The Sovereign Mind

As a supporter of the free market (although not a purist), I tend to prefer a solution to our country’s health care problems that enhances the advantages of the market, rather than places more government bureaucracy on top of it. But a bill that decreases government involvement in health care, rather than increases it, is about as likely to get passed as a white male was likely to have been nominated for Justice Souter’s seat on the bench. So that begs the question: if the conservative approach to health care reform is not viable politically, what is the next best thing we can hope for?

What about the much maligned status quo? Even critics of the reform proposals agree that our current system has problems, but would doing nothing be better than the current proposals? Even if some believe that to be the case, few politicians would admit it for fear of being labeled a defender of a broken system. But is the best option on the right to try to block reform and stall, in hopes of gaining political power in future elections, thus making a more conservative approach more viable? That might be tempting, but given the track record of Republicans on getting any major reform done in our health care system, I wouldn’t bet on that approach working out. A few of us are in the unfortunate circumstance of needing the liberals’ zeal to get something significant done and the conservative ideas to get the right thing done. It’s tough to have both at the same time.

What about a compromise approach? The Senate finance committee has recently come out with a bill that it believes to be more moderate than its counterparts. No public option. Less harsh mandates. Almost universal disapproval. Does compromise mean pulling in all of the best ideas from all sides, or the worst ones? In this case, we have none of the cost controls and all of the government bureaucracy. In an attempt to find common ground, it appears the finance committee has found no-man’s land. Worse still, if something along those lines passes, it is likely to give the impression that something has been done, when in reality nothing has been done except complicating the system even more. This impression is likely to cause real reform to be significantly delayed as we have an endless debate about whether the plan is really working or not (see the current debate about whether the stimulus is working).

How about this for the Next Best Thing for conservatives? Let the liberals’ plan pass. Yes, that’s what I said. Put in that strong public option and individual mandates. Punish those greedy private insurance companies and those evil employers that don’t provide insurance to their employees. Why might that be The Next Best Thing? Because when someone asks, “Why can’t I find a plan a low-premium catastrophic plan?” We can tell him that the government didn’t think that would be good for him. And when someone says, “I got laid off because my employer couldn’t afford the health insurance he’s mandated to pay for.” We can say, “Thanks for taking one for team.” Or when someone on Medicaid Advantage reports that their plan has been discontinued, and they are now forced to find another, we’ll just tell them they were part of the waste in the system that had to be jettisoned. Maybe then there would be more pressure to consider more conservative-minded approaches. (Or, maybe it would actually work. Either way, the American people win in the end.)

There was nothing like prohibition to solidify the idea that alcohol ought to be legal. Nothing like Vietnam to make the public wary of the casualties of war. Nothing like repealing Glass-Steagall to remind us of why it was there in the first place.

Does this idea sound good to me? No. I don’t want to see people in our country suffer. And it would likely take decades to undo the programs that would be put in place. I didn’t say it was The Best Thing. I suggested that maybe it is the Next Best Thing. If conservatives believe that liberal health care reform would be a harmful to our country, should they let the liberals prove it? Just a thought.

At one of Obama’s recent town hall meetings on the health care proposals, a questioner brought up the misinformation that is circulating in the debate:

You touched on this. I would like you to expand a little more. This problem with misinformation in our country, it seems to me that it’s not only just hurting health care reform, health insurance reform, it’s dividing our country. (Applause.) Is it not maybe time — I think we all know where it’s coming from.

Yes, we do. It’s coming from all sides. During that same town hall, as well as those that preceded it, Obama has been using the proposed Medicare Advantage cuts as an example of where we can eliminate waste from the system in order to pay for his plans:

So I’ll give you — let me give you one particular example. We right now provide $177 billion over 10 years — or about $17 billion, $18 billion a year — to insurance companies in the forms of subsidies for something called Medicare Advantage where they basically run the Medicare program that everybody else has, except they get an extra bunch of money that they make a big profit off of. And there’s no proof, no evidence at all that seniors are better off using Medicare Advantage than regular Medicare. If we could save that $18 billion a year, that is money that we can use to help people who right now need some help.

