Friday, April 9, 2010

Health Care for Corporations

Insurance dodgers headed to Canada?

By: Mike Krauss
Bucks County Courier Times

There are two ways to look at President Obama’s effort to reform health care in the U.S. One is that it is a sell out. The other is that Mr. Obama has taken a page from President Nixon’s playbook.

The sell out argument goes like this.

Prior to the legislation, health care in the U.S. was dominated by a system of private insurance characterized by out-of-control costs, driven by: a lack of primary care physicians, little or no competition among insurers in most markets, soaring prescription drug use and costs and a malpractice racket run by ambulance chasing lawyers, with the added costs of the resulting “defensive” medicine of endless tests and consultations.

The major feature of the legislation enacted by Mr. Obama and the Democrats is that it drives tens of millions more Americans into that system.

Drug manufacturers are supposed to lower some prices, but will of course raise others. The lawyers have been left unmolested and the insurers have been busy raising premiums, including among the young and healthy, to set a new floor for prices before millions more are forced to buy their policies.

It is true that insurers have been asked to insure the already ill – at higher premiums – and to please stop canceling coverage on technicalities.

But those two proposed “user friendly” measures will have to be policed and regulated. By who? Almost certainly, by federal regulators dominated by the industry, just like Wall Street and all the other “regulated” industries.

That’s the sell out argument. The other is more subtle.

The one provision in the “new, improved” U.S. health care system that will without a doubt be enforced is the requirement that all Americans have insurance – whether they want it or not – especially the largest group, the young and healthy. That is something the insurers will insist on. Corporate profit is at stake. And in the U.S. today, corporate profit trumps all.

Who will do the enforcing, and how?

Perhaps a new federal bureaucracy: the Health Insurance Compliance Division of the Department of Justice? More likely, the job will be outsourced to private contractors, set up by the insurance companies to bully consumers into accepting a new fraud – policies with “low introductory rates” and deductibles and co-pays so high, they will never be used.

I mean, there will be no incentive to offer a good product at a fair price. This is a sellers’ market. “These schmucks gotta buy one!”

But, how to ferret out the insurance dodgers?

Require proof of insurance on all job applications? That’s a no go. There are no jobs to apply for. Submit proof of insurance with tax returns? Again, with no jobs and income to report, or money with which to pay, especially among the young, lots of Americans will not be filing for a while. Submit proof of insurance with an application for a driver’s license or renewal? That may work. For most Americans, mass transit is not an option.

Or perhaps send inspectors onto college campuses and into workplaces? Random insurance checks on the highways, at baseball and football games or when boarding an aircraft?

“We got an insurance dodger here, officer. Lock him up!”

And how to make sure illegal aliens sign up and buy? There are millions, and the insurance companies will not want to leave them out.

However it is done, this enforcement is very likely to be as unpopular as the draft during the Viet Nam War. Which brings us back to Nixon.

Nixon wanted to end the Viet Nam War. His problem was the “hawks” on the right in his own party, the same crowd that wanted Eisenhower to nuke China, go to war with the Soviets in Eastern Europe and with Egypt over the Suez Canal.

Nixon needed a counter weight. He got it when he ended the exemption of college students from the draft, which mobilized the white middle class to oppose the war - the previously “Silent Majority” whom Nixon called out to support his war end-game, even as they were mobilized to hasten its end.

The man had a very sly sense of humor.

If compulsory insurance is as onerous as it is likely to be costly, “Obamacare” may mobilize the troops to end private insurance and institute a single payer system as candidate Obama promised.

It took the very able Richard Nixon his entire first term and more to get out of Viet Nam. If Mr. Obama comes back before 2012 for changes in health care that actually strike at the profits of the insurers, drug manufacturers and ambulance chasing lawyers, you will know he had a strategy to actually change and reform U.S. health care, and did not just sell out.

But either way, there will be time to decide how to deal with the insurance draft. Because it will be as unpopular as the military draft, there is no way it will be enforced until 2011 – after the Congressional elections.

Plenty of time to figure out a strategy: elect a new Congress to help Mr. Obama finally get the job done, or buy a one way ticket to Canada.

Mike Krauss is a writer and international logistics executive, and a former office of PA county and state government. Reach him at

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