Here is a question I’d love to see candidates answer before
the election.
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| Source: NY Times |
Does the continuing activity around the implementation of
the Affordable Care Act signal the collapse of American capitalism – at least
as it pertains to health and health care?
The myth of American capitalism is so powerful that I
imagine they won’t touch this one with a ten foot pole – or even a ten-foot
long poll! In the politics of our $2.6
trillion healthcare economy, however, capitalism takes a back seat.
The recent activities
of the Connecticut health exchange board explain why capitalism in health care
is about as relevant as a Democratic voter in Utah.
Connecticut is one of the dozen or so states embracing ACA,
and is making an impressive effort to implement its health insurance exchange
on time in 2014. By contrast, more than
half the states have yet to even declare their intentions, even though the
deadline for doing so is mid-November.
According to a recent,
well-written article in CT News Junkie, its health exchange board, tasked
with the job of approving the “essential benefits package” for the state, did
so last week. The essential benefits
package will become the standard in each state for what must be offered by
insurers after the law takes effect.
The board voted to base Connecticut’s essential benefits
package on one of its most popular health insurance plans. The plan is offered by ConnectiCare, an
HMO. ConnectiCare has offered good health
insurance packages for many years – I was insured by ConnectiCare for many
years when I was a resident of Connecticut.
So far, so good.
But here’s the ironic
twist that makes you wonder if capitalism can survive health care, and if
health care can survive capitalism.
The one member of the board voting against the package was
the former CEO of ConnectiCare. His
reason was that the plan will provide to be too rich for many small businesses
and individuals to afford.
He was quoted as saying that small businesses would have to
drop insurance. According to the report,
here is how he put it: The essential
benefits were supposed to set a floor for insurers “but it’s like we’ve taken
an elevator to the 12th floor.”
Think about it.
If an insurance plan that provides fair coverage for
emergency services, mental health services, prescription drugs, pediatric
services, pregnancy services, and rehabilitation has become too rich for all
the people who need those services the most to afford – even with thousands of
dollars in tax credit subsidies – then what kind of an insurance market is
that?
And if Connecticut’s comprehensive, but essential, benefits
cost too much, then what’s your alternative?
As a Florida Congressman once got in political trouble for
asking, “dying quickly?”
If the ACA essential
benefits approach doesn’t work then there are really only two options left to
consider.
The first is to regulate the price of healthcare as
aggressively as you can.
The second is to create a Medicare-for-all system with the
leverage and muscle to decide how much it will pay for healthcare services no
matter what a provider wants to charge.
Both require significant governmental intervention. And neither is an endorsement of the kind of market-driven
capitalism favored by some candidates this year.
So why can’t all this still be part of our national campaign
dialogue about health care? Is the myth
of capitalism and “free” enterprise so strong that politicians can’t even talk
about how important the role of the government is in subsidizing our care and regulating
and managing the marketplace?
I’m just asking.
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