For every problem, there's a cure, and President Obama will tell you what that cure is before he knows the problem. His cure, the nationalization of the health insurance industry. So what's the problem? For one, the majority of Americans do not want his cure and he will not accept that the nation will not roll over and play dead over his "plan". Why? He doesn't have a plan, he has identified the problem, as he and his liberal friends see it, not as the American public sees it. He delegated the job of designing a solution without any guidance, to that much reviled American institution called Congress. No fewer than 5 committees from the House and at least one important Senate committee, with little to no input from the Republicans.
Without leaving Obama's fingerprints on it, Obama's White House negotiated the limitation of damages the major health industry players will incur provided they hop on board the Obama express and promote his "plan". In spite campaigning on a platform to limit the level of involvement of the Washington lobbyists, the backroom arm twisting was facilitated by the very lobbyists he promised to remove from influencing legislation. To show he was going to be tough on removing costs from health care system, he turned his attention on the health insurance industry and on the waste and fraud in the Medicare and Medicaid programs. He wants you to believe that success in these two areas will pay for the new entitlement, subsidized health insurance on a sliding scale for those who claim hardship or can not afford to pay for health care insurance.
Does he think he makes sense? Now, I want to tell you, he does, because he says so. Since the advent of Medicare and Medicaid, every breathing and thinking person in America knows that there is waste and inefficiency. After all, it is a government program, the same government that brought you $1000 toilet seats and several hundred dollar screw drivers. The Amercian people know that their government is not efficient in the handling of taxpayers funds. It knows that Congress is irresponsible with managing the people's money. Every President pledges to remove waste from the government, after all it is there for the picking. Why, with all the Harvard educated geniuses that find their way into government service, have they not wrung out the savings? You know the answer. But, President Obama says he will do it, that it is a new day and we have to look forward. "Yes we can" is his motto. Do you dare to contradict the President? You bet your sweet ass you should because it is all bullshit. If it was there to the degree Obama and his minions believe, it would have been taken and corrected well before now. Nothing in his plan indicates a path to the savings, other than stripping out $500 billion from Medicare under the guise of eliminating waste. Wonder what waste he is talking about, the waste of money by paying for end of life care? How about the "unwarranted subsidies" to insurance companies who offer better coverage to seniors who opt to go to a Medicare Advantage provider, an insurance company that is paid by the government a flat rate to assume 100% of the cost of Medicare patients. The same people who have attracted a growing number of seniors to a government sponsored alternative to traditional Medicare. A plan with growing popularity amongst seniors for its superior comprehensive benefits. Is this the type of waste reduction you can believe in?
When Obama says that seniors should not listen to the scare tactics of the opposition, Should you listen? Damned right you should listen! You need to be aware of the verbal tricks and verbal slight of hand that comes from the rhetoric of the President. You need to challenge his promises. When Obama says that "nothing in our plan requires you to change what you have" you need to be aware of the grand experiment of Congress in the past when the rate to be reimbursed by the government to the Medicare Advantage providers was cut to a level that caused the providers to pull out of the program, leaving the seniors who had opted out of the traditional Medicare up a creek. The reimbursement was reduced to a level that the business was unprofitable and nobody in the industry was going to lose money just to keep the enrollment numbers up. Congress, in subsequent session, reversed the cuts and attracted the insurers back to the program.
Will it happen again? It very well could if the cuts make the program unprofitable! Will Obama and the liberal Congress care, only if the seniors remain silent. Can you afford to be quiet? No, Congress changed the reimbursement and the enrollment was reinstated because the seniors and their lobbyists AARP caused an uproar. Congressmen may be many things, but when it comes to re-election they are not stupid. Obama on the campaign trail said he favored a single payor system. If he does, he may not care that seniors who opted out of Medicare in favor of the Medicare Advantage plans will have to change back to Medicare. He may not understand that your current physician may not take you under Medicare's poor reimbursement or that you will have to change pharmacy providers because the Medicare Advantage pharmacy benefits are managed by someone else. Now, that is change we can believe in!
Now, we know what Obama has said should bethe direction of the solution. His disdain for the health insurance industry is clear, they are the villains, the cause of the high costs of the health care and the leaders of the inflationary acceleration over the last decades. They caused the medical care inflation index to be two to three times the consumer inflation index. They are the greedy ones who kick insureds off the list at the time of most need, the ones who rate based on age and sex, that charge varying rates based on sex and age, and health experience of the individual or the community. Horrors! How could they do that?
