DISPATCHES FROM THE INSURANCE MARKET.

Now isn't this charming?

The penalty for being morbidly obese has gone up. Ditto for schizophrenia and recent breast cancer. And anyone with multiple sclerosis, severe autism or antibiotic-resistant staph infection will now be automatically rejected.Those are among the hundreds of changes in the latest Washington Standard Health Questionnaire, a lengthy and mandatory health-screening test taken by more than 100,000 state residents each year before they can buy individual insurance coverage.The test is designed to weed out the sickest applicants and direct them to high-risk — and high-cost — policies.

Imagine you work for a software company with good health benefits. A few years back, you were diagnosed with MS. This year, your company folded, or your job was terminated as part of a buy-out. So you go to buy health insurance.You can't get it. Not "it will be expensive," or "you'll have to jump through some hoops." You actually can't purchase insurance on Washington's individual market. It isn't profitable to insure the ill, and so insurers do not, by and large, do it. And they never will, unless you reform their industry to force community rating and guaranteed issue; unless you force them to insure everyone who asks, at the same price; unless you restructure their market so they can't make sufficient profits at denying coverage and have to figure out how to do a better job at providing it. And the only way you can get them to do that is to force everyone to purchase insurance, as you actually can't have the healthy opting out while only the ill opt-in, the finances will collapse. This is the real problem with reform plans that lack a full coverage component (be it a mandate, voucher systems, automatic enrollment in a national market, or whatever). The issue isn't the folks who will be uninsured, but the damage that does to your ability to reform how insurers work. To create a working market you need to create a fair market. And that means setting up the rules such that neither insurers nor individuals can game the system.