“You Cannot Have It All”

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From Rick Ungar’s Policy Page at Forbes:

The Truth About Opposition To Health Reform

By RICK UNGAR

A new CNN Poll out today speaks volumes about what is bugging the country about health care reform.

The survey reveals that 59% of those polled oppose the health care reform law with only  39% in support.

But that’s just a small piece of the story.

When the numbers are broken down, it turns out that 61% favor the part of the legislation that prohibits insurers from dropping people when they get sick while 64% like the parts that stop private health insurance companies from denying coverage to those who have pre-existing conditions. We already know that the public supports the provisions that have already gone into effect such as allowing children to stay on their parents’ policies until they are 26, no denial of coverage to people under 19 because of pre-existing conditions, free preventative care and immunization, etc.

So what, exactly, is it that they don’t like?

You guessed it. 60% of those polled object to the legislation requiring that everyone who does not have health insurance be forced to buy it. Clearly, that is the consideration that is carrying the day as that number pretty much mirrors the overall number of those who oppose the law while favoring the remaining key elements of the law.

While you may be among those who object to mandated coverage – and I certainly understand the arguments against it- there is a side to the story that is being completely ignored.

Without mandated coverage, it would be impossible for insurance companies to provide coverage to those with pre-existing conditions and continue to stay in business as a profit making enterprise, unless the price of insurance premiums paid by those who are healthy become so expensive that it is virtually unaffordable by 99% of the nation.

Health insurance operates on a system of pooling risks. As a rule of thumb, 80% of the pool must be comprised of healthy participants in order to pay for the 20% who are sick. This ratio ends up leaving the insurance company a profit margin of somewhere between 2%-4%.

If the insurers are to be required to accept the huge influx of participants with a history of costly illness, they must either have a similar influx of healthy people to balance the ratio at 80-20 or charge vastly increased premiums to all participants. The only way to accomplish the number of additional healthy people to pay for the increased number of sick folks is to mandate coverage for pretty much everyone.

There is simply no way around this if we want to have those with pre-existing illnesses covered – unless, of course, you want to put the government in the business of providing health care to those with pre-existing conditions, thereby removing them from the private market pools.

This is one where you cannot have it both ways. If Americans are hell bent on opposing mandated health coverage (or if SCOTUS eventually finds that the provision is unconstitutional), then we must give up on the idea of private insurers covering those with pre-existing medical conditions or, alternatively, accept that government will be getting deeper into the business of health care.

So, you have to ask yourself –

Do you want to give up on providing coverage to those with pre-exiting illness, leaving these people to fend for themselves?

If your answer is ‘yes’, you need go no further. I would, however, caution you to keep in mind that there is a very reasonable chance that you may join the ranks of those with a pre-existing condition at some point before you reach the age of Medicare qualification. If you do – and you might be shocked to learn how small illnesses can keep you from obtaining a health insurance policy- then you too will find out what it is like to be on your own in the face of extraordinary medical costs. It isn’t pretty.

If this is not what you would wish for yourself, and you do want coverage for those with a pre-existing medical problem, then you must ask yourself if you are prepared to accept mandated coverage so that the private markets can provide the coverage, government issued insurance for those who cannot qualify for private coverage or dramatically higher premium costs for everyone who buys a policy.

Those are your choices. You can choose any one of them – but you cannot have it all.

So the next time you complain about ‘Obamacare’, be prepared to throw into the discussion your opposition to providing health care to those who have already been ill , including yourself should you be struck with an illness in the near future. Or, if you continue to support coverage for those with  pre-existing illnesses, be prepared to state your acceptance of government provided insurance for the previously ill or, alternatively , your support for huge increases in premium charges.

Anything less makes a conversation about health care reform only half of a conversation – and that just is not good enough.This is a serious problem and it requires serious conversation in order to reach a desired, if not perfect, solution.

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