Elizabeth Edwards On The Inequitable Individual Market
Elizabeth Edwards On The Inequitable Individual Market
Our guest blogger is Elizabeth Edwards, a Senior Fellow at the Center for American Progress Action Fund and wife of former Presidential candidate John Edwards.
David Lazarus, in Sunday’s Los Angeles Times, brought us a fresh reminder of the challenges posed by preexisting conditions by raising a new one – being a woman.
Senator John McCain’s health plan is based on the idea that everyone should be on their own to buy their health insurance on the individual market. And it’s an approach fundamentally at odds with the point of health insurance: that we share risks. People with preexisting conditions, like McCain and myself, would pay much more for health insurance under his health plan, if we could get coverage at all.
Insurance companies have all sorts of characteristics they look at in order to increase premiums, such as preexisting conditions, occupation, age, and residence. But I hadn’t realized that the McCain plan would enable insurers to “rate-up” my insurance bill for not only my status as a breast cancer patient, but also my gender.
The ability to become pregnant has long been understood as an excuse to charge women more for health insurance (because, of course, men have nothing to do with that particular health condition). But what makes the Lazarus column interesting is that he tells us that insurers are charging women higher premiums even if pregnancy benefits are excluded. Blue Shield of California (Blue Shield) is now charging woman more in the individual market because:
“Our egghead actuaries crunched the numbers based on all the data we have about healthcare,” explained Tom Epstein, a Blue Shield spokesman. “This is what they found.”
That women get sicker than men?
“It’s all about the statistics,” Epstein said.
That doesn’t really inspire a sense of fairness. Doctors recommend that women have mammograms and other preventative screenings. Is Blue Shield really trying to discourage health screenings? Do they think that women are more accident prone? Whatever their reasoning, one thing is clear – they don’t want to enroll too many women:
“We don’t want to get a disproportionate share of high-risk people,” added Epstein.
As Lazarus noted, “by ‘high risk people,’ what he means is ‘women.’”
Blue Shield, a not-for-profit company, says they are just following the trend of for-profit insurers in California (at least two competitors already adjust premiums based on gender). Blue Shield exists in a competitive market that rewards insurers for doing the wrong things. In that sense, it isn’t fair to pick on Blue Shield in particular, especially since Blue Shield’s CEO speaks constructively on health reform.
The point is that the insurers have given us just another example about how the individual market is fundamentally broken. Embracing it as the solution to our health crisis – as the McCain plan proposes to – will only make matters worse.
15 Responses to “Elizabeth Edwards On The Inequitable Individual Market”
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Cute story, but thats the way the insurance industry works.
Tell me, have you forgotten that women pay less for auto insurance than men?
June 25th, 2008 at 11:10 amThis type of naivety is why our insurance system is so screwed up. EE clearly misses the point. It isn’t that women are sicker. It’s that decades of forcing insurance to cover routine expenses have turned what should be risk-protection into a horribly messy cost-smearing scheme. Women take more meds and get more routine checkups. They have more utilization and therefore more cost. It is painfully simple. You can’t complain about routine women’s care items not being covered and then complain that insurers want to charge more. Easier just to nationalize everything and leave common sense out of it.
June 25th, 2008 at 11:27 amWhat Ms. Edwards fails to mention is that trail lawyers (like her husband) are the REAL cause for outrageous and inefficient use of our medical dollars. The largest malpractice settlement ever in NC was to her husband John Edwards for suing a OB/GYN in a case that an overwhelming majority of OBs would go on record stating that it was NOT the fault of the OB in this case (but “that’s what insurance is for” according to what Mr. Edwards told the incompetent jury). This “settlement” was what allowed Mr. Edwards to fund his run as a Senator in NC (which he failed at miserably) Let’s have a hard look at all the UNNECESSARY costs in medical care (such as the legal expenses) and have a moratorium on these first (of course, this might make it hard for Ms Edwards to afford her 30,000 square foot house). My favorite liberal line in her rant above was the quote “That doesn’t inspire a since of fairness” with regards to the cost is based on MATH and STATISTICS. First, LIFE IS NOT FAIR (not a concept Liberals understand or can deal with very easily as evidence by Ms. Edwards comment) Statistics are basically FACTS – something liberals have a VERY HARD time dealing with – no room for wiggling or shaving the truth. Oh, my fault, the Edwards probably FAILED at Math and that’s why they became LAWYERS – BOTH OF THEM – and they don’t understand something like Freshman college statistics. They’ve never worked a “hard day” in their lives probably (at least not at anything that contributed positively to society) – but would rather sit around pontificating on how everyone else should live their lives (and take 30% in the process). Could we please have someone more informed and “intelligent” give the American people guidance of the subject of health care (as well as someone who is NOT part of the problem of driving up the cost of health care – what a ture liberal hypocrite.)