Insurance is an underwriting game, a game that takes into consideration variables that attempt to quantify the risk so that a premium can be charged on some rational basis that relates to their expected medical loss ratio, the ratio of payout to premium, or simply, the expected costs of reimbursing providers for providing care. That the costs reflect experience and other actuarial algorithms related to risk and timing of incurred claims versus incurred and unreported claims does not make the setting of price irrational, arbitrary, or capricious as you would interpret from the remarks by Obama. That each state has an insurance commission and are members of the National Association of Insurance Commissioner (NAIC) is not recognized by Obama. Each state abides by the standards established by the rules of the state and the NAIC in formulating regulations that govern all manner of insurance. It should not be interpreted as a loose system that needs the assistance of the Federal Government. It is highly regulated and Obama would upset the delicate system of insurance regulation based on State insurance underwriting standards and would abandon sound actuarial standards of risk management in what he has proposed.
Worse, Obama would nationalize health insurance, applying price controls on many of the elements essential to understanding the risk as an insurance provider, eliminating, in fact outlawing age and sex cohorts, experience-rating standards, prohibit pre-existing conditions as a risk factor, arbitrarily cap out of pocket expenses, remove life time caps. The Federal Government would set the rules and regulate the industry. Then, he would force the insurance providers to compete against a government subsidized not-for-profit option that he claims will have lower administrative costs, lower executive compensation, and more efficiency than the companies that provide coverage now, including the many fine Blue Cross and Blue Shield plans that are currently not-for-profit and cover many of the citizens who could not access group coverage without the BC/BS plans?
Obama says he wants competition to keep the insurance companies honest. This is ok if the competition was on a level playing field with like competition, but with the government establishing an agency-like health care entity with an implied government guarantee, doesn't sound a great deal like Fannie Mae and Freddie Mac, with all the benefits of Congressional tampering and politics as usual tramping on private enterprise. We all know how well Fannie Me and Freddie Mac worked out. Can we risk our health system to such antics?
How many companies will survive this competition? Who knows, but if history is any example, many will just cease to exist or merge creating even bigger behemoths and less competition. It means that the estimated number of 5% of the population is seriously understated. As Obama said, there is nothing in his plan that will require you to change your insurer if you are happy with the insurer. He also says, there is nothing that will require businesses to change the coverage for the employees. What he does not say is what happens if the employer, who makes an economic decision and who finds his costs have increased because of the new limits on underwriting such as out of pocket caps and pricing controls, mandated coverage, and other limits placed on his plan. If the cost is higher than the penalty to pay for not providing health insurance coverage, he may make an economic decision. Either drop and pay the penalty or raise his costs without any offset. Which way do you think he will go?What happens if some insurers simply change their business model, refusing to lose money on each subscriber? You lose, and the taxpayer loses.
Now, most large businesses no longer purchase "indemnity" plans, rather, they have switched years ago to what is called "ASO" plans, health coverage where the larger employers self-insure, contracting with insurance companies who bring a network of providers, negotiated prices, information systems for claims processing, consultation on plan design, etc, but not insurance. This is true of the large employers, but encompasses employers as small as 500 employees. The insurance companies charge a few per subscriber, but take no risk. The employer takes the risk and funds the medical expenses, accruing unknown medical expenses. Under Obama's plan, how will they know what their risk is and will they be able to charge the employees and the dependents enough of a contribution, together with the employers portion, so that the health care costs do not become a surprise? With much uncertainty in the calculation, employers will be motivated to find the cheapest care.
What about the people who have been responsible and purchased individual policies, joined community HMOs, bought indemnity plans who now see their cost go up with the uncertainity of underwriting? Will they keep their own coverage or will they capitulate and drop coverage and buy the cheaper plan? undoubtedly, there will be many who change plans to the government plan and probably will have to change doctors because their doctor will not accept the reduced reimbursement the government plan will pay.
That is why it is disingenuous of the President to sell his plan as if there will be minimum disruption to the existing system. This is why it it not credible for the President to stand there and lie to the American public and misrepresent the damge his plan will have to the safety and security of our healthinsurance we currently have. A health system that is working for 85% of the people, the people who favorably rate their existing coverage. Be honest, Mr. Presidnet, tell the people you really want a single payor system. Quite trying to sell them an elixir when you know it is just snake oil! Any other words, no matter how eloquently delivered, are just words, just words, you know!
We know the health system can be improved, can be held more accountable for outcomes, and should provide health care to American citizens who can not afford health insurance with out some help, either with tax credits or vouchers do to incomes to large to qualify for Medicaid, but not enough to pay for Health coverage. We should mandate enrollment of all eligible children in CHIP and SCHIP programs as a condition for the continuation of welfare payments or food stamps. We can change eligibility for Medicaid to provide health insurance to the most needy. We do not need to upset the entire system working for 85% of the people for the 10 to 12 million who need a hand in affording health care. We do not need some grand experiment with a public option, we already have public options, and they are not very efficient nor cost effective, because they are government programs. We do not need another entitlement that will be bankrupt in 40 years. We need some common sense solutions that we can all get behind. We need a bipartisan consensus, not a partisan plus 1 or 2 solution.
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