Blue Cross Out At Kelsey-Seybold: Another One Bites The Dust

Blue Cross Out At Kelsey-Seybold: Another One Bites The Dust


Leonard Zwelling

         On Friday morning, July 29, The Chronicle’s front page announced that over 100,000 Blue Cross and Blue Shield of Texas insured people would lose access to Kelsey-Seybold doctors. This is attributable in part to the lack of profit derived from those gaining access to insurance through the ObamaCare exchanges. (That’s called the MLR or medical loss ratio. It’s the amount of money the insurers have to pay out to actually care for the sick people they cover. They want to keep it as low as possible and it obviously got too high.)

         This problem was also identified in an editorial in the Chronicle on August 2 which noted the marked increase in premiums requested by Blue Cross and Blue Shield. This is estimated to affect 600,000 policyholders. As Jerome Greener notes in the editorial, this is the inevitable consequence of ObamaCare and its demand to include everyone in the insurance pool without real risk adjustments at the premium level. (There are risk adjustments and risk corridors and reinsurance that redistribute dollars from the more to the less profitable insurers, but not real rating based on the likelihood of needing coverage).

In general, premiums throughout the country are on the rise because if the insurers are not permitted to rate the risk of needing coverage of the insured to determine their premiums, then they will either raise everyone’s premiums or drop the coverage completely. The latter is starting to occur. The former already has.

         This was totally predictable when one remembers that “everyone’s definition of health care reform is the same—I pay less,” a quote from American Enterprise Institute scholar Norman Ornstein.

         As much as Mr. Obama and Mrs. Clinton talk about access to affordable, quality health care as a right, it is still a privilege in the United States. Get a good job or have enough money and you can be insured. Be poor or ineligible for insurance (e.g., ineligible for ObamaCare because you are not a legal American) and you are out of luck.

         This is no health care system and no one should pretend that it is.

         This only bothers me because it appears as if getting this right is no longer a part of the national debate. Congress is unlikely to revisit health care reform unless Mrs. Clinton wins and she sweeps in a Democratic Congress with her, very unlikely in the hopelessly gerrymandered House of Representatives. Health care reform was a mere blip on the agenda of either convention and it is not the major concern of most Americans. That’s unfortunate because that means raw capitalism will be in play in the health care-industrial complex and patients and doctors are likely to be the big losers to large insurers, big pharma and large hospital chains. Heck, Anthem wants to merge with Cigna and Aetna with Humana leaving the country three major insurers (United would be the third). The government is moving to block the mergers as anti-competitive. We will see.

         In your comings and goings and discussions about how dictator Trump, aka The Fearless Leader, might govern, keep in mind this problem has not improved much under Obama despite what the current President or his Democratic aspirant might say. Health care is still a mess in America and getting worse. The best and the brightest of our young people are avoiding careers in medicine as their medical elders retire early and advise the young to take a different career path than they did. Caring, discovery and integrity are going the way of the dodo bird in medicine on Holcombe and elsewhere. Just like politics, if someone does not squeeze the money out of the system as the major fuel for the delivery of health care, this will only get worse.

         Six years in, it is time for an honest assessment of ObamaCare and another pass at real reform. If ObamaCare is a good model, and I doubt that, let’s expand it. If Medicare is the best idea, let’s grow it. Or better yet, let’s start with a clean sheet of paper and decide what we want access to our health care system to be, a right or a privilege. Then let’s design a uniquely American answer to the question that has been successfully faced in every other organized democracy on Earth. What is our health care system to be—a system or a mess?

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