Health insurers want to make a deal.
They will kill their underwriting business model -- the attempt to cherry-pick risks by excluding those who are sick -- if everyone has to buy health insurance from the private market.
Deal or no deal?
(Did you know Howie Mandel (right) was a multimedia pioneer? The Fall Comdex launch party featured Linda Ronstadt, Charles Fleischer, Quincy Jones, and, uh, me.)
As BNET's David Hamilton notes today, there are some conditions on this offer. No federal competition with the private market. No "community rating" in which everyone pays the same.
Still have a deal?
This is the kind of back-and-forth that has to happen in order for health reform to happen. David writes of how this is a concession, and it is, but I really doubt if it's enough of one to reach a final settlement.
- Why not allow competition with a federal plan? Are they afraid the government would do things right?
- Why not create larger pools of risks through community rating? Isn't that what group insurance is about?
More important from the perspective of this blog, there is nothing about moving toward a unified Health Internet, with standards and terms every insurer's computing systems must meet for interoperability.
That's where the savings are supposed to come from, after all.
The real bottom line is this. The present system makes decisions on what to cover primarily a matter of private contract, often with arbitration as the only redress. Outside the U.S., savings from making these political questions.
Who decides what falls under the policy is the key marker I want to see moved. It's the thorniest problem out there. And it's the marker no one really wants to hold when the dance is over.
Because on that marker are the big questions. Who should live and who should die? When do we decide that your costs have exceeded your hopes and that it's time to call the hospice?
Right now insurers can pressure hospitals into forcing that decision on families. Should government have it? Can we set a standard for it?
How would you split that baby of cost vs. life?