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Krugman: How To Keep The Insurance Companies Honest

Good Krugman column on healthcare reform, but I really wish he'd dig a little deeper into one particular myth: that most people want to keep the ins

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Good Krugman column on healthcare reform, but I really wish he'd dig a little deeper into one particular myth: that most people want to keep the insurance they have. Like anything else, it all depends on how you ask the question. Do they want to keep their insurance because they don't want to be swamped with paperwork, like Medicare's Part D? Are they afraid of higher out-of-pocket costs? It's a dumb thing to make public policy based on what might be a false notion:

Health reform will fail unless we get serious cost control — and we won’t get that kind of control unless we fundamentally change the way the insurance industry, in particular, behaves. So let me offer Congress two pieces of advice:

1) Don’t trust the insurance industry.

2) Don’t trust the insurance industry.

The Democratic strategy for health reform is based on a political judgment: the belief that the public will be more willing to accept reform, less easily Harry-and-Louised, if those who already have health coverage from private insurers are allowed to keep it.

But how can we have fundamental reform of what Mr. Obama calls a “broken system” if the current players stay in place? The answer is supposed to lie in a combination of regulation and competition.

[...] Now nobody is proposing that Americans be forced to get their insurance from the government. The “public option,” if it materializes, will be just that — an option Americans can choose. And the reason for providing this option was clearly laid out in Mr. Obama’s letter: It will give Americans “a better range of choices, make the health care market more competitive, and keep the insurance companies honest.”

Those last five words are crucial because history shows that the insurance companies will do nothing to reform themselves unless forced to do so.

[...] How could the industry spend 15 years failing to make even the most obvious reforms? The answer is simple: Americans seeking health coverage had nowhere else to go. And the purpose of the public option is to make sure that the industry doesn’t waste another 15 years — by giving Americans an alternative if private insurers fall down on the job.

Be warned, however. The insurance industry will do everything it can to avoid being held accountable.

At first the insurance lobby’s foot soldiers in Congress tried to shout down the public option with the old slogans: private enterprise good, government bad.

At this point, however, they’re trying to kill the public option in more subtle ways. The most recent ruse is the proposal for a “trigger” — the public option will only become available if private insurers fail to meet certain performance criteria. The idea, of course, is to choose those criteria to ensure that the trigger is never pulled.

And here’s the thing. Without an effective public option, the Obama health care reform will be simply a national version of the health care reform in Massachusetts: a system that is a lot better than nothing but has done little to address the fundamental problem of a fragmented system, and as a result has done little to control rising health care costs.

Right now the health insurers are promising to deliver major cost savings. But history shows that such promises can’t be trusted. As President Obama said in his letter, we need a serious, real public option to keep the insurance companies honest.

The last thing we want is something resembling the Massachusetts plan, which is a frickin' disaster. (For instance, if you're making $31,213, the cheapest plan is $9,872 in premiums and out-of-pocket payments - and that's the good news.

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