Now, Sleepless in San Francisco

By Matthew Holt

Having returned from Seattle, the persistent itching from the sand-fly bites of Roatan has awakened me at 5 a.m. So I’m commenting on three pieces of news, which I've commented on before here and at Spot-On.

First, United HealthGroup has introduced two new things this week. One is is a consumer portal/WebMD competitor called myOptumHealth, which gave a sneak preview (and was a sponsor) at the Health 2.0 Conference in October.

At first blush I like the look of what they’ve pulled together, although the about us section doesn’t exactly tell you much about who owns Optum! But the really interesting product United launched this week was aimed right at me. It’s an option to repurchase your individual health insurance without being re-underwritten and rejected.

This is exactly the problem that I had a while back and for which I asked Spot-On readers for advice. It’s also a completely ridiculous problem that would be abolished in any sensible health reform process. United is therefore placing at least a small bet on no reform passing. Here’s the article I wrote explaining the problem, and here’s the news about United’s new offering.

Second, today well known young communist Ezra Klein is venturing bravely into the Cato Insitutute where newly expectant dad Michael Cannon and radical free-marketeer Glenn Whitman (a guess, as I don’t know Glenn) will try to beat him into submission by suggesting that for all the money we spend in the US, we get better health outcomes.

I have no idea why some people on the right keep going on and on about this despite all the data that shows the argument is largely crap, especially given the vast difference in what we spend here versus what them foreigners spend. But they persist.

Early last year, I answered the question, to my satisfaction at least, in this article, and as a bonus you only have to read the first half (although the second half explains the problem AHIP is re-introducing in the next paragraph)!

Third (and thankfully last), it appears that the forces are aligning for some kind of reform bill to be put up next year. AHIP has apparently decided that the plan it put together last year wasn’t good enough and has put out another one. As far as I can tell, it relies on the Shaddeg bill concept of allowing a cheapo high-deductible plan to be sold nationally.

I don't know how AHIP is going to reconcile that with its concurrent support for a ban on underwriting and non-exclusion of pre-exisiting conditions, when every insurer who sells those high-deductible plans now underwrites up the wazoo. But I await the explanation with bated breath. Then again, even if AHIP’s members employ the odd actuary who might understand this problem, I’m sure the work is carefully hidden from Karen Ignagni.

But this has got me thinking about how to ram some kind of real universal insurance plan through Congress, which takes me back to one of the better pieces I ever wrote on THCB called Why Hillarycare Failed. I particularly like my quote about how Johnson got Medicare passed:

Now Johnson had advantages. He had won a landslide; he had more Democratic Senators on his side (although many were very conservative); he didn't have to worry about the deficit and thus could afford to buy off his industry opponents, who of course were much weaker than they were 30 years later, and he wasn't going for universal insurance for everyone (just the most expensive ones). And of course he lied about the cost (Note that that worked for Bush in 2003 too!). But one lesson at least is, if you want to get something done, make it simple and get it done fast before opponents can get it together to stop you. So don't be too fussed about the details so long as it works for your overall principles.

Take a look at the piece, and think about whether 2009 is 1965 redux. And I guess if it is, everyone’s hair is about to get much much longer!