Worst Health Coverage? Medicare? Medicaid? Employer? Private? The Votes Are In

Ezra Klein: 

Those numbers, of course, don't include the people who couldn't get insurance because they were deemed too sick. Consumer Reports put it unusually bluntly:

Individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with 'affordable' premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.

Jonathan Cohn puts a human face on it:

One from my files was about a South Floridian mother of two named Jacqueline Reuss. She had what she thought was a comprehensive policy, but it didn't cover the tests her doctors ordered when they found a growth and feared it was ovarian cancer. The reason? Her insurer decided, belatedly, that a previous episode of "dysfunctional uterine bleeding"--basically, an irregular menstrual period--was a pre-existing condition that disqualified her from coverage for future gynecological problems. She was fine medically. The growth was benign. But she had a $15,000 bill (on top of her other medical expenses) and no way to get new insurance.

This is a market that desperately needs to be fixed. And Obamacare goes a way toward fixing it. It basically makes the individual market more like the group markets. That means that the sick don't get charged more than the well, and the old aren't charged more than three times as much as the young, and women aren't charged more than men, and insurance plans that don't actually cover you when you get sick no longer exist. But the transition disrupts today's arrangements.

(Interestingly, recent Republican plans have focused on disrupting the employer market by ending, limiting, or restructuring the tax exclusion for employer-based plans. There's an extremely good case to be made that that needs to be done, but it means much more disruption for a much larger number of people. Obamacare's focus on disrupting the individual market -- and only the individual market -- is a more modest approach to health-care reform.)

There's been an outpouring of sympathy for the people in the individual market who will see their plans changed. As well there should be. Some of them will be better off, but some won't be.

But, worryingly, the impassioned defense of the beneficiaries of the status quo isn't leavened with sympathy for the people suffering now. The people who can't buy health insurance for any price, or can't get it at a price they can afford, or do get it only to find themselves bankrupted by medical expenses anyway have been left out of the sudden outpouring of concern.

If people have a better way to fix the individual market -- one that has no losers -- then it's time for them to propose it. But it's very strange to sympathize with the people who've benefited from the noxious practices of the individual market while dismissing the sick people who've been victimized by it.

Alan: The better way -- the only way -- to fix the individual markets so that "no one loses" is single payer healthcare. The following National Geographic graph tells the tale. http://paxonbothhouses.blogspot.com/2013/03/national-geographic-chart-of-per-capita.html

Obama is rightly taking flack for making a promise he wasn't going to keep, and he's right to apologize for it. But he shouldn't apologize for blowing up the individual market. It needed to be done.