Monday, August 10, 2009

We don't have to kill the health insurance industry to reform it.

I am convinced that we are fighting for health insurance reform on a battlefield chosen by the enemy. Pushing for a public option as the only way to reform the current system has played into the hands of skilled lobbyists, propagandists and politicians working against the public interest. Insurers and their allies on the Right have been effectively leveraging the public option to tap into the cultural paranoia about government that still runs deep in much of America.

In fact, a public option is a means, not an end, and we need to start treating it as such. If we focus on the end - guaranteeing access to affordable health care to everyone who needs it - there are several possible means to that end.

Why not start by targeting the specific industry abuses that Wendell Potter talked about in his June 24 testimony to the Senate Committee on Commerce, Science and Transportation? We have known for decades that many of the worst defects in our health care system are directly traceable to the abusive practices of a politically-powerful for-profit health insurance industry. Legislating these practices out of existence would be as effective as a public option. It would also be much easier than trying to argue with people who think that Sarah Palin makes sense.

Here are a few things we can and should start fighting for:
  1. Rewrite ERISA, the horribly misnamed Employee Retirement Income Security Act of 1974. As this 2001 study shows, ERISA has pre-empted meaningful state laws regulating health insurance companies. One such law, a Texas law signed by then-Governor George W. Bush allowed lawsuits against abusive practices of health insurance companies. Until the Supreme Court overturned it - and barred any other state from passing similar legislation - the Texas law had resulted in dramatic reductions of insurer abuses in the name of profit. Simply adding a sentence that says ERISA cannot be construed to pre-empt state regulation of health insurance companies would be a body blow to the entire industry.
  2. Outlaw rescissions, sometimes called post-claim underwriting. When I say outlaw, I mean criminalize the practice of retroactively canceling coverage for people who file legitimate claims. And when I say criminalize, I mean make any executive who orders or authorizes rescissions subject to massive fines and jail time. And when I say massive fines, I mean prohibit anyone from covering the fines on behalf of the perpetrator.
  3. Require any insurance company operating in more than one state (including holding companies with multiple single-state divisions) to be subject to strict rate regulation by independent rate boards.
  4. Require any insurance company to cover any person, regardless of pre-existing conditions, who applies for coverage, and to pay claims within 15 days of receipt, period.
  5. Prohibit cancellation of group coverage for small businesses based on claims histories.
There are probably a dozen more practices that you and I could name, and whose demise would mean the end of predatory health insurance business models. Going after these, which NO one but a Limbaugh can defend, would keep the insurance companies as honest as pushing a public option that is becoming little more than a lightning rod for opposition.

Tuesday, May 12, 2009

Focusing on single-payer health insurance confuses strategies with goals

We need to start thinking more critically, and less ideologically about health-care reform. Focusing exclusively on a single-payer system confuses strategies with goals. Ignoring the mixed public-private systems that work all over Europe plays into the strategy of those who have no such confusion. THEIR goal is clear: protect the unregulated freedom of health insurance companies to ration coverage and care in order to maximize profits and executive compensation.

In February, the Organization for Economic Cooperation and Development issued a report on the deficiencies of our current system, with detailed recommendations for reform. The OECD report focuses on issues that get too little attention from political interest groups or the media. This is a serious report and demands a serious read.

Also, in July 2001, the Heritage Foundation issued a report on European health care systems that really surprised me. Although the report is eight years old, it contains some still valuable findings and still useful recommendations. Of course, this was in 2001, before September 11, and before the Bush Administration had fully demonstrated its total allegiance to free-market absolutism.

Predictably, the report was overly critical of the flaws of the European systems, especially, and also predictably, the French. But they also included reasonable “lessons learned”, and virtual endorsements of guaranteed, affordable coverage for all.

Most surprising: all the European models Heritage discussed, except the Swiss, combine publicly guaranteed insurance with private supplemental insurance. And all the flaws are both marginal and correctable. I have always distrusted Heritage because of its ideological bias toward unregluated free markets. But, in this report, the knee-jerk, evidence-free rejection of government regulation of the health care industry, which Cato and others still embrace, is missing.

On this occasion, and perhaps unintentionally, they went off the script. They got a few things right that we can actually leverage for real health care reform.

Saturday, April 25, 2009

Wave and Tidal Energy - again the Next Big Thing?

Thanks to Laurel Krause at Mendo Coast Current for capturing this story from yesterday's Christian Science Monitor.

I live not far from Pennington, NJ, the home of Ocean Power Technologies, but that's not the only reason hydrokinetic energy interests me. Wave and tidal energy resources off the New Jersey Coast could add as much as 100MW to New Jersey's renewable energy potential. That's 50% of the state's still contentious target for onshore wind.

OPTT and other US wave and tidal companies have always struggled in the States, but have gotten a lot of attention from Spain, Portugal, the UK ( especially Scotland) and Northern Ireland. Spanish and Portugese projects have fallen victim to the dryup of alternate energy investments but the US now actually seems interested. If wave and tidal actually take off in the the US, California and New Jersey are probably where they will happen first.

The Electric Power Research Institute (EPRI) maintains a complete directory of active wave and tidal projects, along with extensive reports on wave and tidal R&D. They also published a very informative research report in 2007.

Wave and tidal technologies compete with elevated offshore wind turbines for public and policymaker attention - and funding. They also cost a lot to build and maintain. Another problem is that tidal and wave technologies are still in the early, pre-commercial stage and probably five years away from large scale deployment. While they are coming up to speed, wind, solar, biomass, conservation and efficiency technologies will continue to advance.

That creates the risk that wave and tidal technologies could permanently lag behind in the competition for investment and customers, and remain niche technologies forever. The upside is that niche technologies can do really well if the niche is big enough.

Wednesday, April 22, 2009

Thinking nuclear

I have always looked at nuclear power with a lot of skepticism. Not because I think it is impossible to solve the plant safety and waste disposal issues, but because I have no faith in the industry's willingness to put those issues first and profitability second.

Still, the idea of safer, smaller, distributed nuclear plants has intrigued me since the 1970s. A recently-updated article on the subject makes the idea seem a little closer to reality.

Chrysler-Fiat deal looks promising

More details about the Fiat-Chrysler deal.

I doubt that Fiat will make mistakes of the magnitude that Daimler made in trying to make this deal work. THAT debacle resulted in a lot of serious studies of the risks inherent in international mergers, such as this from Emory University.

What encourages me most is that this is being structured as a global alliance, a la Nissan-Renault, not an acquisition of Chrysler by Fiat. Nissan-Renault seems to be working out, under very tough conditions. A global alliance means that Fiat will work with, not massacre Chrysler's current management.

Also, Fiat is doing a lot better, or at least a lot less bad, than all of its rivals except Volkswagen because of "scrappage payments", European government incentives to trade in old cars for new. Both VW and Fiat have the cars that Europoeans want, and now how the government incentives to make them more marketable.

The Canadion Government has a modest scrappage program but the US has nothing as yet. S.247, the "Accelerated Retirement of Inefficient Vehicles Act of 2009" introduced by Diane Feinstein and co-sponsored by Susan Collins and Chuck Schumer, and its companion House bill, HR 520, are arousing a lot of well-0rganized opposition from dealers and enthusiasts of low-MPG, high-emission cars, and from dealers who want incentives for used cars included.

My own feeling is that real incentives such as scrappage payments could get a lot more people who really need new, efficient cars to move now rather than later.