Mandating Mis-Insurance

A couple of new reports take aim at the obvious flaws in proposals that would throw people into the individual insurance market as part of their "cure" for the nation'a health care financing crisis.

Stephie Woolhandler and David Himmelstein, Harvard Medical School researchers who have been leading the fight for single-payer national health insurance on behalf of Physicians for a National Health Program, this week show how the high deductible policies contained in the Bush, Schwarzenegger and Massachusetts plans will penalize women. The reason is simple: women spend a lot more on health care than men.

The study showed that "in 2006, the median health costs for women age 18-64 was about $1000 higher than for men ($1,844 vs. $847)." This other fact from the study may shock a lot of young women, since most polls show young people are more supportive of the high-deductible, individual mandate approach. Younger women (ages 18-44) had median health care expenditures nearly three times higher than their male counterparts ($1,266 vs. $463).

“High deductible plans punish women for having breasts and uteruses," Woolhandler said. "Our costs are higher than men’s because we need Pap tests, cervical cancer vaccine, mammograms and birth control, and because pregnancy is expensive. When employers raise deductibles, they’re giving women a pay cut. And when politicians offer tax breaks for high deductible plans, they’re discriminating against women.”

The tax break issue was front and center this week in a New England Journal of Medicine perspective by Robert Reischauer, president of the Urban League (he used to run the Congressional Budget Office and now chairs the Medicare Payments Advisory Commission). Giving people tax breaks forces people into an individual insurance market that has, to use his judicious words, "significant shortcomings."

To wit: "In many states, carriers can refuse to insure anyone whom they consider to be high-risk, policies can exclude coverage for preexisting conditions, and premiums vary with enrollee health status, making coverage prohibitively expensive for people in poor health."

Of course, there is a way around those problems. "States could be required to revise their individual insurance-market regulations to meet some minimum federal standards," he writes.

That should be the first question out of any reporter's mouth when anyone, from President Bush to Gov. Schwarzenegger, proposes an individual mandate as part of their cure for the health insurance crisis. "Are you willing to impose national regulation of insurance carriers so they can't discriminate against people with preexisting conditions or age?"

The purpose of health insurance is to pool risk for those who suffer sudden illnesses and provide a social safety net for those who because of age or circumstances need more health care. Only risk pooling can accomplish those twin tasks. And the most efficient and effective way is to cover everyone with adequate insurance is to throw them all in the same pool, i.e., Medicare for all.

Posted by gooznews at April 6, 2007 12:49 PM