Conspiracy theorists should be swarming over the news of the
past week: the Supreme Court pulled a rabbit out of the hat to save Obamacare
for a second time; and five of America’s largest health insurance companies are
involved in possible merger and/or acquisitions. Conspiracy theorists are now invited to
connect the dots. It’s a pretty green
field to work with – so theorize away.
Justice
Scalia is definitely not a part of this conspiracy. He bluntly called Chief Justice Robert’s
decision a foul. How is it that the
Supreme Court could misinterpret a simple phrase that requires an individual to
purchase health insurance through “an Exchange established by the State” in
order to receive federal subsidies? The
wording of the law seemed extremely clear – to qualify for a federal health
insurance subsidy, your state must have established its own website (or “Exchange”)
and you must have obtained your health insurance through your State’s
established Exchange. However, my legal
consultant advised me that the Supreme Court got it right. According to my legal consultant, a law has
to be interpreted in its entirety and its intention must be based on the
entirety of the law. Unambiguous or
poorly written phrases should not be taken out of context with the overall
spirit of the law. Since nobody has read
the 2,000+ page law, who can argue with Chief Justice Robert’s interpretation
of the law’s intention? Furthermore,
does any American believe that the intent of Obamacare was NOT to give subsidies
to people who could not afford Healthcare?
The
Supreme Court based its decision on the spirit of the law; not on the very
clear imperfections in the letter of the law.
But come on, the conspiracy theorists can’t believe this. Chief Justice Roberts must be an actor in the
conspiracy to force Obamacare down our throats.
The conspiracy is not just to force tax payers to subsidize other
Americans’ health insurance – it is also to keep the train moving toward a
fully socialized health care system.
Now, the conspiracy theorists are cranking.
If only
such a conspiracy actually existed. It would
cause us all much less pain then the well-intended but still very imperfect
Obamacare law. An actual conspiracy
would move us down the path to fully socialized health care much more quickly
than the current path we are on. The
current path is one where Republicans scream that we must repeal and replace
Obamacare but never define the replacement.
The current path has Democrats so defensive about the negative emotions
surrounding Obamacare that they dare not take any actions to make it
better. Democrats sit back and say: “you
Republicans say it is so terrible - you figure out how to fix it.” In the meantime, President Obama declares
that the Affordable Care Act (the real name of Obamacare) is a tremendous success
and that it is now so neatly woven into the fabric of America that it will
never go away.
If the
Affordable Care Act (ACA) is such a success then why do the majority of
Americans still oppose it? Could it
possibly be that the majority of Americans do not trust Washington? Could it be that the majority of Americans
believe that there is another foot to be dropped by the ACA? Could it be that those Americans that did not
receive subsidies got screwed by the ACA?
Could it be that health insurance under the ACA covers less than it did
before the ACA even though the law itself mandates coverage for things that
people may not need or want (e.g.: birth control and maternity benefits for a
sixty year old woman)? Could it be that
you really couldn’t keep your doctor if you liked you doctor, or keep your
health plan if you liked your health plan?
Could it be that the little guy making $60K a year that has to pay for
his own health insurance had his premiums double and his deductible go up even
more? Could it be that the law does not
apply to big businesses that are self-insured? Could it be that members of Congress do not
have to purchase their health insurance through healthcare.gov? Or, could it be all of the above?
Note to
the conspiracy theorists: focus on the insurance companies NOT the politicians. These health insurance companies were the
impediment to socializing health care.
The health insurance companies wanted to protect their survival. Now they cannot see the forest for the trees
and are setting themselves up for distinction.
It’s not a conspiracy, it’s the insurance companies’ stupidity – but we
should welcome their stupidity because it paints a picture of the future and
brings into to focus the questions that need to be answered to fix the ACA.
In the
past week, five of the largest health insurance companies in the United States
were in the news because they were trying to buy each other (United Healthcare,
Aetna, Cigna, Antham, and Humana were all mentioned as targets of one or another’s
takeover plans). Apparently, the ACA
leaves little room for innovative health plans to bring the cost of healthcare
down, so the best way for the big insurance companies to bolster their bottom line
is to reduce their administrative costs.
Bigger is better; one set of high
paid executives instead of two or three improves the bottom line. Likewise, one information system is less
costly than multiple information systems.
All the insurance companies are offering the same bronze, silver, gold
or platinum plans so why do they need multiple managers and information systems
to manage the same plan?
If there
is a conspiracy (and I am not a conspiracy theorist) it will manifest if and
when the government does not prevent these large health insurance companies from
massive consolidation. But just for fun,
let us ignore this sensible preventative measure and dream of a world where
consolidation among health care insurance companies proceeds unencumbered.
Eventually
the health insurers will consolidate to only a handful of large companies
providing health insurance to the majority of Americans. Then the government will have to intervene
under our anti-trust laws and regulate these de facto monopolies. Regulating the health care monopolies will
require the government to stipulate the premiums that the health insurance
companies can charge and the remuneration that health care providers will be
paid. Essentially, the monopoly health
insurance companies will be outsourced administrators of the government’s
health plans. And, then someone will ask:
why do we need more than one company to provide the administrative services? And, once there is one administrator of the
government’s health care plan that provides the same benefits to all citizens
and pays the same fees to all health care providers someone will ask: why
should different people pay different rates as over their lifespan they will
all consume the same amount of healthcare?
Then someone will ask: wouldn’t
it be easier to just take a percentage of each individual’s paycheck then to
administer all these individual monthly premiums?
While the
above questions regarding the cost of administration are debated, another issue
will be debated – should we have different pools of people provided with different
benefits and charged different rates.
Today, the self-paying individual is in a pool with other self-paying
individuals while the employees of big businesses are pools unto
themselves. Pools are further divided
based on the geographic boundaries of each state. There are also pools of Medicare and Medicaid
recipients in each state. Government
employees are also in their own, different pools. The obvious question is: why are there so
many different pools with so many different benefit levels? Wouldn’t the underwriting of one large pool with
the same benefits provide less risk (and therefore less cost) than the sum of
the risk associated with each of the individual pools?
The last
question that needs to be addressed is who should pay the premium. Why is America the only developed nation on
earth where businesses pay for health insurance? Doesn’t that put American businesses at a
disadvantage? Individuals should pay for
health care the same way they pay for Social Security and Medicare. This will not only make American businesses
more competitive in the global marketplace it will also result in a more
engaged nation of citizens. Why do a
higher percentage of senior citizens vote than any other voting bloc? Because they have a vested interest in Social
Security and Medicare. If we instill a
vested interest in each individual paying for their health insurance we will
have a more robust democracy.
All of the
above questions will be answered in time and then we will have a fully
socialized health care system with a single payer and basic but equal benefits
to all citizens. And it will be more efficient
than the current mess for which no one can offer a replacement. It will also provide the health care that citizens
of a developed nation deserve. It will
also allow for wealthy individuals who can afford better service to pay for it
themselves. It will also allow for
health insurance companies to sell these “add-on” health care services to businesses
and individuals: although the health insurance companies overall take will be a
much smaller slice of the pie than it is today.
To all
those health insurance companies contemplating mergers and acquisitions: Thank
you for the wisdom your stupidity has revealed.
