For anyone interested in why the lack of sufficient risk adjustment will doom everyone to bad health insurance, I recommend this primer about risk adjustment from the Dutch Ministry of Health, Welfare and Sport. The Dutch health care system is probably the closest useful model to what Congress is trying to achieve with the new health insurance exchange. It says:
Risk adjustment is sometimes called the Achilles heel of the health care system. Provided that risk adjustment works properly, it is possible to reap the benefits of managed competition. If risk adjustment does not work properly, preferred risk selection will be rewarded instead. This may disadvantage vulnerable groups in society such as the chronically ill and the elderly, for whom a health insurer will not receive adequate compensation. Therefore, it is crucially important to compensate health insurers adequately through the risk adjustment system for identifiable groups of insured persons with predictably high care costs and vice versa.
To give you an idea of how robust the Dutch risk adjustment mechanisms are, just over half of all money spent on health insurance goes toward the risk adjustment health insurance fund. That is substantially more than what is proposed in any of the bills in Congress. The Dutch have a long history of using risk adjustment mechanisms in their health insurance and understand how critical the issue of adverse selection is to a working health care system.
The recent CBO report and the CMS report should be a powerful wake up call. The CMS concluded that a robust public option tied to Medicare rates would be so much cheaper that it could afford to absorb the 7% increase in cost due to adverse selection, and still provide high-quality, lower-cost health insurance. The weaker, negotiated rates public option would be only somewhat cheaper and be less able to easily absorb the flood of sick people who would be treated badly by for-profit insurance. Without much stronger risk adjustment mechanisms like the Dutch implemented in their system, no socially responsible insurance plan (be it public, private, or non-profit co-op) can survive with this problem of adverse selection. This is our Achilles heel which will insure health care reform creates bad health insurance for everyone on the exchange.





4 Comments

Support this site!
Subscribe to the newsletter
Advertise on Firedoglake
Send
us your tips
Make us your homepage
About FDL Action
The only risk Obama and the Congress are concerned about is the risk of offending corporate interests. They aren’t going to look at the Dutch plan or the Swiss one or any of the single payer models. They aren’t interested in what works. They are sutmbling all over themselves to be the first who sells out the most.
thank you! amen!
and even if the mechanisms were put in place by congress, how many people here think a bought and paid for administration who’s economic policy is run by mr. larry no-regulation summers is going to implement and enforce the kind of risk adjustment regulation that would be necessary to make this work? and that’s if the public option could even get off the ground, which is an whole other issue.
not me.
True that. Regulation is always cat and mouse. You’d have to appoint a dragon to enforce the adjustment. The public option could get off the ground if it were available to all Americans. But that isn’t what this show is about, is it? It’s about politicians covering their asses while they legislate for their corporate patrons and amass IOUs.
Excellent post. I’ve been wondering about this issue myself lately.