Medicare Advantage is a system in which seniors who would normally qualify for Medicare can instead buy private health insurance plans, and have some of the cost of that plan subsidized by Medicare dollars. In 2003, the system was changed such that private insurers are given a more generous subsidy to provide these services. It is mainly this change that has prompted the concern that tax-payers are lining the wallets of insurance company executives. That is a legitimate concern. However, it is clear that those additional subsidies have encouraged insurance companies to offer more attractive plans to seniors. According to the Congressional Budget Office:

In 2004, Medicare Advantage plans accounted for 13 percent of enrollment in Medicare, the lowest level since 1996. Over the past two years, however, enrollment in those health plans has increased to about 19 percent of all enrollment, or 8.3 million beneficiaries.19 That increase resulted from changes enacted in the Medicare Modernization Act that increased payment rates and added the prescription drug benefit to complement the medical benefits provided under Parts A and B of Medicare. CBO projects that enrollment in Medicare health plans will continue to increase rapidly in coming years, to 22 percent of total Medicare enrollment in 2008 and 26 percent by 2017 (see Figure 1).

So, the higher government subsidy to insurance companies resulted in more seniors seeking after these private plans. There’s a reasonable debate to be had to be sure we are using government money wisely. However, the debate has to recognize a simple fact: if increasing the subsidy caused more attractive plans to be offered to seniors, what will happen when the subsidy is decreased? Will private insurers still offer those same plans as the same premiums to seniors? Reason says no. And yet, there’s this oft-repeated line from the President: “If you like your health care plan, you keep your health care plan.” Unless it’s a Medicare Advantage plan. Then all bets are off.

Some mock the elderly for statements such as “Keep your government hands off my Medicare.” It is true, that statement doesn’t express the frustration well, but the underlying concern is a real one. Maybe, before mocking, we should think about the fact that these people have been around many decades, and maybe have learned a thing or two about how government works. It turns out that, despite the patronizingly reassuring words that are used to try to calm the elderly on this issue, they have good reason to be concerned. If this is Obama’s example of an “inefficiency” in the system, what else might there be?

Paul Krugman, nobel prize winning economist, says that the people protesting at health care town hall meetings are anti-American and amount to a mob.

Tell that to Paul Curtman:

Our country was founded on freedom, not politeness.

For those who might be tempted to brush off his criticism, please read The Federalist #41, written by James Madison, known as the Father of the Constitution.

Continuing my series I began a few days ago, here’s another little gem within the health care bill. The plan imposes a penalty on companies that don’t contribute to health care for their employees. But don’t worry, small businesses. The Democrats are fully committed to engaging in rhetoric to ensure that you don’t think this is going to affect you. From the summary, in a section ironically entitled “Assistance for small employers”:

Recognizing the special needs of small businesses, the smallest businesses (payroll that does not exceed $250,000) are exempt from the employer responsibility requirement. The payroll penalty would then phase in starting at 2% for firms with annual payrolls over $250,000 rising to the full 8 percent penalty for firms with annual payrolls above $400,000.

Democrats know that they must continue the charade of appearing to be on the side of small business. They argue that it will only be big business that will be penalized. You know those businesses with those big pockets. (On a side note, having big pockets doesn’t always mean they have anything in them, but that’s a matter for a different day.)

But now we learn that businesses with a payroll of as little as $250,000 would be hit by a tax. Now we know that Obama means it literally when he says he wants to help the “mom and pop” businesses. Just don’t hire the uncle and a few cousins–that might put you over the limit into evil big business territory. I know that isn’t a fair representation of Obama’s position–he probably does care about helping small business. But, as is common lately, his rhetoric doesn’t match the bill. Unfortunately, congress will not be voting on the president’s speeches. They will be voting on the bill before them that they (hopefully) have read.

But I’ll ask a more fundamental question: why should it be the employers’ responsibility to contribute to health care coverage? I don’t think you can argue that employers have a responsibility to do anything except fulfill the agreement they have made with the employee when he is hired. If I’m an employer looking to hire someone, and I put out the conditions of employment, and someone looking for a job agrees with those conditions, why should the government tell us we can’t make that arrangement, or punish us for doing so.

Those who support the tax on business will argue that businesses should pay for health care because they have the deep pockets. Those who make this argument don’t understand economics. The amount that the employer has to pay for health care is approximately the amount by which they will decrease their employees’ salaries. If it were not so, then I think we should mandate businesses to pay for my groceries and mortgage also. If the money that my employer pays comes out of thin air, we could easily solve our housing crisis that way. Of course that’s ridiculous. If my employer has to pay my mortgage, my salary would decrease.

