Yes, I know that for my readers, this is generally a pretty major challenge — but, look, this isn’t a Big Name blog where you’ll be branded for life as a traitor to the cause for trying to take up my challenge. But imagine that you’re in that negotiating room with Harry Reid and in a moment of candor he says, “yeah, I know, the law has a lot of problems, but I can’t just repeal it.” You’ve got to make concessions. What are your concessions?
I’ll start with this:
I think the basic concept of premium support is a good thing. Hey, it’s practically Vouchers! Of course, it was designed to get the insurance companies to bankroll the re-election campaigns of its supporters, but still — the fundamental reality is that health insurance is out of reach for too many people, and for many more, their personal financial management skills aren’t strong enough for them to recognize the importance of cutting other expenses to afford a health insurance policy, especially if its the difference between, for instance, being able to afford a home vs. an apartment. Some means of getting people onto health insurance coverage is a good thing.
(Yes, of course, I think the premium support system is structured very poorly, but the underlying idea is OK.)
The exchanges? Fundamentally, I think the concept is fine — though it’s not clear to me why a government-run exchange is any better than ehealthinsurance.com and why Navigators (paid relatively low wages, with low levels of training) are any better than insurance agents. (Well, they don’t charge the end users commission, but, in the end, they’re just call-center employees.)
In any case, while I think the gold/silver/bronze categories are kind of hokey, and I’m not sure if each “bronze” plan must hit the mark at paying exactly 60% of medical costs on an actuarial basis or if this is a range, but the idea of disclosing information on the actuarial value of benefits is sound, to allow a consumer to compare the value of a high-deductible plan to a low-deductible, high copay/coinsurance plan in an apples-to-apples way.
I also think that there are some components of the minimum coverage requirements that are beneficial. For instance, the “mini-med” plans that fast food workers used to get, with very low maximum benefits ($5,000 or $10,000), would cover routine healthcare but provide no protection for serious medical treatment, and were almost the opposite of the sort of high-deductible policy a person on a budget should be looking at. From a free-market perspective, I suppose everyone should have the opportunity to choose such a policy, but I’m not going to shed any tears over their demise.
So that’s what I can come up with. Anyone else?
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