Healthcare Insurance History

Last 21 Days ACA Healthcare History

On September 7th and shortly after Pelosi and Schumer decided to be nonpartisan and help Republicans who still had an ounce of decency to pass hurricane Harvey aid and set a new National Debt Limit, I wrote about the inherent dangers of being so magnanimous. Lets face it, during the Obama 8 years, Republicans made it a vow even before he took office to oppose everything coming from the other side of the aisle even refusing to participate in committee meetings. The ACA passed by Democrat votes only.

The danger with being nonpartisan with Republicans and passing good things which are beneficial to the constituency is you allow Republicans afterwards to concentrate on issues which will not favor the constituency or Democrats. Passing hurricane aid and a new debt limit did allow Republicans to get back to the more partisan effort of defunding the ACA and more money for the already rich through tax reform. The two are interlinked. The repeal passes funding for tax reform.

Angry Bear wrote on September 7 about the danger inherent in helping Repubs, wrote again on September 13 about Republicans being confident on defunding the ACA and its impact, again on September 15 about trusting Trump and Republicans with a hand-shake-deal, and last week on September 21 when Kimmel called Cassidy out as a liar and Krugman, other columnists, and blogs finally woke up to the impending danger of the Graham – Cassidy Bill.

Angry Bear called it early in the month on Republican treachery to defund the ACA. The vote will be this week before the 30th. I do not trust McCain. Hopefully, I am wrong on McCain.

Older Healthcare Insurance History

I thought this comment by a blogger was interesting to read as we wait for the Senate to take up the Graham – Cassidy Healthcare Insurance Bill which will defund the ACA if passed this week. I wander the blogosphere and I run into some interesting people from time to time. This particular commenter had a wealth of knowledge on healthcare insurance going back a ways. I have captured the commenter’s words to present them to Angry Bear. Hope you enjoy them.

“When, early in our adventures in managed care, I was marketing for clients like Sisters of Providence, who were attempting to set up their own managed care, non-profit PPO (which ultimately they did not see to completion), in the late 1980s, health care insurance was still non profit.

At that time ‘commercial insurers’ did not refer to health insurers at all. Commercial insurers provided for-profit RISK insurance — which health ‘insurance’ isn’t (and can’t be without defeating its original purpose; to help more people afford care while helping providers maintain expensive facilities and services). Health insurance was created as an additional way, beyond taxes and charity, to socialize increasing health care costs — to assure the healthy, self-interestedly, that the resources to meet their inevitable health care needs would be there when needed. And to ensure hospitals would have a revenue stream to help them maintain the increasingly sophisticated and varied resources to meet the modern care needs of their communities.

Although the first actual, modern health insurance program is credited to a hospital in Texas in the 1920 which contracted with school district employees to provide services to for a monthly premium (it was non-profit); proto-insurance schemes based on the same principle — asking healthy EMPLOYED people to contribute a modest monthly amount to cover care if and when they were injured or ill — were used long before. The Sisters of Providence, for instance, established the first hospitals in my part of the world, the Pacific Northwest, in the middle of the 19th century, offered loggers care for their not-infrequent injuries for a payment of $1 a month (this I understand having cut down trees while gaffing up them). The connection between health insurance and employment did not, as many people believe, just arise as a government idea with favorable WWII tax policies. It arose from a much older recognition of the reality that injury and illness compromise patients’ ability to work, earn and pay — and the recognition the employed, especially those in the more commonly dangerous occupations, had both the income with which to make regular payments and an incentive to make arrangements to provide for themselves, as eventual patients, with care when needed despite the economic vulnerability illness caused — while providing providers with resources that helped maintain facilities and services and workforce to provide that care.

Until the advent of ‘managed care,’ which deregulated the health insurance market in ways giving insurers a greater ability to limit who was covered and what was covered — to their own benefit (but not necessarily to the benefit of our social need for broadly available health care, or increasingly, premium payers’ needs either). In fact, commercial insurers avoided the health insurance market like the plague.

It was understood by everyone that there was no way to make a profit in it While still meeting policy holders actual needs.

Health insurance was created solely as a way to socialize costs for health care consumers.

It did and does not and can not work like a car, flood, or even life insurance where insurers work out, and profit from, fairly reliable actuarial probabilities about what percentage of policy holders are likely to ever make a claim, the likely length of time the average policy holder will be paying premiums before making a claim, and from those probabilities charge — and deny coverage — accordingly. People, the overwhelming majority of policy holders, will depend on health care coverage again and again and again — for services large and small — with more and more needs, and more serious needs, accumulating over time.

Inviting commercial insurers into the market as we did in the late 70s and 1980s, with managed care, was a big mistake.

But many countries, Germany, Switzerland, France, provide excellent, cost-effective universal systems that are not single payer — they rely in different ways on a networks of non-profit and public insurance. Although some countries allow for-profit insurers who provide some limited extra coverage, they are very limited.

I don’t think we should throw their examples out while looking for the best way for the US to provide universal coverage.

Especially considering how many Americans do receive coverage through insurance at work, and are happy with that coverage, and our long history with that method of socialization.”

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