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“A Market Of Systematic Discrimination”: President Obama Shouldn’t Apologize For Blowing Up The Terrible Individual Market

Last night, NBC’s Chuck Todd asked President Obama about the people losing their health insurance despite his promise that “anyone who likes their plan can keep it.” (See the video and read the transcript here.)

“I am sorry that they are finding themselves in this situation based on assurances they got from me,” Obama replied.

The answer is a bit of a dodge. People aren’t finding themselves in this situation based on the president’s promises. They’re finding themselves in this situation based on his policy. And Obama isn’t apologizing for the policy.

“Before the law was passed, a lot of these plans, people thought they had insurance coverage,” he said. “And then they’d find out that they had huge out of pocket expenses. Or women were being charged more than men. If you had preexisting conditions, you just couldn’t get it at all.”

Obama was wrong to promise that everyone who liked their insurance could keep it. For a small minority of Americans, that flatly isn’t true. But the real sin would’ve been leaving the individual insurance market alone.

The individual market — which serves five percent of the population, and which is where the disruptions are happening — is a horror show. It’s a market where healthy people benefit from systematic discrimination against the sick, where young people benefit from systematic discrimination against the old, where men benefit from systematic discrimination against women, and where insurers benefit from systematic discrimination against the uninformed.

The result, all too often, is a market where the people who need insurance most can’t get it, and the people who do get insurance find it doesn’t cover them when it’s most necessary. All that is why the individual market shows much lower levels of satisfaction than, well, every other insurance market:

(Graph by Jon Cohn)

Those numbers, of course, don’t include the people who couldn’t get insurance because they were deemed too sick. Consumer Reports put it unusually bluntly:

Individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with ‘affordable’ premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.

Jonathan Cohn puts a human face on it:

One from my files was about a South Floridian mother of two named Jacqueline Reuss. She had what she thought was a comprehensive policy, but it didn’t cover the tests her doctors ordered when they found a growth and feared it was ovarian cancer. The reason? Her insurer decided, belatedly, that a previous episode of “dysfunctional uterine bleeding”—basically, an irregular menstrual period—was a pre-existing condition that disqualified her from coverage for future gynecological problems. She was fine medically. The growth was benign. But she had a $15,000 bill (on top of her other medical expenses) and no way to get new insurance.

This is a market that desperately needs to be fixed. And Obamacare goes a way toward fixing it. It basically makes the individual market more like the group markets. That means that the sick don’t get charged more than the well, and the old aren’t charged more than three times as much as the young, and women aren’t charged more than men, and insurance plans that don’t actually cover you when you get sick no longer exist. But the transition disrupts today’s arrangements.

(Interestingly, recent Republican plans have focused on disrupting the employer market by ending, limiting, or restructuring the tax exclusion for employer-based plans. There’s an extremely good case to be made that that needs to be done, but it means much more disruption for a much larger number of people. Obamacare’s focus on disrupting the individual market — and only the individual market — is a more modest approach to health-care reform.)

There’s been an outpouring of sympathy for the people in the individual market who will see their plans changed. As well there should be. Some of them will be better off, but some won’t be.

But, worryingly, the impassioned defense of the beneficiaries of the status quo isn’t leavened with sympathy for the people suffering now. The people who can’t buy health insurance for any price, or can’t get it at a price they can afford, or do get it only to find themselves bankrupted by medical expenses anyway have been left out of the sudden outpouring of concern.

If people have a better way to fix the individual market — one that has no losers — then it’s time for them to propose it. But it’s very strange to sympathize with the people who’ve benefited from the noxious practices of the individual market while dismissing the sick people who’ve been victimized by it.

Obama is rightly taking flack for making a promise he wasn’t going to keep, and he’s right to apologize for it. But he shouldn’t apologize for blowing up the individual market. It needed to be done.

By: Ezra Klein and Evan Soltas, WonkBook, The Washington Post, November

November 10, 2013 - Posted by raemd95 | Affordable Care Act, Health Insurance Companies, Obamacare | Discrimination, Health Insurance, Individual Insurance Market, Under Insured, uninsured