Comment by Don McCanne
Affairs, looks at European nations that use variations of market
exchanges of private insurance plans (Belgium, Germany, Ireland,
Switzerland and, especially, the Netherlands) to see what lessons on
risk selection they may have for the United States. But are these the
right lessons for us?
the healthy, with their relatively low health care costs, while avoiding
insuring individuals with greater health care needs. Although the
Affordable Care Act prohibits insurers from refusing to cover
individuals anticipated to have higher health care costs, we are seeing
insurance innovations in gaming risk selection that substitute for
medical underwriting, which sometimes still prevents patients from
receiving the care that they should have.
costs of the wasteful administrative excesses in our health care
financing. In fact, some of these excesses are for the very purpose of
ensuring the business success of the private insurers. So what
efficiencies do the European systems that use marketplace exchanges of
private plans have that might help the United States avoid the
perversities of favorable risk selection on the part of the insurers?
administration), systems to collect yet more data (more administration),
introduction of risk-sharing strategies such as mandatory
community-rated reinsurance or risk sharing between the regulator and
the insurers (more administration), allowing insurers to charge their
enrollees, within a band or range of acceptable charges, risk-adjusted
health insurance premium rates (more administration), and balancing
trade-offs of quality-skimping selection, efficiency, and affordability
of the trade-offs involved, further compromises in quality and equity
would result. No matter what strategies are used, the private insurers
will always find a way around them. That is inherent in their
European nations should be looking for lessons from our neighbor to the
North: Canada and its single payer model of health care financing. We
would do well to do the same."