Broadening the base toward universal coverage; that's one way other industrialized nations bring down their health insurance costs. Getting more people to pay in, so when someone is sick, a larger pool can cushion the blow.
That's what insurance is supposed to be about and President Obama has tried to work toward that goal, but a federal judge has ruled against him.
Judge Hudson's recent ruling tossed out the part of Obama Care that would go into effect by 2014 requiring most Americans to buy insurance; a provision known as "the individual mandate." If this ruling stands up to appeal, it's likely to cripple the whole bill since lots of healthy people need to pay into insurance to cover the sick people taking money out of insurance.
In light of this ruling, it looks like the "Obama compromise" between private health insurance and government "single payer stile" plans is dead.
Single payer "government based" insurance may be the way to go.
Maybe it's unconstitutional to require Americans to buy a particular product, or service, but it isn't unconstitutional to levy taxes. If we want coverage, especially for those sicker than average, we all will have to pay, if not premiums then taxes.
One good thing about taxes is that they can be put on a sliding scale. "To each, according to ability to pay, from each according to need." Sorry for quoting Marx, but that's what insurance is about.
Private enterprise is great, but there isn't profit in caring for the needy.
In the past, private insurance models worked somewhat well, but that was when there wasn't such a wide disparity of income between different groups of Americans. Today, the costs are higher and large segments of the population can no longer afford the premiums. This means lots of folks are left out of the system, including healthy people that could pay in more than they take out, but they can't afford the premiums.
Obama's plan attempted to put more folks into insurance pools, but subsidize the costs for lower income folks. At best, this plan was held together with duct tape and bailing wire.
Trying to maintain everything from the spirit of universal coverage to the current system of private corporations to the idea of not raising taxes is an improbable act of juggling.
No one wants to give ground.
There are a lot of people making good livings in the health insurance industry. Lobbyists on Capital Hill, for instance, but there's more to it than just that.
Some fear that government based insurance would be too much of a "one size fits all" solution. It could threaten marketplace innovation.
Yes, innovation is good, especially when the goal is healthier people in a healthier society. That's what healthcare should be about; healthier people.
Private companies have done some innovation. Offering free free gym memberships, for instance, to promote healthier lifestyles among members of their insurance pool. The goal: more healthy people paying in, less sick folks taking out.
One problem with private companies is the fact that public health is such a large picture that one company's efforts is just a mere "drop in the bucket" when it comes to improving the health of the nation. Governments are larger so when it's in their interest to invest in healthier societies, they can make a difference.
Sure, a private firm can buy gym memberships for it's policyholders, but usually we look to government to fund such things as a bike path system all over town. Governments tend to do a better job investing in things like public parks, education and sanitation.
Private insurance can innovate, but it seems like it's biggest skill is "risk assessment." That's figuring out how to cut off sicker people and target healthy folks for inclusion in the pool.
I'm sure a lot of talented people are employed in risk assessment. Figuring out how to deny care to folks with preexisting conditions. Learning how to steer around the "gauntlet of regulations" so as to "target market" your insurance pool to healthy folks. This brings down average costs.
I think there's even a term called "risk corridor."
Imagine that. Probably work for lots of demographers.
It's figuring out which demographics to target your insurance company toward and how to write your rules to keep out folks that would drive up your costs. Driving up costs, that is, not counting the money you pay your own bloated corporate executives.
Lots of innovation and energy goes into risk assessment. It may help to keep people on their toes. Keep folks working out at the gym so as not to fall outside the preferred "risk corridor."
Still, there's a problem. What do we do with folks who's care costs more than they could ever hope to pay in. Do we slam the door in their faces? Tell them to die early? Dump their care onto the taxpayers?
Maybe the taxpayers just need to be part of the solution all along.