One of the themes of my health care coverage is that so far as interest groups go, it's actually a lot easier to see how you get the insurers to buy into health reform than, say, the medical device companies. As evidence, over the past few months, the insurers have slowly been moving towards supporting the structure that basically undergirds the Democratic consensus: An individual mandate mixed with guaranteed issue (insurers can't deny you coverage) and community rating (insurers have to offer everyone the same price regardless of past health history). A month or two ago, AHIP -- the insurers' trade association -- came out in support of guaranteed issue and an individual mandate. This was largely laughed at. It was an admission that if everyone had to buy health insurance, they'd sell it at some price or another. But today, they've come out in favor of community rating, too. And not just community rating, but "more aggressive regulation of...benefits, underwriting practices and other activities." The devil, of course, is in the details on this sort of thing. And you could still see AHIP bolting into opposition against the inclusion of a public plan. But they've thus far evinced a willingness to find compromises, which is a strategy in contrast to the device and pharmaceutical companies, who went absolutely nuts at the first sign of comparative effectiveness. That's not really a surprise. You could imagine a pretty efficient universal health care system in which the insurance companies did just fine. Indeed, competing on price and quality in a universal system should actually be a better proposition than competing on risk shifting in a system where 47 million people -- and two million more every year -- can't afford their product. It's a more sustainable business model. The opposite, however, is true for device and pharmaceutical companies in a more efficient system. Given that estimates suggest 30 percent or so of care is wasted, an efficient system would support less, rather than more, of their products. Related: Jon Cohn -- you've heard of him, right? -- has a nice post on Pharma's early positioning.
