Private health insurance can only be profitable under certain circumstances:
1) Insurers must to avoid sick people. They do this by 1) denying coverage to people with preexisting conditions, and 2) by using the workplace as a market. Employers tend to hire mostly healthy people, so pre-selection is done for the insurers before the policies are sold. That’s why private health insurance sold through employers, though too expensive, is an otherwise effective system.
2) By definition, insurers have to avoid people who can’t afford premiums. They either do without coverage, or are dumped on government.
3) Wherever possible, insurers have to avoid paying claims. They have many weapons at their disposal – they write the policies and understand them. Consumers don’t. They have tremendous and unequal bargaining power. It’s very hard to fight a claim denied – first you have to appeal to the very people who denied the claim, and second to the courts.
4) If insurers are forced to offer coverage to everyone (the Dutch model), then all people must be forced to buy coverage. This ensures that the companies will he covering a mix of healthy and sick people, and costs will be kept down.
5) Insurers have to avoid competing with one another. They already do this – all companies follow the Dwayne Andreas maxim that competitors are friends, customers enemies. “Free markets” are kind of a sick joke, an illusion, as markets are cruel and destructive. The whole point of accumulating wealth and bribing government officials is to buy insulation from market forces. We all know this. We just don’t say it. (There are over 1,300 private health insurance companies – if one turns you down for a preexisting condition, all do. You’d think that in a free market, one of those companies would take a chance.)
6) If insurers are forced to cover sick people, and if they have to cover people who can’t afford their policies, they will not be profitable investments, and will have to be subsidized to survive.
Hence the Max Baucus plan: 1) Insurance companies must survive, at all costs; 2) The IRS will force us to buy policies; 3) Competition (a strong “public option”) is not allowed, and 4) subsidy, subsidy, subsidy. Baucus is an private insurance tool, so it should come as no surprise that his plan reflects insurance company needs, and not ours.
The illusion of the free market holds strong in this country, so that we will probably stick with the private insurance model. So we will be faced with mandates and subsidy. I doubt we will save any money. More people will be covered, but insurance companies will still operate as a barrier between the public and the health care system. It’s crazy, it doesn’t work, and is what happens when ideologues of the right rule Washington.
Single-payer works because it is not a “free market” concept – it undermines the illusions and bypasses the profit seekers. It provides care to sick people in one easy step. Every country that has tried it has kept it. Every country that has gone to a public system has kept that system with one exception: Iraq. Paul Bremer forced them into the U.S. model.
That appears to be the only way anyone else will buy our health care system. At the point of a gun.
