Each day brings another twist to the health-care-reform saga. Should the president heed the braying of his hard-left allies, manipulate Senate procedural rules, and push through a massive overhaul of our entire health-care system? Or should he scale back the ambition of the proposals already approved by four congressional committees and settle for a “modest” set of reforms to protect consumers from the predations of those sinister health-insurance companies? And, of course, there’s that nettlesome “public plan” option: Should it stay, or should it go?
On some days the prognosticators see less health reform in our future. According to the Washington Post, “the outpouring of anger at town hall meetings this month has fundamentally altered the nature of the debate” and convinced lawmakers such as Iowa senator Chuck Grassley to “consider drastically scaling back the scope of the effort.”
Even if this should prove true, and the reform effort ultimately gives way to a set of insurance-market reforms spun as minor tweaks to enhance our health “security,” it will be crucial for Americans to understand the slippery slope of liberal health-care reform and why liberals cannot ratchet back their reform ambitions.
Those seemingly modest changes urged by the White House, you see, would fundamentally alter the terms and conditions under which Americans purchase their health insurance. Worse, those changes cannot stand alone. They would necessitate a series of additional changes, each building upon the others so as ultimately to produce reform every bit as “robust” — and every bit as lethal — as the $2-trillion government takeover now being so loudly denounced in town halls throughout the nation.
Let me explain.
Start with the three “common-sense consumer protections” trumpeted by President Obama:
Guaranteed issue: Require health insurers to issue a policy to everyone who walks in the door, no questions asked, and to guarantee that coverage for life.
Pre-existing conditions: Bar insurers from screening prospective customers for any “pre-existing” and potentially costly medical conditions.
Community rating: Require insurers to charge all consumers the same premium for their coverage, regardless of relevant factors such as age, gender, occupation, and, of course, health status.
Combined with other items on the White House insurance-reform wish list, such as a ban on “excessive” out-of-pocket expenses and on yearly or lifetime limits on benefits paid, these mandates would effectively socialize the market for health insurance. Everyone could get insurance whenever he decided to sign up for it, and at one guaranteed price. Insurers would become regulated utilities, answering to government-appointed boards and rate commissions.
Not only would such a system drive up the cost of insurance, it would create classes of winners and losers. For example, the 55-year-old cholesterol-challenged smoker would benefit at the expense of the 27-year-old non-smoking vegetarian.
That’s bad enough, but the reforms can’t just stop there. So long as the issuance of insurance is guaranteed but purchase remains voluntary, many won’t buy coverage until they absolutely need it. Why, after all, spend hundreds of hard-earned dollars each month on a product you don’t need right now, when you could be spending that money on a new car, an upgraded wardrobe, or a nice vacation? Why not wait until the morning before your surgery to walk through the front door of your local health insurer, demand a policy, and then run up your medical tab, which your insurer will be required to cover?
Many will try to game the “reformed” system this way. Even liberal reformers admit it. Otherwise, they would have to deny still-fresh and fully documented history.
After all, several states tried these reforms in the 1990s. And the results were nothing short of catastrophic. One review of New Jersey’s experience with community rating and guaranteed issue found “a precipitous decline in enrollment, a corresponding increase in premiums, and a change in enrollment composition toward older and potentially more expensive enrollees.”