As things stand, 65-year-olds get enrolled in Medicare. Buy-in is something of a different beast: Folks between 55 and 64 with access to the exchange could choose to buy Medicare. That sets up an apples-to-apples comparison. And that apples-to-apples comparison is not going to come out well for private insurers, as Medicare has a large and acknowledged price advantage over them. They might be fine with that, because no one wants to insure 60-year-olds anyway. But I doubt they’re going to be fine with a world in which people see the full difference between the prices private insurers offer and the prices a robust public insurer can offer. That, after all, is why they fought the strong public plan so ferociously.
Tag: public option
Opting Out
Paul Starr argues that, because of the potential for real public backlash, the individual mandate should contain an opt-out provision. In a nutshell, you could choose to opt out of coverage…on the condition that you couldn’t easily opt back in for a five year period afterwords.
I agree with Starr that the mandate is the thing that will really burn people up come, oh, 2075 when the last provisions of this damned bill actually go into effect. And that, if the compromises continue, what you’ll have is a mandate to buy today’s overpriced, under-provisioned insurance…now: with a guarantee of coverage! And but so I tend to think a different kind of solution is necessary when talking about the mandate.
Instead of a fine, you automatically enroll mandated but uninsured individuals into Medicare at whatever the premium cost is for a person of their age (and, yes, I’m therefore proposing here that Medicare-based coverage would/should then be open to anybody of any age that fails to procure private insurance; this doesn’t change the fact that it’s a terrible idea that the smelly hippies will hate, hate, hate). That’s the fine: that you have paid for coverage the hard way…through your tax return; but you’ve ultimately just paid for coverage. The end. No further fines, certainly no jail time, just coverage. Whether you like it or not. If you choose not to decide: you still have made a choice.
Ultimately the opt-out only allows for that most dangerous of impulses: the free rider. I won’t pay until I’m really sick or hit by that bus. It just can’t be allowed if we’re to have any chance at all of containing costs. In many ways, it’s precisely this sort of non-covered coverage that is already driving costs today.
Wish in One Hand…
Activists on the left have long insisted that insurance companies aren’t to be trusted. But up until now, it’s been hard to make the charge stick, since the insurance lobby–a.k.a., America’s Health Insurance Plans–has been cooperating with the White House and its allies.
AHIP’s new paper, though, may have changed things. In the last day, the specious claim that reform would raise premiums has provoked a fast and furious response, uniting everybody from the White House to AARP against a common foe. And that unity could have policy implications.
Let’s face it, the insurance companies own reform. They will, in large part, write the final bill in which they will create an individual mandate (and most definitely not an employer mandate) to buy whatever they deign to sell you, the ‘Merican consumer. And, no, there will be zero competition if they have their druthers. Only subsidies such as may be allowed by some made up number in Olympia Snow’s head will affect the final price to the most imperiled future consumers of this insurance, folks earning at ~300% of poverty.
To the extent that rampant dishonesty (like this AHIP report) helps create some wedge-room to make the previous paragraph less expensive to the end-user, it’s for the good. But I think we all need to start adjusting ourselves for the major screwing over that will only be, uh, rectified once the policies are in place and people are pissed off and demanding some major readjustments or, at the very least, some spittle. But this:
“Ironically with AHIP’s report today may make it more likely that such a windfall profits tax would be included in the final legislation.“
is totally nonsensical. The insurance companies (which stand to make, at a minimum, billions on this or any health reforms package that passes) will pay not one dime of new tax. They may well end up with a tax exemption. Mark my words, children. It will be so.
Funniest of all:
“In a strange way, and look, obviously they didn’t mean this, the health insurance lobby today fired the most important salvo in weeks for the public option,” Rep. Anthony Weiner wrote today on his website, as Daily Kos noted. “Left to their own devices, according to their own number crunchers, they’re going to raise rates 111%.”
Yes they are. And no, there won’t be a robust public option. Best we can hope for is a states-opt-in option that, over time, might actually begin to work. But: there will be significant and extended consumer pain. Get ready. Mostly, I wonder what color the sky is in Anthony Weiner’s world…
Lemkin 