Boutique Insurance

I want to comment a little more on Newt’s op ed in the Los Angeles Times today, because he says some things that I have seen popping up in a lot of right-wing commentary.

One key proposal is to mandate an “essential benefit package” for every private insurance policy sold in the United States. Currently, individuals and employers usually make these coverage decisions. This legislation creates a new federal Health Benefits Advisory Committee that would decide instead. For example, if you are a single male with no children, the legislation still requires you to have maternity benefits and well-baby and well-child care coverage. You don’t want or don’t need that coverage? Sorry, you have to pay for it anyway.

Putting aside the fact that single men father children all the time, and in a perfect world those single men would be just as responsible for maternity and well-baby bills as married ones —

Insurance works by risk pooling — everybody throws money into a pot so that there’s money for people who are hit with unexpected expenses. In order for this to work, in any given year most of the people in the pool throw more money into the pot than take it out. Generally, the bigger the pool, the better it works. Insurance companies invest the premium money, and they make most of their profits from investments.

Maternity and well-baby care can be horrendously expensive, because horrible things can go wrong that require megabucks to care for. If the only people who are paying for maternity and well-baby care insurance are young couples who plan to have children, probably few of them could afford the insurance. It is made more affordable by throwing maternity and well-baby insurance into the big pot with toenail fungus, prostate cancer, high cholesterol and the flu.

But let’s be more frank about what Newt really is saying. Essentially, he is arguing against consumer protection. In many states, people are paying premiums for junk policies that turn out not to cover whatever medical problems they eventually develop. For example, we learned recently about a Blue Cross/Blue Shield policy that supposedly had maternity benefits. However, the maternity benefits didn’t cover the mother’s labor, delivery, or hospital stay, and a couple got hit with a $22,000 medical bill for the routine vaginal delivery of a healthy baby.

I’m not likely to ever need maternity benefits again, either, nor am I likely to get prostate cancer. But although there are a small number of conditions that are age and gender specific, the enormous majority of ailments in the world can strike anyone. Non-smokers sometimes get lung cancer. Long distance runners sometimes get heart disease. Young women sometimes get breast cancer. Ya never know. And because ya never know, it’s extremely stupid to pick and choose in advance what diseases or conditions your insurance does and does not cover.

What this is really about: The insurance companies want to separate people into low-risk and high-risk pools, because selling junk policies to low-risk clients is where the money is.

But in the doubletalk of the Right, consumer protection is painted as government interference. Shawn Tully of Fortune says the government wants to deprive you of the freedom to choose what’s in your plan. Righties seem to think people ought to have boutique insurance plans that only cover the ailments they are most likely to get, given their ages, genders and lifestyles.

But what happens when you develop a condition that’s not in your coverage? Oops, sorry, you’re not supposed to have heart disease at your age. You’re not covered for that. Is this not also a form of rationing?

I’ve seen this same “boutique” proposal from other conservative writers. There’s a dippy woman at the Manhattan Institute named Regina Herzlinger who wrote in the Washington Post last year,

In order for employers to get big discounts, they have to buy health care in bulk, offering just one or two basically identical plans to their employees. The result is consistent mediocrity. After all, how can Chrysler find a single health plan that works just as well for a 55-year-old diabetic with a bad back as it does for a 30-year-old triathlete who sees a doctor once every few years for a sprained ankle? Splitting the difference in these cases means that people do not get treated in the preventative or chronic-care settings that they really need.

How many ways does this not make any sense? First, it ignores risk pooling. Second, it ignores the fact that the triathlete will not be 30 years old and healthy forever. In fact, the triathlete could die of cancer next year, and the diabetic could live to be 90. Third, she seems to assume that the insurance companies are the ones directing the patient’s care, and not doctors. Well, that last one is too true.

The whole point of “not getting in between doctors and patients” is that whoever is paying for the care shouldn’t be second-guessing the doctors. In rightie world, it’s OK if the health insurance company kills you.

