Killing Us Softly With Mandates

This morning I snared a couple of polyps out of a patient on a screening colonoscopy. There was a time when the procedure would not have been covered in Alaska. That all changed with a bill passed in 2006.

Rep. Norm Rokeberg made the best point of the day when I testified for that Alaska bill. He pointed out his concern with mandates. At the time, I knew he was right. I justified my support based on what was already being mandated in Alaska.

The Council for Affordable Health Insurance reported in 2007 that there were 28 health care mandates in Alaska. That is twice the number of mandates that there are in Idaho (14) but less than half of the number (60) in Maryland.

No offense to the evil that is breast cancer but it kills less people in this country every year than colon cancer. Yet, 50 states mandate mammography and 49 mandate breast reconstructive surgery. Only 23 mandate colorectal cancer screening as of 2007 (I believe that number is up to 27 now). This only provides one example of how there is no rhyme or reason to the mandates.

Now, some of these mandates are there because a buzzard insurance company played a game and did not cover a patient appropriately. The problem is many, if not most, are there because a special interest got together and pushed for it.

If most plans in a state are not covering a service then a new mandate pushes up the cost of premiums. For example, with the Alaska colorectal cancer screening bill the mandate required coverage of the American Cancer Society guidelines. When an insurer must start covering a colonoscopy every 10 years at age 50 for their policy holders it adds expense. In the case of colon cancer the estimates are about $25K per year of life saved.

It is hard to argue against covering any kind of treatment. The issue is that mandates cause increases of premiums of about 45% nationwide. That number can go even higher. It has been estimated the cost of care costs 65% more in Connecticut with mandates.

It is easy to see how mandates could quickly drive costs to the point where affordability becomes a problem.

According to the Department of Health and Human Services, 5% of the population accounts for 49% of the health care costs in the US. That means the vast majority of individuals are not utilizing health care services frequently. Most people, especially the younger ones, need their health care for catostrophic illness.

When you are starving, a half of loaf of bread is better than no loaf at all. Part of the solution to making health insurance affordable is to strip it back down to the basics.

There are people living in fear of getting a horrible illness because they do not have insurance. What they really need is catrostrophe insurance. The last thing on their mind is colonoscopy. Mandates are a major reason why they get priced out of the market.

Mandates are a state issue. They often do not even achieve their goal completely. There were insurers that were not forced to cover colorectal cancer screening by the Alaska law. State retirees still are not covered for colorectal cancer screening.

As it turns out the driving up of costs may actually favor one insurer over another.

Plans need is to start with options where the bare minimum can be offered. More comprehensive plans can be made available for people who want to pay for them.

The minimal plan should offer some routine and preventive care. It should allow for the consumer to have options for how they want to use that coverage. If they want a lipid profile and a PSA instead of a mammogram than that should be their choice.

It also stands to reason that people who are not planning on using the system as much would want a high deductible which drives costs down. They also would likely want the opportunity to put money in a Health Savings Account (HSA) for later when they might develop a chronic disease.

There is some thinking along part of this in DC. One of the ways to pay for less inclusive plans that has been suggested is to tax the more inclusive plans.

The unions decided to keep their Democrat puppets in line and have complained about this provision. The whole idea should be scraped but it is likely the level will be set high enough to protect the union plans. This is just one example of how the plan is being twisted for special interests at every turn.

The idea of lower cost bare bones coverage is really no different than mandatory auto insurance laws. The solution can only be reached with health insurance by making that minimal plan affordable.

That will require some changes. The elimination of mandates and the setting of a new minimum standard is a good place to start. Allowing the people who are not utilizing the system as much to have high deductible/HSA plans would be another way to bring the cost down.

Some of this could be solved by allowing plans to be sold across state lines which would effectively kill the mandates. The federal government would than have to step in and provide guidelines on minimums.

There are people who would look upon this as providing some kind of inadequate care. It all depends on the definition of adequate and what would be offered. There is already wide variability in coverage out there.

It must be remembered this is only one aspect of building a plan that would work.

The devil is always in the details. Services that truly need to be covered and to what degree for basic needs would have to be defined. Unfortunately, in DC it may mean the interests with the best lobbyists would win.

Medicine is always a discussion of risks, benefits and alternatives. Insurance plans should be no different.