Thursday, August 06, 2009

Redefining Your Insurance

Back to reading the bill …

A central issue in the Health Care Reform Debate is the claim that people will be allowed to keep their current insurance.

Insurance is an interesting product. The product starts by examining a package of goods purchased by a given set of people through a given set of providers. The insurance company uses mathematical modeling techniques to extrapolate future consumption of the goods by the group. The insurance company then offers to cover the package of goods for the group for a set premium based on their analysis.

Looking at the health care bill, we find that it gives the government control in defining the group. As noted previously, it prevents your insurance company from taking on new customers. It also forbids the company from denying coverage to people with pre-existing conditions.

Section 111: A qualified health benefits plan may not impose any pre-existing condition exclusion

The bill gives the public option the ability cherry pick clients. Health and Human Services can thrust people with expensive pre-existing conditions onto those insurance companies with which they are engaged in business war while preventing the company the ability to grow and cover the costs.

The program gives the HHS the power to define the products covered. They define the minimum benefits of plans. It may include things that your current program does not. For example Section 114 requires plans to provide mental health and substance abuse disorder benefits. People who prefer to get such counseling through a church group must pay for those who want the service through secular programs.

Ha, ha. You have to pay twice.

Section 115 (ENSURING ADEQUACY OF PROVIDER NETWORKS) gives the HHS the power to scrutinize and define the provider network for your plan.

If this isn't pathetic enough, the bill gives HHS the power to redefine the formulas of the insurance company to define their formula.

Section 116(b). In implementing subsection (a), the Commissioner shall build on the definition and methodology developed by the Secretary of Health and Human Services under the amendments made by section 161 for determining how to calculate the medical loss ratio.


Your current insurance is really nothing more than an analysis of a package of goods offered by a given network of providers for a given group of people.

The health care reform gives the HHS the power to redefine the package of goods, the method of analysis, the network of providers and the group of people.

The bill gives the government absolute power in fundamentally altering every aspect of your current insurance.

The statement that people can keep their current insurance when government insiders capture the ability to redefine all elements of the insurance is one of the most audacious and cynical political sound bytes ever put before the public.

You don't get to keep your insurance when your government has totalitarian power to redefine it at the root level.

1 comment:

Reach Upward said...

I very much appreciate this series of posts on the nitty-gritty of the health care bill. Keep up the good work.