Newtown, CT – November 4, 2016
For many of us who heralded the introduction of a solution for the uninsured, it’s frustrating to see it unravel in so many places – Even before the current meltdown in many exchanges, the CDC noted that the uninsured rate had started to edge up earlier this year. The culprits are the ever-increasing premiums coupled with high cost-sharing, fueled by a combination of inflationary prices for health care services and creeping adverse selection in the public exchanges. A death spiral is never fun to watch and that’s what we’re seeing. United HealthCare was the canary in the coal mine, but now all the other large players are heading for the doors, eager to avoid the toxicity of the insurance pools. And since the Obama administration has decided to fight against the Anthem and CIGNA merger, why should these insurers bother being good corporate citizens to the ACA? Irrespective of who wins the Presidential elections, the construct of the insurance exchanges will have to be addressed. But that’s not all, because without the active enrollment of healthy individuals to help offset the costs of the sick, there is no exchange mechanism that can work. And therein lies the rub. Inexplicably, we all more or less accept that motor vehicle insurance should be (and is) mandatory, else only the individuals who believe they are at risk or a risk would sign up and premiums would be out of reach for those who simply want some day-to-day protection. The same holds true for homeownership. Anyone that has a mortgage knows that the loan will be called the moment homeowner insurance lapses. And yet, for whatever bizarre reason, we haven’t yet accepted this for health insurance. That has to change.
What this means to you – To a large extent, employers should mandate that all employees have health insurance, either through their employer or through a spouse. Individuals reporting less than the threshold required to pay federal taxes should demonstrate they were covered by health insurance during the course of the year or see their exemption lowered, making it attractive, if not mandatory, to carry health insurance. In other words, there are solutions that, over the years, conservative and liberal think tanks have advanced. These will have to be dusted off and addressed by the next Congress to avoid what would otherwise be a massive regression in social justice. There is always blame to go around, and this administration shares as much responsibility for the current sorry state of affairs as does the Congress. So let’s get past that and solve the problems, because they can be solved. California’s exchange, which is ably led by Peter Lee, is succeeding where others have failed. And while the Left Coast is certainly not representative of the rest of the United States, we should take best practices wherever they emanate and emulate them for the benefit of all. Isn’t that, after all, the basis for the Union? A functional market for health insurance will not solve the underlying deficiencies of the delivery system, but it does create an environment in which everyone has a vested interest in keeping health care affordable and improving its quality. We had hoped that would be the case by now, but it isn’t, and we must continue to strive to create that functional market as we simultaneously reform the delivery system.