Opinionated Thought

A health insurance lawyer takes on industry scare tactics

Politics - U.S.

By Erin Freiberg Erin Freiberg - Tue Aug 18, 5:00 am ET

Madison, Wis. - If knowledge is power, then it sure seems that the players involved with healthcare reform are doing their best to ensure an ignorant populace, vulnerable to manipulation by fear and political trash talking. Now President Obama appears to be bowing under pressure from the fearful public, willing to drop the idea of government-run insurance as part of a new healthcare system.

As an attorney with an insurance agency, I agree with some of the views of my colleagues, but I have been disheartened by the rhetoric surrounding the issue of expanding coverage.

Most of the healthcare proposals in Congress call for "guaranteed issue" that would entitle everyone to coverage regardless of health, an elimination or reduction of preexisting condition limitations, and limits on premium costs and increases.

These are concessions the insurance industry is willing to make in return for an individual mandate - a requirement that every American obtain insurance. Such a mandate assures the companies that it won't only be the sick they are insuring - healthy young people will have to buy insurance so the risk can be spread around. It makes sense.

The real controversy lies with the so-called public option that would compete with private insurers. Insurance companies and their Republican allies in Congress fear this. They believe that the government will set rates so low that insurance companies won't be able to compete, leading to a single-payer system where the government provides all health insurance.

Opponents of the public option characterize the plan as a "government takeover of health insurance," shrouding it in oversimplified generalizations and inflammatory statements. They warn that it is a "slippery slope" toward socialism. Apparently there is no bigger threat to America than socialism, because that word seems to scare off any reasoned debate.

Is introducing a public plan to compete in the healthcare marketplace really driving us toward a society void of private enterprise? Given America's long and proud history of capitalism, I highly doubt it.

The problem is not that there is opposition to the public option, but that many of the arguments proffered against it are disingenuous. Consider arguments such as "a government bureaucrat will stand between you and your doctor."

Every insurance policy I have worked with has very strict rules about the conditions and treatments it will cover, at what cost, which doctors can be seen, at which facilities, and requirements that must be met prior to approving treatment.

Though we have stayed in the same city, my own family has gone through three insurance changes in the last 18 months, and each time we have had to switch doctors. My uncle, who is on Medicare, is not jumping through hoops like I am to get healthcare - so think twice about which bureaucracy is standing between doctors and their patients.

Assuming, as the current House bill requires, the government will negotiate provider payments rather than tie them to Medicare rates, what are insurance companies really afraid of? A system of government, or shaking up the market (dominated by the two largest insurance companies in the country) and losing a share of profits?

I respect that an industry will lobby against something that hurts its interests, but I cannot accept the deceptive methods employed to fight it - let's be honest about what's going on here.

The final fear tactic: rationing. If, as the naysayers contend, a public option does someday lead to a single-payer system (though if insurance companies are right that they are less wasteful than the government, I can't see why it should), then care will potentially be rationed.

What the opponents of the public option fail to mention is that healthcare is already rationed in our country. We ration care based on who can afford it.

Individuals who are neither rich nor have government- or employer-provided coverage are left out. While they may eventually receive care in an emergency room or community-based clinic, they may not. For those who do, the costs are high and usually borne by others. For those who don't, the results are often tragic.

Because the majority of us benefit from the current system, the injustice of it rarely hits home.

Is a public option wise? Some politicians have claimed that a public option is necessary to keep the insurance industry honest. Honesty really isn't the issue; insurance companies are not villains. We should expect that left to their own devices, private corporations will be motivated by profit rather than philanthropy to act in their self-interest. A public plan, however, will force insurance companies to compete with the government for customers, keeping the companies on their toes to attract and retain business.

I agree that the pace with which this summer debate has been moving is a bit unnerving, and I understand why many in my industry are worried about being replaced by a computer - we have lives, we have families, and we do good work.

But as Americans debate the merits of the public option, dismissing an idea that may benefit society by labeling it socialist, or with fearmongering about a faceless government bureaucracy is counterproductive. There is too much at stake in this debate to reduce it to hyperbolic sound bites.

Erin M. Freiberg is a lawyer who works with health insurance, assisting clients with group health mandate compliance.