Every so often, I remember Ronald Reagan fondly — not for his policies but for his skill at the art of persuasion. Right now, for example, I’d like to call the Gipper back to cock his head, give us that quizzical look and say “There you go again.”

Yes, there they go again. They are the defenders of the health care status quo — that is, the insurance industry and its protectors in both parties on Capitol Hill. And they have been frantically arguing these past few weeks that any coming reform of the health insurance system cannot, should not — and will not, if they have their way — include a public insurance plan that uninsured individuals can turn to if they find themselves without affordable insurance, or any coverage at all.

Maintaining what amounts to a monopoly on insurance for the working-age population has become a central goal of the insurance industry, which rightly fears that the government will provide more comprehensive coverage at a lower cost. This is, of course, the whole point of overhauling the insurance system. But never mind.

The industry worries that Americans will find out not only that government-supported health insurance isn’t a socialist catastrophe (see, for example, Medicare) but a fairer, lower-cost and more efficient system than the expensive, inefficient — and failing — market-based system we have now.

Insurers have gone so far as to offer to stop charging people with existing medical conditions more for coverage, if only Congress and the Obama administration would continue to go along with a system more like the one we have now than the one that we actually need. The goal is to have health insurance reform automatically give insurers access to more customers, but without the competition they would face if the government created a plan that offered better value. In other words, universal coverage (and the taxpayer subsidies that would presumably be required to allow uninsured people to buy policies) would benefit insurance companies at least as much as it would consumers.

In essence, this is what the proponents of such a system want: a new and “reformed” health insurance system that works essentially like ours does today.

But the very reason we are again going down the politically treacherous path of attempting reform is that the system we have doesn’t work, not by any standard.

At last official count, it failed to cover 45 million Americans. And that was before the recession struck with force, with millions losing their jobs and their insurance coverage with them. Based on Kaiser Family Foundation estimates, more than 6 million additional people have been left without insurance due to recent job losses.

Per capita health expenditures in the United States “are by far the highest” among the 30 countries that make up the Organization for Economic Cooperation and Development, in which the prevailing system of insurance is a national, government-supported health care system, according to a February study by three OECD economists. And though we pay more, we don’t get better health in return. “The overall health status of the U.S. population, as reflected in variables such as life expectancy and potential years of life lost, appears to rank among the lower third of OECD countries,” the report said.

We have known all this for some time. And for some time what we’ve done is take the same stale approach that relies on the private sector and the presumed magic of the market to cure our system’s chronic failures.

We’ve tried insurance-industry managed care. We’ve introduced private health savings accounts for individuals, and the use of private insurance plans in Medicare to provide both overall medical coverage and prescription drug benefits. None of these efforts led to more people being covered. None led to lower costs.

In fact, government data shows that the introduction of private insurers into the Medicare system has meant higher taxpayer costs for those beneficiaries who are covered by the managed-care plans, when compared with beneficiaries of roughly the same age and health status who remain in government-sponsored Medicare.

So far we have “reformed” the health insurance system by reinforcing precisely what’s wrong with it. To do this again would yield precisely the same result.

It wouldn’t be a reformed system. It would be just another way for the insurance industry to game the one we already have.

Marie Cocco’s e-mail address is mariecocco(at)washpost.com. © 2009, Washington Post Writers Group


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