June 25th, 2008 at 11:29 amTktktk is right. That’s the way it works. You are still pooling risk. Imagine paying the cost of cancer treatments without insurance. It is fair. People who draw the most out of the healthcare system deserve to pay the most. Same thing with auto insurance or any other insurance. The market is not broken. Its actually very efficient and the fact is that this story proves that case.
June 25th, 2008 at 11:31 amindeed, women pay less for car insurance. but they pay more for tampons, birth control and hair stylists.
still, gender bias in car insurance rates raises a good issue. namely, how the insurance companies first began attempting to increase profits by doing away with notions of ’shared risk’.
er, i mean, how they ‘lowered costs’. any insurance commercial will tell you they only want to lower costs and not, as basic economic classes would tell you, to make money.
it began in earnest with car insurance. we bought the argument that risk-factors assessed were behavioral – thus under the control of the insured. controlling people’s behavior to control costs made sense, and was even downright american. now the health insurers are doing the same, but without constraining themselves to assessing people’s behavior.
it’s very logical: if it costs insurers money to take care of sick people, then one way to maximize profit is to insure as few sick people as possible.
some people think profiteering (or self-interest, if you want to pretty it up a bit) should be allowed at all times, under all circumstances, no matter what the industry does and no matter how much power that industry has in relation to its customers.
surely, those who support self-interest under all circumstances are also okay with OPEC’s (and/or the oil industry’s) right to limit production (or at least not raise it) in order to maximize profit. they must also be supportive of china’s government’s right to enslave its people and deny them free expression in order to accelerate the economic growth of the nation. after all, there is little difference between the leadership of china and the leadership of any major corporation. and there is certainly no difference between china’s hunger for wealth and our own.
some people think the tiger-eat-monkey world of the jungle is the best environment of all, as long as they have a nice place to live that protects them from the real madness of that jungle. fancy hair-splitting arguments aside, that’s really all most of these debates are about.
June 25th, 2008 at 12:06 pmI think we should limit payouts on lawsuits, this will eliminate the need for lawyers.
June 25th, 2008 at 1:00 pmFrom Europe: Excessive free market ideology might be destroying the fabric of your society. Access to basic health care (especially for children, but for adults too) ought to be a basic human right at least in a civilized society.
June 25th, 2008 at 3:46 pmYawn, the spin of politics never ceases to amaze me!
June 25th, 2008 at 6:32 pmhttp;//www.Ultimate-Anonymity.com
Some of you all are missing the concept. A birdbath in my backyard and an olympic-sized swimming pool are both ‘pools’. So, would you dive into both of them? Of course not.
EE points out the obvious at the outset of her post: the definition of insurance is something that POOLS RISK. Therefore, the bigger the pool, the smaller the risk to each individual. That is what insurance IS. If you have lots of smaller pools for insurance *everybody* needs – and especially if you have to make a profit – you defeat the purpose of insurance. It’s really not hard to understand.
I’d also point out that, a.) no, trial lawyer’s awards are not the reason insurance premiums have gone so high (I can prove that, but you can’t prove the opposite), and b.) patients have very little recourse if they are the victim of medical malpractice or corporate malfiesance, which is why people sue. I would bet anything that if anybody reading this blog got screwed over by a big corp or health system, you would be the first to hire an experienced trial atty. In fact, you would hire John Edwards if you could get him. You would hire a lawyer because you would probably be s—out-of-luck otherwise.
