Dan Weintraub who’s an interesting (and rare) right-wing journalist working in health care wrote a pretty dumb opinion piece in the Sacramento Bee last week saying that regulating health insurers was the wrong idea and wouldn’t work—because of course most of the money they get in goes out the door to the health care system—so it’s the wrong place to look. In the specific instance of rate regulation only, he may be somewhat right—but of course there’s a whole lot of regulation of insurers that could make a huge difference to that underlying health care system.
I was going to rip him a new one, but THCB regular Matt Quinn did it for me and the Bee printed his letter on it on Sunday.
"Regulating insurers won’t cut health costs," June 10: Daniel Weintraub correctly argues that current proposals to regulate health plan profitability will not materially impact overall health care costs. Imposing rules mandating spending on medical care or requiring permission to raise rates could perversely impact the quality and affordability of care. However, he misses a couple of key ways that regulators could impact the affordability and access challenges plaguing health coverage.
Mandating both guaranteed issue (requiring insurers to cover all comers) and community rating (prohibiting insurers from factoring in age, sex, previous medical conditions, or other factors in setting rates) sets a level playing field for insurers to compete on delivering value to their customers. Guaranteed issue and community rating require each other and are both necessary for reform efforts to work. Since the managed care backlash in the 1990s, insurers have largely given up on holding down health care costs and today compete primarily on underwriting — skimming healthy people and shedding sick or otherwise unprofitable ones. Some have even been caught underwriting retroactively or canceling coverage for members who incur medical bills. Mandating both guaranteed issue and community rating forces insurers to compete on their ability to deliver quality, cost-effective care for a population — and not on their skill in underwriting.
Although Matt misses one extra thing need to make guaranteed issue and community rating work—compulsory participation in the system by all (universal coverage) and cross-subsidization to those who can’t afford to buy in from the wealthier taxpayers. The good news is that the Democrats running Arnie’s reform efforts know about that.