War on Healthcare

Today’s word: medical underwriting. “the use of medical or health status information in the evaluation of an applicant for coverage”

As I’ve pointed out before McCain’s healthcare plan relies heavily on state-run high-risk pools; it would essentially eliminate employer-sponsored group insurance by making group premiums non-deductible for employers. Everyone would be given a tax credit for $2500-$5000 and pushed into the individual market. It would likely be a nightmare for many people. It also bears a striking similarity to the plan offered by the health insurance lobbying group, AHIP. Shocking, I know.

I have suffered through publicly financed healthcare my entire life.  I will waiver in my efforts to save the American people from that fate.  --John McCain

"I have suffered through publicly financed healthcare my entire life. I will not waiver in my efforts to save the American people from a similar fate." --John McCain

If McCain and AHIP are successful in implementing their plan they will have delivered a gold mine to private insurers and a minefield to state governments. Private insurers will be working in the most profitable demographic imaginable: healthy people with money. Everyone else–literally those most likely to need healthcare–will be looking to government at all levels to help them out: the old (Medicare), the poor (Medicaid), and the sick (state high risk pools). As a taxpayer my question would be this: if we taxpayers are going to provide health insurance to all the high risk folks, why not the low risk too? At this point what exactly is the point of having private insurers around?

Moreover, let’s take a look at the process by which insurers would identify these potentially costly customers, medical underwriting. Insurers say they need to screen out high risk people, like people with pre-existing conditions, people with a family history of certain diseases, age, gender, and so forth—so that they can keep premiums affordable for everyone else. This might make some sense if they were planning to actually exclude someone from the healthcare system. But no one, to my knowledge. actually proposes to do that.

That’s not to say it doesn’t happen all the time (for more on that subject, I highly recommend Jonathan Cohn’s book, Sick). No, insurance companies don’t explicitly say they want to exclude people from the healthcare system, they just want to exclude certain people from their healthcare system.

What private insurers propose to do is to use medical underwriting to shift costs from private insurers to the government. In other words, if the health insurance system worked exactly as the insurance industry says they want it to, medical underwriting would be merely an expensive, useless process that shifts costs to the public. However, since our healthcare system doesn’t work as advertised, medical underwriting is an evil process, tossing random people into the giant cracks and crevices of our patchwork healthcare system–in addition to being expensive and useless.

It’s for this reason that our healthcare system cannot work without mandatory participation. Everyone gets coverage; everyone pays something. That requires an end to the vast majority of medical underwriting. if McCain and the health insurance companies had one ounce of dignity they would be begging the government to stop them from medical underwriting. Like slavery and child labor it’s a morally bankrupt practice that has been outlawed in other countries for decades. But, instead of ending it, they want to expand it. They want to refine it, fine tune it, devote vast resources to it, so that they can more efficiently identify those who are at risk of costing them money.  So that they can more efficiently dump them on the taxpayers.  So that they can more efficiently mine their particular niche of the healthcare system for gold.

They call this proposal—I’m not making this up—“a plan for guaranteed access” and “covering the uninsured“. Although the medical underwriting they propose to use has precisely the opposite effect—it excludes people from the system—they call their proposal “guaranteed access” because… ummm…they’re going to ask taxpayers to guarantee it. As AHIP puts it on their website, they will “encourage states to develop and implement access proposals”. McCain’s website assures us that “as President, John McCain will work with governors to develop a best practice model that states can follow – a Guaranteed Access Plan or GAP”.

Right. Is there one person in America who believes the GOP has any intention of raising $1 of tax money to pay for this? As I write they are working as hard as they can to defund social insurance and social programs all across the country. Even children cannot escape the GOP attack on government financed healthcare. Now they are proposing that state governments (with their vast resources!) start covering millions of people who would be uninsurable under McCain’s plan? Please.

Its hard to avoid seeing this as a cynical ploy to protect the private insurance industry’s turf. I imagine McCain and his AHIP buddies sitting around the planning table trying to figure out what to do about financing their “Guaranteed Access Plan”.

McCain: OK, we’ve done what we need to do, consulted industry, packaged our plan with the right buzz words—how can we best insure that in never actually happens?

Adviser: John, let’s get the states involved. Obviously a weaker taxing authority than the federal government; divided into 50 separate jurisdictions; they have constant budget problems, 17 states don’t even have high risk pools, and as a rule, our party operatives have been very successful at demagoguing the tax issues for years.

McCain: OK, excellent. Our plan will be to “work with the states”.

In my humble opinion its a total outrage that McCain and the health insurance industry are taken seriously. Especially McCain, having spent his entire life covered by publicly financed health insurance; where does he get off recommending this type of program for the rest of us?


1 Comment

Filed under economics, healthcare finance, junglenomics, social insurance

One response to “War on Healthcare

  1. donnafairy

    I think that you should edit this down slightly and submit to the RG as a guest viewpoint for their editorial page. It sheds a ton of light on the true GAPs in McCain’s plan. You nailed it!

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