There are several problems with employer-based health coverage:

1) If I lose or change jobs, I lose my coverage. Plans aren’t portable. This contributes to the problem of the uninsured, and also makes people stay in jobs they don’t like, rather than looking for greener pastures. That is detrimental to the labor market, as it means that employers don’t have to work so hard to keep their employees happy.

2) When employers offer health care plans, they offer limited choices. Choice is essential in a free market. If I don’t like my insurance provider, I ought to be able to easily switch to another. This keeps the insurance companies honest because they would know if they do not provide good service and a reasonable price, I’d go elsewhere.

So, considering those disadvantages, why is it that we have a employer-based health system?

1) Employers are offered a tax break to give health coverage to their employees. It still costs them money, of course, but it costs them less money then it would cost their employees to buy the plan themselves, since they would not qualify for the tax break. So, employers can provide something to their employees which is of high value to them, but costs the business less. This could be solved by equalizing the tax structure so that individuals who buy health insurance benefit just as much as businesses. Businesses that want to attract the best and brightest would still be able to contribute to the health care plans for their employees, but they would not get any additional benefit from the government for doing so. In addition, those who don’t have jobs or work for companies that don’t provide health care would not be disadvantaged in the insurance market.

2) Employees like the fact that when they sign up for a health care plan through their employer, they are part of a pool. That means their cost doesn’t depend on their health status, but rather the health status of the entire work force. It means that healthy employees subsidize the health care of the less healthy. Many people see this as a good thing, but a pool is just a crutch since we don’t have a better way to charge people. A better way would be to charge people based on their behavior, which eliminates the need for pools because everyone pays what they should pay, and everyone is equally able to lower their costs by making healthy choices, regardless of pre-existing conditions.

But even if the “charge on behavior” philosophy is not palatable to some who prefer the more tried-and-true mechanism of pools, we could set up such pools at the state level, instead of putting that responsibility on the employers.

But wouldn’t taking away the incentive to provide health care (or the punishment for not doing so) from businesses cause people to lose their health insurance? It might cause some businesses to drop coverage, but it would also add revenue to the system to provide tax credits to help individuals buy coverage, as well as more help for those with lower incomes.

What I’ve outlined is true change–way more than Obama wants to take on since he is determined to build on the current system. At the very least, that proves he is wrong to suggest that the only alternative to this bill is to do nothing. One alternative is to do more. But, really it’s not about less or more. It’s about what’s right. And pinning the responsibility of health care on “big” business is wrong, costs jobs, and leads to less choice in the marketplace.

I recently read the summary of the house bill and a few parts of the actual bill that I wanted to dive into in more detail. No, I don’t have time to read the entire bill. I have to say: it’s worse than I thought.

I won’t bother about the part about the “public option”. It is the most debated part of the bill, and most of the debate is ideological. Although personally I don’t like it as I fall on the more conservative small government side, but I don’t feel I have much to add to that debate. I’d like to focus on some things that are wrong because they are wrong–not because they don’t fit a certain ideology. So this is the first post in a series (if I get around to more) on what’s wrong with the health care bill.

The summary of the bill says this:

It also limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. Under the proposal, premiums can vary based only on age (no more than 2:1), geography and family size.

(You can read the part of the actual bill that relates to this issue here.)

I actually like the idea of preventing insurance companies from charging sick people more. The unregulated free market punishes people for having the nerve to get sick. Now, some diseases are preventable and one could argue that in some cases it is justified to charge people more if they get sick due to their own poor choices. However, there are two problems with this argument:

1) Many people get sick because of bad luck, not because of anything they did wrong.
2) Many people make bad health choices but don’t get sick.

If the intent of a free market is to encourage good choices by rewarding them and discourage destructive choices by punishing them, clearly the free market does not do this well in the health care world. As I’ve argued before, the free market is a great system, but is not perfect, especially in the areas of health care and education (I’ll leave education for another day).

So what’s wrong with this proposal, then? If we’re going to take away health status as a measure of how much someone should pay, what should we replace it with? I propose that we regulate insurance companies such that their premiums must be based on behavior, not health status. For example, someone who smokes can be charged more. Someone who is overweight, but loses weight over a certain amount of time, should see his premiums decrease. That would help accomplish two important goals:

1) Make the pricing system more fair. In our current system, someone with a chronic disease, whether they acquired it because of their own poor choices or not, would have to pay enormous premiums in order to be insured. Or, they have to be in a pool where healthy people help subsidize their care. Why not make people who are making poor health care choices, but who are not yet sick, subsidize the care for those who are sick?

