In this week’s New Yorker, James Surowiecki takes a brief look at the contradictions (mostly on the Republican side) of health care reform.
American politicians—as well as American voters—have a confused, and often contradictory, set of beliefs about how health insurance should work. The wayward, patchwork plan that we seem likely to end up with is probably a good reflection of the wayward, patchwork opinions that most legislators have on the subject
Surowiecki’s single-page essays are almost always an inspired read. After some trenchant analysis, he points out perhaps the biggest contradiction in the current health-care reform package:
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.
The emphasis, of course, is mine. And it’s a point that absolutely has to be considered strongly. The current health care bill is essentially forcing private industry to solve the problem, even though they’ve repeatedly proven that they’re not up to the task.
Surowiecki conclusions point to the screamingly obvious – that health care should be treated as a utility, not a privilege for the rich. And that forcing private industry to operate by government constraints isn’t nearly as effective as allowing the government to compete on level ground with private industry.
As a wise friend of mine recently pointed out, the for-profit health insurers are dinosaurs. They are an industry whose time has past, and for those of us with eyes on the future, it’s time to gradually sunset those providers and replace them with a more sensible solution.