Newt repeats a pack of lies about Dr. Ezekiel J. Emanuel, already debunked by Alex Koppelman at Salon. He also wants to let people buy insurance across state lines, which I’ve written about in earlier posts. This would allow insurance companies to set up shop in low-regulation states and sell junk policies across state lines. According to the president of the National Association of Insurance Commissioners, Sandy Praeger,

Insurers will set up shop in states with few regulations and market low-cost policies to people across the country. These policies will offer minimal coverage and appeal primarily to younger consumers.

“It will be a race to the bottom,” Praeger said, and there will be “very few consumer protections. … You’ll have plans that don’t cover the benefits that people need. … And healthy people are going to buy those less costly plans, because they don’t think they need [the protection].”

That may be a good deal for young people who don’t have health problems, but it would probably become a bad deal for everyone else, Praeger said. The policies that sell comprehensive coverage would draw a sicker, older customer base, becoming more and more expensive.

The end result will be a segmenting of the insurance market into the “haves and have nots,” Praeger said. One segment of the market will become more affordable, but the other segment will become less so, disadvantaging those who need coverage most.

Rationing, anyone?

11 thoughts on “Boutique Insurance

  1. Which is, of course, why you need the public option. To expect the insurance companies, who are out to make a profit however they can, to cover people they know will cost them a lot of money, is laughable. Speaking of the young, the leading cause of death of youth is accidents and suicide, I believe. When they need care they need a lot of very expensive care, for a long time. We need to pool all of our money and allow those that need the care that particular year to use it. You know, a pubic option.

  2. Buckyblue: Can you change that 2nd last word. I think you meant public.
    I was feeling pretty good today. Contacted several people to attend Gene Green’s town hall in support of robust reform. Wrote a letter to CEO of Whole Foods and joined a boycott. Went to a good meeting where an informed person gave an update on reform in congress. So far, not too bad! Then my husband read the latest New York Times best seller list to be. Now I want to jump off a cliff. Glen Beck no.1, Michelle Malkin, Mark Levin, and Dick MOrris are in the TOP spots. What gives????

  3. Glen Beck no.1, Michelle Malkin, Mark Levin, and Dick MOrris are in the TOP spots. What gives????

    Oh, that’s just an old marketing ploy..The publisher buys several thousand copies( on paper) of their own book to boost the sales numbers and make it appear like the general public is buying up on the trash they are trying to hawk. It’s the same concept as priming the tip jar. If you’ve ever listened closely to Glen Beck, you’d know he’s just not capable of producing any works of intellectual merit…He’s a dry drunk, who like Malkin, who can only spout stupid and outrageous ideas designed to increase their public exposure and offend senibilites.

    Although I believe Malkin produced a highly acclaimed, in depth, historical analysis of the internment of Japanese-Americans during WWII. And definitively proved that the suspension of constitutional guarantees for Japanese-Americans was not only correct, but also instrumental in our winning of WWII.

  4. i am so impressed with your overall moral framework, that you can be engaged enough to take Newt Gingrich seriously on anything regarding. health-care.

    I’m not snarking at you, because I have utmost trust in your values and intentions.

    But Newt Gingrich on healthcare? Seriously. Aside from his opportunistic political antics, he has dumped not one, but two wives when they faced enormous health choices. They first wife had cancer, the second wife had MS. What kind of dickhead would cheat on and then dump his wife (both wives) under those circumstances. He’s not just a loser. He’s a sociopath. He shouldn’t have a seat at the table. He shouldn’t have a seat in the garage. He shouldn’t have a seat in the driveway when it’s raining. Someone should call the police when he’s standing on the public road in front of your house.

    I can’t believe the Roman Catholic Church accepted this guy, when his actual actions go against everything they profess to believe.