2) Basing premiums on behavior would be a driver to improve health choices, and therefore lower health care costs. If people know they can lower their health care premiums by making better choices, they’d be more inclined to do so. Safeway has proven it, but according to my reading of the bill, Safeway’s program would not be approved.

Fortunately, I’m not the only one making this case. Although I haven’t heard much in the media, and have yet to find any other blog post regarding this important issue. Obama likes to talk about decreasing health care costs, but I don’t see much in the bill that actually does. This would be one way to do so, and it’s not even an partisan issue.

When Republicans tried to explain the size of the stimulus bill based on the amount of money it amounted to per day since the birth of Jesus, I objected: “I’ve never really thought these sorts of number analogies all that useful. I can make just about any number look large or small using some visualization.”

I had a similar reaction when Obama said that healthcare costs cause a bankruptcy every thirty seconds. But I have ever greater reason to be annoyed, because it turns out Obama’s number is not only a meaningless statistic, but is actually dead wrong:

“The cost of health care now causes a bankruptcy in America every thirty seconds,” Obama said at the opening of his White House forum on health care reform. The problem: That claim, based on a 2001 survey, is simply unsupportable.

The figure comes from a 2005 Harvard University study saying that 54 percent of bankruptcies in 2001 were caused by health expenses. We reviewed it internally and knocked it down at the time; an academic reviewer did the same in 2006. Recalculating Harvard’s own data, he came up with a far lower figure – 17 percent.

…

Himmelstein tells me that the reason for the difference is a change in federal law that sharply reduced the number of bankruptcies. In 2005, the year he and Warren wrote their op-ed, there were just over 2 million bankruptcies. Data out just today say that in 2008 there were 1.1 million (up sharply, by the way, over 2007). So this error in the White House claim stems simply from the fact that it’s using out-of-date information. The next question is whether the estimate of “medical bankruptcies” is reliable in the first place.

A good part of the problem is definitional. The Harvard report claims to measure the extent to which medical costs are “the cause” of bankruptcies. In reality its survey asked if these costs were “a reason” – potentially one of many – for such bankruptcies.

Beyond those who gave medical costs as “a reason,” the Harvard researchers chose to add in any bankruptcy filers who had at least $1,000 in unreimbursed medical expenses in the previous two years. Given deductibles and copays, that’s a heck of a lot of people.

Moreover, Harvard’s definition of “medical” expenses includes situations that aren’t necessarily medical in common parlance, e.g., a gambling problem, or the death of a family member. If your main wage-earning spouse gets hit by a bus and dies, and you have to file, that’s included as a “medical bankruptcy.”

You might think, “So what? Healthcare reform is important, so why so much fuss over a statistic?” I would agree that healthcare reform is important, as I’ve blogged about before. But to illustrate why I think this mischaracterization (and the many that take place every day in the world of politics) is important, let’s do a little thought experiment:

Imagine that you are an HR rep, and you come to your boss with a new brilliant idea to increase employee retention:

You: “Sir, I believe we should give away free soda in the break rooms.”

Boss: “Why’s that?”

You: “Well, did you know that someone quits every five days because there is no free soda in the break room?”

Boss: “Every five days? Wow, that’s a lot. Where did you get that number?”

You: “Well, in 2001, we gave everyone who quit a survey, and some said that no soda in the break room was a reason they quit. And actually it’s closer to one person every 9 days, but that’s not the point…”

Boss: “Wait, we’ve cut the number of people who quit in half since 2001 due to other policy changes. And just because someone says it’s a reason they quit, doesn’t mean it was the main reason. But even so, that number seems high.”

You: “Yes, well I also included people who said they liked soda even if they didn’t list it as a reason they quit. I assume that if we had free soda, they might not have quit.”

Boss: “I see. How much do we pay you again?”

I hope that makes it clear. We would never tolerate this sort of fudging in our real lives, but for some reason we tolerate it from our politicians. I don’t mean to single out Obama. Almost every politician does this. But of all the politicians that have come along, Obama was the one who had the most power to change the norms that we have come to accept. Looks like the opportunity will be wasted.

Saturday, February 28th, is Rare Disease Day 2009. Some might wonder why we need a day to recognize rare diseases. I would have wondered the same thing myself about two years ago. But as a parent of a child with Eosinophilic Esophagitis, I now understand that patients with rare diseases face a unique challenge. For more common diseases, research and investment dollars are much easier to come by. This is for good reason, because each dollar carries more bang for the buck because of the economy of scale. If you could help save 1000 kids for the same amount of money as it would take to save 1, which would you choose?

