Negotiate with AHIP vs. Best We Can Get 51 Senators For?

Originally posted here at 2009-03-09 16:20:07 -0500; all crossposts of items by Dr. SteveB are done with the good doctor's permission. Even the hijacked ones. :) Many thanks to CTMan for bringing this one over. -- GH

Hijacked in its entirety from DrSteveB at dkos.

Since we all want to get health some (any?) kind of health reform" we are being told by Washington insiders to set aside our advocacy for single payer and join in with the kumbaya negotiations with enemy (AHIP) to get 'er done. Sure, as a matter of policy and economics, single payer is the best way to reduce and control costs, and also get to universal comprehensive coverage. However, as a matter of realistic power politics, I am told by the powers that be that we can't do it this year, so we should settle for what is doable.

Okay. I'll bite. Let’s get the best plan we can get with 50% plus one in each house of Congress. And as usual, that means 51 Senators, since we have a larger and more probably liberal majority there.

But can we please please stop pretending that we can or should "negotiate" with AHIP? This idea that the private insurance companies are compromising is nonsense!


Ron Brownstein provides some happy talk in the Atlantic regarding talks between SEIU Andy Stern and Karen Ignagni, president and CEO of America's Health Insurance Plans, the industry trade association. Supposedly, there is a convergence around the goal of "universal" coverage with progressive calling for "guaranteed issue" while the insurance companies get "individual mandates." They are of course opposite sides of the same coin. The insurance companies would have to sell you an insurance plan product; the police power of the state would require you to buy it.

Brownstein does point out that the "only" thing left to negotiate is "affordability." Gee. Is that all?

Community rating is the term for setting the cost of a plan (your premium) based on everybody in the same insurance pool, and not basing it on your individual risk. It ends the practice of most insurers in most states charging different customers different prices (not just premium, but also deductible, copes, exclusions, etc) based on age, health status, location. This is important since even if they have to sell it to you, and even if you have to buy it, if you have a serious pre-existing condition (i.e. are actually sick and need care), they may charge you a million dollars to buy the plan. Or exclude your prior condition. Or set a million dollar deductible. Or 50% copay. Or whatever makes it so they can still make a profit, even if they have to sell you plan and you have to buy it.

Therefore, community rating helps a bit with this, though once again the devil is in the details. What is the community, that is the pool, on which your plan rate is set? Is it just the small company who is your current employer; in which case, one person getting sick increases the rate a lot for everybody? It is always better (for we the people) to have the community pool be as large and unselected as possible. Of course, the best would be a single big insurance pool covering all Americans. Hmmmm... I wonder if there is a name for something like that...?

Of course, if there were also a broadly available public option, open say to everybody, then the insurance companies would have to compete for your business.

So there has been lots of talk about AHIP compromising and being weak 'cuz everybody hates them. Yes, insurers ought to be operating from a position of weakness, and their business model is increasingly inadequate, and everyone should be able to imagine a health system without their participation. Alas, we have on our side Senator Max "lobbyists just want what’s best for America" Baucus negotiating for our side, who knows what we are going to get.

Actually it was pretty funny reading Brownstein's Atlantic piece about Andy Stern/SEIU trying to find common ground with Karen Ignagni/AHIP, having just read the NY Times a day before reporting just the latest collapse of the phony grand coalitions, with AFSCME and SEIU pulling out when AHIP & Pharma were signaling no compromise was possible on Public Option, and silence on Community Rating.

On the other Michael Hitzlitz gets it better than most in today's LA Times:

The genius of modern marketing is pouring old material into new packaging. Over the years this has given us yogurt in tubes, prechopped salad greens in cellophane bags and, most recently, the health insurance industry's new image as a friend of reform.

In December, the industry's trade group, AHIP (for America's Health Insurance Plans) revealed that it had experienced an epiphany and decided for the first time to support the principle of universal healthcare -- insuring everyone in America, regardless of health condition.

It described its change of heart as the product of three years of sedulous soul-searching by AHIP's board of directors, who claimed to have "traveled the country and engaged in conversations about healthcare reform with people from all walks of life."

As a connoisseur of health insurance lobbying practices, however, I withheld judgment until I could scan the fine print. What I found by reading AHIP’s 16-page policy brochure was that its position hadn't changed at all. Its version of "reform" comprises the same wish list that the industry has been pushing for decades.

Briefly, the industry wants the government to assume the cost of treating the sickest, and therefore most expensive, Americans. It wants the government to clamp down hard on doctors' and hospitals' fees. And it wants permission to offer stripped-down, low-benefit policies freed from pesky state regulations limiting their premiums.

As for universal coverage, which is the goal of many reformers (if not yet the Obama administration), the industry will accept a government mandate to take on all customers, as long as all Americans are required by law to buy coverage.


The insurers think government intervention is fine if it applies to customers they don't want. The way they put it in their reform plan is that we need a system that "spreads costs for high-risk individuals across a broader base" -- the base consisting of all taxpayers, that is.

Who are these "high-risk" individuals, by the way? At an AHIP convention last year, I heard a prominent industry consultant describe the customers the industry is desperate to dump on taxpayers as those with multiple chronic diseases, like diabetes sufferers with asthma or cancer patients with heart problems. He called these people "clinical train wrecks." (Nice way for someone connected with the "caring professions" to talk, isn't it?)

So how about this:

Insist that the CBO do an honest, complete, side-by-side comparison that includes true single payer such as John Conyers HR-676 United States National Health Insurance Act, and the alternative of a strong public option such as Pete Starks' HR-193 AmeriCare (keep what you have if want to; strong public option of expanded and improved Medicare otherwise), and whatever it is that HCAN, Obama and Baucus, etc are proposing as of now. Heck, for that matter, they should also look at whatever it is important Republicans such as Enzi or Grassley or AHIP are proposing.

And, then lets have a straight up and down vote... on the best plan that can get 51 senator (heck let's make it 50 + vice president Joe Biden; gotta give him something to do).

Let the Republicans (and if need be blue dog DINOs) block the best real reform we can get now. One option is to bypass the filibuster via budget or reconciliation. The other is to make them REALLY filibuster by having the Senate Majority Leader (I hear he is one of us) disallow or revoke Senate Rule 22 (which it is his power to do) and actually force them to vote.

No votes yet


At Salon:

How much less? Nations with comparable standards of living like France, Germany, Sweden, Finland, the United Kingdom, Canada, Norway, and Japan spend roughly between half and two-thirds per capita what we spend annually. They cover everyone and their results are measurably better. And the supposed downsides of universal coverage, such as lack of access to sophisticated medical technologies, are belied in many of these countries. For instance Japan has lower per capita health expenditures than the United States (and universal coverage,) but its citizens have greater access to MRI machines, CT scanners and kidney dialysis equipment than Americans do.

As the study suggests, our grossly inflated and poorly managed health budget results from a variety of pathologies, including a greater prevalence of obesity and other chronic illness, a powerful pharmaceutical lobby that keeps prices high, and the profit-making imperative of the private insurance companies that still dominate American health policy, more than four decades after we established universal coverage for the elderly and the poor. Looking forward, the OECD advocates many of the same incremental reforms contemplated by the Obama administration.

But it is difficult to imagine how the United States can afford to provide quality healthcare for all of its citizens in an era of diminished resources -- unless we look to the example of other democratic states around the world. Long ago, they realized that if healthcare is a public good and a human right, the domination of private interests must be curtailed.