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Tuesday, Apr 24, 2018
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Letter of the Day

Digging beyond a convenient excuse

Much attention is rightly being paid to the thousands who have received notices of cancellation of their health insurance policies. The dislocation being caused in all these lives is considerable and is very concerning. However, all the blame seems to be directed to President Obama (who amended the rules last week in response). And in the sense of Harry Truman’s dictum “The buck stops here,” this is understandable.

But this is a much more complex problem, and it is deserving of much broader analysis than has generally occurred in the public airways and in the media.

Largely unexplored is the role of the health insurance companies in contributing to, if not actually creating, much of this crisis.

Being able to terminate policies that are not fully compliant with the Affordable Care Act (ACA) may serve as a ready excuse for ending policies that are less profitable, and forcing people into more costly higher-profit policies, often with different and perhaps lower-cost providers, all under the cover of “It’s because of the ACA requirements.” Left unexplored is the question of whether existing policies could have been made ACA-compliant without being altogether discontinued, perhaps with much more modest cost increases.

It is easy — and fashionable these days, not to mention often politically advantageous — to blame government, and to proclaim the ACA “a train wreck.” It is much harder to delve into the inner workings of the insurance companies to consider what their options were, and how they may have exploited this transition period for their own economic advantage. A complex problem like we have now deserves broad-spectrum inquiry and investigation, but this has been largely lacking.

When health care reform was being debated legislatively, there were many who called for a “single-payer plan” or, as a fallback option, a “public option.” Either of these would have avoided or enabled solutions to most of the problems we see now with these policy cancellations. The Obama administration and the Senate Finance Committee chose to side with the health insurance industry and leave their central role intact. Is this, at least in part, an instance of “No good deed goes unpunished?”

Edward H. Stein, M.D.


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