members to play nice with the special interests, the will of the people — on the left and on the right — will continue to be stymied on every issue, in every Congress, under every administration.