One day, and I like to think it soon, politicians will muster their will and Americans will call forth their outrage and we'll finally fix our broken health care system. And when we do, and the histories of the epic battle to guarantee coverage are written, these folks will be the villains:
One of the most talked-about new plans is Tonik, launched a few months ago by the California Blue Cross subsidiary of WellPoint Inc., the nation's largest health insurer. Directed toward people in their 20s, Tonik seeks a coveted group insurers call the "young invincibles" because they are rarely sick.
The company's marketing campaign looks nothing like the button-down image the Blues have long presented. Silhouetted snowboarders careen across Tonik's website, on which medical plans have hipster names such as the "calculated risk-taker" and the "part-time daredevil." Its monthly premiums are as low as $64, with out-of-pocket deductibles as high as $5,000 (the "thrill-seeker").
The most controversial feature of Tonik is its exclusion of any maternity coverage.
Blue Cross says Tonik serves a niche of the uninsured market — people who are put off by high premiums because they rarely see a doctor. "Because of their age, attitude and culture, this group wasn't interested in paying for maternity coverage," said Michael Chee, a Blue Cross spokesman. "Maternity is one of the higher-cost items to price a policy for, so taking it out allowed us to price it lower."
Critics say such plans allow insurers to cherry-pick the healthiest consumers but offer skimpy benefits. "The market is likely to turn PPOs from the Cadillac of plans into Pintos that might cost less but have much less protection," said Jerry Flanagan, a spokesman for the Santa Monica-based Foundation for Consumer & Taxpayer Rights.
"The problem when you exclude benefits like maternity coverage is you don't have fair risk pools in the marketplace anymore," said Astrid Meghrigian, a lawyer for the California Medical Assn. "People have babies on [an HMO plan] and then go back into a cheaper PPO."
This plan-hopping has pushed a rising tide of people with costly health problems such as diabetes, morbid obesity and heart failure onto HMOs, whose costs are capped.
That, right there, is our whole health care problem in a few simple paragraphs. You can time travel back to the beginning of Blue Shield, where they created a one-size-fits-all plan with true community ratings that could've been the model for a perfectly efficient health care sector, right up until start-up competitors saw an opportunity and began cherry-picking the healthy out from under them. That was early in the 20th century. Since then, the same tactic has replicated itself over and over, and now it's bringing us to the breaking point.
This is why health care is not a market. Because in a market, you limit your liabilities. In health insurance, your liabilities are the sick. In health care, the aim is to cover the sick. In private health care, the aim is to turn a profit, and thus you have to ignore the sick and cover the healthy. It just doesn't, it just can't, work.