[Vision2020] Health Insurance Exchanges are a Great Idea

[Donovan Arnold]

Yeah, and I got a bridge to sell you in Brooklyn? Health insurance is NOT health care. 
 
There is no way in hell health care is going to become "affordable" to the sick and poor that really need it in the next four to eight years.
 
Health Insurance companies will always lobby and push the cost of health care to beyond the reach of the average citizen without buying their product. They will always limit and control what you pay, and what you can afford to maximize their bottom line. 
 
If anything, a Democratic House, Senate, and President, will cave into the big lobbying powers of the health industry, like they did at UI and the Commonwealth of Massachusetts, and force every man, woman, and child to buy worthless health insurance and fine them into deeper poverty if they cannot afford to buy it.
 
Health Insurance, is NOT health care. 
 
Best Regards,
 
Donovan

--- On Wed, 10/8/08, nickgier at roadrunner.com <nickgier at roadrunner.com> wrote:

From: nickgier at roadrunner.com <nickgier at roadrunner.com>
Subject: [Vision2020] Health Insurance Exchanges are a Great Idea
To: vision2020 at moscow.com
Date: Wednesday, October 8, 2008, 11:36 AM

Greetings: 
 
Obama would reign in the health insurance abuses, but McCain would allow them
to increase, especially under his plan to allow insurers to sell policies across
state 
lines. 
 
Obama's insurance exchange program could save $70 billion a year in
excessive 
insurance costs and would forbid insurers from rejecting applicants because of 
pre-existing conditions. 
 
Nick Gier 
 
October 7, 2008,  The New York Times 
Insurance Exchange Is a Good Idea 
By Ezekiel Emanuel 
 
Ezekiel Emanuel, an oncologist, is the chairman of the department of bioethics 
at the National Institutes of Health. 
 
Americans loathe health insurance companies. We all have our stories. When my 
family moved to Chicago, our new insurer sent back all doctor’s bills the
first 
year marking them: “pre-existing condition.” This for my children’s strep
throat 
and ear infections — acute infections that could hardly be “pre-existing”

conditions. 
 
This dread of insurance companies makes it worthwhile to examine how John
McCain 
and Barack Obama handle them. If you don’t like health insurance companies,
Mr. 
McCain’s plan is not for you. It is likely to lead to higher costs, less 
protections and more paperwork. Mr. McCain wants to move people out of 
employer-based insurance by: eliminating the tax exclusion for employer-based 
coverage (making insurance provided by employers taxed as income, which it is 
not today); providing a tax credit to all Americans for purchasing health 
insurance; and allowing health insurers to sell nationwide, so a person living 
in New Jersey could buy insurance from a company in Nevada not subject to New 
Jersey laws. Why? Because like the banking industry, Mr. McCain wants to open
up 
the health insurance market to “more vigorous nationwide competition.” 
 
This approach suffers from three major defects: 1.) insurers charge in relation

to a person’s health, so those who are sick could pay $20,000 or $30,000 a
year; 
2.) these policies typically cover less than employer-based insurance and 
usually have higher deductibles and co-pays; and 3) the insurer’s
administrative 
costs in the individual market are substantially higher because, when the sales

are to each individual separately, there is more underwriting and no economies 
of scale. 
 
One way to solve these problems is to have “insurance exchange” in which a 
variety of insurers would offer the same benefits at a fixed price and have to 
take all comers, while being paid more if they enrolled sicker patients (risk 
adjustment). This keeps prices down by reducing administrative costs.
Doubtless, 
Mr. McCain’s savvy policy advisers understand this option. It seems they 
rejected it because it conflicts with their ideology of less government 
oversight and regulation. 
 
Barack Obama’s plan adopts this insurance exchange idea; creates a public 
national health plan open to all Americans with benefits based on what members 
of Congress get; protects people by requiring insurance companies to enroll 
anyone and charge the same premium for all people and gives subsidies to poor 
people to buy health insurance. 
 
Most health policy makers think this exchange is a good idea. According to 
consultants with McKinsey and Company, if used for everyone, exchanges could 
save $70 billion or more. The guaranteed enrollment and community rating also 
protect people, especially sick people. 
 
One problem is what will be covered in the national health plan. History 
suggests special interests — whether patient advocacy groups for particular 
diseases, physicians offering a particular intervention or manufacturers of 
drugs, devices and tests — can lobby for that particular issue. This pressure

often ignores whether the medical intervention actually improves health, but it

can drive up costs tremendously making the standard benefit a Rolls Royce 
offering. 
 
One of the key ways the insurance exchanges can work to reduce costs is to have

a basic package, and, if people want more services, they could decide whether
to 
buy them. Former Sen. Tom Daschle, a health adviser to Mr. Obama, has suggested

that decisions about what services are covered should be made by a national 
board insulated from political pressure much like the Federal Reserve Board. 
 
If you are like most Americans and think health insurance companies behave
badly 
and you want more protections, lower premiums and less paperwork, don’t wear
a 
John McCain button. Barack Obama’s approach should be more to your liking. 

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