What to Do About Pre-existing Conditions
Originally Posted At Wall Street Journal
By JOHN H. COCHRANE
August 14, 2009
Even if you don't like the massive health-care package being considered in Congress, you have to admit that health insurance and health care in this country are not working well. There are two basic problems:
First, if you get sick and then lose your job or get divorced, you lose your health insurance. With a pre-existing condition, new insurance will be ruinously expensive, if you can get it at all. This, the central defect of American health insurance, explains why most Americans are happy with their current coverage yet also support reform.
Second, health care costs too much. Yes, we get better treatment, but the cost-cutting revolution that has swept through manufacturing, retail, telecommunications and airlines has not touched health care.
The problems are real, but the proposed remedy—even more government intervention—is counterproductive. A market-based, deregulation-focused reform is possible, and it will work.
Health care and insurance are service-oriented, retail businesses. There is only one way to reduce costs in such a business: intense competition for every customer. The idea that the federal government can reduce costs by negotiating harder or telling businesses what to do is a triumph of hope over centuries of experience.
Take the claim that centralized record-keeping can cut costs. In his July 22 press conference, President Barack Obama noted that a new doctor today might run a test again rather than ask for records of a previous result. That seems silly. But maybe it isn't. Maybe the test is cheap, the condition changes, the test can fail, and the cost of setting up an integrated record system between these two doctors isn't worth two tests a year.
The cost-cutting revolutions in other industries didn't settle questions like these with acts of Congress, expert commissions, armies of regulators, or via a "public option"—while leaving in place a system in which consumers have little choice, aren't spending their own money, and suppliers are protected from lower-cost competitors. That approach has never spurred efficiency, and for good reasons. Cost-cutting is painful. Even in Mr. Obama's trivial example, lab technicians and secretaries will lose their jobs to computer programs, and they will complain. Patients might have to get tests at inconvenient times and locations. They will do this when their money is at stake—what people will put up with from airlines for a few dollars is truly amazing—but they will never accept it from the government.
But what about pre-existing conditions?
A truly effective insurance policy would combine coverage for this year's expenses with the right to buy insurance in the future at a set price. Today, employer-based group coverage provides the former but, crucially, not the latter. A "guaranteed renewable" individual insurance contract is the simplest way to deliver both. Once you sign up, you can keep insurance for life, and your premiums do not rise if you get sicker. Term life insurance, for example, is fully guaranteed renewable. Individual health insurance is mostly so. And insurers are getting more creative. UnitedHealth now lets you buy the right to future insurance—insurance against developing a pre-existing condition.
These market solutions can be refined. Insurance policies could separate current insurance and the right to buy future insurance. Then, if you are temporarily covered by an employer, you could keep the pre-existing-condition protection.
Some insurers avoid their guaranteed-renewable obligations by assigning people to pools and raising rates as healthy people leave the pools. Health insurers, like life insurers, could write contracts that treat all of their customers equally.
The right to future insurance could be transferrable to another company, for example, if you move. You could have the right that your company will pay a lump sum, so that a new insurer will take you, with no change in your premiums. Better, this sum could be occasionally placed in a custodial account. If you got sick but had something like a health-savings account to pay high premiums, you could always get new insurance. Insurers would then compete for sick people too.
Innovations like these would catch on quickly in a vibrant, deregulated individual insurance market.
How do we know insurers will honor such contracts? What about the stories of insurers who drop customers when they get sick? A competitive market is the best consumer protection. A car insurer that doesn't pay claims quickly loses customers and goes out of business. And courts do still enforce contracts.
How do we get to a competitive market? The tax deduction for employer-provided group insurance, which has nearly destroyed the individual insurance market, is a central culprit. If we don't have the will to remove it, the deduction could be structured to enhance competition and the right to future insurance. We could restrict the tax deduction to individual, portable, long-term insurance and to the high-deductible plans that people choose with their own money.
More importantly, health care and insurance are overly protected and regulated businesses. We need to allow the same innovation, entry, and competition that has slashed costs elsewhere in our economy. For example, we need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren't we allowed to purchase in another state?
