Lot of interesting feedback on the Wyden plan, some of which I want to explore a little further. But first, I want to ask a question: Can anybody truly see Congress passing a piece of legislation and a president signing a bill that, in one stroke of the pen, dissolves Aetna, UnitedHealthGroup, Kaiser Permanente, Blue Cross, and all the rest? We're talking about the full dissolution of multibillion dollar corporations that employ thousands and thousands of people, contribute heavily to a wide swath of politicians and provide massive tax revenues to a large collection of states, and have been the sole providers of health coverage for nearly a century now. Forget whether you, or I, think their demolition would be a good idea: Do you see it as a possibility?
I've tried to imagine it. Believe me, I have. But I can't. Not in the near-term, anyway. Which why I'm somewhat unimpressed by demands that Democratic proposals start from a single-payer stance and condemns any that don't as "signal[ing] a sell-out by the Democratic congressional leadership." Politics is the art of the possible, and so long as the health system is genuinely harming millions of Americans, the perfect can't continually be the enemy of the good -- the question must be whether what's achievable is good enough.
That said, insurers are a problem. But what you can't destroy, you may be able to reform. That's the strategy of the Wyden plan. Insurers long ago realized the easiest way to make money was to expend vast amounts of energy and resources figuring out who will actually use health care, then deny it to them. So they identify everyone who is sick, has been sick, or possibly, one day, will be sick, and price them out of the system. We're left with a system that excludes precisely those who need it. Wyden's plan imposes "community rating," which means insurers can't price discriminate between applicants. Instead, they have to cover everyone for precisely the same price. You could have an enlarged heart, a missing limb, and a lazy eye, and you're getting the same deal as the triathlete down the block.
