The CBO contention that the public option would offer premiums rates higher than that of private insurance in the exchanges implicitly assumes that private insurers would not take all comers or welcome sick patients – and that they would get away with it.
Ezra Klein explains some of the logic behind the score.
To translate some of that back into English, the public plan will pay prices equivalent to those of private insurers and may save a bit of money on administrative efficiencies. But because the public option is, well, public, it won’t want to do the unpopular things that insurers do to save money, like manage care or aggressively review treatments. It also, presumably, won’t try to drive out the sick or the unhealthy. That means the public option will spend more, and could, over time, develop a reputation as a good home for bad health risks, which would mean its average premium will increase because its average member will cost more. The public option will be a good deal for these relatively sick people, but the presence of sick people will make it look like a bad deal to everyone else, which could in turn make it a bad deal for everyone else.
The nightmare scenario, then, is that private insurers cotton onto this and accelerate the process, implicitly or explicitly guiding bad risks to the public option. In theory, the exchanges are risk-adjusted, and the public option will be given more money if it ends up with bad risks, but it’s hard to say how that will function in practice.
Ezra tries to turn this into a quasi-defense of the insurance companies, but what he seems to be saying is that sick patients with access to the exchanges would flock to the public option because it would provide more reliable service to them than private insurance. Indeed, this assumes that private insurance will try to violate new federal laws that ban discriminating against sick patients. The risk adjustment is probably not enough of a deterrent for the private insurers, and they would rather find ways around the law to dump patients onto the public option.
I agree that this would mean that a public option as a dumping ground could be worse in practice than a world without a public option at all. What’s more, that could turn people off to public plans in general, although the culprit would be the private industry.
I’m trying to square this with the insurance industry’s insistent opposition to a public option. Perhaps the industry believes that the policymakers would fix the adverse selection problem down the road, either with enforcement or risk adjustment. But as it exists now, it would be a great safety valve for them. Jon Walker has great posts on this here and here.
The only way to combat this is through strict enforcement of non-discrimination rules. The regulatory enforcement of patient dumping would be likely to go through the National Association of Insurance Commissioners, at least as it stands in the Senate Finance Committee bill. But they have long been seen as tools of the insurance industry.



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Don’t worry, I’m sure those anti-discrimination rules will be removed from the final bill through amendments. Then the private insurers won’t be doing anything illegal.
it doesn’t take violation of the law.
here’s a simple example, the insurance company includes a really nice membership to the gym as a benefit to attract new customers. who is going to be attracted to such an offer? younger, healthier customers.
this is the kind of thing insurance companies do to compete (they also practice denial of care) on cost. they are experts at it.
nope. not enough. risk adjustment is where the action is. not to worry though, i’m sure the industry lobbyists won’t try to game the system on that. and even if they tried, i’m sure our bought and paid for gov wouldn’t let them. /snark
sorry to be so obnoxious about this point (and not directed at you dday), but this is one of the very important weaknesses of a public-option-in-a-multi-payer-system (if it should even be able to get off the ground) and there are lots of healthcare policy experts who have been making this point for a very long time (i know, if they are single payer advocates they can’t be listened to. that there are lots of experts who are single payer advocates BECAUSE they are experts on the policy doesn’t seem to register).
Believe it or not, the public option can be BOTH a dumping ground for the sick and a drag on private insurers.
The reason is that a private insurer’s worst-case scenario is ALWAYS to be stuck with a lot of sick patients. Risk adjustment never makes you 100% whole. So insurers will try to avoid them no matter what regulations are in place.
If you have a risk adjustment mechanism, then not only do insurers have to try to get rid of the sick, but they also have to try to cover their tracks so it looks like the patients they have are sicker than they really are.
All of this subterfuge costs everyone money, and it one reason why a weak public option is probably worse than none at all.
i’ll refrain from linking to single payer advocates. instead, here are a couple of diaries from scarecrow explaining some of the issues involved:
http://seminal.firedoglake.com/diary/9592
http://seminal.firedoglake.com/diary/8870
“But they have long been seen as tools of the insurance industry.” ;say no more,wink,wink.
Isn’t time everyone start questioning if the CBO can actually provide non-partisan analysis?
Where is the scoring for single payer??????????????
and not just the fed portion – total national health expenditures including costs to households, employers, state and local gov. single payer financing all goes through the fed gov. if only fed gov data is scored they can make it look bad if they want to (even though it should be the best by far).