  5. I am feeling rather disgusted as megabucks and the GOOpers along with their Blue Dog allies are successfully preventing any attempt to reform health care delivery. Apparently we are supposed to unquestioningly finance dubious wars and bailouts of large investment banks, and the billionaires that run them, but we are not supposed to benefit our citizens with any meaningful attempt at reforming how we make sure people who need care get it.

    Swami is right about the bulk buys. Conservative groups have been doing it all the time. They buy huge runs of books by the likes of Glenn Beck, Michelle Malkin, Ann Coulter, Rush Limbaugh, Michael Savage, Mark Rubin, etc. and then give them away as premiums to the suckers who sign up to join their various astroturf groups.

    From what I understand, the Scientologists pulled a similar ploy to get L. Ron Hubbard’s “Battlefield Earth” and its sequels onto the best sellers charts. The Scientologists had the faithful go to bookstores and purchase as many copies of Hubbard’s science fiction work as they could. However, I must note that there were no sales ploys the Scientologists could use to rescue the truly awful film version of “Battlefield Earth.” It should also be noted that the wingnut political titles and Hubbard’s science fiction titles can be found used bookstores, thrift shops, and any other places where unwanted books can be found.

  6. Shawn Tully used to be a tennis pro at a private country club in Ohio. He had the nerve to ask a member’s daughter for a date. She was horrified,because he was the help. He thought his Princeton undergrad counted for something. These people don’t live on the same planet as the rest of us.

  7. If you listened to Obama and some other Dem’s over the last few days, it looks as if the public option is a goner. It looks as if they’re going to give that up to get some Republicans on board for health care.
    Someone remind me again please why the Dem’s are negotiating with a disgraced, morally bankrupt minority party? These people don’t want a national health care policy, or at least one that’s any good. The American people might like it and not vote for these turds in the punchbowl for a generation or two.

  8. I agree, the pubLic (I’ve got a stickey L key) is probably a goner. And given that, they shouldn’t try and pass anything. But they can’t do that because of the perceived political failure. If they weren’t willing to go it alone and ram through what most people believe is the best option, the pubLic one, then they shouldn’t have started this trek in the first place. It comes down to political will, and sadly, many of the Dems simply don’t have it, making it necessary to negotiate with people who take marching orders from lunatics.

  9. Insurance works by risk pooling — everybody throws money into a pot so that there’s money for people who are hit with unexpected expenses.

    But isn’t that socialism? Doesn’t that put some insurance executive in between me and my doctor? And what about those insurance company recission death panels? Is it considered rationing when the insurance does not pay for something I cannot afford?

    OK, thats a little tic, but pretty much the same thing we are hearing from the right when it comes to any competition from a public option with much less adminstrative overhead.

    Ano another note, Swami I read about the publisher buy-back of conservative books in the past but then did a lot of googling a month ago to find out more and found precious little on this. I wonder whether there is any more objective measure of sales that cannot be corrupted by this buy-back. I also wonder how much impact buyback can have…are only major metrics such as NYTimes and other leading bestseller lists targeted? How much are they spending and exactly how much influence does this buy them? Is it a minor bump in ratings or does it completely account for wingnut books presence on the bestseller lists?

    I am very curious but have googled to no avail.

  10. I keep seeing the insurance guy in The Incredibles screaming “They’re penetrating the bureacracy!”

  11. And yet again, a conservative from the party of no has inadvertently and effectively argued for Single Payer health insurance! He’s right – we all have different needs from our health care providers and thus our insurance. And you pointed out correctly that what you need today may not be what you need tomorrow and 10 years from now.

    So it would be astronomically stupid to lock yourself into a health plan that is good for you at age 35 that would suck for you at age 55. And never mind if you get diagnosed with something at age 36.

    So what’s the right solution? Everyone pays basically the same thing into a large risk pool (a sliding scale percentage of income) and everything we need at any given time is taken care of.

    So no man is paying for “his” maternity care and no woman is paying for “her” prostate exams, but we are all paying a low and fair amount into an enormous risk pool that allows us to get what we need and only what we need.

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