Wouldn't employers just dump their coverage, pay the government penalty and let workers use the public option? Would a public plan become overburdened with sicker-than-average folks?
Maybe. But could things possibly be worse than what we have now?
Across Maryland, employers are again seeing double-digit medical insurance increases.
"Some people say 10 percent is not that bad," said David Noel, senior benefits consultant with Group Insurance Solutions in Sparks. "Well, 10 percent is that bad. You're outpacing inflation. You're outpacing employees' gains in wages. And it's compounded over the years. Somewhere, somebody is going to hit their ceiling."
And many companies are doing much worse than 10 percent. An insurer just asked one small-employer client of Noel's to pay 47 percent more. The lowest increase I have heard this year for employers of any size is 8 percent.
"When I came into the business, there were probably at least 10 or 12 insurance companies selling health insurance to small businesses in Maryland," says Stephen Shaff, executive vice president for Employers Plus, a Baltimore-based benefits administrator.
That was in the 1980s. Now there are maybe half as many.
Shaff and other middlemen partly blame Maryland regulation, which in the mid-1990s limited how much insurers could raise or lower premiums based on the health of small-group members. That made the market less attractive.
But whatever the reason, there isn't enough health-insurance choice.
CareFirst blames continuing premium increases on rising health costs, but that's begging the question. With little competition, carriers have no incentive to drive down expenses. They just pass them on to customers.
Shaff and others I talked to for this column opposed a public option, arguing that a new government insurer might be a Trojan horse for getting rid of private insurers altogether. But how else will we start to control medical costs?
A modest measure to pay for counseling so families could choose to avoid expensive, heroic and dubiously effective end-of-life treatment got turned into a call for mercy killings by reform opponents. That won't be in the bill.
Republicans oppose "comparative effectiveness" studies that would reduce costs by identifying treatments that cost too much for what they deliver. Democrats oppose tort reform, which might keep lawsuits from driving up the cost of care.
Now they seem to be backing away from the public option. So we may get health "reform" that gives the insurance companies we know and hate millions of new customers, fabulous taxpayer subsidies and few cost controls.
That's a recipe for national bankruptcy. If we want to expand access to health care, making it unaffordable for everybody, including the country, may not be the way to go.
