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Friday, March 19, 2010

Paul Krugman: Why We Reform

Revisiting the arguments for health care reform:

Why We Reform, by Paul Krugman, Commentary, NY Times: One way or another, the fate of health care reform is going to be decided in the next few days. ... So this seems like a good time to revisit the reasons we need this reform, imperfect as it is.
As it happens, Reuters published an investigative report this week that powerfully illustrates the vileness of our current system. The report concerns the insurer Fortis, now part of Assurant Health... In particular, according to the Reuters report, it targeted every single policyholder who contracted H.I.V., looking for any excuse, no matter how flimsy, for cancellation. In the case that brought all this to light, Assurant Health used an obviously misdated handwritten note by a nurse, who wrote “2001” instead of “2002,” to claim that the infection was a pre-existing condition that the client had failed to declare, and revoked his policy.
This was illegal, and the company must have known it: the South Carolina Supreme Court ... concluded that the company had been systematically concealing its actions when withdrawing coverage, not just in this case, but across the board.
But this is much more than a law enforcement issue. ... The truth ... is that behavior like Assurant Health’s is widespread for a simple reason: it pays. A House committee estimated that Assurant made $150 million in profits between 2003 and 2007 by canceling coverage of people who thought they had insurance, a sum that dwarfs the fine the court imposed...
Beyond that, this is a story that could happen only in America. In every other advanced nation, insurance coverage is available to everyone regardless of medical history. Our system is unique in its cruelty.
And one more thing: employment-based health insurance, which is already regulated in a way that mostly prevents this kind of abuse, is unraveling. ... This means that in the absence of reform, an ever-growing number of Americans will be at the mercy of the likes of Assurant Health.
So what’s the answer? Americans overwhelmingly favor guaranteeing coverage to those with pre-existing conditions — but you can’t do that without pursuing broad-based reform. To make insurance affordable, you have to keep currently healthy people in the risk pool, which means requiring that everyone or almost everyone buy coverage. You can’t do that without financial aid to lower-income Americans so that they can pay the premiums. So you end up with a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies.
Or to put it another way, you end up with something like the health care plan Mitt Romney introduced in Massachusetts in 2006, and the very similar plan the House either will or won’t pass in the next few days. Comprehensive reform is the only way forward.
Can we afford this? Yes, says the Congressional Budget Office, which on Thursday concluded that the proposed legislation would reduce the deficit by $138 billion in its first decade and half of 1 percent of G.D.P., amounting to around $1.2 trillion, in its second decade.
But shouldn’t we be focused on controlling costs rather than extending coverage? Actually, the proposed reform does more to control health care costs than any previous legislation...
Can you imagine a better reform? Sure. ... But an ideal plan isn’t on the table. And what is on the table, ready to go, is legislation that is fiscally responsible, takes major steps toward dealing with rising health care costs, and would make us a better, fairer, more decent nation.
All it will take to make this happen is for a handful of on-the-fence House members to do the right thing. Here’s hoping.

    Posted by on Friday, March 19, 2010 at 01:08 AM in Economics, Health Care | Permalink  Comments (110)


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