Last year American Express hosted a competition, of sorts, between charitable initiatives. The idea was to have people present ideas that needed funding, and then narrow it down to 25, based partially on public voting. The project named “EE – Save Sick Children”, aimed to raise money for APFED, finished second in the overall vote count. However, American Express decided to exclude the project from the final 25 projects. Am I angry about that? No. I don’t really blame them. I don’t know that the project was really more deserving than other projects. Still, this illustrates the difficulty those with rare diseases have in getting the research attention needed to help them.

It’s important that our society does not forget about those of us who have the double-challenge of not only having a chronic disease, but one that is not well known, understood, or researched. That is why I’m grateful that organizations like The National Organization for Rare Disorders have fought for people like me long before I knew I would care. Please watch this video and take a moment this Saturday to think how you can help those who are sick for no fault of their own, especially those struggling not only with their disease, but fighting a lonely battle:

Thanks to The Moderate Voice for bring this day to my attention.

Cross posted to DaddEE

I hesitate to post a picture of my son for all the world to see, but I thought it was important that you see my inspiration for this topic. Too often we talk of politics as if it’s some cold theoretical science. Once in a while, politics and real life collide and we understand why the policy debates matters at more than just a cerebral level.

On my son’s first birthday, he enjoyed his first–and probably last–birthday cake. Since he was born he has had severe reflux. After being told a hundred times that he would grow out of it, he was diagnosed with Eosinophilic Esophagitis (EE) shortly after his first birthday. The disease causes him to be allergic to many foods. The hardest part is that we don’t know which foods he is allergic to, since traditional allergy testing is not as effective for kids with EE. After his diagnosis we removed some foods we thought bothered him the most, but we didn’t see any significant improvement. Finally, as many EE patients eventually do, we took away all foods and fed him a complete-nutrition hypo-allergenic formula. The taste of the formula is horrible, which is why he needs the NG-tube so that he can get enough. After that we saw improvement in his condition. We finally got to see the little boy inside of him–the one who is not screaming all of the time. We are now trying to introduce foods one at a time, to see which ones he reacts to. So far, the only food that he can eat is pear (precious, blessed pear). My son will probably deal with this for the rest of the life, unless some miracle cure is found.

My point in sharing this is not to make you feel sorry for me or my son. I would not trade out trials for anyone else’s. Firstly, there are many kids worse off than he is. His condition is chronic, but not fatal. Secondly, as parents, it is our responsibility to teach our kids how to deal with life, with the challenges it brings. We will teach him to be strong, and not to be a victim. Lastly, I am fortunate enough to have a good job where I bring home enough to support my family so my wife can stay home with him and our daughter, and I have good health benefits. Sure, there have been times when we have disagreed with our insurance company on what is best for my son, but in general they’ve been good. For example, they agreed to cover his expensive formula, which we’re told most insurance plans will not. They would not, however, cover his portable feeding pump, insisting that we instead feed him manually (a process that requires him to sit stationary for a half hour, six times a day). So we had to turn to our secondary insurance for that: eBay.

Had my family been in less fortunate circumstances, I might have had to find a way to pay for my son’s health-care, or a costly insurance plan that would agree to pay for his needs. Saying we are “high risk” doesn’t seem adequate, since there is nothing unsure about it: my son requires expensive health care, and he probably will for the rest of his life. Doctor’s visits every-other week, expensive testing and supplies, not to mention his formula. If not for my employer-sponsored pool, what insurance company would cover us? They’d be foolish to.

With this in mind, how the presidential candidates deal with pre-existing conditions is not just one part of their health care proposal. To me, it is the foundation on which the plan either succeeds or fails. So, let’s look at each of their plans on this issue. I would love to have enough time to analyze each of their plans in full, but here is just a brief overview of how I view their plans.

John McCain

McCain’s health care plan tries to encourage a more market-based approach to health care, where individuals would be more able to choose their own coverage instead of relying on their employer. The thought is that this would make individuals more cost-conscious about their health care, which in turn would lower costs overall. The problem, though, is without the protection of a employer-sponsored pool, how is it possible that high risk patients could possibly get affordable plans on the free market. This is an example of one of the problems with the free market that I outlined in my previous post. McCain’s solution:

As President, John McCain will work with governors to develop a best practice model that states can follow – a Guaranteed Access Plan or GAP – that would reflect the best experience of the states to ensure these patients have access to health coverage. One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

So, high risk people would be pooled with other high-risk people and those pools would be sold to the insurance companies? Nothing about that says “affordable” to me. I appreciate the “reasonable limits on premiums”, but he does not mention how that would be accomplished. The bottom line is that I’m sure to get worse coverage at a higher rate than I am now if my employer decides to drop their plan due to McCain’s plan.

