Check out this first rate piece in New York Magazine on “The Young Invincibles:
They’re young and healthy, and insurance is expensive. As long as they don’t catch the flu, slip on the ice, crash a bike, snowboard into a tree, rupture an appendix, or get hit by a bus, everything will be fine. Right?” Outstanding journalism by David Amsden. Best treatment of this issue I’ve ever seen. Great comments by Karen Davis from the Commonwealth Fund.
Interesting contrast between New York and Massachusetts (two highly regulated insurance markets). New York’s individual insurance market is based on “pure” community rating — meaning individual market insurance rates are the same for everyone, regardless of age. Better deal with folks 45-65, and worse deal for folks 18-39. Massachusetts has “modified” community rating, meaning rates vary by age constrained by a 2-1 ratio. Better deal for the young and worse deal with older folks. Which approach is better? On balance, we think the MA approach makes more sense because it makes is easier for the large number of younger folks to get it. But it’s sure open to argument.
Jon Kingsdale, last October or November admonished the Connector Board to eschew metaphor and allegory. For the longest time I wondered exactly what he meant, but I think I understand now. It is precisely the anecdotal, the metaphorical—no matter how realistic, no matter how real, no matter how well written—that stirs the passions when what we need is to inspire the rational.
Articles like that in New York may stir us, may even incite a novel thought, but they won’t put meaty health policy on the table. They won’t change the beer and donut consumption patterns of a couch potato. And they won’t put meaningful pressure on a key politician. To my way of thinking they amount to a kind of soft porn: they feel good, but they don’t do much.
The New York article is, without a doubt, well-written prose. And the juxtaposition of reports and factual materials from the likes of the Commonwealth Fund coupled with the observations about the consequences of pure community rating do work out to a compelling overall result. OK, pulling heartstrings in the popular press may just be the ticket to manifesting that groundswell of public discontent we need to REALLY get something done.
John, how good a job could that staff of yours do writing for a new reality-TV show!
Gerry, You’re right that anecdotes don’t necessarily tell the full policy story. But you could make that point about any article that uses real life stories. So, I’m not sure what your concern is about the article otherwise–are you raising concerns about community rating and modified community rating? Or something else? I agree with John that the article was terrific, so I am surprised by your response.
Nancy, I guess it’s just the sense of having fallen from that detached state of unimpassioned reason into the steamy pit that just is human. I am a romantic about my desire to be cold and logical. I want to always be in that unassailable position of being a logic-chopping, ethics-grinding Solomon. But, of course, if that were possible, I would NOT be human. So I guess articles like that in New York magazine will continue to pull at my heartstrings and I will continue to rail against the fact that I have any.
Too, as I have watched Jon Kingsdale during Connector meetings, I have marveled at the Solomonic wisdom he has wielded as emotionally-charged criticisms fly across the table alternating with rock-solid facts about the cruelty of healthcare. I take from his performance a lesson about just how to use a gathering of more than one to form health policy. His is a force to be admired.
As for the balance along the community-rating/age-rating axis, I’d guess there is no NEW thought or idea. The math, the social dynamics consequences, the implications for 20-somethings and 60-somethings are all pretty clear, predictable and, I suppose, on a rainy day, depressing.
Ho, hum.
Well, at least today is sunny.
Considering that as between the 20-something ans the 50-something, it is the latter that are more likely to need medical care and the least likely to be able to afford non-group coverage or even the Connector’s plans if they lack employer-coverage. As of the two groups, the latter age group who can not afford coverage are the more likely to not ever be able to recover financially given their age at the time of the onset of medical debt.
From 25 to 55 is 30 years and the premium basically goes up 400%. In Medicare the premium is he same for the 65 year old and the 95 years old- also a 30 year spread and also higher costs associated with the latter than the former.