By now it’s pretty clear that the Obama administration will make health coverage a priority item. The question is, what form will it take?
The NYT has a glance at the future:
Health Insurers Offer to Accept All Applicants, on Condition
The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.
The idea behind that is to avoid antiselection: When you cover the entire population, the incidence of catastrophic illnesses is minimal compared to the whole.
But there are a number of things to consider:
1. Will it still be employer-paid coverage?
If so, who’s paying for the insurance for unemployed people?
In what way is that different from Medicaid?
What happens in an economy that is contracting instead of expanding?
Do existing health savings accounts issued through insurance companies count as coverage? Or do you have to cancel that and enroll in the insurance policies?
2. What kind of coverage are we talking about?
Routine check-ups and preventive care, immunizations? How about EKGs, mamographs, colonoscopies? Dental care, eyeglasses? Plastic surgery?
How much would the insurance pay for doctor visits? Paying very little for office visits will reduce the number of physicians. France has found out the hard way.
Or would it be an HMO-type of service where the government decides who are the participating doctors?
3. What if you get sick when travelling overseas? What if you go, say, to India for knee surgery, as many Europeans are doing now?
4. Can one go outside the compulsory coverage and pay directly to private physicians?
What if you have a critical illness that can’t wait?
5. Who gets billed for the coverage? Do the elderly pay more for coverage? Again, how is this different from Medicare?
Or should we asume it will be one community rating fee for all, regardless of age, in which case people with many children will pay the most?
6. How are the fees collected? Will it be through existing governmental bureaucracies, such as the IRS, or through paying insurance companies, or will there be yet another new bureaucracy sinking in more of the taxpayers’ money? How will the department of Health and Human Services fit in the picture?
As a former group benefits administrator and underwriter, I have more questions that I can post right now. But then there’s a really big question,
Insurers did not say how the government should enforce an individual mandate: whether through fines, tax penalties or other means. Politicians have also been reluctant to specify details of enforcement, which could prove highly unpopular.
Lots of questions.