Bob Barr

Barr’s health care plan is vague, but basically amounts to having the government get our of health care and let the people buy their own. He doesn’t mention anything about pre-existing conditions, but another part of his website hints at how he would handle the problem:

Government should stop acting as the welfare agency of first resort under the guise of providing social insurance. In general, private charity should be the first resort for anyone in need. The process of welfare reform begun by Congress in 1996 should be continued to reduce even further people’s dependence on Washington. In 2007, for example, Americans gave more than $300 billion to charity, an increase over 2006 despite growing economic uncertainty. Government should eliminate regulatory barriers that inhibit private philanthropy, and expand tax deductions to encourage charitable giving.

Personally, I love the idea of expanding tax deductions for charitable giving, and I agree that Americans are very generous. I would love to believe that Americans would be willing to take care of each other, without the need for government. That sounds like the ideal solution, but unfortunately I can’t believe it just yet. The fact is, even with the government health programs we have today, there are still many people suffering because they can’t get affordable, quality insurance because of pre-existing health problems. Clearly, the charitable organizations are not fully up to the task today. So why should I believe that we, as a community, would all step up, if we are not already doing it?

Barack Obama

If McCain and Barr don’t do enough to help high risk individuals get affordable health coverage, Obama’s plan goes too far the other way:

The Obama-Biden plan will create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL provided for people and families who need it. Insurers would have to issue every applicant a policy and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.

I credit the Obama campaign for at least recognizing that something needs to be done about this issue, and not treating it as an after-thought, as it feels the other campaigns have. However, I feel he has gone too far in the other direction. Under his plan, patients would pay only according to what they make, regardless of their health status. This basically takes all decision making out of the hands of the free market regarding who insurance companies can cover and at what price.

The problem I have with this is that some pre-existing conditions are not preventable, but some are. Should I really be charged more to compensate for those who make poor decisions, have illegal habits, or have dangerous lifestyles? Obama loves to criticize McCain for using a hachet instead of a scalpel when it comes to the economy. To me, Obama’s plan feels like a hachet.

Conclusion

Clearly, this is not a problem that will be solved by any of the candidates. Whoever gets elected, I hope that the conversation on this issue doesn’t end. I don’t have the solution. My instincts always favor a free market solution, but on this issue I simply don’t see how the free market alone can make this work. If anyone can show me why I’m wrong, I’m all ears.

But here are some guiding principles I’d like to see discussed:

1. A fair system would penalize people for their choices, not their health status. It’s fair for a smoker to be charged more for health coverage than a non-smoker, for example. I’d be in favor of regulation that requires insurance companies to come up with formulas to determine premiums based only on choices, and to publish their formulas so it can be independently verified that customers are being charged according to the formula. I admit though, that this is easier said than done. How would you, without bring an end to freedom as we know it, charge people who eat big-macs more than those who don’t? And how do you implement this without over-simplifying the formulas so much that they disproportionally punish only the choices that are easily measured (ie. smoking)?
2. Insurance companies should be given a limit for how long after an application is accepted before it can be denied because of errors on the application, with the exception of lies about behavior. Insurance companies should not be allowed to deny coverage to a person after that person falls sick, just because they forgot some minor detail on their insurance application years earlier. It should be the insurance company’s responsibility to investigate the application before accepting the application.
3. There needs to be more transparency. In the industry I work in, there are several well-respected companies who’s sole business is rating our type of service. This is an essential service to potential customers. Why aren’t there more private entities who can rate the insurance plans offered to us? They could rate them based on how well they treat those with rare conditions? What is the level of customer satisfaction? They could present their finding in easy to read reports, so customers can have confidence in what they are getting. Such transparency go a long way, in my opinion, to inspire the insurance companies to make sure they are treating their customers fairly.

I hope we can get beyond talking points and start talking about the real issues. Unfortunately, real discussion will probably have to wait until after the election, when the pressure is off and people can start thinking with a clear mind. I’ll be ready.