Health Care - Republican's one idea

Recently someone asked me for my thoughts about opening the purchase of Health Insurance to out of state located, out of state regulated, providers as proposed by Senator Burr, Congressman McHenry and others.

1. Senator Burr proposed, and Congressman McHenry has embraced, this buying across state lines just to avoid being called the Party of No. In fact they have no other ideas. In two McHenry Town Halls and a Chamber Forum that I have attended, McHenry first gets everyone to admit that Reform is needed. He tangentially and conditionally concedes the issues of portability and pre-existing condition exclusion. Then his only new idea is this open-market one, presented with little discussion. After that he is just critical of everything the Democrats have proposed.

2. This open-market concept, as proposed, is nothing more or less than Reganomics and de-regulation revisited. The only regulation now is at the State level. Without comprehensive reform, the industry has shown that it has the power in Washington to pull the teeth of any attempt at Federal Regulation of the private insurance market.

3. This open-market proposal, like ones before it in energy and transportation, will lead to further consolidation and un-regulated shenanigans that hurt the public.

4. This open-market proposal may well spell the end of the non-profit Blue-Cross/Blue-Shields like the one in North Carolina. Your employer gets an alternate sweetheart proposal from the Podunk State Blue-Cross/Blue-Shield, a private corporation. You, as employee, hardly notice the difference until you have to sue in Podunk state when there is a problem. I think the big national providers will especially target any remaining non-profit BC/BS units. The non-profit is more constrained in how it can spend its money for lobbying and advertising and sales commissions. The big guys are afraid of the non-profits because they know they are one step away from a public option. Good-bye.

5. One of the biggest problems in a Medical Office is the proliferation of forms, treatment standards and authorizations. Now in NC there are just a few. This open-market as proposed adds to rather than reduces paperwork, complexity and Office overhead.

6. States love to have businesses like a major insurance company's headquarters operation as employers and taxpayers. This will begin a "race to the bottom" as various states strive to have the least regulation and attract the industry to concentrate their health insurance units with them.

7. I heard Jay Rockefeller, D Senator from W.VA on this topic today (9/18/09) on Charlie Rose. He was very much against it. He confirmed that different states had different levels of regulation. He compared W.Va. and Oklahoma. He said W.Va. had a high level of regulation and Oklahoma almost note and that providers located in Oklahoma would have an unfair advantage.

8. Employers have long used health-insurance to bind their workers to the job. Making the health- care provider and regulator more geographically and legally remote increases the strength and entanglement of these bonds.

9. I have emphasized "as proposed" because properly regulated competition is not bad. We cannot know what the "health care exchanges" or other mechanism yet to be introduced might provide. However, I am concerned about "interstate commerce" and "states rights" complexities and long lasting suits that might follow from the open-market inclusion in a poorly written health care reform law.

10. This proposal, and nothing else the Republicans say, changes the health care industry incentive to create "cherry picked" work groups that exclude older and "pre-exist condition in family" workers from employment. This creates a permanent un-employable class and a rush to early retirement that is an un-necessary burden on Social Security and a loss of valuable work skills/experience for our industry.

Steve Ivester
Hickory, NC