Health care consulting, health strategy management and marketing communications, and healthcare policy analysis. Serves insurance, HMO, medical, consumer advocacy, foundations and other clients. Provides strategy, reports, articles and strategic implementation. Principal is Kathleen O'Connor, incorrect spellings include Kathleen O'Conner, Kathleen Oconnor, Kathleen Oconner, include Cathleen O'Conner, Cathleen Oconnor, Cathleen Oconner. Web site is oconnorhealthanalyst, not healthanalyst. Publishes the O'Connor report monthly. Author of "The Buck Stops Nowhere."

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Insurance not just for healthy, wealthy

by Kathleen O'Connor
Special to The Times

Hidden behind the gibberish of insurance terms like pre-existing conditions, guaranteed issue and portability, is the fight to restore insurance options for individuals. Because insurers could stem their financial losses in the one market they could close, they simply stopped offering new individual policies. Now, 600,000 people - roughly the population of Seattle - have no chance of buying insurance in 31 of our 39 counties. And 250,000 people with individual policies live in fear of losing theirs.

Insurers say they are losing money because people jump between policies, or buy insurance, then use it to pay for maternity care or a knee replacement and leave. Insurers say this leaves them holding the financial bag because premiums didn't cover their costs.

But this is equally true of the commercial market, which insurers cannot afford to lose. Employers act just like individuals. They buy a plan, use it, and when it becomes too expensive, they drop it and shop around for another insurer. If individuals are culpable in how they behave, so are employers.

So the issue is not behavior. It is the bottom line and who is in whose risk pool.

The Dark Ages

Like medieval walled cities, insurance risk pools are designed to exclude the dangerous and protect those inside. They assume those inside are familiar and safe, and that outsiders, if taken in, will either contaminate them and/or use up resources and drain the treasury.

So large employers, like Boeing or Washington State, have their own risk pools, small businesses have theirs and some businesses band together to get better prices for their members.

Safety-net programs, such as Medicaid for the poor and Medicare for the elderly and disabled, have taken those who tend to use more services out of the commercial market and put them into separate pools.

The 250,000 individual policyholders are grouped into yet another pool, but are easy prey. They number relatively few and have no organized voice. The 600,000 waiting to get insurance also have no organized voice or rallying point.

Each group tries to protect itself by keeping others out. But because each of us acts in our own economic self-interest, we build more walled cities and have unintentionally created morally suspect choices.

Moral choices

It's not that insurers don't want an individual market. They just want one that is more predictable and healthy.

So now, to open up the individual market, a health screening is proposed for new applicants. If someone has a chronic disease or health problem, they will be routed to the Washington State Health Insurance Pool (formerly, high-risk pool) where their costs will be partially subsidized. And the pre-existing condition term will be extended to nine or 12 months rather than the current three. This compromise may be the only way to get an affordable individual market now.

But, what this all means is that those programs we once created as safety nets have become the moral equivalent of leper colonies. We put the old and disabled here, the poor over there, take those who can afford it in part and put them into the Basic Health Plan and ban the sick to yet another colony.

All this to hold down the costs of the commercial market. And who of us is to know when we or someone we love will become disabled, poor, sick or old?

Shame on us.

Feet to the fire

We are close to compromise on the individual market. So compromise we must, now. But after these proposals pass, we must find another way. We are morally bound to find solutions other than casting people into leper colonies based on income, age or health status. After all, who among us would choose to have multiple sclerosis, diabetes, leukemia or cancer?

If we take the course to give options to 600,000 people, then we must find ways to stop dividing the insurance market so it is not just for the wealthy and healthy. We are better than that as individuals, as a society, as a state.

If we do this, and reluctantly, I think we must, then it is the absolute duty of each of us to demand that the governor appoint an interim citizen task force to find less morally culpable solutions. Many suggestions have emerged, but cannot be dealt with in the haste of a 90-day session. Options exist. It does not take rocket science; it does take political will.

There is no one bad guy to blame. No malevolent intent created this "system." We are all responsible for what has emerged from a self-interest driven system. But now is the time to say this is wrong.

Martin Niemeuller, a Protestant minister, said it best when talking about the insidiousness of the Nazis: "When they came for the Jews, I was not a Jew, so I said nothing. ... When they came for me, there was no one left to protest."

So, which pool are you in now?

Kathleen O'Connor is a health-care industry analyst, consultant and writer with more than 20 years' experience in various sectors of the health-care industry.

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