Buy or die
Universal plan can cost under $300, insurers say
By Alice Dembner
The Boston Globe
February 5, 2007
Many state residents will probably be able to buy basic health insurance for less than $300 a month to meet the new state mandate that everyone obtain coverage, insurers and observers said last week.
Although it might still be too expensive for some people, that would bring the price closer to what the Legislature envisioned when it passed the universal health insurance law last April.
The state’s largest health insurer, Blue Cross Blue Shield, said that with more flexibility from the state, it could offer slimmer coverage for an average of $210 a month — near the price originally suggested by former governor Mitt Romney.
“If it’s buy or die, they could buy at $210 or $220,” said Allen Maltz, chief financial officer for Blue Cross.
That plan, however, would not satisfy requirements proposed by the state board overseeing the law’s implementation because of the plan’s high deductible and out-of-pocket limits.
Comment:
By Don McCanne, MD
Massachusetts is proving to the rest of the nation what we already know: the traditional model of a multitude of private insurers is obsolete.
Health care has become too expensive to be financed by this model. Segregated insurance pools which include primarily the healthy workforce and their healthy families are the least expensive pools, with the lowest premiums. But the high costs of health care for even the healthy are now so high that comprehensive coverage is possible only with insurance premiums that are no longer affordable for most average-income Americans.
With the current drive towards universal coverage, the pools will have to accommodate those with greater health care needs. The upward pressure on premiums can no longer be tolerated, which is resulting in the trend to shift more of the responsibility of paying for care to the patient with significant needs. With segregated private risk pools, insurance premiums are affordable only when access to health care is made unaffordable.
Risk pooling is intended to shift funds from the healthy to the sick. But since the cost of health care for healthy pools is now so high, we have to accept the principle that the health care risk pools must also shift funds from the wealthy to both low- and average-income individuals with health care needs, if we expect to have effective universal coverage. Segregated private insurance pools cannot do that.
We need to remove the function of pooling risk from the control of the private insurance industry and shift that control to a universal risk pool using progressive tax policies to fund it (i.e., single payer). If we don’t, we’ll end up with a profoundly expensive administrative boondoggle of tax credits and government reinsurance, which will still perpetuate the “shared responsibility” of the sick to pay unaffordable expenses of their health care.
Blue Cross’ Allen Maltz suggests that the Massachusetts individual mandate to purchase insurance could be accomplished by forcing citizens to either buy low-premium plans or die. Unfortunately, since the coverage provided by the low-premium plans makes health care access unaffordable, Blue Cross will have to change their “buy or die” slogan. The new slogan? Buy and Die!