August 6, 2009

Blame the Government for Healthcare Foolishness

Justin Katz

The government (abstractly speaking) has somehow wiggled its way into a comfortable position in which, as an entity, it need never take blame. Consider a letter from Ben Jones, in Providence:

When my wife and I moved to Rhode Island, my wife's employer-provided insurance plan increased its pricing to over twice the cost, with fewer benefits, than rates for me as an individual. Unfortunately, I discovered that I could not buy insurance in Rhode Island as a sole proprietor, since I had rejected my spouse's employer's plan. Being forced to choose a group plan that cost us more and delivered less didn’t seem like much of a choice to me.

A public health-insurance plan might have offered a true choice, or at least kept the private insurers' rates competitive. In Rhode Island, two insurers cover 95 percent of people with health insurance, limiting our choices further.

Tracing the history of Rhode Island healthcare — of which there is no helpful summary for the immigrant — one observes that the General Assembly created Blue Cross as a non-profit. Apart from that, the state has layered on sufficient mandates and regulations, some microspecific in scope, that we arguably have experience with a "public option."

Take Jones's specific complaint: His lack of eligibility for health insurance as a sole proprietor is a statutory allowance created as part of legislation with the following purpose:

The purpose and intent of this chapter are to enhance the availability of health insurance coverage to small employers regardless of their health status or claims experience, to prevent abusive rating practices, to prevent segmentation of the health insurance market based upon health risk, to spread health insurance risk more broadly, to require disclosure of rating practices to purchasers, to establish rules regarding renewability of coverage, to limit the use of preexisting condition exclusions, to provide for development of "economy", "standard" and "basic" health benefit plans to be offered to all small employers, and to improve the overall fairness and efficiency of the small group health insurance market.

This is what it looks like when a government imposes "options." The only difference under the regime that Jones advocates is that the government would not be forcing distinct (or semi-distinct) entities to operate its preferred plan; it would just regulate and mandate directly as a definition of its offering.