On the Third Hand: Stress list

The people inside HHS and its Centers for Medicare & Medicaid Services (CMS) division are clearly having knockdown fights over all of this stuff. But we never get a milligram of the information needed to figure out who at HHS or its divisions has even a small clue as to what’s going on, or any evidence that any part of HHS is sincerely interested in working with insurers to make the exchange system work properly.

The statement HHS released Thursday about how well the exchange system is working actually conveys an idea that completely contradicts the apparent thesis of the statement. HHS officials seemed to want to convey the idea that the exchange system is doing fine, but, instead, the message is that they’re ignoring insurers’ complaints.

The statement also conveys the ideas that HHS officials probably wouldn’t understand insurers’ complaints even if they were listening; that they’re not making any effort to let insurers come up with their own exchange system rescue effort; and, really, that they’re mostly just going out on job interviews. Why would they waste their job board search time trying to figure out something as complicated as the exchange system?

3. It’s fine for the health insurers if the exchange program flops, because the insurers still have huge, profitable Medicaid and Medicare operations. Uh, right. Because we all know that Medicaid and Medicare are so completely independent from the governmental entities that created PPACA World, and we know that the Medicaid and Medicare systems are so wonderfully immune from government intervention. 

I mean, OK. Maybe, whatever the risks that are involved with turning health care finance over to the government, we should have a single-payer, government-run health insurance system, at least for some kinds of basic health care needs, for moral and practical reasons. I don’t really agree with that, exactly, but, in practice, I’m too soft to want us to let people with broken legs die on the sidewalk. That means, implicitly, I’m in favor of at least enough of a single-payer charity care system to pay hospitals for part of the cost of caring for people with broken legs who are lying on the sidewalk. 

But: Whatever the morality of government health care programs, and whatever benefits they might possibly have for the patients, or for society as a whole, they’re not necessarily great for private insurance companies. I think insurers that are joyous about the idea of trading a messy, dysfunctional, freeish commercial market for the glories of bidding for giant government plan contracts subject to election-year whims may end up wondering what they were smoking.

4. Returning to medical underwriting and risk pools for people with high blood pressure will be peachy keen. There are some general pockets of support out there for penalizing high-income people who go without health insurance, then suddenly want health insurance after they have heart attacks.

But I don’t think a single person outside of the health insurance community, and, possibly, the diehard Ayn Rand objectivist community, is enthusiastic about a return to the days when health insurers were rejecting applicants over common health problems, and scouring the applications of new enrollees who developed serious health problems for signs the enrollees had failed to report care for acne and hangnails.

Those wonderful days when people with diabetes or cancer who ended up in the risk pool in California had a $75,000 annual cap on benefits, and when people who had diabetes or cancer in Illinois had to wait years for a slot in an oversubscribed risk pool program.

So, on the one hand: argh.

On the other hand, I don’t have any great answers, either. Everyone is right. Health policy life is unfair.

On the third hand, if HHS would just stop issuing those idiotic statements about how great everything is working, and PPACA exchange defenders would stop boasting about how much the insurers still in the exchanges love the exchanges, that might at least make the fundamental unfairness of health policy a tiny bit less annoying.