Phil Hauck's TEC Blog

Saturday, February 27, 2010

"Everyone Can Agree On"? No Way!

The latest Washington proposals to enact the several things that "everyone can agree on" keep talking about giving smaller businesses the opportunity to combine into pools so they can both use the power of the pool to (1) make health insurance less expensive for less healthy groups and (2) provide higher volume for leverage in getting better deals with insurers and providers.
The problem is, this won't work ... and it's been proven time and again, most recently by our own Healthy Lifestyles Co-op of Brown County. No healthy group will stay a part of a group where it is subsidizing less healthy ones. Result: Adverse selection as other insurors pick up the healthy groups with lower prices.
Everyone knows this, I think, so why do the Washington negotiators even bring it up? (Help me to understand this. What am I missing after years of involvement in trying?)
PS: Our Co-op didn't yield better rates because our very real fitness gains were offset by non-participants whose prognosis for sick care expenses increased. Houston: "We have a COST problem, NOT an INSURANCE problem!"

Another observation, about the "everyone can agree" that people with PRE-EXISTING CONDITIONS should be automatically accepted by insurors, and can't reject services as "not covered". What kind of a business model is that for any privately-held organization? Help me: I'm required to take on a "customer" who will pay me $6,000 but I know will cost me $25,000?
This MIGHT work if everyone is required to buy insurance (about which there is far from agreement), but even if that's done, any insuror could get a disproportionate amount of expensive pre-existing condition people that could financially ruin it.
(Yes, there are ways to deal with this as a nation that would actually reduce total costs AND include people with major pre-existing conditions ... but these models definitely aren't being discussed in Washington. Nothing that would reduce costs is.)

For ideas about what "everyone can agree on" (other than industry lobbyists), see my blog below.
They are:
• Transparency of pricing.
• Reduction of Medical Liability exposure.
• An emphasis on Fitness and Wellness.

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