Certian people (GUESS WHO?!) have called for and worked on a Patients Bill of Rights, and other recourse for individual citizens, so there would be a possible alternative to a lawsuit, but some of you would rather fall for a line of bull from the Republicans you vote for, who tell you that it’s trial lawyer’s fault, and if we limit what they can collect for themselves (and for YOU), prices will come down. Sure they will!! Those Republicans get millions from…the insurance industry and corporations. Do you think they really care about you? Or about fixing the system?
It’s your right to vote for people who screw you over. It”s also your right to stick your own hand in a wood chipper.
have a nice day
June 26th, 2008 at 2:08 pmI’m Tom Epstein, the egghead quoted in Lazarus’ story. I appreciate the comments about how rates reflect actual costs, as well as Elizabeth’s recognition that Blue Shield of California is a progressive health plan that has long supported universal coverage. We have lobbied for six years to reform the system to insure everyone with community rating and without regard to health status. That would make all this discussion irrelevant. Lazarus is an aggressive proponent of single-payer and looks for opportunities to criticize how insurers do business.
June 26th, 2008 at 6:02 pmThank-you JPHR from Europe for your input: “Excessive free market ideology might be destroying the fabric of your society. Access to basic health care (especially for children, but for adults too) ought to be a basic human right at least in a civilized society.”
Yes, all political parties and political philosophies need to support that health care be a human right.
We want single-payer … as clearly seen in the facts about the Popular Support
Single-payer makes economic sense … as per the Costs and Savings
People in the current system are dying unnecessarily
Single-Payer Education inforums us that single-payer has so many benefits its amazing … although not so amazing to those in all other industrialized countries who have had it for many decades
We will finally get what millions of people in other countries already have … peace of mind regarding health care instead of fears and worries, bankruptcies, loss of homes, calls from creditors, divorces
We too can have Peace of Mind regarding health care.
We just need to get people taking action, as per the Schedule
Bob the Health and Health Care Advocate
June 26th, 2008 at 11:31 pmjonnybutter:
June 27th, 2008 at 12:50 pmInteresting comment on the size of the risk pools.
Individual insurers typically close off blocks of business, by issuing different policy forms.
Imagine what happens when a block of business is closed.
The healthy tend to switch, while the not-so-healthy tend to stay.
Compounding the problem is that when healthy people prove their insurability and switch out of the ever-dwindling pool, they receive discounts for proving their current insurability.
They obtain these discounts, whether they stay with the same insurer or switch to another.
So, by design, insurers, including Blue Cross, help to divide pools between the healthy and the sick.
That’s beneficial if you are healthy.
Don Levit
Yes, it’s beneficial to the individual who doesn’t (or thinks they don’t) need health care, and it’s beneficial to the company because they can still make money. Not so beneficial if you actually NEED the product being sold.
June 27th, 2008 at 5:31 pmjonnybutter:
June 28th, 2008 at 2:00 amAbsolutely correct.
Insurance companies set up the system to win the game over the long term.
If you are unable at some point to prove your health and receive the discount, you continue to pay the ever-increasing premiums.
Eventually, 95% of those people will probably have to drop the insurance, because it is unaffordable.
Don Levit
From Europe: So you let a predatory insurance system running wild. I guess you will have to regulate the insurance industry so it will deliver the desired product. Society has to define the playing field. Health insurance as a basic human right within a civilized society requires to pool all basic health risks as an expression of solidarity within that society. Are the USA really a society or only a predatory bunch of individuals and corporate interests?.
July 21st, 2008 at 9:25 amPoliticians have to take responsibility: 1) Society has to severely limit the practice of slicing the pools to the advantage of the insurance company. 2) Mandatory unconditional acceptance will be an essential part.
Citizens of the USA seem to desperately need some serious consumer protection and not only with regard to health but mortgage, credit card, environment etc. too.