If you're a health insurer in the United States right now, your worst nightmare is a 50-year-old woman with a slowly progressing terminal illness. Throw in some expensive cancer treatments or a long-term course of drug therapy and you've got the insurer's boogieman.
But never fear, the Senate has just swept in to save the day. Too bad the public is the one funding the white knight.
The new Senate health care compromise proposes two important changes to the existing health care system: an expansion of Medicaid and an expansion of Medicare. Those who are the very poorest members of a community -- including the homeless and chronically unemployed -- and those who are the oldest members of a community -- those over 55 -- will now be taken out of the private insurance system and rolled into the public insurance system.
Older people and poor people are at higher risk for serious illness and other costly health problems. They are expensive and risky and private health insurance companies don't like to have them on their roster.
Middle and upper class Americans under 55, however, are ideal clients. They can pay their premiums, they are at a lower risk for serious illness, and they are unlikely to cost more than they put into their insurance system.
So how is it that, after decades of health insurers who kick sick people off their plans, charge exorbitant rates, refuse to cover people with existing illnesses and lie and cheat to avoid paying out health care costs, the public has decided to relieve the private sector of all the costly and problematic clients.
We'll take on the risk, you enjoy a healthy pool of clients who are very unlikely to threaten the current business model. Sure, you have to pay out 90% of premiums collected in the form of health benefits, but we aren't going to let anything harm your profit margin. We're doing the best we can to take the risk out of the health insurance business.
The hope is that this will drive down insurance costs for the rest of the country. This hope (and we have had such a difficult relationship with hope recently) doesn't even come close to consider the extreme overburdening of a public system that deals only with the unhealthiest patients. It also is not a guaranteed rate reduction.
The Senate is about to take on the worst deal in history. And at the end of the day, the only winners are the same companies who got us in this mess in the first place.
*gratitude to Clayton Ruby for insight and inspiration for this column