Securities analysts and Wall Street investors have come to what, to me, seems like a strange conclusion in recent years.
They seem to think that, for an insurance company, doing business with the federal government, or at least, with state governments, is a much safer way to earn revenue than to try to sell products to employers or to individual consumers who are spending their own money on premiums.
Of course, every known human civilization that has had a government, has had some kind of government or government-like intervention in health care delivery and health care finance.
Reasonable people can have different views about just how much the U.S. federal government and U.S. state governments ought to get involved with health care finance.
Those reasonable people might say, furthermore, that the federal government imposes so much regulation on the “commercial health insurance market” and on the markets for some commercial health-related insurance products other than major medical insurance — such as long-term care insurance (LTCI) — that those markets are actually more like single-payer systems with limited private-company involvement than they are like true free markets.
Regardless, recent developments have shown that, when the federal government does get involved, it can really be a jerk. It lures private companies into the Patient Protection and Affordable Care Act (PPACA) private exchange system by saying that it will offer a temporary risk corridors margin protection program, then it says, “Oops! No program,” or rather, “just 13 percent of the program we said we’d offer.”
The federal government strangled the old version of the Medicare Advantage plan, Medicare+Choice, by veering between Republican warmth for the program and Democratic coldness, and now, from an insurers’ point of view, it seems to be bringing winter back.
Today, long-term care (LTC) policymakers are talking about “public-private partnerships” for financing the baby boomers’ future LTC services.
It seems as if those kinds of discussions should be reasonable. But that raises the question: How can private companies of any kind get involved with programs that will require decades of investment and planning, and may require program managers to pay benefits for individual people for decades, if the “Game of Thrones wannabees” in Washington are always trying to kill the other party’s programs, even when ordinary people generally like the those programs?
And why should private companies get involved when, not only do the “Game of Thrones wannabees” strangle the other party’s programs, but they do what they can to strangle the poor vendors that dared to win the bids for those programs by making drastic changes in program behavior between the day the program receivable is booked and the day the program actually sends the check?
In the kind of semi-medieval, semi-feudal universe depicted in the Game of Thrones TV series, running a big, modern, corporate business or modern-style bank or investment company would be very difficult because marauders would soon swoop in and break everything.
In our current system, running a big, modern business that does business with the government is difficult because … marauders from the Democratic or Republican party will soon swoop in and break everything.
Certain socialists might be fine with that.
If any Republicans or non-socialist Democrats want private companies to get involved with helping the government solve the nation’s enormous health financing problems, then they need to develop some kind of treaty or self-enforcing peacekeeping mechanism that keeps Red, Blue or Purple versions of the Game of Thrones “White Walker” monsters from attacking the companies that dare to enter into long-term business relationships with the government.
Otherwise, what’s the point?
A big insurer might help build a flawed but well-meaning, useful, huge program and see marauders come in and knock it down because, increasingly, they see politics not as warfare continued by nonviolent means, but simply as war.
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Red, Blue or Purple versions of the Game of Thrones “White Walker” monsters from attacking the companies that dare to enter into long-term business relationships with the government.