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.

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