The bills being considered in Congress address the pre-existing condition problem by forcing insurers to take everybody at the same price. It won't work. Insurers will still avoid sick people and treat them poorly once they come. Regulators will then detail exactly how every disease must be treated. Healthy people will pay too much, so we will need a stern mandate to keep them insured. And this step further reduces competition.
Private, competitive insurance markets are a superior way to solve the pre-existing-conditions problem, and the only hope to lower costs.
Mr. Cochrane is professor of finance at the University of Chicago Booth School of Business, and author of "Health Status Insurance" (Cato, 2009).
|
|
Urgent Petition
|
Sign the petition to stop Social Security Cuts and send a fax to every Member of Congress demanding they cut other spending, NOT SOCIAL SECURITY.
Share This Petition
|
Recent News
Friday, May 18, 2012
Congressional Republicans are back up to their old shenanigans on ObamaCare. Politico reveals that Republicans would try to replicate popular parts of Obama’s health care law if the Supreme Court overturns the law this summer.
Read Full Story
Tuesday, May 15, 2012
Source: ABC News
The Food and Drug Administration has warned doctors to watch for fractures of the upper thigh bone in patients taking several popular drugs designed to prevent hip fractures and fight osteoprothesis. The FDA warns that Fosamax and Boniva in particular, if taken unnecessarily or for too long, may actually be causing the bone fractures they are prescribed to prevent. Watch ABC News video.
Read Full Story
Thursday, May 17, 2012
 Exit Not An Option In Chuck Schumer's America. New York Senator Chuck Schumer has introduced the Fugitive Taxpayer Act of 2012 to re-impose taxes on expatriates after they flee the United States and take up residence in a foreign country. Proposal also would impose a mandatory 30 percent tax on the capital gains of anybody who renounces their U.S. citizenship and would bar such individuals from ever reentering the United States again.
Read Full Story
Wednesday, May 16, 2012
Whether President Obama gets his second term or Romney enters the Oval Office, there’s a third candidate no one’s paying much attention to, and that candidate is guaranteed to be the one clear winner of election 2012: the U.S. military and our ever-surging national security state.
Read Full Story
Friday, May 11, 2012
According to the New York Federal Reserve, two million US seniors age 60 and over have student loan debt, on which they owe a collective $36.5 billion; and 11.2 percent of this debt is in default. 4.2 percent of all student loan debt is held by people over the age of 60, and that share grows with each passing year.
Read Full Story
Tuesday, May 15, 2012
Across the U.S. economy, anxiety is rising about the potential for widespread disruptions after the November election, when a lame-duck Congress will have barely two months to resolve a grinding standoff over taxes and spending.
Read Full Story
Thursday, May 10, 2012
Two-thirds of Republicans and nine in 10 Democrats polled support making immediate cuts to the military across the board -- a position at odds with the leaderships of both political parties.
Read Full Story
Monday, May 7, 2012
Video revealing the circumstances of how a mentally ill homeless man in Fullerton, Calif. died last July was finally published Monday, revealing a stunningly brutal police assault that left Kelly Thomas bleeding, broken and near death.
Read Full Story
Monday, May 7, 2012
The number of people with jobs declined for the second month in a row, falling by 169,000 in April after easing by 31,000 in March. This means that there were 200,000 fewer Americans with jobs in April than there were in February. Additionally, the percentage of working-age adults who either have jobs or are looking for work, fell to 63.6%, which is the lowest level since December 1981.
Read Full Story
Tuesday, April 24, 2012
In November 2010, a police lieutenant from Parma, Ohio, asked Vanguard Defense Industries if the Texas-based drone manufacturer could mount a “grenade launcher and/or 12-gauge shotgun” on its ShadowHawk drone for U.S. law enforcement agencies. The answer was yes.
Read Full Story
Read All Recent News
Get in the Know Now
Get SSI Email Alerts
Social Networks
Action Center
|
