It's not too surprising that health insurers would be for mandated universal coverage, since under the current Massachusetts-led reform paradigm, it means guaranteed universal business for them. Why shouldn't they be for requiring everyone to buy stuff from them? As one health care wonk once told me, “You let the insurers compete on quality and price, they'll be on [reform] like white on rice.” (I don't know if he meant to rhyme …) Their cooperation/co-optation is baked right into the cake, in the new health reform vogue.
Of course, the insurers would certainly be against government competition for that business. And insurers would be against any regulation that they feel would compromise their ability to “manage” risk. Although they've agreed to guaranteed issue (i.e. they can't refuse to insure someone), they have not agreed to community rating (i.e. spreading risk around to the whole population, instead of sticking sick or risky people with unaffordable premiums). If they haven't agreed to it, you can damn well believe they'll fight it.
Let's be clear: No community rating is an absolute non-starter. It can't possibly be called “health care reform” if there's no community rating. We've had that mandated across age groups in Massachusetts for a while now — since well before Chapter 58. Does it make premiums more expensive for the healthy? Yup. Does it make them more reasonable for many, many people? Yup. Is it more just than soaking sick people — the ones who most need health insurance? Plainly.
A government mandate is a tradeoff for both sides — security in coverage for us, security in revenue for insurers. But when insurers reap the windfall, they should expect to be regulated pretty thoroughly. With administrative costs such a huge portion of the American health care dollar, they even ought to have some pretty strong regulation and oversight of their internal finances and loss ratios. If we all have to have insurance, they should be regulated at least as tightly as public utilities.
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As a side note … I'd like to point out the obvious of how things work in policy-making in Washington and other legislative bodies: You don't have a bunch of elected officials representing various large voting constituencies, all negotiating with each other on behalf of the interests of millions of their constituents at a time. No, you have some legislators who genuinely fight for the interests of the broad-based millions, versus some who are simply doing the bidding of a well-funded and well-connected few thousand folks. In other words, it is bizarre that we have to “negotiate with insurers” to get a law passed. The insurers have money and lobbyists, but they sure as hell don't have the actual number of warm voting bodies to swing an election. But hey, that's the system.
would be best served if Medicare was one of the options available.