[Note: This item comes from friend Bob Frankston. Bob’s comment:’The author blithely offers a “let them eat cake” piece of advice by saying that people with preexisting conditions can just get a job and get coverage via their employer. Totally out of step with a gig and entrepreneurial economy. Or for that matter, any rational economy that doesn’t try to hide the true costs of healthcare.’. DLH]
What the Republican Health Plan Gets Right
By MARC K. SIEGEL
May 5 2017
Now that the Obamacare replacement bill has passed the House and is moving on to the more centrist Senate, the real debate begins. What is the true purpose of health insurance, and what is our government’s goal in ensuring we have it?
I learn from my patients every day about the benefits, limitations and contradictions of their health insurance. One charming 60-year-old with severe seasonal allergies insists on seeing me every few weeks this time of year, even though I tell her she doesn’t need to — her antihistamines and nasal spray treatment rarely changes. But she worries that her allergies could be hiding an infection, so I investigate her sinuses, throat, lungs and ears. I reassure her, and her insurance (which she buys through New York’s Obamacare exchange) covers the bill.
If she was responsible for more than a small co-payment for these visits, I’m sure I would see her less often.
We pride ourselves on being a compassionate society, and insurance companies use this to manipulate us into sharing the costs of other people’s excessive health care. Meanwhile, 5 percent of Americans generate more than 50 percent of health care expenses. Why shouldn’t a patient who continues to see me unnecessarily pay more?
The government’s job is to maintain public health and safety. It should ensure that insurance plans include mandatory benefits like emergency, epidemic, vaccine and addiction coverage. The Republican bill would let states apply for waivers to define these benefits differently; it would be a big mistake to drop such coverage entirely. But Obamacare went well beyond these essentials, by mandating an overstuffed prix fixe meal filled with benefits like maternity and mental health coverage that drove smaller insurers with fewer options out of the market. The few that remain often have a monopoly, and premiums rise.
Speaking of compassion, how about some for the 20-something construction worker who can’t afford to pay his rent because his premiums help subsidize overusers like my allergy sufferer? Why shouldn’t a patient who is risk-averse pay more for coverage she might never need, while that construction worker be allowed to choose a cheaper insurance plan that might cover only the essentials?
In addition to limiting the menu of essential benefits, the House bill would let states create high-risk pools for patients with pre-existing conditions who had let their insurance coverage lapse, and who could then be charged premiums more in keeping with their health care needs. This is the only way to make insurance affordable for most consumers; pre-existing conditions will continue to drive up premiums if everyone is compelled to pay the same price.
These risk-pool premiums can and should be subsidized by the government. A recent report from the Kaiser Family Foundation found that high-risk pools can work, but have been historically underfunded. Trumpcare should change that — though it will cost more than the House bill’s $8 billion in additional funding. Drastic cuts to Medicaid should also be reversed, which could help the bill pass the Senate.