Matthew Holt

Now, Sleepless in San Francisco

Having returned from Seattle, the persistent itching from the sand-fly bites of Roatan has awakened me at 5 a.m. So I’m commenting on three pieces of news, which I’ve commented on before here and at Spot-On.

First, United HealthGroup has introduced two new things this week. One is is a consumer portal/WebMD competitor called myOptumHealth, which gave a sneak preview (and was a sponsor) at the Health 2.0 Conference in October.

At first blush I like the look of what they’ve pulled together, although the about us section doesn’t exactly tell you much about who owns Optum! But the really interesting product United launched this week was aimed right at me. It’s an option to repurchase your individual health insurance without being re-underwritten and rejected.

This is exactly the problem that I had a while back and for which I asked Spot-On
readers for advice. It’s also a completely ridiculous problem that
would be abolished in any sensible health reform process. United is
therefore placing at least a small bet on no reform passing. Here’s the
article I wrote explaining the problem, and here’s the news about United’s new offering.

Second, today well known young communist Ezra Klein is venturing bravely into the Cato Insitutute
where newly expectant dad Michael Cannon and radical free-marketeer
Glenn Whitman (a guess, as I don’t know Glenn) will try to beat him
into submission by suggesting that for all the money we spend in the
US, we get better health outcomes.

I have no idea why some people on the right keep going on and on
about this despite all the data that shows the argument is largely
crap, especially given the vast difference in what we spend here versus
what them foreigners spend. But they persist.

Early last year, I answered the question, to my satisfaction at least, in this article,
and as a bonus you only have to read the first half (although the
second half explains the problem AHIP is re-introducing in the next

Third (and thankfully last), it appears that the forces are aligning
for some kind of reform bill to be put up next year. AHIP has
apparently decided that the plan it put together last year wasn’t good
enough and has put out another one. As far as I can tell, it relies on the Shaddeg bill concept of allowing a cheapo high-deductible plan to be sold nationally.

I don’t know how AHIP is going to reconcile that with its concurrent
support for a ban on underwriting and non-exclusion of pre-exisiting
conditions, when every insurer who sells those high-deductible plans
now underwrites up the wazoo. But I await the explanation with bated
breath. Then again, even if AHIP’s members employ the odd actuary who
might understand this problem, I’m sure the work is carefully hidden
from Karen Ignagni.

But this has got me thinking about how to ram some kind of real
universal insurance plan through Congress, which takes me back to one
of the better pieces I ever wrote on THCB called Why Hillarycare Failed. I particularly like my quote about how Johnson got Medicare passed:

Now Johnson had advantages. He had won a landslide; he had more
Democratic Senators on his side (although many were very conservative);
he didn’t have to worry about the deficit and thus could afford to buy
off his industry opponents, who of course were much weaker than they
were 30 years later, and he wasn’t going for universal insurance for
everyone (just the most expensive ones). And of course he lied about
the cost (Note that that worked for Bush in 2003 too!). But one lesson
at least is, if you want to get something done, make it simple and get
it done fast before opponents can get it together to stop you. So don’t
be too fussed about the details so long as it works for your overall

Take a look at the piece, and think about whether 2009 is
1965 redux. And I guess if it is, everyone’s hair is about to get much
much longer!

1 reply »

  1. Matt, I had not read about your insurance dilemma. I was interviewed this summer and quoted on this very topic in the Winter 08-09 Momentum Magazine published by the National MS Society. Here’s the excerpt (also posted on my blog which I supplemented with a few remarks [in bold]:
    What’s Ahead for You? Planning to Plan by Heather Boerner (Excerpt from pages 26-27):
    Planning to put money where your future is: insurance and savings
    For Lisa Emrich, $325 a month is a small price to pay for ensuring her insurance.
    That’s how much she spends now on her individual health insurance. As a self-employed musician and music teacher, she was shopping for a policy that would pay for her MS needs. [MS drugs, specifically] Insurance brokers advised her to hold onto her current insurance for dear life. So even though she could have been added to her boyfriend’s insurance policy when the couple moved in together, she said she’s unlikely to let her own insurance go. You know, just in case.
    “It’s sort of an insurance policy for an insurance policy,” said Emrich, 40, who lives in Washington, D.C. “If anything did happen–if he changed jobs–paying an extra $325 a month might be a good investment.”
    Since her diagnosis in 2005, Emrich has made several other good investments: She opened a Self-Employed Pension account and an Individual Retirement Account.
    She’s lucky. She’s always been a good saver. But even if you don’t have that advantage, you should still think about how you can protect yourself financially. Some people with MS work without much interruption in their earning power for decades. For others, sudden symptom progression leaves them without work–and without health insurance. For everyone, financial planning is one of the most important tools to protect against the unpredictable.

    [Personal note: This insurance policy was obtained in 2000, years before receiving the official MS diagnosis. The policy was underwritten which explains why it doesn’t cost over $500 as do other individual policies in the state do, if you have MS. See Mandy for an example.
    In this article, “MS needs” really means “MS drugs.” I like my insurance policy except that pesky detail which limits my coverage to $1500 each year for pharmaceuticals. Oh, and maybe the part where standard MRIs cost me a $500 co-insurance. But other than that, I’m good. I guess.
    Oh, except that other part……]

    Matt, thank you for letting me know that I’m not the only one considering paying insurance premiums ($3900 in my case) just to keep access to an insurance policy in the future.