Strong opinions, weakly held

Individual health insurance is not available to many individuals

Donna Dubinsky explains how her family was shut out of the individual health insurance market in the New York Times. Here’s how she starts out:

This isn’t the story of a poor family with a mother who has a dreadful disease that bankrupts them, or with a child who has to go without vital medicines. Unlike many others, my family can afford medical care, with or without insurance.

Instead, this is a story about how broken the market for health insurance is, even for those who are healthy and who are willing and able to pay for it.

I realize many people are against the Affordable Care Act, but I don’t see any of them offering feasible proposals for fixing this problem. On the left, the most reasonable alternative is Medicare for everyone. I’d be in favor of that, but there aren’t anywhere close to 60 votes for it in the Senate just as there weren’t when the Affordable Care Act passed. As activists, we can clamor for legislation that won’t actually make it through the legislative process, but it doesn’t do much good for elected leaders to spend too much energy on those types of proposals.

And from the right, what alternatives are on offer? Or is the argument from the right that this is not a problem worth tackling?


  1. She’s right, the system is broken. But her (and your) headline is at odds with the story: money DID eventually buy insurance for everyone in her family. HIPPA mandated that many (all?) companies offer a plan for everyone, and while she didn’t make it clear I am guessing that is what they eventually got. But the high monthly premium and high deductibles of the HIPPA plans make them painful to accept for upper middle-class and higher income levels, and out of the question for anyone with less income.

  2. The only counter-proposal I’ve heard from the right is the combination high-deductable insurance with medical savings accounts.

    However, if you have a chronic condition, then paying for high-deductable insurance and putting aside money in a MSA doesn’t work. And if the chronic condition goes untreated, you may not be able to work.

    Also, the private insurance market is still able to cherry pick until the mandate kicks in.

    1. Don’t get sick

    2. If you get sick, die quickly

    3. Profit!

  3. Remember, the bill was just passed last year. As Bill mentions, the mandates aren’t all being enforced yet. Insurers have a vested interest in being “behind the curve” on implementing policies for the previously uninsured.

    Medicare for everyone isn’t financially viable for healthcare providers, as far as I can tell. The DRG system changed the way Medicare pays for care and resulted in a lot of providers losing money on Medicare patients. I’m for universal access, but I’m not sure that would work if you suddenly made Medicare the single-payer system. I think a lot of people would find themselves out of work. Even last year’s bill shifted some patients to Medicaid (which has states hurting worse than ever).

    Also note that phase 1 of the health care reform plan (the bill already passed) does very little to lower costs, but rather makes a lot of attempts to widen coverage. That is fine as a first step. Providers (and at some level insurers) need to know they can keep the lights on. Phase 2 needs to be insurers ratcheting down costs on providers – once more people are on the rolls and fewer people are being written off, insurers should have some bargaining power with providers – sort of an “ok, you’re getting paid for 90% of your patients now, so how about cutting us a better deal?” I guess we’ll see how that plays out.

    I expect more of this sort of article as we continue to move through phase 1 – lots of clamoring over “OMG failed health care reform!!1!” because plans are too expensive, before some insurers a) figure out some ways to bring down costs at which point we’ll be in phase 2 and reform will have worked, or b) insurers will have found lots of loopholes to deny coverage, at which point we’ll never reach phase 2 and reform will have failed.

  4. I don’t think this article is arguing that health care reform failed, but rather that the status quo is unacceptable, and unless we allow health care reform to be fully implemented, people who don’t get health care coverage from their job are screwed.

  5. I turned down a job opportunity today partly because it was an early stage startup that doesn’t (yet) offer health insurance (my wife has a family history of cancer, do the math…). The utter brokenness of the current insurance situation has all sorts of side effects that the short sighted folks on the right are sweeping under the rug. If the arguments against reform had any substance, I’d be all for having a debate, but by and large it’s all demagoguery. I just don’t understand why we’re still stuck on “ZOMFG, death panels!”. If people really are that stupid then I guess we deserve the mess we’re in.

  6. Unfortunately, Dirk, the ones saying ZOMFG and the ones getting screwed are different sets of people…

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