In a Washington Post opinion column, Matt Miller argues that instead of single-payer or a public option we need a system of regulated private insurance companies, such as they have in Switzerland and the Netherlands.
He says that “The central progressive breakthrough in any reform should be to make it possible for every American to access group health coverage outside the employment setting….”
I agree, but the insurance exchange won’t come online until 2013. What are the uninsured supposed to do meanwhile? The Democrats have talked about expanding Medicaid, but I don’t know how extensive that would be or when it will happen. When Obama signs the bill? Before 2013?
If insurers are still allowed to set premiums based on age, a lot of older people will not be able to afford individual policies from the exchange without subsidies. Can we really depend on competition within the exchange to lower premiums? Or negotiation between the exchange and insurance companies to get group rates? I don’t understand the mechanism of that. Who does the negotiating?
There is also the question of the underinsured. The insurance exchange will apparently require a basic benefit package for participating insurance companies, but the exchange will only be open to those not covered by employers. If your employer gives you crappy insurance, apparently you just have to live with it. Or die with it.
Contrary to Miller, it is unacceptable to “have billions of ‘health’ dollars siphoned off by middlemen and marketers,” and no, I don’t want to think of health insurance as a jobs program. There are better ways to employ people than bureaucratic paper shuffling.
