Organ donors run risk of being denied health insurance
Eight years ago, Los Angeles resident Patricia Abdullah decided to donate a kidney to an acquaintance. She calls it one of the proudest moments of her life.There was a dialogue on NPR with some expert about how this was unfair and wrong, but it made me think, and I don't entirely agree. Under the current set of rules, if (and I stress the if) there is an actuarially-measurable risk related to prior kidney donation, it makes sense and is fair for insurers to price that into an individually underwritten policy. Why wouldn't they? Sure, you don't want to punish people for being altruistic, but Blue Cross shouldn't have to bear the responsibility for their insured's altruism. Maybe the transplant center or Medicare or someone should cover the costs down the road. I don't know.
Now she wonders what will happen if she can't find another job with group coverage. If she turns to the individual insurance market, will her act of compassion as an organ donor be perceived by insurers as a "preexisting condition," resulting in higher premiums or even denial of coverage?
But that got me reflecting on the notion of "pre-existing conditions" and then I read KevinMD's surprising and bold endorsement of the proposed ObamaCare:
[W]hat if reform doesn’t pass? It’s quite possible that preserving the status quo will be far worse for doctors going foward than the current proposals. I also believe that it’s important for doctors to “get a seat” at the table, lest they be marginalized further if they don’t.This also sparked some reflection on my part. As the political wars have heated up, I've gotten deeper into the policy weeds especially with regard to the public insurance option, which has become the flash point between right and left. But here's a little perspective: if we lost the public option, but got the rest of the package, how would the reforms look?
I cited a quote from Paul Krugman a few months ago, where he wrote something along the lines of, “the perfect is the enemy of the good.” He was referring to the single-payer supporters and grassroot reformers who felt that Congress’ proposals didn’t tilt enough to the left, and as such, oppose the current efforts.
I think that sentiment goes both ways. Some reform is better than none, and doctors advocating for a free market-based system shouldn’t hold out, hoping for the perfect package.It’s not coming anytime soon.
The answer is: pretty good.
Even absent the public option, the House and Senate HELP bills read like a wish list for liberals:
- Regulation of the individual and small group insurance market via a National Insurance Exchange
- Guaranteed issue (prohibits insurers from excluding people with pre-existing conditions)
- Community rating (prohibits ratcheting up the fees for those with pre-existing conditions)
- No recissions (prohibits insurers from rescinding the policies of people who become sick)
- Universal coverage via an individual mandate
- "Pay or play" employer madates to fund subsidies and encourage retention of employer-based coverage
- Sliding scale subsidies for those too rich for Medicaid but unable to afford insurance
Don't get me wrong: I still think a public insurance plan is a good idea and a critical element to include. It will make the cost of reform go down, no question about it. If we are going to "bend the curve" and try to rein in the escalating costs of health care, a public plan is necessary. There are also some gaps that need to be filled, like the IMAC proposal, which might also help control costs. So we are not done, and I hope Obama and the Democrats are able to keep the pressure on, hold their caucus together, and get a final bill passed with a mid-range public option intact. It won't be easy, but we are on track and in as good a position as we could hope for at this point (albeit behind schedule).